Too late for EM?

[EMthrowaway2]

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Hey all, I’m in a bit of a tough situation and would really appreciate some advice. My medical school has not been particularly helpful and we don’t have a home EM residency program. I’m a soon to be MS4 at a “low tier” (whatever that means) allopathic school in the Midwest. I’m a strong candidate on paper, 260+ Step 1, good MS3 grades, likely AOA, some abstracts/posters. Until recently, I was set to apply to a competitive surgical specialty but have been having strong doubts about it for the past few months. I kept trying to convince myself that my doubts were just last-minute jitters but I can’t ignore them anymore. After rotating in the ED, I realized that EM would be a much better fit for me. I love that I’d be able to use almost everything I learned in medical school and then some, I love the mix of quick thinking and procedures, better lifestyle and shift work, etc. I’m well aware of the drawbacks of EM and to me they aren’t nearly as much of an issue as the drawbacks of the surgical specialty.

So basically, I want to apply EM this cycle. I have 3 aways lined up in the surgical specialty but I’d cancel them if I could get EM aways for August/September and get SLOEs. The problem is it’s late and I’ve already called 20-25 programs and no away slots are available so far, which I unfortunately expected. Does anyone have any word on programs that have available slots for August/September? If I can’t get an away or two lined up, what should I do? IM is my backup specialty as of now for what it’s worth.

TL;DR: was originally going into surgical specialty, now want to do EM. Not having any luck getting aways for August/September this late in the game. No home EM program. Does anyone know any of any away openings for this time? If not, what should I do to get into EM? IM is my backup.

Thanks!

 

[WalkingCorpse]

Get on waiting lists for aways, people will cancel. I did away rotations into November because of scheduling issues. I matched at the place I rotated at in October. So a later rotation is not the end of the world.


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[hebel]

Were the programs you checked with on VSAS? If so, have you tried contacting residencies that aren't on VSAS for away openings? If you don't find anything until later, I do think your strong app will carry you. If you were an average or below average applicant in your scenario I would be a bit more concerned.

 

[Hereiam888]

Just cancelled my away rotation Resurrection for sept/oct block and last I heard before they had availability in October

 

[mega_colon]

Apply for the non vsas programs they may have early season openings and also check the list at cordem, there is a running doc there of programs with subi openings.

 

[alpinism]

Start here: https://cdemcurriculum.com/2016/05/27/open-spots-for-away-rotations/

If that doesn't work start cold calling the other 100+ EM programs out there. There's probably a few spots still available at some of the less popular programs. Unfortunately you don't have the luxury of being picky since its already late June and many programs have been full since early May.

 

[MSmentor018]

had similar situation when i was ms4. no home institution. during the christmas/new years time period some places like large academic institutions don't have med students during that time period b/c their off. unfortunately (or fortunately) my school doesn't allow that requiring us to continue with a rotation....somewhere, anywhere. I kept calling till I finally found one and made my own dates. it had me showing up late at the next rotation but any face time with an EM program is always worth it

 

[Jlaw]

You have time. As an applicant doing aways you have two objectives, 1) get SLOE's, 2) do audition rotations at programs you really want to end up at. When you are early/lucky you can do both at the same time. If you are late or have schedule issues you may need to do them separately, but you need to do both.

You need at least one, preferably two SLOE's, so I would focus on that first. Apply to the places you want to go of course, but a SLOE from bumble*ck is better than no SLOE, so if you need to cast a wide net do it...apply everywhere and get a rotation for August/September to get your letters. You can schedule auditions at places you want to match at for later in the season, i.e. October, November, December, January are too late for a SLOE but if you crush the rotation they will interview you and rank you.

With your step 1 score you could skate with 1 SLOE if Step 2 is also good, so don't panic. My experience was that auditions were valuable in some respects but a lot of people end up matching somewhere they didn't rotate.

 

[milkycow]

You can get SLOE from a toxicology or EM ultrasound rotation as well. Regular EM physicians that allow you to rotate may also write a SLOE though not as strong from an academic PD.


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[racerwad]

You can get SLOE from a toxicology or EM ultrasound rotation as well. Regular EM physicians that allow you to rotate may also write a SLOE though not as strong from an academic PD.

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This is not true and a waste of your time (and theirs). Only academic faculty can write SLOEs that will have any useful effect on your application. Anything else is just a regular LOR. In addition, while you could get a SLOE from an EM residency's tox or US elective, it will be less useful, especially if it is your only SLOE, because the whole point of the SLOE is to compare you against the other 4th year medical students that year. Less students do tox or US electives and there is little to no actual clinical work done there compared w/ regular ED electives, so you will not have as robust a letter. If you're doing an elective because you like the subject and it is an additional SLOE, then go for it.

 

[Hereiam888]

Hey all, I’m in a bit of a tough situation and would really appreciate some advice. My medical school has not been particularly helpful and we don’t have a home EM residency program. I’m a soon to be MS4 at a “low tier” (whatever that means) allopathic school in the Midwest. I’m a strong candidate on paper, 260+ Step 1, good MS3 grades, likely AOA, some abstracts/posters. Until recently, I was set to apply to a competitive surgical specialty but have been having strong doubts about it for the past few months. I kept trying to convince myself that my doubts were just last-minute jitters but I can’t ignore them anymore. After rotating in the ED, I realized that EM would be a much better fit for me. I love that I’d be able to use almost everything I learned in medical school and then some, I love the mix of quick thinking and procedures, better lifestyle and shift work, etc. I’m well aware of the drawbacks of EM and to me they aren’t nearly as much of an issue as the drawbacks of the surgical specialty.

So basically, I want to apply EM this cycle. I have 3 aways lined up in the surgical specialty but I’d cancel them if I could get EM aways for August/September and get SLOEs. The problem is it’s late and I’ve already called 20-25 programs and no away slots are available so far, which I unfortunately expected. Does anyone have any word on programs that have available slots for August/September? If I can’t get an away or two lined up, what should I do? IM is my backup specialty as of now for what it’s worth.

TL;DR: was originally going into surgical specialty, now want to do EM. Not having any luck getting aways for August/September this late in the game. No home EM program. Does anyone know any of any away openings for this time? If not, what should I do to get into EM? IM is my backup.

Thanks!

List of current openings from various sites...
https://cdemcurriculum.com/2016/05/27/open-spots-for-away-rotations/

 

[Bouddha]

It's not too late! It's also really important to trust your gut. I had these same doubts creep in fall of MS4 year after applying to general surgery, only to ignore them until November of my surgery intern year. I ended up going through the match again, and fortunately matching in EM. All I can say is it's a lot easier now, and to listen to yourself.

 

[EMthrowaway2]

Thanks for all the advice and encouragement! I was able to secure an away starting in late July at a well-respected community program in my state. So I'll be able to get at least 1 SLOE. I've been in touch with another program that may have an open spot for August-September as well. Looks like I'll be applying EM this year after all!

 

[LovesBikes]

Any tips on finding last minute rotations? I decided EM kinda late, and while I have a couple pending apps on VSAS for August, I am starting to panic about not having a rotation set up at all for August and not being able to get a SLOE from an MD program (I go to a DO school).

 

[racerwad]

Any tips on finding last minute rotations? I decided EM kinda late, and while I have a couple pending apps on VSAS for August, I am starting to panic about not having a rotation set up at all for August and not being able to get a SLOE from an MD program (I go to a DO school).

Make polite phone calls a emails, ask to be placed on waiting lists, pull any networking favors you may have, cross your fingers. Good luck!

 

[LovesBikes]

Make polite phone calls a emails, ask to be placed on waiting lists, pull any networking favors you may have, cross your fingers. Good luck!

Thanks! This was my general plan, glad to know I'm on the right track. I'll need the luck. 🙂

 

[WeeBay]

Any tips on finding last minute rotations? I decided EM kinda late, and while I have a couple pending apps on VSAS for August, I am starting to panic about not having a rotation set up at all for August and not being able to get a SLOE from an MD program (I go to a DO school).

cant help you get a rotation, but i didnt decide on EM until like December of my application year, and I still made it work. no need to panic. you arent as late as you think.

 

[racerwad]

cant help you get a rotation, but i didnt decide on EM until like December of my application year, and I still made it work. no need to panic. you arent as late as you think.

You didn't decide on EM until the December of the year you matched? I am a little skeptical; can you tell us a little more? Without that additional context, I think it is disingenuous to advise someone based upon your experience.

 

[WeeBay]

You didn't decide on EM until the December of the year you matched? I am a little skeptical; can you tell us a little more? Without that additional context, I think it is disingenuous to advise someone based upon your experience.

What other "context" would you like?

 

[doggydog]

What other "context" would you like?

Since almost 100% of the EM interviews are given out by December, how did you get any interviews?
With no SLOEs, how did you get any interviews?
How did you get any interviews?

 

[WeeBay]

Since almost 100% of the EM interviews are given out by December, how did you get any interviews?
With no SLOEs, how did you get any interviews?
How did you get any interviews?

Since the match happens in February....

Since the match happens in February.....

Since the match happens in February.....


I was able to get interviews

I was able to get interviews

I was able to get interviews

 

[doggydog]

I'd be curious to see the percentage of interviews that programs have left to give out in December/January.

 

[racerwad]

Since the match happens in February....

Since the match happens in February.....

Since the match happens in February.....


I was able to get interviews

I was able to get interviews

I was able to get interviews

I'm not saying you didn't do it. I am asking how.

As @doggydog alluded to, December is exceptionally late to decide, let alone be successful. I know like it seems as though I am calling you out; please know that I am not. I am genuinely curious. You probably have a lot of lessons learned to share.

 

[racerwad]

I'd be curious to see the percentage of interviews that programs have left to give out in December/January.

We had none.

The literature suggests that the time of year that one interviews has little impact on their ability to match, but I am surprised that any programs has any spots to give, regardless of the desirability of the candidate.

 

[WeeBay]

I'm not saying you didn't do it. I am asking how.

As @doggydog alluded to, December is exceptionally late to decide, let alone be successful. I know like it seems as though I am calling you out; please know that I am not. I am genuinely curious. You probably have a lot of lessons learned to share.

no lessons. the rank system is a very fair system. if you want to match into a program, and they want you to be in their program, it does not matter when you apply.

since 100% of the roster fulfillment happens in February, it doesn't matter when you apply as long as the program takes applications.

you should apply early if you can, but timing is not going to affect your rank position.

 

[racerwad]

no lessons. the rank system is a very fair system. if you want to match into a program, and they want you to be in their program, it does not matter when you apply.

since 100% of the roster fulfillment happens in February, it doesn't matter when you apply as long as the program takes applications.

you should apply early if you can, but timing is not going to affect your rank position.

I agree that the timing of the interview does not affect your rank position, but programs simply not having interview spots to offer will.

What you are saying runs counter to conventional wisdom which is why I'm curious how you did it. Without divulging where you ended up, how difficult was it to find programs with available interview spots in December? How many SLOEs did you apply with?

You are right that if a program wants you and you want them, little else should affect your rank. This ignores a lot of other variables (namely, the thousands of other applicants who submitted in September).

 

[doggydog]

no lessons. the rank system is a very fair system. if you want to match into a program, and they want you to be in their program, it does not matter when you apply.

since 100% of the roster fulfillment happens in February, it doesn't matter when you apply as long as the program takes applications.

you should apply early if you can, but timing is not going to affect your rank position.

This just isn't true. You literally have less of a chance of matching if less programs are offering interviews at the time you apply. Yes, once you get an interview, it doesn't affect your rank at that program whether you applied in September or December. Your spot on their rank list is affected at all of the programs where you might have gotten an interview if you applied two months earlier, because you aren't on their rank list.

Let's say you are competitive enough to get an interview at 25% of the programs you apply to. Let's say you apply to 80 programs because you're worried that you're applying so late. Let's say that 50% of those 80 have already given out all of their interviews for the year (probably an underestimation and you don't know which ones aren't taking apps anymore as far as I know). That leaves 10 interviews. Best case scenario. That's enough interviews to match, sure. But you are also sweating until Match day. This also isn't even taking into account that your 25% chance of getting an interview in October turns into a much lower chance simply due to the fact that every program has given out at least a majority of their interviews by December.

If you are even less competitive it goes down quickly.

I'm assuming you had a SLOE too, which changes a lot of things. Having a SLOE and applying in December is completely different than applying in December without a SLOE.

 

[racerwad]

Hey all, I’m in a bit of a tough situation and would really appreciate some advice. My medical school has not been particularly helpful and we don’t have a home EM residency program. I’m a soon to be MS4 at a “low tier” (whatever that means) allopathic school in the Midwest. I’m a strong candidate on paper, 260+ Step 1, good MS3 grades, likely AOA, some abstracts/posters. Until recently, I was set to apply to a competitive surgical specialty but have been having strong doubts about it for the past few months. I kept trying to convince myself that my doubts were just last-minute jitters but I can’t ignore them anymore. After rotating in the ED, I realized that EM would be a much better fit for me. I love that I’d be able to use almost everything I learned in medical school and then some, I love the mix of quick thinking and procedures, better lifestyle and shift work, etc. I’m well aware of the drawbacks of EM and to me they aren’t nearly as much of an issue as the drawbacks of the surgical specialty.

So basically, I want to apply EM this cycle. I have 3 aways lined up in the surgical specialty but I’d cancel them if I could get EM aways for August/September and get SLOEs. The problem is it’s late and I’ve already called 20-25 programs and no away slots are available so far, which I unfortunately expected. Does anyone have any word on programs that have available slots for August/September? If I can’t get an away or two lined up, what should I do? IM is my backup specialty as of now for what it’s worth.

TL;DR: was originally going into surgical specialty, now want to do EM. Not having any luck getting aways for August/September this late in the game. No home EM program. Does anyone know any of any away openings for this time? If not, what should I do to get into EM? IM is my backup.

Thanks!

I realize I was criticizing another poster for not offering actionable advice when I was doing the same thing... My advice: go to the EMRA/ACEP residency fair in Vegas on October 15th. Bring copies of your CV/ERAS and get as much face time as you can w/ PDs. PDs are certainly able to offer additional interviews, regardless of how many spots may or may not be available.

Anyhow, EM is super awesome and I think you are making the right choice. Good luck!