US MD M4 EM Applicant - Went on 17 interviews - no match, no SOAP, seek research job/advice

Discussion in 'Emergency Medicine' started by EastCoastEMApplicant17, Mar 17, 2017.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
Thread Status:
Not open for further replies.
  1. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    Hi all,

    You may have seen my posts on the applicant thread and SOAP thread, I am a 4th year student at an allopathic school who applied EM and went on 17 interviews, yielding me a (per charting outcomes, 2016) 99.7% chance to match. My application was absolutely not perfect, I had a low STEP II for instance, but based on the number of interviews I was getting, the strengths of my application (e.g., 3 honors EM rotations with good SLOES) and reasonable intuition, my home PD, my Deans, and myself did not see a need to rank another specialty (e.g. IM) concurrently.

    My home PD was "very surprised" and Dean shocked to see that I did not match, and I was unsuccessful in SOAP. I have an extensive research background and realize that further research will not therefore help my application, but it seems like the only way I can find employment in the next year as I prepare to reapply (and of course, prepare for IM or FM). If any academic attendings reading this might know of an opening and be willing to help a student who seems to have fallen through the cracks, I would be happy to exchange messages with you.

    Any other advice regarding my gap year would also be appreciated: I plan on taking STEP III in a state that allows it, and perhaps scribing as the best possible option to show I have stayed in the clinical environment, while going on whatever observorship an ER or hospital might allow

    One of my traits I believe has fit me well with EM is the ability to be calm under pressure. It seems I am in a very precarious situation right now, but I know that after one year of hard work, I will be able to land on my feet somewhere - be it in EM or a less competitive field. I appreciate the advice of anyone who may be able to guide me.
     
  2. SDN Members don't see this ad. About the ads.
  3. anxious3456

    anxious3456

    5
    15
    Feb 26, 2017
    I think you should ask your school, especially your home PD for advice. They might be able to pull some strings/suggest a reasonable path.
     
    Babycatsinabag likes this.
  4. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

    17,767
    1,606
    Nov 24, 2002
    SCREW IT!
    Physician
    Years ago, I had a double bad deal - I'm an FMG, and I was in the first year of the CSA. ECFMG couldn't give enough exams, so I couldn't get certified in time. Fortunately, I got a pretty good prelim IM spot, which hooked me up with Mt. Sinai. However, when I reapplied, I got 4 or 5 interviews (thanks for nothing for the "courtesy interview"), but I didn't match. So, I was a two time loser, but I scrambled into an EM spot.

    Now, I'm board (bored) certified in EM, and am gainfully employed. If you got 17 interviews, although possible, it is highly unlikely that you were at the very cusp of not being invited for every one of those programs. So, you really, REALLY have to introspect as to if there was something that didn't get you over the hump. Did you not stand out enough? I ask that, because, if you actually turned people off, someone, somewhere, would have given you a hint.

    See if someone you trust (like the home PD) can confidentially look at your app, and offer something (like, "maybe you should drop this letter").

    My point is, I was off way worse than you, and things have a way of working out. As I've said elsewheres, wherever you are is where you're supposed to be!
     
  5. enalli

    enalli

    20
    11
    May 15, 2016
    You need to ask your PD to be honest with you. He couldn't have been that "surprised" given that he also ranked you low enough not to match.

    Given your current situation, I would advise you to defer graduation then applying once again next year as a US Senior.
     
    MedStud18, Makati2008 and gro2001 like this.
  6. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    Thank you all for your responses!

    School admin and home PD have been very receptive, gone over all routes with me. They have definitely taken the lead, and I am grateful for all the help they have given. Just posting here for more advice from more EM attendings/residents/etc. - more brainpower is sometimes beneficial at a time like this.

    PD was definitely very honest with me - my STEP II was very, very low, but 17 interviews was a very safe place. It's nearly unbelievable 17 PDs brought me to interview and then ranked me too low to match, but I'm not going to dwell enough to take away from me making moves looking to the future.
     
  7. GandalfTheWhite

    GandalfTheWhite Chillin in Isengard 5+ Year Member

    2,181
    269
    Aug 8, 2011
    Middle Earth
    From what I read on OP's post, he passed step 2 by 1 point and failed a course in med school. He released his score after getting several interviews. Combined with a 220 (lower than avg score for matched applicants).

    OP, I think deferring graduation is your best bet. Its an extra year of tuition but in the grand scheme of things, its not much considering the alternative. The unfortunate thing is that theres not a whole lot of emphasis placed on a research year in EM like it is in ortho, derm, or plastics for unmatched residents. I am sorry to hear of your situation, and hope that next year will bring you some good news.
     
    Makati2008 likes this.
  8. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    Thank you, above post is completely correct. To elaborate, half interviews came before, half after posting CK.

    Unfortunately, deferring graduation is not a possibility at my school.
     
  9. rkmoto121

    rkmoto121 7+ Year Member

    164
    37
    Mar 31, 2010
    You could contact Eisenhower Med Center in Rancho Mirage, CA. They are recruiting outside the match this year according to their website.
     
  10. Lucre

    Lucre 2+ Year Member

    49
    0
    May 5, 2012
    A lot of good advices up there. Based on statistics, 17 interviews does yield a good percentage of matching. However, if the interviews were bad/decent or something happened during the interview day, that 99.7% (from your post) becomes low. From my experiences (and probably most applicants), I find that the interaction between "people", not just the interviewer or the coordinator, played a major aspect. Has your mentors went over with you on that aspect?

    Your application is certainly much better than mine, and I only went to 10 interviews due to family restrictions, yet matched to my first choice.
     
  11. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    17 interviews and no match... I know you are focused on the low step 2, and while that's important, its not as important as SLOEs and personality/fit/interview. I think there is likely something else here, which maybe you aren't aware of. A bad SLOE, or just something where you don't interview well. Because if you were able to get 17 interviews, I'm really surprised statistically you didn't match. I'm sure there were people out there with lower board scores that did, so there has to be something that held your application back.

    Maybe not, who knows, you could just be the unfortunate statistical anomaly... the system is far from perfect.

    I'd ask your home PD to be brutally honest if you didn't already. Ask them, other than your step 2, was there anything else that held your application back (SLOE ratings, personality, your interview).
     
  12. HooliganSnail

    HooliganSnail 5+ Year Member

    601
    568
    Mar 13, 2012
    Get on with your life. Pick a different specialty.

    I would NOT do a research year.

    If you had 17 interviews, then you were good enough on paper. Getting better on paper won't make a difference.

    I think you have to come to terms with the fact that there is "something going on' for all these programs to pass on you, but deep down inside, I think you know what it is....
     
  13. gman33

    gman33 Moderator Emeritus 7+ Year Member

    2,175
    455
    Aug 18, 2007
    Let me see if I have this correct.

    You had one red flag of a failed course.
    Not the end of the world.

    Then you had a terrible step 2, basically the kiss of death, but some other places gave you an interview anyway.

    You didn't get a spot.
    Reapplying will now be with 3 red flags without a chance of fixing any of them.

    My honest advice would be that you should try to get a spot in something else.

    If you really want em and nothing else, try to get a prelim spot or anything at a place that has an em program.

    Crush the year and an em rotation and maybe somebody will give you a shot.

    And hopefully this place has a less competitive em program that would be more willing to take a chance on someone.
     
  14. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    Appreciate everyone's honesty, you are all spot on, I am developing contingency plans and being realistic as I move forward. It is looking like, should I not receive a spot this year in EM or anesthesia (something I may be slipping into), and not find a prelim position, I will try to crush STEP III, work as a scribe, do research in EM and IM, and perhaps train as an EMT and work as an EMT, and then reapply EM, Anesthesia, and IM, being sure to be in close contact with local community IM programs to ensure I have a successful match the second time around. I have been in love with EM forever, as seen on my CV showing SAEM committees, ACEP oral presentations, and (to complete the trifecta?) attendance at AAEM sponsored meetings, but I will be happy to be a physician where I have the privilege of training. I should have waited on all that stuff later and just focused on CK
     
  15. DO2016EM

    DO2016EM

    96
    54
    Aug 29, 2015
    Please don't work as a scribe or EMT. I can't find that being useful.
     
    Backtothebasics8 likes this.
  16. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    I am going to need something, anything that keeps me remotely clinical over the next year to counter the negative of being clinically rusty (to an EM, or even IM PD) - options other than the two I presented do not seem to exist. Willing to hear anyone's suggestions, I will take all thoughts into account as I plan my next year
     
  17. theseeker4

    theseeker4 PGY 1 5+ Year Member

    You are saying there are no spots anywhere in the country where you can get a prelim spot as an intern?
     
  18. GonnaBeADoc2222

    GonnaBeADoc2222 7+ Year Member

    141
    57
    Oct 31, 2008
    Sucks to be a statistical anomaly...I legit feel for you bro.

    Maybe releasing the CK score after already getting a bunch of interviews was the death kiss?

    Honestly, the idea of maintaining student status and staying on for MS5 with more debt makes me want to vomit. Personally, I'd cut my losses and choose another field. Maybe IM to something procedural like Cards or GI.
     
  19. High Roller

    High Roller 10+ Year Member

    104
    22
    Mar 2, 2007
    What!? 17 interviews and you didn't match? Goddamn. That's more than an anomaly, thats a statistical nightmare.

    You say you got at least 8 of those interviews after releasing Step II, which means on paper you were still good enough to match. You honored all three EM rotations, which means you're not a freak and EM people liked working with you. Make sure you're getting brutally honest feedback from your PD, your peers, and your dean about what the hell happened. On the surface this doesn't add up.

    And I agree with most other posters. I would scramble like hell for any available prelim spot before entertaining any other options.

    I'm sorry. Good luck.
     
  20. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

    4,845
    1,611
    Nov 18, 2002
    Physician
    SDN Partner
    What's with the bizarre recommendations to pay for another year's tuition so you can call yourself a senior med student? Go be an intern somewhere. Anywhere. Reapply next year. Do all you can to figure out what the problem was and fix it. If it truly was only a bad step 2 score, rock step 3.
     
    EM Junkie, racerwad and OnlyOneZlatan like this.
  21. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    I know! I've seen this advice on several other threads now. I don't know where it's coming from, I definitely think that is not the wise thing to do.
     
    racerwad likes this.
  22. dadaddadaBATMAN

    dadaddadaBATMAN 2+ Year Member

    468
    627
    Apr 27, 2014
    Umbrella pulled out
    In my schools case at least, it comes from our deans office. Per our student affairs dean (who is a md) students re-entering the match from a usmd as a senior had around double the chances of matching overall by comparison to those who were independent, like interns.

    The chances remained better when correcting for school of origin.

    I'm not familiar enough with the data to quote the actual study, and I don't think it necessarily accounts for students who apply to a less competitive specialty on the second go around.

    I also have no idea how it applies to em specifically, where a "research year " or equivalent has less meaning.

    If I hadn't matched I would definitely have looked into it myself, but as it stands I lack the motivation. The opportunity cost and tuition are obvious to everyone.
     
  23. David Mitchell

    David Mitchell

    27
    48
    Oct 30, 2016
    Move on. EM is just too weird. Delay graduation, do anesthesia research, watch the invites pour in next fall
     
    hundreddaysoff likes this.
  24. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    I'd love to see the data. It may be true, it may not. What was the sample size. Was it looking at people that failed to match and applied to the same specialty? Was this an actual study (I couldn't find anything on this) or just a Dean saying "according to my numbers, you are twice as likely...). I just would need to see more details before this should be considered something I would ever even consider suggesting to a student. The financial cost of this decision is very, very high, and I find it very very hard to believe residencies out there would value someone who went back to be a student again for a second 4th year, as opposed to gaining experience as an actual physician. Maybe there are programs out there that would, I just can't see the logic in it.
     
    dadaddadaBATMAN and Angry Birds like this.
  25. dadaddadaBATMAN

    dadaddadaBATMAN 2+ Year Member

    468
    627
    Apr 27, 2014
    Umbrella pulled out
    I wouldn't hold your breath, but I'll see if I can find it.

    They may well have been wrong, but the logic was mostly that you were less likely to be pre-filtered out of residency selection. It's probably confounded by all sorts of factors (re-applicants with more programs, more research for specialties that care, dual applying to a less competitive specialty or altogether, etc).

    But that's where it comes from, which is what was asked.
     
  26. Barker Posey

    Barker Posey 5+ Year Member

    14
    6
    Jan 12, 2012
    http://www.nrmp.org/wp-content/uploads/2017/03/Advance-Data-Tables-2017.pdf

    If you graduate and apply to the match, you are an independent applicant. If you are able to stay and reapply as a fourth year, you are a USMD. 38.5% of independent applicants went unmatched, while 5% of USMDs did. As far as PDs go, I would think they could see from the timeline that this might be an applicant's second time around and would expect some significant work to show for it. I can't imagine that someone who is reapplying even as a USMD would only have a 5% chance of falling through the cracks unless all the factors that were impediments the first time were fixed.
     
    Epinephreus likes this.
  27. swamprat

    swamprat 7+ Year Member

    1,553
    100
    Jul 25, 2008
    Physician
    While I agree with you 100%, I do distinctly remember my buddies (one of whom did not make it into ortho the first time 'round) delay graduation. They were advised the same thing - chances go down significantly if you lose your US MD student status and go on to do a prelim year in something else. I have no clue why that is. Maybe PDs use screening tools to screen for things (i.e. step 1 score minimum etc) and will auto select US MD (with other physicians and DOs being separate entities they may not select when they initially go through applications).
     
  28. gman33

    gman33 Moderator Emeritus 7+ Year Member

    2,175
    455
    Aug 18, 2007
    The cynic in me would say the med school is just looking for another $50k for no real benefit.
     
    pencilcase and Babycatsinabag like this.
  29. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    Those aren't accurate comparisons. The comparison isn't independent applicants vs USMDs, the more accurate comparison is independent candidates who do a PGY1 prelim year vs USMD's who didn't match first time and do a 5th year of medical school. I don't think you are going to find that data, I'm not sure how it could ever be tracked. The failure to match rate for USMDs is 5.7%. We have no idea what the failure to match rate of someone who does a 5th year of med school after failing to match the first time.

    This stuff isn't hidden from PDs, so its not like PDs aren't going to know you didn't match and repeated your 4th year over again. Its required to be in your deans letter. ERAS shows the time you started to the time you finished med school. Any delays have to be explained in ERAS as well as the Deans Letter. So its not like if you do a 5th year after failing to match you are somehow going to trick residency programs into thinking you just did four years. In my opinion, I wouldn't consider a student who does a 5th year of med school to repeat 4th year over again after failing to match. I think that is a huge flaw in logic, and shows no career progression. I've interviewed many who've gone on and did a traditional intern year or prelim year, and matched several of those.

    Again, this is just my opinion, and I know what I and the program I work at value in a candidate. I can't speak for 200 some programs and certainly wouldn't dare doing so. But I'd be SHOCKED if most residency leadership in EM didn't think similarly on this topic.
     
    racerwad likes this.
  30. enalli

    enalli

    20
    11
    May 15, 2016
    You don't necessarily have to pay for a full year of tuition. And you're not just getting the title of senior med student, you're getting the time for applications and interviews that you wouldn't get as a surgery prelim.

    I don't think you're going to find any data on this, so no one will be able to objectively say that this is some catastrophic decision. Yes, the cost can be high if you assume you have to pay full tuition for a full year, but if you can get some sort of part-time or special-student status, then it's not that different from taking a research year.

    You could say this of everyone who doesn't graduate medical school in four years, but I doubt you hear PDs saying "why did you take that research year instead of gaining experience as an actual physician?" or "why did you get that MPH/MBA instead of gaining experience as an actual physician?" It probably comes down to what you do with your time, doesn't it?
     
  31. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    Absolutely it would. But in the end, but most students that take a year to get there MBA or do research don't do it right after they complete their fourth year and delay graduation. It would be clearly obvious that's what happened, that someone didn't match, and therefore decided to stay in med school. Because I highly doubt there has been many med students who graduated 4th year, then voluntarily didn't enter the match, and did research for a year instead before entering the match the next year. It just doesn't happen that way. The students that take 5-6 years to graduate and get an MD/PHD for example are doing their research congruently in their preclinical years, not after 4 straight years of medical school, then the research at the end.

    Sure, I agree that if a student parlayed that experience into doing something that was really beneficial and truly exceptional, then great for them. But how is that even going to happen? To set up a legitimately good clinical research study in EM, that's going to take months and months just to plan and get approval, let alone do the study. Landmark studies don't get planned in a few weeks after you find out you didn't match, then get performed, and then published all in a few months before interview season starts. And how would you even get involved in a big study anyway logistically even if the timeframe allowed it? I mean, I talk to TONS of students that can't even find an EM advisor at their schools. Just an advisor. And all of a sudden, people are going to find an ED research advisor who is going to hand an unmatched 4th year student a project of their dreams to author. Maybe this is a possibility at some schools, but I can tell you that at least many of the DO students I talk to certainly aren't going to easily find an ED faculty member at their school who's doing big time research. So, a big research project is just not going to happen for the reasons I outlined. And since the research you may be able to setup is unlikely to be something of major importance, I just can't see it making a huge difference in the eyes of a PD. Seeing that someone took a year off to do some retrospective chart review study and go on a bunch of interviews is just not going to fly when compared to a candidate who spent a year performing actual clinical medicine. Add all of this to the fact that EM doesn't usually value research like some other specialties do anyways, and the research heavy academic places aren't exactly the places that are real friendly to folks who didn't match the first time around.

    I don't want to give the impression I don't like research, I do. I like research, and I am always impressed when a student does some legitimate study while in school. But I still value clinical experience over a research project. Someone who is a top 10% student clinically with no research is always going to do better in the match than a student who is a middle/low 1/3 SLOE student with a bunch of research. It's just the mentality of EM.


    I'm not outright dismissing this strategy. If there is data to back it up, or success stories of people that used this method as a means of matching EM the following year, then great, I'd be all open to hearing more about it. Maybe I'm way off here. I don't think I am, but I'm open to learning more about it. I think, if anything, it may be more of a benefit for people going into fields where research is a more important part of the application.
     
    Last edited: Mar 25, 2017
    racerwad likes this.
  32. tux4

    tux4

    158
    114
    Dec 23, 2015
    Yeah had a bunch of research on for my application, was mentioned twice briefly on interviews. They focused more on just the type of person I was, LOR's, and if I could hold a convo. From my perspective, research seems like one of the least important things to these PD's and would be very low priority in between matches. If you can get it, great, why not? I fee TRI is the best way because in these situations you have to kind of realize that EM might not happen and prepare for possibly choosing another specialty. Other specialities might really value that intern experience or might require one to begin with anyway. Just seems like the best way to keep your options open in a dire situation.


    Sent from my iPhone using SDN mobile app
     
  33. dadaddadaBATMAN

    dadaddadaBATMAN 2+ Year Member

    468
    627
    Apr 27, 2014
    Umbrella pulled out
    The suggestion is not that you are more likely to match EM, but rather you are more likely to match somewhere in some specialty. That would have been my priority if I had not matched.

    Being a student means an opportunity to craft an application towards a new specialty: IM, peds, anesthesia, etc. you need to explain to those pds why you changed direction, but it is hardly unheard of. You have more time for interviews than any intern would, and you have the flexibility to arrange whatever rotations are necessary for the new specialty. Not likely to be true as a pre-lim. It also gives you access to advisers who care whether or not you match.

    You are likely locked out from competetive specialties, but there are other options that will ensure you have a job in two years.

    I'm not sure there is a right choice, but there is more to it than the suggestion that someone opted to delay career maturation/advancement. The opportunity cost of one choice is time, advancement, and a year of attending salary. The opportunity cost of the other is flexibility in career path and opportunities for additional interviews.
     
  34. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    Ok. I see. I thought it was meant as a strategy to reapply to EM after failing to match EM. I didnt realize this was being advocated more as an approach to refocus efforts to applying to less competitive fields. I guess that makes sense, although I would argue that you could always just soap into and IM or FP spot somewhere and not lose that year. But obviously since you are soaping into unmatched spots they'll be at less desirable places. Guess thats a trade off as to whether that year is worth it to get into a better IM program or not.
     
    Tigerhawk77 and dadaddadaBATMAN like this.
  35. Makati2008

    Makati2008 SDN Moderator 7+ Year Member

    1,562
    357
    Dec 18, 2008
    I'm wondering if OP ranked all the places she/he interviewed? I know back when I went through the process I had a few friends that didn't match but they failed to rank all the places they interviewed.


    Sent from my iPhone using SDN mobile app
     
  36. Clintamycin

    Clintamycin

    7
    0
    Mar 16, 2017
    I'm in a similar situation. US IMG, didn't match anywhere and couldn't get even a prelim or transitional in the scramble. There's always a chance to slide in during the hectic June/July months with people not being able to start residency, but I'm not holding my breath. I'm looking for ANY postion ANYWHERE just to stay relevant, but haven't been able to find any program that is open. Does anybody have any advice or resources on trying to find a position to work, do research, or stay relevant clinically in any capacity? I'm more than willing to put in a year or two of working my way up to an EM residency, but at this point I have nothing!
     
  37. MedStud18

    MedStud18 2+ Year Member

    5
    0
    Oct 3, 2014


    I disagree with most people on here
    If you got 17 interviews than you should have matched, even with a bad step 2
    Plenty of people matched with a red flag, I would really work on your interviwing skills and convince people that you are worth taking, if you have 17 interviews next year you can do awesome on your interviews and convince people that you are worth taking

    It also probably is not a bad idea to do research somewhere that you can dual apply next year to anesthesia or something else as a back up just in case
     
  38. justaregularmed

    justaregularmed 7+ Year Member

    509
    8
    Jul 9, 2008
    Not a PD but it may be worth working with your home PD (if they are not sick of you) to maybe e-mail or contact a few programs and ask for some honest feedback from the outside.

    This is assuming you ranked all 17 programs, etc, etc and all other obvious signs of error are accounted for.
     
  39. EastCoastEMApplicant17

    EastCoastEMApplicant17

    49
    62
    Oct 5, 2016
    An EM spot opened up, I interviewed for it and got it. My 22nd residency interview - you could say I was well practiced. Thank you everyone for giving me your two cents as I prepared for plans B, C, D, etc. This ends the tale of EastCoastEMapplicant17. Don't take STEP II CK lightly, friends
     
  40. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Gold Donor

    532
    975
    Feb 10, 2016
    Physician
    Faculty
    This is phenomenal. Love to hear when stuff like this works out for the best.
     
    ButteredLobster likes this.

Thread Status:
Not open for further replies.

Share This Page