Changed the name since I've put enough info on here to identify me over the years.
State school in the South, not considered flagship state medical school.
Pre-clinical: Passed everything, mostly C's.
Clinical: A's in peds/obgyn. B's in the other clerkships.
Step 1: 211
Step 2: TBD
Significantly non-trad, married with kids, worked in ED prior to medical school. Would like to stay at home institution, if possible (school age kids, spouse has a job here). My advisor/dept chair is recommending me have a back-up specialty (probably FM) just in case I don't match. I have applied to 4 away rotations on VSAS and all but one have gotten back to me that they denied my application.
What do I do? What if I don't get an away rotation? Does that kill my chances of EM?
I basically went to med school to be an ER doc, end of story. I know I'm not the most competitive candidate but I don't have any true red flags other than my low Step 1.
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Got Step 2 back today. 224.
I was able to get 1 away rotation at a community program. I had no complaints at my home program rotation and would really like to stay. I should have a really good SLOE from home. I imagine I will at my away as well.
Is a back-up necessary? It'll probably be pediatrics if I must. Mainly, because I can do peds EM.
I will be applying to every 3 year program in the South and Midwest except the high tier programs where I have no chance. I think there's 42 programs saved on my ERAS right now.
Applying to more EM programs is the number one thing you can do to improve your chances of scoring more interviews and being on more rank lists. I know it's challenging to break out of a region as a non-trad with a family, but I would strongly encourage you to broaden your geographical restriction before you start thinking about a backup.
The average 2016 US applicant applied to 44.4 programs. The average 2016 US MD applicant (i.e. not a DO) applied to 47, and the average DO applied to 36. These numbers come from here:
https://www.aamc.org/download/358770/data/emergencymed.pdf
The chart here:
Data and Analysis - AAMC (be sure to select Emergency Medicine from the drop-down menu) shows that 11% of EM residents who matched during the 2014-2015 cycle had Step scores at or below you. (Someone correct me if the math is totally wrong on this - I arrived at this number by finding the cell where 210 to 219 on Step 1 intersects with 220 to 229 on Step 2, then found the sum of that cell plus all the cells to the left and below that cell).
Based on this, I would say that, as a below-average scoring student, you should apply to a very above-average number of programs.
The good news is, 90% of people with Step 1 between 211 and 220 matched in 2016 (180 out of 200). 81% of people with Step 2 between 221 and 230 matched in 2016 (126 out of 154), per Charting Outcomes 2016. It's very very doable!!! But you have to decide which matters to you more: Geography or specialty?
A backup specialty could be something you choose to pursue in addition to applying broadly within EM... But again, I feel strongly that applying to Every EM Program In The Country is the better approach than applying to a below-average number of programs and potentially ending up having to do 6 years of Peds Residency -> Peds EM fellowship. Especially since you may end up having to go out of the region for fellowship anyway.
If you were particularly risk adverse, you could apply to 80+ EM programs, AND backup programs in your desired region, and reevaluate your options later. If you did, a couple things could happen:
- Possibility A: You end up with 12+ EM interviews in the south! Yay! You spent a little more money than you might have, but at least your chances of matching are great!
- Possibility B: You end up with 12+ EM interviews, but not all of them are in the south. You also get some Peds interviews in the south. You can now decide whether you want to rank some of the southern peds institutions higher than the non-southern EM programs, or whether you'd be happier in EM in Upstate NY than in Peds in Charleston, SC.
- Possibility C: You don't end up with 12+ EM interviews, but you have enough Peds interviews that you're likely to match somewhere. You're bummed it didn't work out and that you spent the money, but you know you gave it your best shot - You never have to live with the regret that you didn't apply to enough EM programs.
That's the safest, and most expensive option.
Full disclosure: The AAMC's Apply Smart data indicates that for students with Step 1 scores less than 215, applying to more than around 45 programs did not actually increase their chances of matching:
Apply smart in emergency medicine: New data to consider - Careers In Medicine This finding doesn't make a whole lot of sense to me, and I have to wonder how many data points they had from people who applied to that many places... Logically, more places should yield more interviews. Even if it turns into 1 additional interview for every additional 30 places you apply, that's still 1 more shot at matching! At $26 per program, that's a bargain. You'll easily recoup that additional cost once you're an attending. Not to mention the lost income for 3 years of Peds EM fellowship...
Incidentally, the AAMC's Apply Smart page also state there was a match rate of 74% for students with Step 1 scores under 215, which is lower than what's published in Charting Outcomes, but students have to grant the NRMP permission to publish their data in Charting Outcomes. Additionally, the Charting Outcomes range is "211 to 220," instead of AAMC's "less than 215," so 74% may be closer to your true chances of having a successful match.
I know this is a long post with a lot of doom and gloom, and I'm not trying to make applying more stressful :/ Just wanted to lay out some data so you can avoid having to SOAP or match into another field, since you have such a strong commitment to EM. Hope this helps!
