Official WAMC thread for EM applicants

[Rekt]

You'll probably be able to just walk through the door with how many residencies are opening.

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[gamerEMdoc]

I'm not quite sure if this is the right forum for this as I am new to the site, but I just got my step 2 CK score back recently and would love some advice about the ramifications it will have at my chances of matching EM. I got a 230 on step 1 and my practice exams for step 2 CK were averaging ~240s, but then I got my official score back of 227. I'm extremely disappointed. I have 2 more auditions lined up for the summer and already have one solid SLOE (top 1/3). No other red flags on my application and my 3rd year clinical rotations were solid (mostly honors, two high pass). I've tried to look through old threads of people with similar drops in score, but haven't found too much and responses seem to be a really mixed bag. I'm feeling pretty discouraged and am beginning to look at back-up options. I would love to hear any advice and/or encouragement you may have to offer.

Looking at backup options? You are definitely over-reacting. People with Step 1 scores of 220 have a 90% match rate in EM. You'll be fine. Just do well on your EM rotations and you will have zero trouble matching. No one cares about step 2 scores if someone has great SLOEs.

 

[gamerEMdoc]

Don't let the score discourage you. Step 1 of 200 had a 70% match rate for EM in 2018. Sure, its not 100%, but the odds are still in your favor. Doors at competitive places will obviously be closed, but a huge portion of the residency programs in EM are at community hospitals, not ivory tower programs. SLOEs will determine your match status. If you traditionally grade out well clinically, you'll probably do so on rotation in EM as well, and if you do and get decent SLOEs, you'll match.

 

[Dr.Bruh]

Got my score today. Overall happy. Trying to match EM specifically in Florida where I’m from. But not sure how I fair against MDs in a pretry popular state with average scores. Could use some insight. Thanks.

 

[EMhopeful2020]

That's probably fine for most programs at least in terms of being screened out, honestly no one can really say at this point since SLOEs are the most important part of your application. 220s and great SLOEs will do better than 250s and below-average SLOEs. In terms of the fact that you're a DO student, I'd look into programs and their current residents, see which ones have DOs that are currently there, and apply to do aways there so you can impress. Schedule that one later on in the cycle (maybe your second or third EM sub-I) so that you go into it ready and know basics of EM. Good luck!

 

[Dr.Bruh]

That's probably fine for most programs at least in terms of being screened out, honestly no one can really say at this point since SLOEs are the most important part of your application. 220s and great SLOEs will do better than 250s and below-average SLOEs. In terms of the fact that you're a DO student, I'd look into programs and their current residents, see which ones have DOs that are currently there, and apply to do aways there so you can impress. Schedule that one later on in the cycle (maybe your second or third EM sub-I) so that you go into it ready and know basics of EM. Good luck!

Awesome thanks for the advice! Have two EM rotations at home in Jan and Feb. so hoping I can seem somewhat polished before showing up to a residency.

 

[Brigade4Radiant]

Try the southeast so many HCA residencies forming

 

[lost premed]

Thank you everyone for your words of encouragement. I was feeling pretty down, starting third year thinking all the doors have closed already.

You'll probably be able to just walk through the door with how many residencies are opening.

Are there a lot of new EM residencies opening? May I ask where you are getting this data?

Try the southeast so many HCA residencies forming

What are HCA residencies?

 

[deleted497653]

You'll probably be able to just walk through the door with how many residencies are opening.

even with the new residencies EM is still competitive. Just offering a balanced view....

 

[GonnaBeADoc2222]

Thank you everyone for your words of encouragement. I was feeling pretty down, starting third year thinking all the doors have closed already.


Are there a lot of new EM residencies opening? May I ask where you are getting this data?


What are HCA residencies?

They are garbage factories with poor training and forced kool aid drinking

 

[DeadCactus]

What are HCA residencies?

Many of the large staffing corporations in emergency medicine are opening a large number of their own residency programs presumably to train a workforce more friendly toward the idea of corporate medicine and to flood the market to decrease physician salaries. The quality of many of these is likely lacking though a few likely provide quality training.

 

[TooMuchResearch]

I'm waiting to meet some of these HCA grads, though I hope that is many years off in my group.

Many of the large staffing corporations in emergency medicine are opening a large number of their own residency programs presumably to train a workforce more friendly toward the idea of corporate medicine and to flood the market to decrease physician salaries. The quality of many of these is likely lacking though a few likely provide quality training.

 

[Rekt]

Thank you everyone for your words of encouragement. I was feeling pretty down, starting third year thinking all the doors have closed already.


Are there a lot of new EM residencies opening? May I ask where you are getting this data?


What are HCA residencies?

Everyone planning on going into/are interested in EM, including you, should be doing research on the future of EM. This includes Contract Management Groups such as HCA, USACS, EMCare, Envision, Vituity, whatever new name change they undergo, etc. They're MBAs and physician sellouts that swoop in to become middlemen between the hospital and EM Physicians by promising the hospital lots of money. This is at the expense of increased metrics and pressure on EMPs, cutting EMPs salaries, and staffing EDs with mid-levels with scarily non-existent training like NPs and on top of that you're then forced to sign their charts. This is done through selling themselves through the guise of streamlining backend stuff like billing and administrative garbage, which is only true in rare select locations/hospitals. They push-out/buyout independent/democratic groups/employed docs. After that, turnover increases, but they don't care because they can fill it with all the new grads due to a tightening job market. Also, EM is probably the most politically tied specialty and reimbursement is constantly under attack.

As for new residencies, as above CMGs are opening plenty and it's not just HCA. There was at minimum 3-4 new ones the year before me, about 5-6 my year and I'm sure there's plenty more opening for your cycle. I constantly see on other websites/groups about how "We're opening a residency now/soon!" stated as a positive thing, which it's not.

If you go into EM because you actually like it, not because of other reasons, you'll be okay, but don't expect reimbursement to stay where it's at. Maybe it will, most likely it won't.

even with the new residencies EM is still competitive. Just offering a balanced view....

We probably are in the plateau right now. Anecdotally many people my year didn't even take Step 1 and only had average/low COMLEX with only 1 or 2 SLOEs that got plenty of invites from all the new shops.

 

[Brigade4Radiant]

It’s not the CMGs it is HCA it is the hospital that makes residencies not a CMG since these days team health and envision go back and forth with their contracts.

HCA is behind the residency expansion in Florida.

 

[lost premed]

Everyone planning on going into/are interested in EM, including you, should be doing research on the future of EM. This includes Contract Management Groups such as HCA, USACS, EMCare, Envision, Vituity, whatever new name change they undergo, etc. They're MBAs and physician sellouts that swoop in to become middlemen between the hospital and EM Physicians by promising the hospital lots of money. This is at the expense of increased metrics and pressure on EMPs, cutting EMPs salaries, and staffing EDs with mid-levels with scarily non-existent training like NPs and on top of that you're then forced to sign their charts. This is done through selling themselves through the guise of streamlining backend stuff like billing and administrative garbage, which is only true in rare select locations/hospitals. They push-out/buyout independent/democratic groups/employed docs. After that, turnover increases, but they don't care because they can fill it with all the new grads due to a tightening job market. Also, EM is probably the most politically tied specialty and reimbursement is constantly under attack.

As for new residencies, as above CMGs are opening plenty and it's not just HCA. There was at minimum 3-4 new ones the year before me, about 5-6 my year and I'm sure there's plenty more opening for your cycle. I constantly see on other websites/groups about how "We're opening a residency now/soon!" stated as a positive thing, which it's not.

If you go into EM because you actually like it, not because of other reasons, you'll be okay, but don't expect reimbursement to stay where it's at. Maybe it will, most likely it won't.



We probably are in the plateau right now. Anecdotally many people my year didn't even take Step 1 and only had average/low COMLEX with only 1 or 2 SLOEs that got plenty of invites from all the new shops.

I don't know much about HCA or these groups but I work for a few years for Vituity. In fact most of my EM experience was with them and they are the reason I am wanting to go into EM. The doctors I met were fantastic and far from sell outs. But again my knowledge is very limited in this and I have no idea how to judge residency programs from these programs vs traditional residency programs. I guess I have some research to do.

 

[deleted436726]

Anecdotally, I'm a USMD with a 228 Step 1 who didn't match last year (now doing a TY and reapplying), but I suspect I had one or more crappy SLOEs. Point being? Get good SLOEs as they are far more important than scores.

 

[enalli]

The doctors I met were fantastic and far from sell outs.

He's not talking about the docs working clinically; he's talking about the corporate clowns actively making life worse for their ER brethren and destroying the practice of EM in the process just so they can make a few bucks.

 

[GonnaBeADoc2222]

I don't know much about HCA or these groups but I work for a few years for Vituity. In fact most of my EM experience was with them and they are the reason I am wanting to go into EM. The doctors I met were fantastic and far from sell outs. But again my knowledge is very limited in this and I have no idea how to judge residency programs from these programs vs traditional residency programs. I guess I have some research to do.

Vituity is a cmg just like all of them. Good luck ascending to the top of their pyramid scheme. Also what happens when you're a level 3 "partner" and the they lose the contract for the shop you're at and there's not another one close by and you just bought a house? You're screwed, that's what.

 

[deleted497653]

They are all cmgs but cmgs cannot be avoided in present day EM unless you work for the VA, small democratic group (becoming fewer and fewer) or get a job as a hospital employee (there are a few out there).

 

[alpinism]

You'll probably be able to just walk through the door with how many residencies are opening.

Sad but true.

During the last 3 years CMGs have started over 30 new EM residencies. There’s plans for another 20 over the next 2 years. Bottom line is that there’s going to be over 50 new EM residencies starting in just 5 years.

At this point as long as you can pass the boards and get a couple SLOEs you can get an EM residency.

 

[gamerEMdoc]

EM was always not difficult to match in, new programs don't really change the equation much. Mainly because just like residency spots are going up, so are the number of medical schools. Its not a cake walk to match into, but it's hardly competitive. To get to a 90% chance of matching for US allopathic seniors for Step 1 scores, you needed a 220 for EM. To get to 90% match in Derm or Ortho, you needed over a 260. THATS competitive. 9 times out of 10, if you are a US allopathic graduating student, and you want to do EM, you'll match into EM.

People apply to EM and don't match. This is true. Usually its because something doesn't come across well clinically, and their SLOEs sink them. It is statistically harder for osteopathic students, who match at about an 80% rate in EM in total. But overall, its hardly a competitive specialty when compared to some of the

 

[R1MD]

Still very doable with that Step score, but arm yourself with data and be smart about the whole process. Try to do better on Step 2. Check out the NRMP Charting Outcomes data for EM. Optimize your application. Check out advising guides from EMRA, CORD, AAEM, etc. EMRA Match has data on programs, Step scores, etc. Be realistic when choosing where to apply and have a backup plan. Work with an advisor (i.e., PD, clerkship director, etc.) who is specifically familiar with the EM world. Get involved, educate yourself through EMRA, AAEM other organizations if you can. They have lots of resources.

Residency Data & Reports

The latest Match results and data for the Main Residency Match.

www.nrmp.org

EMRA Match

webapps.emra.org

EMRA and CORD Student Advising Guide

Medical students, learn how to apply smarter, not harder, with the help of our brand-new EMRA and CORD Student Advising Guide. Read it free online.

www.emra.org

Good luck!

 

[Buckeye1992]

Apply to the right programs. There were a lot of unmatched spots this year.

As said above improve on your step 2. I was in your spot and matched last year after a 30pt jump for step 2.

Get your application together with SLOEs early.

 

[lost premed]

Apply to the right programs. There were a lot of unmatched spots this year.

As said above improve on your step 2. I was in your spot and matched last year after a 30pt jump for step 2.

Get your application together with SLOEs early.

Congrats dude!!! And thank you for the words of encouragement, you are giving me hope.

 

[Johnny Utah 93]

Hello I’m a MS4 with a question about step 2 CK timing. My school advisor suggested scheduling my test date in mid-October after aways and required ICU/medicine rotations. Other classmates have taken in and I’m worried I’m waiting too long.

My step 1 is 245-250, mostly MS3 honors, and I’ve honored my home EM rotation (suspecting a good SLOE from my first away as well - grade pending). Will not having a step 2 score when ERAS goes out be a problem?

 

[cyanide12345678]

Will your result be there by application time? If not, then you're waiting too long.

 

[gamerEMdoc]

It shouldn't affect you. If you have a good application, good sloes, and a good step 1 score, no one is going to care that your step 2 score is still pending when they initially interview you. They may want it back before they decide to rank you, but I don't think not having the score back by the start of interview season will make a big deal at all.

 

[Johnny Utah 93]

It shouldn't affect you. If you have a good application, good sloes, and a good step 1 score, no one is going to care that your step 2 score is still pending when they initially interview you. They may want it back before they decide to rank you, but I don't think not having the score back by the start of interview season will make a big deal at all.

Thank you for the reply!

 

[OneTwoThreeFour]

I had a couple schools contact me about not having a step score and that they were waiting for the score to offer me the interview.

 

[bceagle411]

Im in the same spot but taking it in a couple weeks so its available for programs. I just heard some programs dont interview without a step 2 score, but i have no idea which ones, so ultimately i just sucked it up

 

[Johnny Utah 93]

Im in the same spot but taking it in a couple weeks so its available for programs. I just heard some programs dont interview without a step 2 score, but i have no idea which ones, so ultimately i just sucked it up

Yeah this scares me... trying to move some rotations around to take in a few weeks. Unfortunately I have required ICU/medicine coming up so it’s hard to move them.

 

[funnybanana]

Long story short, didn’t match ophthalmology, decided I would rank my transitional year to begin internship. Landed a nice TY through match (not SOAP). Completed an EM externship end of 4th year at my home institution, so I’ll have a SLOE from there.

My TY does not have an EM residency, so I can’t get a SLOE from it, but I can get LORs from EM attendings I’ve worked with. Will I be okay in this year’s match with 1 SLOE and 2 traditional LORs? Decent boards (240 step1/2, avg clinical scores).

Advice appreciated.

 

[andrewbobert]

Hey everyone,

4th year here, planning on applying to IM/TY prelim years for likely rads/gas residency. However I just started an emergency elective and....what do you know....I'm actually enjoying it. SO let's say I still apply this cycle to ERAS, get into an Internal Medicine prelim year but then decide I want to do Emergency Medicine instead of my intended residency, how can I transfer over to EM? Is it possible to do it without SLOEs or should I work on obtaining some of those SLOEs during my 4th year just in case I really do want to change my residency?

Thanks!! Ugh so much stuff going on the first half of 4th year...it's crazy how stressful picking a residency really is.

Good luck everyone though where ever you are in this journey!

 

[GatorsKW14]

I am a DO with 228 step 1, 251 step 2 that matched at my number one program at one of the best EM programs in Florida. Definitely possible if you improve on step 2 and have solid SLOEs.

 

[AlgernonMed]

My impression is that you need two sloes.

 

[BoardingDoc]

Hey everyone,

4th year here, planning on applying to IM/TY prelim years for likely rads/gas residency. However I just started an emergency elective and....what do you know....I'm actually enjoying it. SO let's say I still apply this cycle to ERAS, get into an Internal Medicine prelim year but then decide I want to do Emergency Medicine instead of my intended residency, how can I transfer over to EM? Is it possible to do it without SLOEs or should I work on obtaining some of those SLOEs during my 4th year just in case I really do want to change my residency?

Thanks!! Ugh so much stuff going on the first half of 4th year...it's crazy how stressful picking a residency really is.

Good luck everyone though where ever you are in this journey!

You sound very casual about this idea. Whether or not that is correct, you should know that what you're proposing is not simple.

- If you want to do EM, you should try to get 2 SLOEs this year and apply to EM.

- If you wind up matching to a prelim program, you are aware that you wont "transfer" right? Barring extenuating circumstances, you would go through the match again and match into EM as a PGY1. Doing a year of IM doesn't let you start EM as a PGY2. As such, I reiterate my original statement: if you want to go into EM... try to match into EM and consider IM/TY as a backup.

 

[GonnaBeADoc2222]

Why would you give up a year of attending income to do this?

You need SLOEs

All you are in em / rads / gas is a replaceable hospital based commodity. Surgsub is the way to go

 

[The Knife & Gun Club]

All you are in em / rads / gas is a replaceable hospital based commodity. Surgsub is the way to go

Dude I see you posting this all over this forum, and with all due respect (you’re much further along than I am) I’ve gotta disagree.

The specialty to peruse is the specialty you enjoy. As long as someone is going into EM aware of the risks, that’s fine in my mind.

I tried to love the surgical subs but it just wasn’t there, and I don’t think I’m unique in that regard.

 

[deleted497653]

Dude I see you posting this all over this forum, and with all due respect (you’re much further along than I am) I’ve gotta disagree.

The specialty to peruse is the specialty you enjoy. As long as someone is going into EM aware of the risks, that’s fine in my mind.

I tried to love the surgical subs but it just wasn’t there, and I don’t think I’m unique in that regard.

He’s just trying to look out for those who sound unsure of EM

Mind you, the OP never said he “loves” EM just that it’s one of his top runners in picking a specialty just recently. He hasn’t committed.

The process of picking a field is one of the hardest things about med school. I personally found it very confusing. EM is fine but if I could go back maybe I would choose something else...

Weigh your options carefully.

 

[gamerEMdoc]

Try and get two SLOEs, or at least one, and give it a shot for applying this year, with transitional years as a backup. Then, you'll have that SLOE (or SLOEs) for applying next year if you go the TRI route.

If you can't get any SLOEs early this year before say December, and you have no EM interviews because of it, then go with your TRI plan, and try to get some EM rotations lined up in the back half of 4th year. They are much easier to secure. Then you can get the SLOEs you may, or may not, need once you decide the following year.

 

[gamerEMdoc]

Long story short, didn’t match ophthalmology, decided I would rank my transitional year to begin internship. Landed a nice TY through match (not SOAP). Completed an EM externship end of 4th year at my home institution, so I’ll have a SLOE from there.

My TY does not have an EM residency, so I can’t get a SLOE from it, but I can get LORs from EM attendings I’ve worked with. Will I be okay in this year’s match with 1 SLOE and 2 traditional LORs? Decent boards (240 step1/2, avg clinical scores).

Advice appreciated.

My impression is that you need two sloes.

You will probably be fine. Yes two SLOEs are GENERALLY necessary, but there are special populations, and reapplicants who applied to a different specialty the year before are one of them. Or people leaving a different residency or TRI. It's very difficult to get SLOEs in some situations, and if they have one SLOE, especially if its a decent one, they'll usually be ok.

The PD data on this shows that over 80% of PDs will extend interviews to people with only one SLOE. Once you get the foot in the door for the interview, then people understand the situation people are in when it's an individual case like this.

I am usually one of those "requires two SLOEs" to rank type of people, but rank people every year with only one, and occasionally people with zero SLOEs, if they are in a special situation.

Not everyone's application is the same.

 

[SterlingMaloryArcher]

SLOE stands for what exactly ?

I assume some kind of evaluation on rotations?

 

[Backpack234]

SLOE is a standardized letter of evaluation. Look up a sample SLOE online. It's pretty much designed to objectively rank you in a top, mid, or lower tier of students rotating at a program. Also be aware that you may get a really terrible SLOE that could bomb your chances or you can make friends with an attending on an away rotation resulting in a perfect SLOE and an almost automatic invite to residency regardless of scores or anything else.

 

[The Knife & Gun Club]

Got my score today. Overall happy. Trying to match EM specifically in Florida where I’m from. But not sure how I fair against MDs in a pretry popular state with average scores. Could use some insight. Thanks.

You’re in luck in that there’s a huge spread in Florida - from the powerhouses like UF-Jax all the way down to new corporate residencies that will take any us grad with a pulse. There’s also Sinai In Miami Beach which is an old DO program which continues to have a strong DO contingent.

Discaimer - I’m an M4 and have not yet matched.

 

[deleted436726]

You’re in luck in that there’s a huge spread in Florida - from the powerhouses like UF-Jax all the way down to new corporate residencies that will take any us grad with a pulse. There’s also Sinai In Miami Beach which is an old DO program which continues to have a strong DO contingent.

Discaimer - I’m an M4 and have not yet matched.

I know from firsthand experience that these so-called new corporate residencies will most certainly not take any US grad with a pulse.

 

[FMtoEM]

I had none. Had a letter from trauma surgeon though. Circumstances dictate whether you have one or not.

 

[The Knife & Gun Club]

I know from firsthand experience that these so-called new corporate residencies will most certainly not take any US grad with a pulse.

Ok THIS US grad with a pulse then. Obviously there’s people out there who won’t make the cut no matter how generous, but I don’t think OP falls into that category.

Obviously providing no occult red flags like criminal record, failed classes, or god aweful sloes.

 

[Lbjisyuki]

Hey all.

I’ve been reading on SDN that 90% of your apps competitiveness is based on your SLOES, which you cannot see. So what’s the best gauge of how competitive of an applicant you are?

I have solid board scores (250s/260s) and first quartile, but it seems like that stuff doesn’t really matter and your away performance determines everything. I’m hoping to head back to California, so I’d like to better understand how to assess if I’m competitive for California programs (with ties), but from Midwest school.

 

[Rekt]

Hey all.

I’ve been reading on SDN that 90% of your apps competitiveness is based on your SLOES, which you cannot see. So what’s the best gauge of how competitive of an applicant you are?

I have solid board scores (250s/260s) and first quartile, but it seems like that stuff doesn’t really matter and your away performance determines everything. I’m hoping to head back to California, so I’d like to better understand how to assess if I’m competitive for California programs (with ties), but from Midwest school.

Despite that commonly being said about SLOEs and scores, you're scores and medical school performance absolutely do matter. My stats were mentioned in 90% if my interviews. You're very competitive. Yes, your SLOEs play a big role, but its slightly overblown on their effects on your application. They can certainly tank you if you have a trend of poor SLOEs. You can usually gauge based off rotation feedback. And only you know if you have personality problems.

 

[SamtheWise]

You just sort of have to take a leap of faith, apply to programs you want to go to (the Cali county programs are quite competitive), and a lot of other 'less' competitive programs, and just wait and see how many interviews you get. Everyone is going to hate me for saying this, but if you're curious where a programs general 'prestige' (aka how competitive it is to match), look it up on Doximity, while that list is imperfect and has a lot of flaws, it's fairly accurate in a general sense (i.e. all the top 10 programs on it are probably the 10 best EM programs, but maybe not necessarily in the order they're on Doximity).

Make one of your first interviews your home program for 2 reasons: 1. it is in their best interest to at least give you a hint of how competitive your SLOEs are, and 2. you are a known commodity there and they have likely decided on where you rank before you even interview, so the interview is a little more laid back and serves as good practice for your upcoming interviews.