Applying - Choosing where to apply

Updated February 2017

The ACGME and RRC do a really good job of making sure that all of the EM programs are going to provide you with the education you need.  They will all get you to the goal of being a competent Emergency Physician.  Where they differ is in how they do it, what the experience is like, and what other opportunities there are.  So how do programs actually differ?

Location, Location, Location - This is the most important determinant for many applicants.  If you are happy outside the hospital, you are more likely to be happy and productive in the hospital.  The EMRA Match Residency Index is the best available resource for finding programs geographically, and finding more detail about what they have to offer.  

Philosophy/Culture - How does teaching occur in the ED?  Who will be supervising you?  How about when off-service?  Is the Program Director going to stay on top of you or will you be more self-directed?  Does their "wellness" philosophy match your own?

Curriculum and Opportunities - What is internship like?  How are they used?  How much ED time?  How many hospitals do you rotate at?  How busy or acute are they?  What demographics do they serve?  What fellowships are there?  What is the research culture like?  Are there ready-made international opportunities?

Duration - All EM program are 3 or 4 years and at all of them have you as part of the program from the beginning (no separate internship).  Length in training is something that is fixated on by many applicants but try to remember that 25 years from now, you probably won't remember if you did 3 or 4 years of residency.  Many people have very strong opinions on which is better, and they will be happy to share.  My advice is that you treat this like a tie-breaker at most.

Stability - EM is a relatively new specialty and the RRC has been careful not to give programs to unstable hospitals.  A significant time passed between an EM program closing but one did recently lose accreditation with ACGME and may need to close.  A final ruling has not been made, but this would be the first EM program to close in more than a decade.  

More common is for there to be leadership changes within a program: Chair or Program Director.  These can be a big deal depending on the circumstances.  Did somebody get fired or was this a planned leadership transition to a well-chosen successor?


  1. Hi Dr. Kellogg,

    Thank you for your informative posts! I really appreciate it. I am a DO student with the following stats: (Step 1: 225; Step 2: 233). I just completed 2 EM audition rotations (one AOA and one ACGME accredited) and I have 2 more EM audition rotations (both ACGME accredited). The audition rotations I've already completed will be filling out SLOEs for me. As a backup, I also asked an EM doctor for a letter (not SLOE; I was a scribe for 4 years before medical school and did it for the first two years of medical school). Do you think I should submit his letter (it's already uploaded), or should I wait to ask for more SLOEs from my upcoming rotations? Any other advice would be greatly appreciated. Thanks Dr. Kellogg!

    1. You want to have your application "complete" as soon as possible. To most programs that means 3 letters received. If you are going to have 2 SLOE's then you can use the EM doc non-sloe and designate the 4th slot for the first of your upcoming rotations. When that letter uploads you can use it as a reason to touch base with programs who are on the fence.