Applying - Choosing where to apply

Updated March 2018

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 25 years from now, there will be little impact from 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 evaluate how well each program fits your needs and goals and consider length as a minor factor.

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 closed. This was the first EM program to close in more than a decade.  An element that played out in this case and can affect stability is the practice structure of the EM faculty for a residency site. Private and Hospital based EM groups are both stable but conflicts over contracts can arise. Again I recommend applicants focus on fit, and avoid focus on group types as this was an isolated occurrence. 

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.

  2. Hi Dr. Kellogg,

    At this point in the cycle, I have a total of 15 interviews (which I felt good about until talking to a classmate this morning who apparently has 30). I know I'm not the most competitive applicant, but what has me worried is where the interviews come from. I'll list them below:

    -1 from my home institution (Allopathic)
    -2 from aways that I did, so they were guaranteed
    -9 from ACGME programs excluding home and aways. Mix of community programs and some mid to low tier academic institutions.
    -3 from newly accredited ACGME programs that were beforehand osteopathic.

    What I'm worried about as far as hitting the magic number of interviews is whether or not I should include the three historically osteopathic programs. Since this is a new thing for allopathic candidates, I don't know how to gauge whether an MD would have a reasonable shot at getting a spot at places that I would think would still give DOs preference (and rightfully so). Given this concern, it seems I basically have 9 interviews at this point (since home and aways were guaranteed interviews anyway).

    Do you think I should be worried about matching given what I have so far, and what are your thoughts on these newly accredited programs?

    Thank you so much!

    1. I think you are in an enviable position. You have all the interviews you need to match AND you are likely to have more coming.
      Any program that offered an interview at this stage saw you as one of their most desirable applicants. You may not feel the same about them but there are probably some great places to train in there. Same goes for the former Osteopathic only programs - they would not invite you if they were not seriously interested.
      With 15 interviews you are going to have to start making a list of who you are going to drop as more personally desirable offers come in off wait lists and later released interview dates.
      So unless you think your home and aways are not planning to rank you, you have 15 interviews, which conveys a >95% chance of matching (so does 12 if you don't want to do all those interviews).