Updated July 2022
The ACGME and RRC ensure that all 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 an excellent 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 you are "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 much ED time? How many hospitals do you rotate at? How busy or acute are they? What community 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 are 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 (tie breaker).
Program and Hospital Stability - Until recently program stability was only a minor concern for EM applicants. As a younger specialty with the majority of programs having been newly accredited in the last 20 years it seemed pretty stable. The RRC (who accredits and regulates residency programs) is careful not to give programs to unstable hospitals. Unfortunately that has changed recently. A residency program lost their accreditation a few years ago after the entire attending group had their contract terminated. This was the first EM program to close in more than a decade, but was followed by two hospital closures that resulted in all of the current residents needing to seek a new program to finish their training. In both of these cases the hospitals were not financially solvent and their closing took all the residency programs down with them. Both hospitals that closed were well established and essential to their communities so their closure came as a shock, at least to outsiders. In addition, there is growing concern that some EM programs may shrink, or even close, if the one year decrease in interest in EM turns into a multi-year trend. Asking questions about hospital and program stability on the interview day is reasonable.
Much more common than programs closing is for there to be leadership changes within a program: Chair or Program Director leaving or moving into another position. These can be a big deal, depending on the circumstances. Did somebody get fired or pushed out, or was this a planned leadership transition to a well-chosen successor? The individual circumstances make all the difference.
The ACGME and RRC ensure that all 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 an excellent 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 you are "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 much ED time? How many hospitals do you rotate at? How busy or acute are they? What community 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 are 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 (tie breaker).
Program and Hospital Stability - Until recently program stability was only a minor concern for EM applicants. As a younger specialty with the majority of programs having been newly accredited in the last 20 years it seemed pretty stable. The RRC (who accredits and regulates residency programs) is careful not to give programs to unstable hospitals. Unfortunately that has changed recently. A residency program lost their accreditation a few years ago after the entire attending group had their contract terminated. This was the first EM program to close in more than a decade, but was followed by two hospital closures that resulted in all of the current residents needing to seek a new program to finish their training. In both of these cases the hospitals were not financially solvent and their closing took all the residency programs down with them. Both hospitals that closed were well established and essential to their communities so their closure came as a shock, at least to outsiders. In addition, there is growing concern that some EM programs may shrink, or even close, if the one year decrease in interest in EM turns into a multi-year trend. Asking questions about hospital and program stability on the interview day is reasonable.
Much more common than programs closing is for there to be leadership changes within a program: Chair or Program Director leaving or moving into another position. These can be a big deal, depending on the circumstances. Did somebody get fired or pushed out, or was this a planned leadership transition to a well-chosen successor? The individual circumstances make all the difference.
Hi Dr. Kellogg,
ReplyDeleteThank 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!
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.
DeleteHi Dr. Kellogg,
ReplyDeleteAt 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!
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.
DeleteAny 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).
Dear Dr. Kellogg,
ReplyDeleteI'm a Canadian IMG that went to a Caribbean school. I passed all classes, CS and Step 1 (233) on 1st try. Currently studying for CK. I have a 5 yr gap because of finances between Basic Sciences and Clinical rotations. My school doesn't have Honours or High Pass and despite working harder at my EM electives they are the only ones I didn't get an A in (2B, C+). Though one was audition with interview, when I thought I was taking my CK last year. I was Class President of Med School Class 3 times, volunteer at Northwestern ED, but won't get a letter from them till after CK bc I have 12 more hrs to complete to get letter. As a Canadian, I can only apply to 4 year programs. I have 1 SLOE, 1 EM LOR and 1 Burn Director LOR (Cook County). I do have name on 1 published paper in GI (2010) journal. I have industry (vaccine/cancer) research work history, founded/own/ran rehab & post MVA assessment company in past, also previously teacher. As an older, non traditional student with a GAP I would appreciate your help with the following:
How do I find which programs accept Canadians at IMG programs? Where to find programs to get SLOE that are IMG friendly for rotations? How to make myself more competitive and what strategy to take?
First a caveat: I am not qualified to speak on your chances of matching into EM in Canada. It sounds like you will certainly be qualified for training but you do face several issues that make matching in EM at a US program very difficult. Your citizenship limits you only to those programs with visas available to EM residents. Your school limits you only to programs that consider students from carribean schools. The gap in med school will need to be explained in your application as well, but is not on its own that much of a problem. The best source of EM rotations are hospitals where students from your school have previously rotated. The best way to find out which program will consider you as an IMG (and thus are open to visas) is using EMRA Match. You can search by %IMG.
DeleteHello,
ReplyDeleteI am a rising MS4 who will be applying EM next cycle. My step 1 = 248, with 30/40 weeks honors 3rd year. Do I have a chance at top programs? Is there any thing else I can do besides working hard on upcoming aways? Thank you
Based on that limited information, you would not be excluded from consideration by the most competitive programs. Doing well on your EM rotations is going to be the most important part of your application left.
Delete