New Program outside Philadelphia and in the 2021 Match!

There is another new Emergency Medicine residency program that has been approved to recruit for this 2021 match.  The Pottstown/Phoenixville EM Residency in suburban Philadelphia will be in ERAS soon.  The Program Director, Ernest Leber, would like to hear from interested students through the email at the end of the message below:

I have been approved for a new EM program with Tower Health at Pottstown and Phoenixville Hospitals. Our program will  be a 3-year community EM program here in suburban Philly. We will have rotations at Pottstown, Phoenixville and Reading Hospitals. We have an excellent and enthusiastic group of physicians ready to train residents/learners.

We are recruiting for a July 2021 start. The process of getting listed in ERAS takes time but should be completed within the next couple of days which does not leave us much time for students to forward us their app and for us to interview. Please pass my email address on to any students you think may be interested in my program. They can email me directly to set up an interview before we get listed on ERAS.

Ernest.Leber@towerhealth.org

Thanks everyone
~Ernie

EM Application Uncertainty - What do we know?

There is a lot of concern on both sides of the Emergency Medicine residency application process.  Some programs have reported dramatic increases in the number of applications they have received.  Many students are worried by how few interviews they have been offered.  Has something fundamentally changed in the application process that can explain what is going on?  The answer is that yes, there has been a change, but there is not more competition for residency spots than in previous years.  

Below is a dive into the preliminary ERAS data for 2021 taken from the ERAS Statistics page at AAMC.org.  The data shows that applicants have not (or at least not yet) applied to substantially more programs than in previous years.

The answer to what is going on, unfortunately, does not have data to back it up.  Anecdotally, many EM residency programs are reporting that their interview acceptance rates are way up this year.  Applicants who get offered interviews are reportedly saying “yes” to almost all of them and are rarely cancelling.  This is different from previous years and is depriving other applicants of the chance to interview.  

Every year we see the applicants with the best on paper applications get the majority of the interview offers in the early stages.  As their schedule fills up they decline interviews which are then offered to other applicants.  So far this year, that is not happening.  With travel not being a barrier the “haves” are able to hoard interviews without repercussions. 

A US MD Senior guarding their collection of Emergency Medicine interview offers.

If you have more than 12-15 interviews:  it’s time to let some go.  Making decisions is a core skill in EM.  Each program offering you an interview already wants to match you.  You can narrow your list and cancel or decline the ones that are not in your top 15.

If you don’t have very many interviews: hang in there.  More are coming.  Either when your peers start to drop them or when programs add interview slots as they recognize that many of the applicants interviewing with them early in the process are not genuinely interested in their program. 

And now the data deep dive...

Looking at this data can help answer some questions about this unprecedented match year for Emergency Medicine.  First is the data followed by some analysis.

The total number of applicants to EM has been trending up steadily.  Folks do not appear to have been scared away by the front-line nature of EM. Instead, the steady growth in applicants has continued.  It is important to note that this increase has been accompanied by a steady increase in the number of residency spots available, both from new EM Residencies opening and existing residencies increasing their class sizes.

In addition, the data in this table make it look like DO applicants have just discovered the wonders of EM, but that is not what is really going on.  Instead this data just reflects the move to a single-accreditation system under the ACGME.  All DO applicants to EM are now shown here, not just those who applied to ACGME residencies (by 2021 all residencies are under the ACGME).  

The Bottom Line: The number of applicants to EM has NOT gone up in a way that will affect your chances of matching.   

According to this data, which is preliminary, the number of applications per applicant has actually leveled off for the last few years for both US MD and DO applicants.  That big climb in DO applications is deceptive as it did not include the applications to osteopath-only programs before the merger.  IMG applicants have steadily increased their numbers of applications.  

What we don’t see here is the expected increase in applications due to uncertainty.  If this holds it may reflect improved dissemination and uptake of application advice.  Or there could be another wave of applications coming as applicants panic over not getting sufficient interviews.  We shall see. 

Bottom Line:  So far, there has not been an increase in the number of applications per applicant, despite anecdotal reports by residency programs of significantly increased application numbers.  

This table argues against a generalized increase in the number of applications programs are receiving. Some programs may be seeing a significant surge in applications, but there does not appear to be a dramatic increase for most programs.  One possibility is that there has been a real increase in the number of applicants at programs that were prohibitively expensive for applicants to apply to.  This could be programs in areas that required most applicants to fly to.  For example, a student on the east coast (where there is a heavy concentration of medical schools) faced a significant cost to interview on the west coast.  That financial barrier is gone. 

Conversely, if some programs have seen a significant increase in the number of applications they have received, but the overall average number has barely changed (+33 from 2019), then there would have to be a group of programs that have seen their number of applications decrease.  

The Bottom Line:  There will be more competition for interviews at some programs, but not at all.   

If you have questions, comments, or other interpretations of this data, please share them in the comments and we will try to figure this out together.

Where are the Emergency Medicine interviews? Asking for a friend...

On October 21 at 8 am EST your meticulously crafted ERAS applications were sent to your chosen EM Residency Programs.  Now you are waiting to hear who wants to meet you in a virtual interview.  And waiting.  It's been 5 days?!?  Where are the interviews?!?!

(I know you don't really feel this way.  You get that to do proper application review takes time. But it is human nature to worry and to self-doubt, so I wanted to share some concrete information that may help in a year when there is a pronounced lack of solid information to go on.)

This year the County Program Unified Release Date is November 2* at 12 pm EST.  

This means that any program that is part of this agreement will not offer their interview spots until then.  Most of the self-identified "county" EM residencies participate, as do many other EM programs for whom this date makes sense.  This year it is reasonable to expect that the majority of the first wave of interview offers will go out around November 2.  

Therefore, there is no reason to panic right now.  Even if you don't have 12 interviews by November 4, it is still NOT time to panic.  After this first wave of offers there will be more.  Many programs do not release all their interview spots right away and all programs will have openings as applicants rearrange their schedules as higher priority interviews become available.  Every year this process takes a while to sort itself out.  

Have a look at this reference page on on the mechanics of interview season and submit your questions in the comments below.  

*A previous version of this post listed the Unified Release Date as November 3rd.  

Last Minute Questions for the Emergency Medicine Match

On Wednesday October 21 your applications will go to the EM Residency Programs you applied to.  So we are going to try to answer some common last minute questions that a lot of folks are asking.  These are questions where there is no evidence base for answers/recommendations, so what you are getting is one advisors opinion, informed by conversations with other advisors and PD's.

Question 1:  How should I describe work, research and volunteer experiences in ERAS - bullets or paragraph?  

Either is fine.  Applicants are paying more attention than usual to how they complete the ERAS application, probably because they have more time on their hands to craft and perfect these entries.  Just make sure you concisely explain what you did and what your role was.  This won't affect how programs rate your application.

Question 2:  Should I customize my Personal Statement to different regions or even to different programs?  

Maybe.  In previous years (and posts) I have pretty strongly said "no" - because this is a poor use of time and Program Directors generally felt this comes across as "too desperate" and unnecessarily raises concerns: "what is wrong with this persons application that they think they need to do this".  HOWEVER, this year is probably different.  You do not have the ability to do Away Rotations to demonstrate interest in a specific region or type of program.  You can and should use the "hometown" section of the application to clarify regions you have a connection to.  It is also common to include in your Personal Statement a section (usually closing paragraph) that describes what you are looking for in a Residency Program: academically and geographically.  And it would also be reasonable to have different versions of this closing paragraph for different geographies or types of programs.  This is OPTIONAL.  It may not help.  It may even hurt you if interpreted as desperation.  BUT, if you are concerned that there is no other way to make clear your interest in a region or in a type of program, then this MAY be helpful.  

Question 3:  Should I hold a spot for a late arriving letter or just fill all four spots with what I have now?

Hold a spot if it is an eSLOE from a residency program.  This application season is starting later than in years past but the date of the Match has not changed.  Programs are on a compressed timeline to review applications, and offer and complete interviews and rank lists.  And we all expect to interview more applicants than we normally do.  Programs will look at whatever you have on October 21 as they make INITIAL interview offers.  A late arriving letter can still impact your chances of getting a "wait list" interview when someone cancels later in the season.  Only an eSLOE from a residency program is a valuable enough addition to your application to move a program from "maybe" to "interview".  Other letters, even O-SLOE's, are unlikely to make a difference late in the process.

Question 4:  Should I be doing more than 10-12 interviews this year because programs are interviewing more people?    

Yes, but not many more.  The number of interviews (and ranks on your rank list) needed to reliably match in EM has been steady for many years at 10-12.  Even with the number of applications submitted per applicant steadily increasing over the last decade this number has not changed (because the number of residency spots has grown at the same pace as the number of people who are applying).  Ranking 10-12 programs gives a 95%+ chance of matching in EM.  BUT, that is based on non-pandemic application cycles.  This year we anticipate applicants are going to apply to more programs (because they have more available funds with interviews being virtual and less ability to audition) and programs will interview more applicants because they are worried that many of their applicants are not really interested but are just panic-applying.  HOWEVER, residency programs are limited in how much they can increase the number of interviews they do.  On the program end the virtual interview process takes just as much faculty and coordinator time, AND possibly more time, if you account for the challenges of trouble-shooting virtual interviews.  So while an applicant can pretty easily (though not wisely) double the number of applications they send out, the programs will need to make a huge investment of resources just to increase their number of interviews by 20-30%.  If you are an applicant without extenuating circumstances, like being in a complicated couples match, you can do 12-15 interviews and be confident in matching.  AND for most of you 12-15 is overkill, just like 10-12 was overkill for most applicants over the last decade (1/3 of applicants match to their #1 and more than half match in their top 3).  

Question 5:  Wait a minute!  I should be doubling the number of programs I apply to?!?

NO!  That is totally unnecessary.  But fear and uncertainty have steadily driven up the number of applications per applicant for the last decade.  And this year has produced an abundance of fear and uncertainty.  As an applicant your chances of matching are exactly the same as they have been in the past.  The proportion of available EM residency spots to applicants who want them (spots/applicants) has not changed.  Because you can't go to most of the programs you will eventually rank the most important thing to do this year is research programs throughout the process.  Hopefully you have been doing this already.  You want to make good use of your interview time so choose places to apply that you are actually interested in and have already vetted for matching what you are looking for.  A plan of "apply to a ton, see where you get interviews, and then learn about the programs on interview day" is going to work even more poorly than usual this year.  Programs are going to be looking to interview applicants who are obvious fits for their program: geographically and academically.  A smart application is one where most of the programs on your "core list" (the 20-30 realistic programs, NOT the longshots) make sense for you. Your geographic ties are clear: connection from med school, college, work/life spent there, or explained in PS.  AND your academic profile (degree, scores, specialty interests like US, wild med, research, etc.) match what they advertise they are looking for.  

I bet these questions generate even MORE questions.  We will try to respond quickly to anything you put in the comments section, so fire away!

New Program in California: UHS SoCal

 There is a new EM residency program in California that is recruiting for the 2021 Match.  From their Program Manager:

We are thrilled to announce that our new Emergency Medicine Residency at UHS SoCal MEC has received initial accreditation by the ACGME!! We are a Three-Year Categorical program based in Temecula, CA and approved for 10 residents per year. Our Sponsoring Institution, UHS SoCal MEC, is comprised of 5 hospitals recognized for quality of care and patient safety. The program is integrated with 3 of these sites: the primary site is Temecula Valley Hospital (TVH), a busy advanced primary stroke center and STEMI receiving hospital. The other integrated sites include Inland Valley Medical Center, southwest Riverside County's only trauma center, and Rancho Springs Medical Center, which provides the region's only dedicated pediatric emergency services.The program provides EMS Medical Direction for Riverside County, a comprehensive ultrasound and simulation curriculum, PICU experience at Rady Children's Hospital San Diego with lodging provided, and opportunities for healthcare advocacy.

The Program Director(PD) is Stephen R. Hayden, prior PD at UC San Diego, Past President of CORD, Editor-in-Chief of the Journal of Emergency Medicine, and an Editor for the 5-Minute Emergency Medicine Consult and Research in the Acute Care Setting. The Associate Program Director (APD) is Robert Steele, an Associate Professor and was one of the founding physicians at TVH and UHS SoCAL MEC. Between them, Drs. Hayden and Steele have over 25 years experience in residency leadership and GME!

 Accepting applications and scheduling interviews via ERAS this interview season and we expect to start our first residency class in July 2021. Please spread the word to EM bound medical students and help us begin our journey!!

Keri Kinley, C-TAGME | Emergency Medicine Program Manager | Keri.Kinley@uhsinc.com | O: (951) 331-2535 | UHS Southern California Medical Education Consortium | Universal Health Services, Inc. | 31700 Temecula Pkwy., Parkway Suites #2-GME, Temecula, CA 92592 | 

www.socalresidency.com

Emergency Medicine Application Advising Q&A on September 11, 2020

We will be part of a Zoom Q&A for students in the 2021 Emergency Medicine Match:

Acing Your Applications: Expert Advice from Baystate EM - Friday 9/11 @ 1pm EST

The UMMS-Baystate Faculty includes three past Chairs of the CORD-EM Advising Students Committee (ASC-EM), the creator of the EMATCH Tool, a co-developer of the EMRA Match Residency Navigator, and the authors of the EM Advisor Blog.

Our panel of experts: Lucienne Lutfy-Clayton, Liza Smith, and Adam Kellogg, will answer all of your questions on how to make the most of your application to Emergency Medicine.

UPDATE: The recording is available on the Baystate EM Seminars page.

Participants do not need to be planning to apply to the UMMS-Baystate residency, or even anywhere in New England, to join in. Our panel has expertise in advising applicants across the United States and are happy to provide advice to all.  

Alternative SLOE's for Emergency Medicine in the 2021 COVID Match

EM Residency Programs will start seeing applications on October 21st.  The goal is to have all of your Letters of Recommendation uploaded to your application by that date, which has been pushed back compared to previous years.  Despite more time to complete rotations most applicants in the 2021 match have not had access to as many EM rotations as in a "normal year". 

To address this the Council of Residency Directors for Emergency Medicine (CORD-EM)  created several additional SLOE templates for use by letter writers who are NOT faculty at an EM Residency Program.  

1. The SLOE Sub-Specialty Rotation - for use by EM Sub-specialty Clerkship Directors (Pedi EM, Ultrasound, Toxicology, etc.)
2. The SLOE Non-EM RESIDENCY Faculty - for Emergency Physicians not affiliated with a residency program (community hospital or academic center without a residency).  
3. The O-SLOE - The "O" stands for "other rotation" or "Off service".  This is for non-EM letter writers like Trauma, Family Med, Critical Care, IM, etc.  

Ask all your letter writers to use these letter templates.  They guide the writer to give the EM Program Directors the information they want to know.  This is not always intuitive to writers from other disciplines.  

While these alternative SLOE's should be a significant improvement from traditional narrative letters the expected hierarchy of letters remains: 

SLOE from EM Program Leadership >> EM Sub-specialty SLOE or SLOE from EM Faculty at a Residency Program > SLOE from EM Faculty NOT at a Program > O-SLOE >>>>>Narrative letter

 Program Directors expect that letters of recommendation will remain the most important part of your application to Emergency Medicine, so make sure you get the right ones.