A Budding Emergencist
Thursday, December 14, 2006
  Residency Spot Anxiety
I'm worried.

Worried that, come March 14th, the day of reckoning for all residency applicants, I'm going to come up bupkis.

My EM spot at Metropolis is assured, my inside guy tells me, but again, he is fickle, and who knows how much pull this guy really has?

I started worrying for real when one of my interviews, actually one of my safeties, went south because they had no spots for PGY-2's. Briefly I considered asking for an interview for a PGY-1 spot, but after the hell I went through as a rotator in Surgery, I said nothing. I've told people I wouldn't mind repeating PGY-1 in a linked program, repeating Surgery I don't want to do.

So now my eggs are pretty much all in one basket at Metropolis. I'll have to admit, it seems like a sure thing, but another intern in my program is also rotating at that ER, and she is also wants a spot there. I need a Plan B. Options. Here's what I've been thinking:

1.) Calling up the programs I didn't hear from and asking for an interview. I'm going to do this regardless.

2.) Prepare for The Scramble--several EM spots in my area went unfilled last year, so I definitely have a chance. I'd put my odds at 50-50 for this, though. Taking the USMLE ("U-Smile!") Step II, although unnecessary (I'm a D.O., and have done well on the COMLEX II), might be an ace that would tip the cards in my favor. I'll have to plan it for late Jan or early Feb in order to have the scores back in time for the Scramble. Or I could take COMLEX step III, required for licensure. Easier, and perhaps more useful given some options I've listed below.

3.) Scramble into IM or FP. Not exactly what I want to do, but I've always enjoyed primary care. Actually, I've always thought of EM as primary care on steroids, and I mentioned my primary care skills as a strength in my personal statement. Additionally, my FP mentioned he'd like to retire soon, and intimated I'd have a practice if I went FP.

4.) Hold out for a second round of EM applications. I'd be growing a little long in the tooth for residency, and I'd have next year to fill with some kind of meaningful activity:

a.) EM research would be an obvious choice here, if I could get it. Probably would be a great resume buff to add publications and research experience in the field, especially given ACEP's mandate for research for residency accreditation.

b.) Taking Step III as mentioned above and apply for licensure. Hit the streets and try to get a job as a "physician extender," maybe in a clinic or a private office. Maybe work some connections.

c.) Medecins* Sans Frontieres: See the world, save some lives. Pros: learn another foreign language, get great experience, and who cares about money when you've got no debt and are living in a shack in Nigeria. Cons: would they even take me? I'd be licenced but not board certified. Flying back for interviews would also be difficult, not to mention expensive. Family might help out, though. Parasites and privation would be a problem, but it would demonstrate my commitment to medicine as well as humanity. Might be a valuable lesson.

d.) Join the military. As a doctor in the military, I think I'd be part of the solution versus part of the problem vis-a-vis the Iraq war, which I was wholeheartedly opposed to from the beginning. Helping out our own guys or possibly even helping out some Iraquis, I'd be doing my part. Sure it'd be dangerous. But again, it'd be a great experience, and would probably form the basis of any future residency application. Again, however, interviews might be a problem. With a little planning, it might work. However, with the ominous "stop-loss" program currently in place, the time commitment might very well be indefinite, anywhere from two years to four. I'd be a great candidate for residency, but I'd be at least 3 years out of med school, still looking for a residency spot.

Although, the military has its own system of residency training...

d.) Find work with Big Pharma or the medical device industry. Hold my nose, sell my soul. I hear the job market for doctors in medical companies is pretty good. Unpalatable, to be sure, but I gotta eat.

Related posts at SDN:

Scramble advice from a PD.
List of unfilled EM spots for 2006.
Getting interviews.
I'm not alone.


*Changed "Docteurs" to "Medecins": Thx Dr. Couz! J'ai besoin de perfectionner mon francais!

UPDATE:Two more Interviews! Just shows to go you. I need to improve my negative capability.
My opinion?

Only back up with FP or IM if you'd be happy there. Otherwise, hold out for the big one.

If it works the same there as it does here, you can always do FP, work in rural ED's and challenge the EM certification later on down the road.

I wouldn't apply to Medecins Sans Frontieres, though... at least not until you get the name right! ;-) Seriously, I looked into it and they won't take you until you have a few years of practice under your belt anyway.

I'll be curious to see what you decide, though.
Never underestimate the power of connections. If your VIP is solid, you're in. But it's also good to have a backup plan. If I were in that position, I'd go military and avoid the "big pharma" job. I'm assuming you really want to be a doctor and not a figurehead. Or you could do like I did and go IM. There are a lot of options after an IM residency, including slinking in the backdoor of EM.
Drs. Couz & Scalpel,

Thank you, fellow travelers. Good words.

EM residency positions are still quite competitive, despite reality sinking in contra: the "ER" drama-draw.

EM has a lot of great things going for it--a young, vibrant, and active membership; shift work; immediate gratification; constantly challenging; high demand; at the forefront of systems-based analysis and research; high renumeration and prestige.

Can't wait.
icksnay the restigepay
ER is not a medical speciality.
It is learned helplessness
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Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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