Tag Archive: Spotlight: All

How to Match into a Great Emergency Medicine Residency

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Choosing a Specialty, Emergency Medicine, Emergency Medicine Rotation, How to match in....?

July 13, 2015

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Emergency_room

An Emergency Medicine Attending Physician's Perspective:

From an interview with an Emergency Medicine physician in Colorado. Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

How competitive is the Emergency Medicine match?

Emergency Medicine has increased in competitiveness over the last 5-7 years, and seems to fluctuate somewhat in competitiveness. I personally think that competitiveness will maintain or increase as graduates are more attracted to specialties that compensate well while maintaining a good lifestyle (with minimal call), but that remains to be seen.

 

What must a student do to match into a great Emergency Medicine residency?

As with all specialties in the match, a good score on Step 1 is a must, but additionally a good Step 2 score is also important. EM program directors value this clinical-based test and your ability to perform in a clinical environment. Some say that this score is even more important than Step 1.

More important than either of those is your performance on clinical rotations, shelf exams, and letters of recommendation.  Emergency Physicians greatly value working with partners and colleagues who push themselves to be not only be great physicians, but team players who give the effort to help their fellow physicians. You have to go above and beyond with a solid knowledge base, evidence-based practice, and great interpersonal skills. 

The core 3rd year rotations are especially important (in addition to a sub-internship in EM) as our scope of practice really does encompass a significant portion of every other specialty.

 

What are residencies looking for in an Emergency Medicine applicant?

See the above – work ethic, integrity, clinical acumen, decisiveness, procedural competence, and being a team player.

 

What should students look for in an Emergency Medicine residency?

This will vary; you have to prioritize what is most important to you. Important considerations include location, reputation, research and leadership capability / opportunities, faculty, etc. Compensation is a consideration, but I think you (like me) will find that the variability is slight. Some programs offer coverage of meals while working, and some offer full health insurance benefits including dependents.  You will find a litany of differences – some of which may be deal breakers, some of which will only be perks – it's up to you to decide what's important.

Most programs have some subtle differences in their rotation schedule, which may make or break the decision for some, but I find that the differences are small, and many programs will provide excellent training. There are some programs which rise above the others for one reason or the other, but these reasons may be different for each applicant.  I found that focusing on subtle schedule differences created frustration, and got away from the more important consideration, which was fit.

In my opinion, the most important consideration is how you feel you fit with the program. Does your personality mesh well with your fellow residents and those of the faculty? If you have a family, will they be welcomed at events, or is every out-of-work gathering going to be held at a bar? What is your overall impression of the program, and how does that fit with your goals?

 

Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

With regards to ranking programs, most of that in my opinion is answered above. It's important to make a list of priorities and stick to it. As for the application, LORs, and personal statement: LORs should be obtained from practicing Emergency Physicians who know you and can speak to your clinical skills as well as personal attributes. Having an impersonal letter from a "big name" in Emergency Medicine is not nearly as important as one from someone who can write a strong letter touting your abilities as a provider as well as a person.

Your personal statement should be concise (no more than a page) and clearly demonstrate WHY you are going to be a rock star EP. However, you should not explicitly write all that out. Find a case that will grab the attention of the reader, demonstrates why you think EM is a no-brainer choice and why you are committed to it, and also showcasing your talents and skills.  This is your chance to express how you stand out from your peers, so you need to do that without sounding egotistical.  This is not a time for straight humility, but you must represent yourself with quiet confidence.

 

What do you wish you knew before application/interview season?  

Be familiar with the results of the match from recent years, and discuss with your faculty mentors how many programs you need to apply to / interview with.  Currently, 9-12 interviews is likely sufficient for the average applicant, but that may vary in coming years, and depending on the applicant. Interviews can be expensive, so consider your top picks ahead of time, but don't be afraid to adjust that list as you visit programs and formulate your impressions. You will likely be surprised about which programs stand out, or which will fall in their rank (I know I was…).

 

What other advice do you have for students applying for Emergency Medicine residency?  

This is a great specialty and profession. While we tout fun procedures, fast-paced shifts, and a great lifestyle, you should make no mistake and know that we work hard. Very hard. We do work that no one else does, and that many shy away from. We are not experts in every field of medicine, but we are masters of resuscitation, emergent airway management, trauma, and critical care. You will hear some people bash Emergency Medicine for not being "experts" in their specific area of expertise – that's by design! I was never trained to be an OB/GYN, but I am trained to recognize and treat OB and GYN related emergencies, referring those non-emergent cases for outpatient follow-up.  This does not give us room to slack and provide substandard care, but rather excellent care of urgent and emergent problems, leaving more obscure and less urgent problems to the specialist. Emergency medicine is awesome, enjoy it!

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Why did you go into Emergency Medicine?

Categories:

Choosing a Specialty, Emergency Medicine, Emergency Medicine Rotation, Why did you choose....?

July 13, 2015

by

Glidescope_02

An Emergency Medicine Attending Physician's Perspective:

From an interview with an Emergency Medicine physician in Colorado. Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

What attracted you to Emergency Medicine?

Emergency Medicine is the perfect combination of acuity and generality. I'd like to say that every patient I treat has an emergent reason to be in the ED, but unfortunately, that's not the case.  However, many do.  We evaluate, stabilize, and initiate treatment for critically ill patients every day. We hold difficult discussions with families, provide reassurance to parents, and address a large spectrum of medical illnesses. We are specially-trained to address any potential problem that could walk through the door, be it trauma-related, pediatric, geriatric, or anything in between. 

 

Describe an emergency department physician's typical work day?

The typical day is quite variable, depending on the day of the week and time of day that you are working.  As emergency physicians, we work in shifts. This means that our work days have predetermined start and end points. While those end points may flex slightly depending on the flow of the department on any given day, and you may be required to stay an hour or so late, when you leave you are done and no longer have to worry yourself about patient care responsibilities. 

I usually arrive 10-15 minutes early for a shift to provide the off-going doctor with a few extra minutes of relief, knowing just how busy his or her day could have been. After signing PA charts and verbal orders from the day before, I get right to seeing patients, or asking around to see if there's anything pending that my partners might need assistance with.  From that point, it's moving from room to room, patient to patient, providing counsel, instruction, reassurance, and at times, bad news. The number of patients seen in a typical shift will vary from day to day, and depending on where you work whether it be a busy urban / suburban ED or a more rural setting, but even in the rural setting any given shift can become incredibly busy; it all depends on the day. 

The hallmark of the emergency physician is the disposition.  At the end of every patient encounter, the patient will either be discharged home, admitted, or transferred.  There are typically no loose ends to worry about or results that will be pending for tomorrow that require attention. Each day brings a new census of patients that will come and go according to their respective disposition, and the cycle repeats itself. 

 

What type of lifestyle can an Emergency Physician expect?  

As a result of "shift work", the lifestyle of an emergency physician is largely customizable by the individual.  In my group, it's fairly easy to request certain days off for sporting events, school performances, or other special occasions. When those come up unexpectedly, fellow physicians are very accommodating of shift trades. This allows me to be present for my family when I want / need to be. When I'm off during the day, I have time with my wife and young child, and I am home to help with school-aged children, homework, as well as afternoon trips to the park and bike rides, etc. 

Saying that an emergency physician never takes call is a bit of a misnomer; our group does have a back-up call system for unexpected illness, emergency, or even a horrendously busy day in the department when we need an extra person to decompress the waiting room.  I take one 24-hr period of call each month, and find that I very rarely get called in.  Specifically, in the last year I cannot remember being called in, and have only seen 1 or 2 of my partners called in. 

Our group is very equitable about how we disperse shifts.  We do have several dedicated night-docs who take the majority of our night shifts, and the rest are dispersed equally among the rest of us. I work a mixture of shifts, and find that I work on average 14-15 shifts a month (mostly 9 hour shifts), with 4-5 of those being overnights or late evening shifts. This varies by month of course, but on average my number of night shifts is very manageable. 

There will be times when you will have to work nights, weekends, and holidays, but the trade off is time off on weekdays 

 

What is the potential salary of an Emergency Physician?

Specialty-specific salary information is available from many sources, and this varies by region as well as the collecting agency. The most current numbers from Medscape (http://www.medscape.com/features/slideshow/compensation/2014/emergencymedicine) show a competitive salary averaging at $272,000. It is not unheard of for a partner in a private group to exceed that, but that's the posted average.

 

What is the job market like for Emergency Medicine?

Honestly, it's great.  You can literally get a job anywhere in the country.  Having said that, not all jobs in EM (or medicine in general) are created equal.  There are certain markets that are more difficult to break into because of a given reason (i.e. mountains, beach, prestigious academic institutions, etc.) but those doors can open by pursuing fellowship training, other post-graduate experience, networking, and sometimes just persistence and demonstrating proficiency above that of your competitors. 

 

What can you tell us about Emergency Medicine subspecialties?

Post-graduate fellowship training is currently available for Critical Care, EMS, Ultrasound, Administration, Research, Toxicology, Pediatric Emergency Medicine, Disaster medicine, Simulation and Education, Sports Medicine, Health Policy, Emergency Cardiology, International Emergency Medicine and Global Health, Hyperbarics, Legal Medicine, Emergency Neurology, and Wilderness Medicine. 

Most of these are 1 year, some are 2 (CCM, Peds). Salary numbers will vary greatly depending on your chose practice site (private vs Academic, geographic location), and as you subspecialize, your job market narrows significantly (i.e. if you train in Peds and need to work at least part of your shifts in a large children's ED, that limits you geographically), but at the same time some of this post-graduate training can give you quite the edge over other applicants to help you break into more difficult markets. It's all about what you want to build your practice into. For example, if you want to be a toxicology or legal expert, you can likely work in either an academic or private group while still taking call at the poison center / consulting with a malpractice firm. 

 

What are the potential downsides of Emergency Medicine that students should be aware of?

Every specialty and every job will have some downsides. There are times when dealing with consultants can be challenging, or when patients come to the ED with a chronic problem, sometimes having had a thorough workup, expecting you to be able to solve their problem in an hour or two. You have to be able to take these experiences with a grain of salt, knowing that they will come occasionally, but are greatly outweighed by the opportunity to positively impact both the critical and not-critical (but still ill) patients.

Most people also quote chronic narcotic-seeking patients as a downside. These patients can be challenging as well, but in all reality many emergency departments have policies in place that make this much easier, and you have the backing of your administration and the nurses in the department, making disposition without narcotics on these patients easier.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interviews: What is a Transitional Year Residency?

Categories:

Residency, Anesthesia, Choosing a Specialty, Dermatology, How to match in....?, Neurology, Ophthalmology, Radiology, The Match, Why did you choose....?

September 11, 2012

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A Transitional Year Resident's Perspective: An interview with a transitional year resident from the Ann Arbor, Michigan.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty. See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What is a transitional year residency?

Transitional Year (TY) residencies might be the least well known residency option after medical school. The TY is a one year residency with a general focus which prepares recent graduates for advanced residencies. To understand where a TY fits in, you must understand that there are a number of residency programs that do not start specialty training until the 2nd year after medical school graduation (i.e. PGY2). These specialties include anesthesia, dermatology, neurology, physical medicine and rehabilitation, radiology, radiation oncology, and ophthalmology.

Each of these residencies begin their specialty training after a resident's intern year. Many of these residency programs will combine the intern year (PGY1) with the advanced specialty training. In these cases, the resident will remain in the same residency throughout their training and there is no need to complete a transition year residency. However, there are programs in each of these specialties that do not start training their residents until the second year after medical school (PGY2). These programs require their residents to complete an approved intern year prior to beginning specialty training. Approved intern years include a year of preliminary medicine, preliminary surgery, preliminary pediatrics, or a transitional year residency.

 

  • How is a transitional year residency different from other intern years?

The goals of training are basically the same among all intern years; we all learn hospital based patient care. Surgical interns take care of patients before and after surgery in the hospital, medicine interns take care of medical patients in the hospital, pediatric interns take care of kids in the hospital. A transitional year resident will take care of all of the above. The transitional year aims to be a broad hospital-based training. TY residents will spend various months working on medicine, surgical, OB, pediatric, outpatient, ED, ICU, and elective rotations. The great asset of a TY is that it provides more flexibility, allowing residents to focus on their interests. I am interested in research and was able to complete two months of intense research during my intern year: something no one from an internal medicine, surgery, or any other residency could say.

 

  • Are Transitional Year Residencies easy?

Not all TYs are made equally. It is a well known fact that there are some pretty cush TY residencies out there. However, there are also some very difficult TYs. To illustrate this fact, last year I interviewed at a number of TY residencies of varying difficulties. The easiest one had 4 required inpatient months, one outpatient month, one ED month, and 6 electives. Sign out during inpatient months was 3pm. When you were in the ICU you covered 2-3 patients, and you were NEVER on call the entire year. In contrast, I interviewed at a big hospital TY where there were two MICU months where you covered 15 patients, 6 required inpatient medicine months, 2 surgery months, a busy ED month, terrible call, and three 'electives' which were all time consuming. In general, however, the answer to this question is yes. Transitional years are FAR easier than prelim surg residencies and quite a bit easier than prelim medicine residencies as well.

 

  • Is the training as good at a Transitional Year Residency?

Absolutely, if you choose the right place. Many months this year I have more free time than I did in medical school. I have found that with the free time I am actually reading and studying a ton. I think that you MUST take call to learn how to be a doctor during your intern year. I am not sure how you can become a 'well trained' doctor if you never take call during your intern year. Being on call at night is when you really have to make decisions and you really learn a ton. You don't need 11 months of inpatient work to become a great radiologist or a great ophthalmologist. However, 6 solid months of medicine/surgery will certainly prepare you for your next level of training. Then you can spend the other half of the year becoming great at something else: research, pediatrics, surgery, golf, sleeping, etc etc

 

  • Describe a typical transitional year schedule?

Everyone must do: 1 month in the ICU, 1 month ED, 1 month outpatient, 2 months general medicine. I believe the rest is up to the residency program. Most programs end up giving 3-5 months of electives.

 

  • What are the potential downsides of a Transitional Year?

Not many! More free time, less stress, more fun…what's not to like. I guess one downside is that it closes some doors if you choose to switch specialties. For example, if you were doing a preliminary medicine year at an academic center and decided you wanted to do medicine instead of anesthesia, the switch would be easier. After completing a TY year you can only go into the specialties I listed above.

 

  • How competitive is the Transitional Year match?

It is actually very competitive. There are not many spots, and they are all coveted because they represent less work, more free time, more electives, and a much easier year. Also, imagine all the applicants trying to get spots: future radiologists, ophthalmologists, radiation oncologists, dermatologists. This is not a list of ordinary applicants. Matching into a TY is about as hard as matching into radiology or ophthalmology.

 

  • What are residencies looking for in a Transitional Year applicant?

I asked my TY program director this exact question and this was his response: "We know we will only have you for one year. However, during that year the TY class will take care of about 50% of all the patients in this hospital. So, it is in the hospitals best interest to have someone who 1- will work hard without being asked, and 2- will maintain the great patient care that we have at the hospital." I think those two things are exactly what all programs want. I think item #2 may touch on competency a little bit, but is mostly referring to your interpersonal skills.

 

  • What should students look for in a Transitional Year residency?

Whatever you want to look for in a TY year. That sounds cliche, but as I said above, not all TYs are made equally. Do you want a chill year at the risk of missing out on training? You can find that. Do you want to do pediatrics as well as medicine and surgery? You can find that.

 

  • Is there anything you wish you knew before application season?

I interviewed at a few places that had both TY years as well as preliminary medicine years but the curriculum was exactly the same. In other words, if you match into the preliminary medicine year, you still have the flexibility that the TY residents at the same program have. All of these programs will let you apply to both the TY and the prelim med year after your single interview. These are great programs to find because even though there is no difference at all in the curriculum, the preliminary medicine years are a bit easier to get into.

 

  • What other advice to you have for students applying to a Transitional Year?

Good luck, intern year is exhilarating, fantastically rewarding, difficult, and very very short. Enjoy it. Read The House of God (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs where the characters are interns…it is incredibly realistic!

 

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: An Orthopaedic Surgeon’s Job Description

Categories:

Residency, Choosing a Specialty, How to match in....?, Orthopedic Surgery, The Match, Why did you choose....?

August 18, 2012

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An Orthopedic Surgery Resident's Perspective: An interview with an orthopedics resident from the West Coast

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Orthopedic Surgery?

I feel like you can learn a lot about a specialty based on what you see in the attending physicians of that specialty. The orthopedic attendings, for the most part, seemed happy. There are many sub-specialties in Ortho and was interested in nearly all of them. The patients' prognoses in many cases were very good. Patient’s lives were improved dramatically by Orthopedic intervention.

 

 

  • Describe an Orthopedic Surgeon's typical work day?

Long. Orthopedic Surgery is no place for individuals looking for a structured 8 to 5 job. Attendings often work harder than residents. First and foremost, the patient comes first and your day ends when the work is done.

 

  • What type of lifestyle can a an Orthopedic Surgeon expect?  

It's not dermatology. Call and nights vary between sub-specialties, but generally if you are asking this question, Orthopedic Surgery may not be the right choice for you.

 

  • What is the average salary of an Orthopedic Surgeon?

Also varies from specialty to specialty. Generally speaking Orthopedic Surgeons are some of the best compensated surgical specialists, but that should only be a perk. Don’t go into Orthopedic Surgery for the money, times are changing.

 

  • What is the job market like for Orthopedic Surgery?

The market varies amongst subspecialties. Hand Surgery and Sports Medicine are amongst the most competitive now, but are also rather saturated. Generally speaking, our aging population bodes well for our job security for the next couple of decades at least.

 

  • What can you tell us about Orthopedic Surgery sub-specialties?

Residencies currently range from 5-6 years with 1 year fellowships available in: Shoulder, Hand, Spine, Tumor, Joints, Sports Medicine, Pediatrics, Trauma… About 85% of current residency graduates are going onto Fellowship training.

 

  • What are the potential downsides of Orthopedic Surgery?

Be prepared to work hard and not complain.

 

  • What else would you tell medical students who are considering Orthopedic Surgery?

With a good work ethic and the right motives, Orthopedic Surgery will offer a rewarding lifetime of challenge and service.

 

  • How competitive is the Orthopedic Surgery match?

Very, with the caveat that interpersonal and personality traits cannot emphasized enough.

 

  • What are residencies looking for in an Orthopedic Surgery applicant?

You will need to reach a certain threshold of competency/test scores (different programs weight each of these differently). The rest is studying and hard work. Away rotations are usually weighted pretty heavily and should be considered a month long job interview. Dress appropriately, prepare for cases/clinic, show up early, etc.

 

 

  • What should students look for in an Orthopedic Surgery residency?

I would want to feel fairly comfortable with the people you interact with. You will be spending a good chunk of your life with them. Also, ask them the appropriate, but difficult questions. I always appreciated programs that seemed to be up front and honest.

 

 

  • Do you have any advice about the residency application?

Spend plenty of time on your personal statement and have it proofread by several different people. Another thing that I found useful was to offer to draft letters for those you ask…chances are good they are probably busier than you are.

 

  • Is there anything you wish you knew before application season?

Give every day your best shot. Otherwise stop worrying. The rest takes care of itself. No amount of worry will do anything but shorten your life span.

 

  • What other advice to you have for students applying to Orthopedics?

Good luck! It is a stressful, but dynamic time in life.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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