Can you do anything EM related? Toxicology? Sports medicine? Ultrasound? EMS? That may help your case. Can you ask your school to let you do an EM rotation and put off one of your other core rotations until 4th year? (like OB or something similar)
Also, if you can find room for even ONE shift with your program director or department chair, often they are willing to write letters based on that. We had so many students applying EM from our school last year that we each only got one or two shifts in with the VIPs. However, those VIPs were willing to write us all letters based on the scant experience. Make sure you tell them at the start of the shift that you are looking for a letter, and that you'd like to present exclusively to them. Then, at the end of the shift, ask if you can set up a time to meet and talk about yourself, your career goals, etc. I had two EM letters, and one IM letter, so it's acceptable to get letters outside the specialty.
I did not apply to any backups, but if you're worried about it, ask your dean or EM program director if they would reccomend applying to backups in your situation.
Feel free to PM me, I'm a first year EM resident, and I was very recently in your shoes. (my daughter turned 1 yesterday)
These stories are so encouraging!! I begin medical school (God willing) next August, and am getting married the following June, right after my first year of school. I have alwaysss wanted a family and like I have said on other threads, I want to actually be a mother and not just reproduce. I would like to have my first baby perhaps during my residency, unless it is better to have baby #1 during the 4th yr of school?? I really would not know. Anyway, it seems really encouraging that some of you feel EM is the perfect specialty for moms. I love the idea of EM (constant change, broad range of ailments, team feeling, lively atmosphere... and I had at one point wanted to do surgery but am thinking it will not be conducive with mothering... so being able to do some procedures would be fantastic)! Any advice would be greatly appreciated.. Thanks so much!!
Do you guys worry about the lack of options in EM? It sounds ideal to me (I think) I have even been doing some shadowing, but what if I like it less in 10, 20, 30 years? There isn't really any room to specialize/ change. Can you shift into non-emergent primary care as an older doc? Can you do an FP or IM fellowship as an EM doc?
Current fellowships for emergency medicine physicians are toxicology, sports medicine, pediatric EM, EMS directing, critical care (can't get boarded yet, but we're working on it), ultrasound, research, teaching, international, and hyperbaric medicine. (I'm sure I'm missing one or two, feel free to add to the list.)
I do know one or two EM docs that have gone to urgent care centers, but most EM physicians find outpatient primary care medicine to be unattractive. I think the personality types that are drawn to EM versus IM or FP make it less likely that an EM doc would want to make that transition.
There is room for change in the specialty. An academic EM job is very different from a community practice, and practice locations (city versus more rural) are also very different.
Burnout is a problem in all specialties, and I don't think that EM is any worse than anywhere else. I think you are faced with the same lack of options for change as a cardiologist or a surgeon 20 years into your practice if you decide you don't like it. In all cases, changing would mean another fellowship at a minimum, possibly another residency.
Lack of options? Au contraire- there are MORE options in EM! Tired of where you are? Do some locums in the Caribbean. Travel! Work on the beach or the mountains. Every group and practice is different, and yes, academics and community practice are very different.
As an EM trained doc, I do not feel that I am equipped to practice primary care. Although much of what I do is primary care, I am certainly not trained to manage outpatient medicine. Drey hit the nail on the head (as usual) in that there is no way I could ever do that. Because I really don't like it.
And yes, so what if you went into anesthesia and hated it? Or orthopedics? EM is a speciality just like they are. As a wise friend says, "You can't be a stem cell forever."
Haha, I am so a stem cell still. Its so scary trying to choose something without really being able to know how well you will like it in the long run! I do know that I would do best in something varied and fast paced that has lots of face to face interaction. Do you feel like there is any time for connection with the patients required in EM since the time you spend with them is so brief? Also, how much intuition is used in the ER? Is it so evidence-based that you feel like a protocol-following machine or is there still some creative thinking that goes on? I am shadowing right now but these aren't really the kinds of things you learn from shadowing. To the EM docs that love what they do, I am curious as to what your meyers-briggs (sp?) result is. I am an ENFJ...
Also, what is it about outpatient medicine that you dislike? Wondering if I would feel the same way.
It also helps that EM residencies are much more humane than other fields, at least where I am. That is a big plus when you have little ones! The EM docs I have seen seem unusually happy, with the exception of one who told me she hated "complainers." Oops, all of medicine is a bad choice for her!
I appreciate the input ladies.