Looking at Emergency Medicine Match Data and Surveys

Introduction

Dr. Ryan Gray: Specialty Stories Podcast, session number 14.

Whether you’re a premed or a medical student, you’ve answered the calling to become a physician. Soon you’ll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.

Welcome to the Specialty Stories Podcast, my name is Dr. Ryan Gray, and I am your host here on the Specialty Stories Podcast as well as several other podcasts on the Med Ed Media network which you can find at www.MedEdMedia.com.

Last week we had a physiatrist on and that seemed to be a very popular episode. This week I’m going to dive into more match data. I did an episode like this a couple episodes ago in episode 11, or session 11, and I want to do the same thing again today. The first one I dove into was Anesthesiology. This next one I’m going to dive into is Emergency Medicine. Now if you follow the NRMP match results, and you go alphabetic order, Anesthesia is number one, Child Neurology is number two, and Dermatology is number three. But I’m going to skip those two because they’re much smaller and I’ll reserve some time for those maybe in a bigger episode where I cover a lot of these smaller programs. I’ll definitely want to look for Child Neurology to come on, I’ve had a dermatopathologist on already. So I will be talking about those specialties, but I don’t want to dive into the match data for those right now.

Emergency Medicine at a Glance

So what I want to do, or what I want to dive into is Emergency Medicine, and Emergency Medicine is a very popular specialty these days. And I did speak to an Emergency Medicine physician back in session 2 of the Specialty Stories Podcast, which you can find again, Specialty Stories, session number 2. And it’s becoming very popular because of the shift work, and the amount of work that you’re doing. So I think what I remember is that what is considered full time for an Emergency Medicine physician is about fifteen or sixteen shifts a month. So when you think about that it’s like, ‘Wow I only have to work fifteen days a month to be considered full time?’ That’s basically- I mean if you think fifteen days over business days, that’s three business weeks, Monday through Friday, five days times three. So that’s a whole extra week off that you’re getting every month. But obviously shift work comes with some negatives as well, which we talked about in that episode.

So I do want to talk about this NRMP data, and again if you Google NRMP match data for 2016, then you can follow along with me in this PDF document. It’s a 120 page PDF document called, ‘Main Match Results and Data for 2016.’ And right off the bat we look at table one here for this NRMP match data, and Emergency Medicine has 174 programs, and just I’ll give you some comparisons. So Anesthesia we talked about last time was 119 programs, so a lot more programs, almost 60 more programs- 55 more programs if you want to be specific. And of those 174 programs, there are 1,895 spots, which works out to a little bit over ten spots, almost eleven spots per program. And very competitive, very, very wanted specialty. Out of the 174 programs, only one program went unfilled. There were 2,476 applicants to Emergency Medicine for those 1,895 spots. And 1,693 of those were US seniors. So a good chunk of them were US seniors trying to match into Emergency Medicine. And when you look at the number of matches, US seniors made up 78.5% of those that matched. So 1,486 US seniors out of 1,894 that matched. And so again, looking back at Anesthesia, there were 72% of those that matched were US seniors. So Emergency Medicine is matching more US-based seniors going into Emergency Medicine. And what that means is there are possibly- what that means is there are less international students applying for Emergency Medicine, and there are less students who did not match right away into Emergency Medicine trying to come back in and matching- at least successfully matching into Emergency Medicine. And so looking at that number of total matches, 1,894 if you remember all of those numbers I’ve been throwing at you, 1,895 positions offered. So there was one spot in one program that went unfilled. 99% filled for Emergency Medicine, so it’s pretty competitive.

Emergency Medicine and PGY1 Positions

Now again this is table one from the NRMP match data. Last time when I talked about Anesthesiology, table one has PGY1 positions, PGY2 positions, and physician positions. Emergency Medicine only has PGY1 positions listed here in table one, meaning that you don’t go and do an internship separate from your Emergency Medicine residency. It’s all built into the one main residency. So that’s a big difference here, and I know it can be very confusing for those that are still getting their feet wet with all the terminology about a prelim year and a categorical year, and a surgery internship, and an internal medicine internship, and a transitional internship, and what residencies require you doing a prelim residency, or a prelim internship, and ones that have the categorical internship built into it. So Emergency Medicine does not have that other internship outside of the program, so there are no PGY2 positions or physician positions available to apply to.

Applicant Types in Emergency Medicine

And table two here shows- again in the 2016 NRMP match data, again go to www.NRMP.org or just Google ‘NRMP match data’ and you can follow along here. The match data for NRMP for Emergency Medicine, table two breaks down the specialty and applicant type. So again 1,895 positions available for Emergency Medicine, only one was unfilled, so 1,894 positions were filled. 78.5% of those were US seniors. 73- so let me rephrase that. So there were 1,486 US seniors, that’s 78.5. There were 73 other US grads, and remember from the last time we talked, if you listen to that episode, you can be a US senior that’s matching into these specialties, or you can be a US grad meaning that you either took time off between trying to match and graduating from medical school, so you didn’t try to match during your senior year of medical school, or you didn’t match and you took some time off and strengthened your application and reapplied and now are getting in. So out of the 1,894 students that matched, or people- physicians that matched, there were 73 that were non-US seniors. Or actually non-senior US grads. So they made up an extra almost 4%. Now I know I loved talking about this last time, the osteopathic world. They had 224 osteopathic students matching into Emergency Medicine through the NRMP match, or ERAS, and that just means that these are osteopathic students that went outside of their AOA match, or national match, and applied through these MD programs instead of to DO Emergency Medicine programs. So almost 12% of the students applying or are matching into Emergency Medicine were osteopathic students. There was one Canadian, there were 87 US international medical graduates, 23 non-US international medical graduates, and then that one unfilled spot.

So the non-US international medical graduates, those are non-US citizens that graduated from an international medical school. So maybe an Indian physician, or I’ve seen a lot of Iranian physicians, or German physicians, whatever they may be coming and trying to match into residency. So they made up a little over 1%. And just to give you some comparison looking at Family Medicine, which you would assume being a primary care specialty would have a large percentage of availability for international medical grads, they had 382 international medical grads out of 3,083 spots. So almost 12% or a little over 12% which is interesting.

Now we learned in the Emergency Medicine Specialty Stories Podcast, again session number two, that was a community based Emergency Medicine physician. We learned that Emergency Medicine is still a relatively new specialty, and it’s interesting when you look at the table three here for the NRMP match data, again NRMP match data for 2016, the table three shows the positions offered from 2012 to 2016, and Emergency Medicine just at a quick glance here, outside of the primary care specialties, Emergency Medicine is the fastest growing specialty out of all of the more sub-specialties. And so if you’re interested in Emergency Medicine, that’s a good thing, that means there are more and more spots available every year. So in 2012 there were 1,668 spots, 1,743, 1,786, 1,821, and now 1,895. So it’s growing, and growing, and growing relatively consistently between 6.5% to 7% year over year, which is kind of cool. Now if you look at some of these other ones, the primary are specialties, family medicine growing 11.5% every year which is huge but expected for primary care specialty. Pediatrics almost 10% every year, but Emergency Medicine as a specialty outside of primary care is the fastest growing which is pretty awesome.

Osteopathic Students & Emergency Medicine

I do want to take a second- I didn’t talk about this back in the anesthesia episode because I couldn’t find the specific page, but I was instructed and was pointed in the right direction by Chad in the Hangout- which if you’re not part of our Medical School Headquarters Hangout, it’s an awesome place, www.MedicalSchoolHQ.net/group. The national matching service which is the DO matching service, their program, they have a 2016 program stat. So if you Google ‘national match DO 2016,’ I’m looking at- it’s a very different amount of data compared to the NRMP. The NRMP is 120-page report, this specific list that I’m looking at is just a one-page website basically, and it’s showing me that Emergency Medicine for osteopathic students, there were 58 programs, and 307 positions. So again, if you compare that to the NRMP, there were 174 programs and 1,895 positions. So a lot more MD programs which makes sense I think historically. Obviously there are more MD programs throughout the country, DOs are still relatively new in the grand scheme of things. Obviously Emergency Medicine being a newer specialty but still DOs being a newer breed of doctors. And so they just have less of a footprint which is not a bad thing, not a good thing, it just is what it is. So 58 programs, 307 positions available, and five of those positions went unmatched in the Emergency Medicine for osteopathic students in their matching in 2016.
Now table seven, going back to the NRMP match data for 2016, table seven shows the number of positions offered and filled by US seniors and all applicants between 2012 and 2016. And so doing some quick math, the number of US students that are filling these spots for Emergency Medicine has basically stayed the same, around 78% to 80% every year, which is pretty good. It means US applicants are staying very competitive for these programs.

Moving onto table nine for the NRMP 2016 match data, table nine is all applicants matched to PGY1 positions by specialty 2012 to 2016. And this kind of goes back to the fact that Emergency Medicine is one of the fastest growing specialties out there, or has been the fastest growing outside of the primary care specialties. The Emergency Medicine applicants and students that matched, they made up the most out of any of the specialties, again outside of the primary care specialties. They made up about 7% every year since 2012, with the 2016 match data showing 7.1% of all students matching into a PGY1 positions, or matching into Internal Medicine. Now just for numbers here, 11.5% matched into family medicine, 25 almost 26% matched into Internal Medicine, 6.8% matched into a PGY1 only spot for Internal Medicine, and Pediatrics was 10%. So all of these big primary care specialties are 11.5%, 10%, obviously Internal Medicine huge at 26%, but Emergency Medicine, very shocking number to me. I wouldn’t have thought that before looking at these numbers. Emergency Medicine has the largest number of students matching into it outside of the primary care specialties.

And kind of going along those same lines, looking at table eleven is the osteopathic students that are matching into PGY1 spots for these DO programs, and again, Emergency Medicine is the highest outside of the primary care specialties at 9.3%. So 9.3% of all osteopathic students matching into an MD position matched into Emergency Medicine.

Emergency Medicine as Only Specialty Choice

Figure six in the NRMP match data talks about the percentages of unmatched US seniors and independent applicants who ranked each specialty as their only choice. And so if you look at Emergency Medicine, again figure six in the 2016 match data, Emergency Medicine had 11.3% un-match number with almost 6% of US seniors that were applying for Emergency Medicine as their only specialty choice, 6% or 5.9% of US seniors that listed Emergency Medicine as their only specialty choice did not match. And so that doesn’t- that data alone doesn’t tell you enough to do anything. You may go, ‘Oh that’s super competitive,’ and while that may be true- and let me give you some other numbers here. So if you look at Psychiatry, not typically considered a very competitive program, a very competitive residency, but there were 8.7% of US seniors unmatched for Psychiatry. There were almost 20% for Neurosurgery that were unmatched. Family Medicine, almost 5%. Internal Medicine, that’s a prelim year and I’ll skip that one. Orthopedic Surgery, almost 21%. So 6% isn’t very high, and when you look at these you just have to question how competitive were these students for Emergency Medicine if they weren’t matching?

One of the things if you look at table eighteen for the NRMP match data for 2016 is SOAP data. So this is participating programs and positions filled in SOAP for 2015 and 2016, and SOAP is the program- the Supplemental Offer Application Program. Or I guess more technical, the Supplemental Offer and Acceptance Program through the NRMP. These are for students that did not match, they find out before the actual match date, and they are given time to talk to programs that have some spots and hopefully match after they find out they didn’t match to begin with. And for 2016, Emergency Medicine did not participate, at least it’s listed here in the NRMP match data for 2016, they did not participate in the SOAP. And that kind of makes sense because there was only one spot unfilled. Why that one program didn’t participate, I don’t know. Maybe they filled it another way.

Charting the Outcomes – Emergency Medicine

Now switching over the NRMP charting the outcomes report, which is another great report, 211 pages of awesome data. I’m looking at chart three now charting the outcomes in the match for US allopathic seniors. So this is very specific to US allopathic, so MD program seniors, and looking at the Emergency Medicine data, 91% of US allopathic seniors matched into their preferred specialty.
Now here’s an interesting chart, in chart four for charting the outcomes for 2016 US allopathic seniors. It shows the median number of contiguous ranks of US allopathic seniors. So when you make your rank list, you’re ranking the programs that you interviewed at or applied to, and you rank one, two, three, four, five, six, seven, eight, nine, ten; all of the programs that you want to go to in order of how you want to go to them. And those that matched, the median number of contiguous ranks was- for Emergency Medicine was twelve. Those that did not match was four. So these students that did not match were very, very selective with who they ranked. So they were probably hoping to only match in a very specific part of the country, or it’s a couple very specific programs. And so when you do that, just like when you apply to medical school if you’re a medical student and you can understand this, or if you’re a premed student you’ll understand this soon, the less schools that you apply to, the more strict you are with your availability to apply to a larger number of schools is going to limit your chances getting into medical school. And that’s exactly what happened here with students applying to Emergency Medicine, is they didn’t apply, they didn’t match to enough programs, and so they didn’t match. So again, twelve compared to four contiguous rank numbers.

And so just to give you an idea of what could happen, so I- when I filled out my rank list, I was couples matching with my then fiancée, wife- or no she was my fiancée at the time. No she was- I don’t even remember anymore. She was- I think she was still my girlfriend at the time, I hadn’t proposed to her yet, but she’s my wife now. So Allison and I, we couples matched, and she really wanted to go to Mass General, the Harvard program for Neurology, and so I interviewed at a program in Boston for a transitional year internship, and I ranked that number one, and then my second was no rank. So for me, my contiguous number of ranks was only one. So you could have these funky things where you do a no rank, but it is tricky and usually it’s the rare case.

So looking at chart six in charting the outcomes, looking at Step 1 scores. So Step 1 is the first step of the boards for allopathic medical students. For osteopathic medical students, they take the COMLEX Level 1. Osteopathic students can take the USMLE but we’ll just talk again about US allopathic seniors here. So those that matched into Emergency Medicine scored between 225 roughly and 245 which are great scores, and those that did not match scored in roughly 205 to 235. So their scores were much lower on the bottom end, and only went up to about the middle of the road for those that did match. So Step 1 scores mean a great, great deal for your ability to match. It opens up- just like a great MCAT score opens up a lot of doors, a great Step 1 score is going to open up a lot of doors for you. And looking at Step 2 CK scores, Emergency Medicine, they were between 238 roughly and 255, and those that did not match were 224-ish to 242-ish. So again, lower obviously Step 2 scores.

Research didn’t seem to play a huge part in those that matched and did not match looking at chart eight for the charting the outcomes NRMP match data. The mean number of research experience for US allopathic seniors was 2.4 for those that matched and only 2.2 for those that did not match.

Importance of Research, Abstracts, and Publications

Though research that actually led to something seems to be more important. The mean number of abstracts, presentations, and publications for those that matched in Emergency Medicine, they had 3.3 and those that did not match had 2.2. Again those were the mean number of abstracts, presentations, and publications.

AOA data is- not American Osteopathic Association, but AOA is Alpha Omega Alpha which is the medical Honor Society, and 13% of US seniors that matched were AOA for Emergency Medicine, and 1% of those that did not match were AOA. So AOA seems to play a little bit of a role possibly in matching to Emergency Medicine, and it’s usually the case with the more competitive specialties. The AOA seems to play a role, though is it really the AOA that plays a role, or just the fact that you have great grades that leads to you getting an AOA is really the biggest outcome, and obviously having great grades leading to the ability to do well on your board scores.

Board Scores & Emergency Medicine

So further down in charting the outcomes, you have table EM-1 for Emergency Medicine and it gives you all of the raw numbers here, makes it a lot easier than the charts I was reading earlier. So mean USMLE Step 1 score 233 for those that matched, 220 for those that did not match. 245 Step 2 score, mean Step 2 score, and 232. So huge difference, thirteen points in each of those for Step 1 and Step 2 for those that matched and those that did not match.

Now chart EM-1 has the number of distinct specialties ranked by US allopathic seniors. Now if you are a medical student, and you probably have never heard of The Premed Years, or what I talk about with having a plan B for wanting to go into medicine, and I’m not a fan of having a plan B when you are a premed and you’re interested in going into medical school. Sure you need a plan B going into a surgery and figuring out what to do on the operating table, but when you want to be a physician, go for it 100%, don’t have a plan B. That kind of holds true for picking your specialty as well, and that’s where this chart comes in handy. Number of distinct specialties ranked by US allopathic seniors here. Chart EM-1.

For US allopathic seniors that only ranked Emergency Medicine, 1,269 matched, 72 did not. So that’s 5.4% roughly of those that only listed Emergency Medicine did not match. Let’s take that to the second column here in chart EM-1. 88 students- so column number two is if you had two programs, two specialties that you’re ranking for. So if you’re not completely sold on Emergency Medicine it means you’re applying for Emergency Medicine programs and you’re applying for Internal Medicine let’s say. And so for students that aren’t 100% in on Emergency Medicine, 88 of those matched, 40 did not. So if you look at that number, it’s 31% of those that ranked two programs here. 31% that ranked two distinct specialties did not match compared to 5% for those that are only ranking one. You need to make up your mind because you’re obviously not selling the programs that you’re interviewing at that you’re dedicated to going to whatever specialty that you’re interviewing at for that day.

MedScape Lifestyle Data

Alright I want to change gears here and dive into the MedScape survey data for Emergency Medicine, and looking at the newest MedScape Lifestyle Report for 2017, Emergency Medicine, slide number one here- or slide two I guess is at the top for burn-out. 59% of Emergency Medicine physicians are stating they are burned out. What’s interesting though is on the next slide, when it asks about the severity of burn-out, Emergency Medicine is way down the list at 4.2. So it’s a scale from one to seven, Urology is at 4.6 at the highest, Infectious Disease is the lowest on this list at 3.9, Emergency Medicine is 4.2. So they’re burned out but not the highest which is interesting.

Not surprising for Emergency Medicine given that it’s shift work, is that they are almost very close to the top. They’re one, two, three- they’re fifth on the list for which physicians are happiest, and it looks like it’s mostly based on outside of work. So Urology is 76% are happiest outside of work, Emergency Medicine is 71% are happiest outside of work, and Emergency Medicine is 28% happiest at work. So there’s a big discrepancy there, and obviously with shift work you have a lot of time outside of work which is great, and so Emergency Medicine physicians are loving that time, but they’re getting burnt out at work.

And switching one more time to the MedScape physician compensation report for 2016, how much do physicians earn overall? Orthopedics at the very top just to give you some understanding of where we’re at. Pediatrics at the bottom. So Ortho at $443,000, Pediatrics at $204,000 Emergency Medicine is almost in the middle at $322,000 a year. What’s interesting in this compensation report is that they have a list here for which specialties have the most female physicians, and Emergency Medicine is on the lower end of the list at 19%. OB-GYN unsurprisingly is 55%, Pediatrics, again unsurprisingly 53%. So OB-GYN 55%, Pediatrics 53%, Emergency Medicine 19%. So we need some more female physicians in Emergency Medicine. So if you are a female, go for it.

What’s nice here is that physicians that feel fairly compensated, Emergency Medicine is top three at 60%. So 60% of Emergency Medicine physicians feel fairly compensated which is good. Dermatology 66%, Pathology 63%, Emergency Medicine right there at the top at 60%.

What’s interesting looking at slide seventeen here, Emergency Medicine has the fifth highest satisfaction overall for physicians at 57%. 60% being satisfied with their income, 66% would choose medicine again which is at the higher end, but only 44% would choose Emergency Medicine again. Now I have a hypothesis about this. I don’t think it’s Emergency Medicine necessarily that is causing this 44% that would choose this specialty again. Looking back- if you go back and listen to session two, speaking to an Emergency Medicine physician, he talked about how Emergency Medicine docs need to know a lot about a lot, and I have a feeling that a lot of people go into Emergency Medicine because they haven’t found that one thing that lights them up every day all day. And when they’re practicing Emergency Medicine, at some point they realize what that thing is, and then they wish their whole time was spent doing that one thing, but they’re ‘stuck’ in Emergency Medicine. So it’s kind of an interesting thing with how low it is. There are some lower ones, Emergency Medicine is nowhere near the bottom, but it is one of the lowest ones. You have Pulmonary Medicine which is kind of surprising at 37%. OB-GYN 41%. Unsurprisingly Internal Medicine is at 25% which is too bad.

Final Thoughts

Alright I think I will wrap up there. I hope that was good information for you, useful information for you. Again go check out the NRMP’s data, go check out the DO data from the National Matching Services, the MedScape Data; all of those sites and the documents that they provide there, they have all the information, I’m just providing my commentary for you and helping you break down that information, and I know it would be better for you if you follow along with that information in front of you. So I hope that was useful, we’ll cover another one soon enough. If you know somebody that you would like to hear on this podcast, I am constantly looking for new specialists to interview. I would love for you to reach out to me, reach out to the specialist that you know. Maybe it’s somebody that you shadowed, a mentor, a dad, a mom, whoever it may be, let me know and I’d appreciate it. Ryan@medicalschoolhq.net.

I hope you have a great week. If you found this useful, I’d love a rating and review in iTunes. They are pretty cool to us, iTunes is when we get ratings and reviews, but actually I’d love for you to do something else instead. I want you to go- if you’re a medical student, go to your class, send an email to your class and say, ‘Hey check out the Specialty Stories Podcast’ and share the love of this podcast with your class.

Have a great week, we’ll see you next week here at Specialty Stories.