Nova Southeastern University
College of Osteopathic Medicine
Emergency Medicine Society

Matching to an Allopathic (ACGME) Residency in Emergency Medicine
Questions, Answers, and Challenges for the Osteopathic Medical Student
(Allopaths welcome!)

Compiled by Ben Lawner, DO, EMT-P
Emergency Medicine Intern
University of Maryland Medical System

Welcome to yet another rat race! Emergency medicine has become quite the competitive residency in recent years. Many of the specialties perceived benefits have lured more applicants to the already crowded scene. Whichever program you choose, there are several rules of thumb to keep in mind. Matching in emergency medicine is contingent upon board scores, grades, rotations, and the interview. I hope the information contained within these several pages is of some use to you when deciding to apply for a position as an emergency medicine resident.

I. Preliminaries and Pre-requisites

It is vitally important to register with the NRMP and ERAS. The National Residency Matching Program administers "the match" and supervises the confusing computer algorhythm that attempts to place students into programs of their choice. The NMRP website is excellent and full of information, Registering with the NRMP requires a fee of approximately 100 dollars and the completion of a brief application. Once registered, the NRMP
will provide you with the necessary dates and time tables. The NRMP's site is the one in which you will compile, order, and eventually submit (certify) your rank list. ERAS, the Electronic Residency Application Service, is key to the application process. Your school will provide you with a 'token.' Once your token is recieved, go to the ERAS site and start entering information. The biggest hurdle to overcome is the submission of a COMPLETE application. ERAS will ask you for a virtual CV and then organize your data into an electronic file that will be sent to your selected emergency medicine programs. Make sure your resume/CV and transcript is within reach when compiling the ERAS application. Once complete, your electronic file will consist of a personal statement, a curriculum vitae, your designate letter of recommendation authors,  your picture, and your potential programs. The cost varies in accordance with the number of programs selected. Plan on spending 300-400dollars and apply to as many programs as possible. You do not need any hard copies to scan into ERAS. The dean's office will upload your medical student performance evaluation/dean's letter to the ERAS post office. The office is also responsible for uploading your letters of recommendation. Frequently check the ERAS site to see if the LORs and required documents have been received. ERAS will start sending your data to EM programs on or about the second week of September.

To conclude, the following items are important to submitting a proper ERAS application:
-Letters of Recommendation (ERAS permits a maximum for four per program)
-Curriculum Vitae / Resume (to assist you in answering the ERAS application questions)
-Personal Statement (can be cut and pasted into the ERAS application)
-COMLEX and/or  USMLE scores (electronically submitted to ERAS)

Ia. Do I have to take the USMLE?

Yes and no. There is no evidence based, peer reviewed, prospective study to answer this question. Many programs are DO friendly and welcome osteopathic applicants. It is NOT necessary to take the USMLE when applying at dually accredited programs. However, some allopathic residencies are less familiar with COMLEX scores and will have trouble comparing the DO student to their MD counterparts. Research individual programs and ask direct questions  of their residency coordinators and program directors. Many competitive New York programs desire USMLE scores and encourage completion of at least Step one. University of Florida/ Jacksonville is a program that has enrolled DO's since its inception and does not require completion of the USMLE. Below is a list of ACGME accredited programs that accept COMLEX scores and welcome DO applicants. This list is admittedly incomplete, so please email me with your own take on this issue. If your COMLEX scores are in the 90th percentile, there is much less incentive for you to complete the USMLE step one. This list was compiled from personal communication with current PD's and or residency coordinators. Generally, scores above the 80th percentile are considered competitive.

-University of Massachusetts, Worcester
-University of Connecticut Integrated Residency in Emergency Medicine
-Palmetto Health Richland (South Carolina) Residency in Emergency Medicine
-University of South Florida / Tampa General Hospital Residency in Emergency Medicine
-Albert Einstein Medical Center (Philadelphia) Residency in Emergency Medicine
-University of Maryland Residency in Emergency Medicine
-Yale / New Haven Hospital Residency in Emergency Medicine
-Massachusetts General Hospital/Brigham and Women's Hospital Harvard Affiliated Emergency Medicine Residency
-Duke University Residency in Emergency Medicine
-Maine Medical Center's Residency in Emergency Medicine
-Baystate Medical Center/Tufts University Affiliated Residency in Emergency Medicine
-University of Florida/Health Science Center Jacksonville's Residency in Emergency Medicine

II. Program Selection and Emergency Medicine Electives

Though most programs are aware that it is impossible to remain completely knowledgeable about individual perks and policies, it is important to be at least somewhat familiar when attending an interview. It is advisable to apply to as many as thirty emergency medicine programs. You can always decline an interview, but current odds necessitate sending your application to a wide variety of residencies. If you are keenly interested in one program over another, plan to schedule an away elective. Popular programs, like UF Jacksonville, for example, can fill up as much as four-five months in advance. Contact programs early and plan on completing an emergency medicine elective at one of your favorite institutions. Faculty and residents are generally eager to tout the benefits of their program to visiting students. Furthermore, away rotations allow you to network. Faculty are eager to talk about their own residency experiences and will give you good advice about programs across the country. It is difficult to assess a program's "likeability"  unless yourotate or interview at their institution. There is much more to a an emergency medicine program than the annual volume of level one trauma admissions. It is vital to gauge resident satisfaction, learning environment, and support systems prior to ranking a program number one. Though most programs do not recommend more than two electives in EM, you can complete away electives in radiology and then visit the ED on down time. It is absolutely appropriate to contact program directors and express your interest. Completing "observational shifts" at a select number of ED's shows commitment and intent. Residents and attendings WILL take notice ans remember you when it comes down to interview/ROL submission time. Review The Society for Academic Emergency Medicine's website and select thirty or more programs on your ERAS application. Plan away electives early. These two strategies are key to securing a good number of interviews.

III. What about the Osteopathic Match?

This is a personal and complex question that demands consideration. The AOA has moved towards centralizing its match process and might utilize ERAS to help ease the applicant burden. Should you participate in both allopathic and AOA matches, it is vitally important to keep some things in mind. First, any AOA match result will supercede that of the ACGME match. If you match to an AOA program, you will AUTOMATICALLY without question be dropped from the MD match. This isn't a problem if you are committed to a DO program. However, the match is a binding and contractual agreement between you and the matching organization. Matching with an AOA program will prevent you from continuing your participation with the ACGME selection process. It is generally advisable to select one avenue or the other. When participating in the AOA match via the National Matching Services Program, you will still be able to apply to the dually accredited EM residencies like Albert Einstein Medical Center's program in Philadelphia. A proposal for a truly combined categorical AOA and ACGME match is currently under discussion. The theoretical proposal would permit osteopathic/independent applicants to apply to both AOA and ACGME accredited programs without penalty. Even through the most updated AOA intern match utilizes ERAS, the osteopathic applicant is still dropped from the NMRP if they are matched to an osteopathic internship or combined program.