Session 14

Today, we break down the match data, compensation surveys, and lifestyle reports for Emergency Medicine. If you’re interested in EM, this is a must listen.

I also talked about dove into match data back in session 11 specifically on Anesthesiology and now I'm going to dive into Emergency Medicine.

If you follow the NRMP results, Anesthesiology is first in the alphabetical order, followed by Child Neurology and then third, Dermatology. However, these two are relatively smaller so I'll reserve a separate discussion on the smaller programs at a later date. For now, let's focus on Emergency Medicine, which is a very popular specialty these days.

[02:05] Emergency Medicine at a Glance

Back in Session 2, I was able to talk to an Emergency Medicine physician and learned that because of the shift work and the amount of work, it has become popular. What is considered full-time for an Emergency Medicine physician is about 15-16 shifts a month. That is equivalent to three business weeks (Monday through Friday, five days times three) which means an extra whole week off per month. Of course shift work comes with some negatives which were also mentioned in that episode.

[03:10] NRMP Match Data for 2016

First, check out this 120-page PDF document called, Main Match Results and Data for 2016. Looking at Table 1 (page 12 of 120) for this NRMP match data, Emergency Medicine has 174 programs, which means it has 55 more programs compared to Anesthesia with 119 programs.

Of those 174 programs, there are 1,895 spots and this works out to almost eleven spots per program. It is a very competitive and a very, very wanted specialty that out of those 174 programs, only one program went unfilled.

• Number of applicants: 2,476
• Number of available spots: 1,895
• Number of applicants that matched: 1,894
• Number unfilled: 1
• Number of U.S. Seniors that matched: 1,486 (78.5%)

As compared with Anesthesiology, 72% of those that matched were U.S. Seniors. Hence, Emergency Medicine is matching more U.S.-based Seniors going into Emergency Medicine. This possible means that there are less international students applying for Emergency Medicine and less students who didn't match right away.

Looking at the total number of matches which is 1,894 (out of 1,895 positions offered), there was one spot in one program that went unfilled. This suggests how very competitive the specialty is with 99% were filled for Emergency Medicine.

[06:18] Emergency Medicine and PGY1 Positions

Last time, when I talked about Anesthesiology, Table 1 has PGY1 positions, PGY2 positions, and physician positions. Emergency Medicine, however, only has PGY1 positions listed in Table 1.0, which means that you don't go to do an internship separate from your Emergency Medicine residency because it's all built into the one main residency.

It can be very confusing considering that different specialties have different terminologies. As with Emergency Medicine, it does not have other internship outside the program so there are are no PGY2 positions or physician positions available to apply to.

[07:35] Applicant Types in Emergency Medicine

Table 2 (page 16 of 120) of the 2016 NRMP match data breaks down the specialty and applicant type. For Emergency Medicine:

• Number of filled positions: 1,894
• % of U.S. Seniors that filled: 78.5%
• Number of (non-Senior) U.S. Grad: 73 (almost 4%) - U.S. Grad means that you either took time off between trying to match and graduating from medical school. It's either 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.
• Number of Osteopathic students matching into EM: 224 (almost 12%) - 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.
• Number of Canadians: 1
• Number of U.S. International medical graduates: 87
• Number of non-U.S. international medical graduates: 23 (These are non-U.S. citizens that graduated from an international medical school)
• Number of unfilled spot: 1

Comparing it with Family Medicine, which you may assume as a primary care specialty to have a large percentage of availability for international medical grads, they had 382 international medical grads out of 3,083 spots, equivalent to 12% more or less.

[11:20] Emergency Medicine as a Relatively New Specialty

We learned from the Specialty Stories Podcast session 2 where we interviewed a community-based EM physician, that Emergency Medicine is still a relatively new specialty.

Table 3 (Page 20) of the NRMP match data for 2016 shows the positions offered from 2012 to 2016. And Emergency Medicine (outside of the primary care specialties) is the fastest growing specialty out of all of the more sub-specialties. If you're interested in Emergency Medicine, that means there are more and more spots available every year which is a good thing.

• 2012 - 1,668 spots
• 2013 - 1,743 spots
• 2014 - 1,786 spots
• 2015 - 1,821 spots
• 2016 - 1,895 spots

It's growing relatively consistently between 6.5% to 7% year over year. Now if you look at some of these other ones, the primary care 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.

[13:20] Osteopathic Students in Emergency Medicine

The national matching service which is the DO matching service, their program has a 2016 program stat. If you Google ‘national match DO 2016,' I'm looking at a very different amount of data compared to the NRMP.

While, the NRMP is 120-paged report, this specific list is just a one-paged website showing that Emergency Medicine for osteopathic students had 58 programs and 307 positions. NRMP has 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 since DOs are still relatively new in the grand scheme of things (Emergency Medicine is a newer specialty but still DOs being a newer breed of doctors). So they just have less of a footprint which is neither good nor bad but it's just 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.

[15:20] U.S. Applicants & PGY-1 Positions

Going back to the NRMP match data for 2016, Table 7 (Page 30 of 120), 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 U.S. applicants are staying very competitive for these programs.

Table 9 (Page 37 of 120) of the NRMP match data for 2016 shows all applicants matched to PGY-1 positions by specialty from 2012 to 2016.

Emergency Medicine being one of the fastest growing specialties out there or has been the fastest growing outside of the primary care specialties, applicants and students that matched 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 PGY-1 position, or matching into Internal Medicine.

Now just for numbers here, 11.5% matched into family medicine, almost 26% matched into Internal Medicine, 6.8% matched into a PGY-1 only spot for Internal Medicine, and Pediatrics was 10%. So all of these big primary care specialties are 11.5%, 10%. Internal Medicine is huge at 26%.

But Emergency Medicine has the largest number of students matching into it outside of the primary care specialties. Looking at Table 11 (Page 39 of 120) shows the osteopathic students matching into PGY-1 spots for these DO programs and 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.

[18:15] Emergency Medicine as Only Specialty Choice

Figure 6 (Page 45 of 120) in the NRMP match data talks about the percentages of unmatched US seniors and independent applicants who ranked each specialty as their only choice.

Emergency Medicine had 11.3% unmatched number and almost 6% of U.S. seniors that were applying for Emergency Medicine as their only specialty choice did not match. However, that data alone doesn't tell you enough actually.

Here are comparisons of U.S. Seniors unmatched for other specialties:

• 8.7% of U.S. seniors unmatched for Psychiatry
• 20% for Neurosurgery
• 5% for Family Medicine
• 20.8% for Orthopedic Surgery

So 6% of unmatched U.S. Seniors 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?

[19:58] SOAP Data

Table 18 (Page 55 of 120) of the NRMP match data shows the SOAP data for 2015 and 2016. SOAP stands for 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.

For 2016, Emergency Medicine did not participate in the SOAP. And that kind of makes sense because there was only one spot unfilled.

[21:00] Charting the Outcomes - Emergency Medicine

Switching over to the NRMP Charting Outcomes Report, which is another great 211-paged report.

Chart 3 (page 10 of 211) shows the rates of U.S. allopathic Seniors. 91% of US allopathic seniors matched into their preferred specialty.

Chart 4 (Page 12 of 211) 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 all of the programs that you want to go to in order of how you want to go to them.

The median number of contiguous ranks of those that matched for Emergency Medicine was 12. Those that did not match was 4. So these students that did not match were very, very selective with who they ranked. They were probably hoping to only match in a very specific part of the country or to a couple very specific programs.

When you do that, the less schools that you apply to, the more strict you are with your availability to apply to a larger number of schools. This is going to limit your chances getting into medical school. That's exactly what happened here with students applying to Emergency Medicine is they didn't apply and they didn't match to enough programs. Again, 12 compared to 4 contiguous rank numbers.

[24:23] Charting the Outcomes - Step 1  and Step 2 CK Scores

Chart 6 (Page 14 of 211) in Charting the Outcomes shows the Step 1 Scores of U.S. Allopathic Seniors. For osteopathic medical students, they take the COMLEX Level 1. Osteopathic students can take the USMLE but we're focusing here on U.S. allopathic seniors.

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. 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 deal for your ability to match. Just like a great MCAT score, it opens up a lot of doors.

Looking at Chart 7 (Page 15 of 211) shows the 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.

[25:54]  Importance of Research, Abstracts, and Publications

Looking at Chart 8 (Page 16 of 211) for the charting the outcomes NRMP match data, research didn't seem to play a huge part in those that matched and did not match. The Mean Number of Research Experience for U.S. Allopathic Seniors was 2.4 for those that matched and only 2.2 for those that did not match. Though research that actually led to something seems to be more important.

The Mean Number of Abstracts, Presentations, and Publications (Chart 9 - Page 17 of 211) for those that matched in Emergency Medicine, they had 3.3 and those that did not match had 2.2.

[26:39] AOA Data

Chart 12 (Page 20 of 211) shows the AOA Data, referring to the Alpha Omega Alpha which is the medical Honor Society. 13% of U.S.seniors that matched were AOA for Emergency Medicine and 1% of those that did not match were AOA.

AOA seems to play a little bit of a role in matching to Emergency Medicine. 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? Obviously, having great grades leading to the ability to do well on your board scores.

[27:31] Step 1 and 2 Scores and Distinct Specialties

Table EM-1 (Page 60 of 211) in Charting the Outcomes Report shows all of the raw numbers.

• Mean USMLE Step 1 score: 233 for those that matched and 220 for those that did not match
• Mean USMLE Step 2 score: 245 for those that matched and 232 for those that did not match

Chart EM-1 (Page 61 of 211) has the number of distinct specialties ranked by U.S. allopathic seniors. For US allopathic seniors that only ranked Emergency Medicine, 1,269 matched, 72 did not. That's 5.4% roughly of those that only listed Emergency Medicine did not match.

The second column here in chart EM-1 shows that 88 students (column number two is if you had two programs or two specialties that you're ranking for). And so for students that aren't 100% in on Emergency Medicine, 88 of those matched and 40 did not. So if you look at that number, it's 31% of those that ranked two programs here 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.

[30:43] Medscape Lifestyle Report 2017

Diving into the Medscape Survey Data for Emergency Medicine, and looking at the newest Medscape Lifestyle Report for 2017, Emergency Medicine.

Slide 2 shows that 59% (at the highest) 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 burnout, 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, specifically, fifth on the list for which physicians are happiest. It looks like it's mostly based on outside of work. 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.

[32:26] Medscape Physician Compensation Report 2016

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.

Ortho at $443,000, Pediatrics at $204,000, and 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%. Emergency Medicine is 19%. We need some more female physicians in Emergency Medicine. So if you are a female, go for it.

For physicians that feel fairly compensated, Emergency Medicine is top three at 60%. Dermatology 66%, Pathology 63%, Emergency Medicine right there at the top at 60%.

What's interesting looking at Slide 17 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, speaking to an Emergency Medicine physician back in Session 2, he talked about how Emergency Medicine doctors need to know a lot...