Blog Archives

A Bad Prognosis for Emergency Medicine

I read a fascinating piece by Dr. Thomas Cook in the December edition of Emergency Medicine News. In it, he cites work done by Cameron Gettel, MD who devised an interesting way to assess the attrition rate of emergency physicians (EPs): Gettel and his colleagues used data from the Centers for Medicare and Medicaid Services (CMS), noting which healthcare providers stopped billing CMS for emergency medical services. Gettel used this information to calculate the attrition rate for EPs. What he and his colleagues found is that the EP attrition rate was approximately 5% prior to the pandemic while it shot up to approximately 8% in urban spots and more than 11% in rural areas during the first year of the pandemic.

Using information from the American Board of Emergency Medicine, Gettel found – shockingly – that the median age of attrition for male EPs was 53.5 years and for female EPs was 43.7 years in 2019. This means that the median EP career was around 23 years long for men and fewer than 14 years long for women. Wow!

It’s absolutely critical that medical students who are considering a career in emergency medicine think about what their professional trajectory might be, considering the short median lifespan of the typical EP.

For more information on this interesting topic and how attrition might affect the job market, the need for physician personal finance training, and who applies to emergency medicine, see Dr. Cook’s piece here.

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For Pre-Meds Applying in the Next Cycle, What IS Solid Clinical Experience Anyway?

Getting into medical school has gotten so competitive that it’s increasingly important to have a strong candidacy with excellent grades and robust extracurricular activities. As I’ve mentioned in previous blog entries, one mistake I see pre-meds make is that they are so focused on leadership and research, they forget a critical component – clinical experience. To prove you want to be a doctor, it’s essential you obtain clinical experience for a significant period of time – not just a health fair or two. Good grades will not make up for a lack of clinical experience. Here are some ideas for obtaining strong clinical experience:

EMT (some universities have EMT classes and/or jobs on campus)
Participate in a good hospital clinical care extender program
Work at a low-income clinic
Certified Medical Assistant
Certified Phlebotomist
Certified Nursing Assistant
Work at a hospice
Scribe (usually a full-time job)
Veterinarian’s Assistant (a great way to get hands-on procedural experience)
Volunteer for a crisis text/phone line (might need to be paired with an in-person clinical experience)

Shadowing is a mixed bag: Medical schools don’t know whether you’re second-assisting in the operating room or just standing in a corner being ignored :(. If you choose to shadow, make sure you strategically delineate your clinical experience in your written materials.

If you’re not excited about getting clinical experience, it’s time to question your interest in a career in medicine… which is exactly what admissions committees will do if they don’t see that experience.

Do your research before accepting a “clinical” job so you ensure you’ll really get a satisfying experience and show admissions committees you can handle the heat.

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Medical School and Residency Admissions: It’s Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn’t personal. He likened the situation to Boston traffic – how drivers lean on their horns for little cause because they are simply frustrated about their days.

It’s not personal, he said.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another; some turn up wholly unprepared – reading students’ applications for the first time during the interview itself. Remember: It’s not personal. This process is arduous and cruel, and most candidates, faculty, and program coordinators are tired and doing their best in a dysfunctional system.

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The AAMC Will Expand the FAP to Include Some Residency Applicants

The American Association of Medical Colleges has announced that they will expand their Fee Assistance Program to certain residency applicants starting with the 2024-5 ERAS application season. At that time, the FAP will include residency candidates who were previously approved for the program during their medical school application process. The qualifying candidates will receive a 60% fee discount on up to 50 ERAS applications. This is great news for medical students who have severe financial needs. The AAMC reports that it will be providing more information in the following months.

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Is Getting into Medical School Harder than It Was Before or Does It Just Feel Like It?

Last cycle, over 52,000 brave candidates applied to medical school, with just under 23,000 matriculating. While getting into medical school is extremely competitive, the number of applicants has actually decreased from two years ago when over 62,000 individuals applied to medical school (and the number of matriculants/spots has stayed almost the same). People attributed that peak in applications to the Fauci Effect, a trend that motivated individuals to simulate medical leaders and contribute to the health of society in the setting of the pandemic. In reality, it’s unclear why numbers rose significantly that year. But since, applications have declined. The problem for candidates is that the number has decreased only to levels that are about equal to those pre-pandemic and still higher than the 2014 cycle when there were under 50,000 applicants. 

Having said that, there are more open medical school slots than there were in the past. In the 2014 cycle, 20,343 individuals matriculated out of 49,480 (41.1%). This past year 22,981 matriculated out of 52,577 applicants (43.7%).

None of these statistics take into account the fact that a more competitive applicant pool may have emerged over the course of the last decade. In other words, the whole achievement level of the application cohort may be stronger than it was in the past.

Bottom line: Looking at numbers alone, it is easier to get into medical school than it was during the anomalous cycle two years ago. Furthermore, although there were more applicants, it is slightly easier to get into medical school now that it was about a decade ago because there are more spots. 

That conclusion is likely reassuring for upcoming applicants, while at the same time, maddening for any of this year’s candidates who have received a recent rejection. 

Either way, getting into medical school is extremely competitive.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital. She was appointed to the Assistant Residency Director position for the Harvard Affiliated Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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