Five tips for changing which medical discipline (or specialty) you’ll apply for 2 months before the ERAS submission deadline

Disclaimers and context: I’ve always approached life with a jack-of-all trades mentality, and I entered medical school fresh from two years of community service activities. These two elements supported my interest in family medicine–a wide toolkit for practicing medicine in poor communities and a way for me to never become bored with doing the same thing every day. However, in medical school, I became interested in emergency medicine for pretty much the same reasons, but also connected with the part of me that feels fulfilled helping people when $h!t hits the fan. Then, two things happened: 1) During my emergency medicine rotations, I kept thinking about how I might tackle two problems: so much of what I was seeing was acute-on-chronic disease (eg, a heart attack after years of cardiovascular disease) and non-emergent issues (eg, cold symptoms without fever during a pandemic). 2) My academic advisor mentioned in passing to me that she always saw me as a family doc. That clicked for me. I spent the next four weeks reaching out to strangers working in family medicine, often through established connections but also with cold emails, asking for specific pieces of advice as I contemplated changing gears from emergency medicine to family medicine with weeks before I needed to submit my ERAS application for medical residency training programs here in the United States. I changed my application list to family medicine programs and the three joint emergency medicine-family medicine residency programs and applied. My thinking has continued to change over the course of the interview cycle but in the same direction of questioning that started when my advisor ventured her opinion and changed the course of my professional trajectory.

Tip 0. Likely less helpful if you’re here in a similar situation that I was in, but worth mentioning for those more junior medical students. Try to find the right fit earlier in the path. One technique that may be useful is be fear-setting, as popularized by Tim Ferriss. This technique functions as the opposite of goal-setting and I find it pretty useful.

Some more context: I was at first worried that if I were to pursue family medicine, I would not get to participate in trauma cases like in emergency medicine, and I was also concerned that I would become bored if I got caught in a daily cycle of refilling outpatients’ diabetes and cholesterol medications. Although I still enjoy being useful trauma cases, helping with the primary and secondary surveys and performing FAST exams, I realized that those are not all-day every-day experiences for many emergency physicians. Likewise, the reason I was interested in family medicine was to be able to work with a variety of patients, not just older unhealthy adults–and besides, there are so many opportunities to help improve patients’ health outside of the clinic and with the prescription pad left behind at the office. What’s more, programs like unopposed family medicine residencies (where family medicine residents are the only residents in the medical center and are consequently “unopposed” by other residents) often offer more experiences to be involved in emergency and trauma care, along with many other areas.

  1. Seek objective assessments, when possible. I recommend visiting and revisiting every quarter to half-year AAMC’s Careers In Medicine tools (ask higher-ups if your school does not offer access through your school). Be honest and intuitive, and do not try to “guess” the answer most likely to place you in the category part of you is hoping to be matched in. If you disagree with the results, ask yourself why.
  2. Pay attention to how you react when people describe the kind of work that they imagine you doing. That feeling may not be correct, but there is likely important information there, especially if you are surprised. When my advisor told me when she looked at my extracurricular activities and interests (eg, lots of volunteering, truthfully listing “learning about sustainable development” as a hobby), she saw that they seemed to line up more with family med hopefuls than emergency medicine-bound students (apparently rock climbing and kayaking are more common among emergency docs).
  3. Seek out supporters. I found it was helpful to know exactly the question, which were 99% open-ended, to ask people before we connected. I was reminded from my days working in an office of the importance of small asks (no more than 10-15 minutes’ of time from people you do not know) and brevity (keep the body of you emails capped at five sentences). Among those supporters, I also used the convention shared with me by another academic advisor (who was my Gandalf during Step 1 dedicated studying): mentors are people who have a shared visions, coaches are people who help you with specific tasks or projects, and advisors offer general advice and guidance. Have an idea of what you are looking for before you approach a potential support person, but that’s okay if things change. Do not waste your time or their time.
  4. Notice how easy it is to write your personal statement. What attracts you to the specialty? Why do you think you are a good fit, and how do you see yourself practicing within that discipline in the future? Think less about the near-ubiquitous clinical story that many medical students include in their personal statement; apparently that gets old for reviewers to read time after time. I realized that writing my personal statement for family medicine was much easier that writing a statement for emergency medicine, and writing my statement for the joint FM/EM programs was easier when approaching as a family med-hopeful who wants to be ready for emergency in rural or global health settings.
  5. Applying for the discipline you were interested in previously as well as another discipline is fine, it is just more work. Budget well beyond the time and energy you think you will need write a second personal statement, assemble another program list, and prepare yourself for an interview for said disciplines.

Hope that it helpful!

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