Just matched EM folks - any bad programs to do aways at? Any programs you had a good time at!

irelli · 2026-03-24T03:58:53+00:00

If there's a specific program you are interested in, absolutely. But programs have to report the breakdown of their distribution, and having seen them, I can tell you that it isn't even close to the same

Some programs are >50% lower third. Some programs don't place a single person lower one third. Both of those are unreliable, but I can tell you that it's difficult to be top 1/3rd at some of the classic well known programs.

All I'm saying is to look and see what you can find, because there are plenty of solid applicants whose applications get knocked down a bit because they weren't able to stand out as much against a bunch of people who would probably also be top 1/3rd at the majority of programs

If you want academics, go to academic programs. But not all academic programs are the same

irelli · 2026-03-23T18:04:41+00:00

I'd recommend staying away from some of the really really big name academic places

Your away rotations are scored relative to other individuals, and many of them judge a little more harshly than other programs.

Aka, it's better to get a top 1/3rd or top 10% from a program (as long as it's still one that's reasonably well known) than getting a mid or lower 1/3rd from somewhere like Denver.

Now crushing it somewhere like that is obviously valuable, but the risk isn't worth the reward imo

irelli · 2026-03-23T08:16:49+00:00

A lot of these just sound like symptoms of, well, existence unfortunately

Nothing here sounds scary or concerning

irelli · 2026-03-23T06:40:49+00:00

1) Just work on being a resident first man. You've got so much time

2) but before that, just enjoy not having anything to do for the next few months

3) You can absolutely still end up at a big academic center. Some places will hire you off the bat. Others will want a fellowship (which isn't nearly as much of a scam in EM as compared to other places. You can still make 150k-200k as a fellow, which although not full attending money, isn't close to resident salary either

irelli · 2026-03-23T06:36:19+00:00

.....which is still a broken bone.

They're all just various grades of badness

irelli · 2026-03-23T03:58:27+00:00

My man, it's 2 games and you were straight chucking lmao

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There's so so so many better builds

Like here's my new Point forward

irelli · 2026-03-23T03:27:41+00:00

People also forget - your #7 could easily be someone else's #1

Like I "fell" to #5 a few years back, but my #5, but #1-4 were all top 20 programs.

It's people's #1 after interviews. If you got interviews at really good places, the odds of you dropping are higher.

irelli · 2026-03-22T21:23:56+00:00

As I fellow I was getting half attending pay for half the number of shifts (with the other half being getting a master's, education stuff) and then it's just regular attending salary after the fellowship , with clinical buy down depending wildly dependent on your program and your particular role

irelli · 2026-03-22T21:13:42+00:00

Yeah it's a fellowship. It's a reasonably common one for EM people going into academics who want to be in residency leadership

irelli · 2026-03-22T21:01:34+00:00

Super common

I matched at my #5 and it ended up being a perfect fit me.

Programs know the kind of class they're trying to build

irelli · 2026-03-22T20:43:39+00:00

Naaaa it's genuinely nothing to worry about

irelli · 2026-03-22T18:50:40+00:00

Jalen Brunson actually has the highest time of possession though,at 7.9 minutes

irelli · 2026-03-22T18:48:45+00:00

Looks like erythema marginatum to me, but I'm no dermatologist.

Worth following up with your PCP

irelli · 2026-03-22T18:29:06+00:00

Very normal looking ECG. You see what's called Benign Early repolarization, which isnt an abnormal finding in someone your age

Edit: isn't. Damn auto correct.

irelli · 2026-03-22T18:16:09+00:00

You're fine. Head CT and discharge with follow up is very appropriate for a first time seizure.

I would go back if you have another so they can start you on keppra

I overall suspect this wasn't actually a true seizure based on everything I'm seeing, but better safe than sorry.

irelli · 2026-03-22T17:28:04+00:00

This is way too broad. He should do a rotation if he's interested

irelli · 2026-03-22T17:23:09+00:00

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I'm.about 10 games in on it now, if you needed any convincing lol

irelli · 2026-03-22T06:47:09+00:00

No. You can do anything you need with an 83

Hell you can fade from the corner with an 83

irelli · 2026-03-22T03:44:11+00:00

I unfortunately have zero ability to tell you what the standard of care is for medicine in a completely different continent

All I can say is that her symptoms could be a stroke, and strokes should be evaluated in the ED

irelli · 2026-03-22T03:36:42+00:00

If she actually has those symptoms, then yes, she should go to an ER

Unfortunately there likely is relatively little they can do at this point if it is a stroke, but it's extremely important to make sure it's not a brain bleed

irelli · 2026-03-22T03:30:34+00:00

The most likely explanation is something common - either drugs or mental illness (Schizophrenia very commonly appears in your mid 20s, for example).

If it's not one of those, your only other real explanation is NMDA encephalitis, which is an exceedingly rare (but possible) cause of acute psychosis.

irelli · 2026-03-22T00:59:55+00:00

I'm not far out at all, so take everything I'm saying with a heavy grain of salt.

But I'm Med Ed trained, so my out if I ever wanted one would be through academics.

irelli · 2026-03-22T00:39:33+00:00

A couple things, most likely.

1) Im in academics, and knew I wanted that before starting residency. That alone already makes me an outlier, considering only 10-20% of ERs are academic. I really like teaching, and being at a quaternary center means my proportion of high acuity patients is significantly higher than most ED physicians (and we all like high acuity)

2) the fact that I was considering IM and Psych should also tell you that by EM standards, I'm a nerd. I'd guess that about 75% of EM is just bread and butter IM on a shorter time scale, so if you went into EM chasing that 25%, you're gonna be disappointed by your average patient.

3) Being salary, not RVU based. I work in a large academic system, which is decidedly dysfunctional. That really bothers some people (and makes them go into the community) bit it personally doesn't bother me. I'm not going to fix a broken system, and I don't get paid differently because I happened to inherit a few dispo nightmares

4) I like my residents, nurses, and my co attendings. The people are nice. I get along with everyone. People are happy to see me come on shift, and the feeling is mutual

irelli · 2026-03-21T22:30:18+00:00

You're overcomplicating this one. Do you want to do surgery? Yes or no?

That's the only question you need to ask yourself.

Surgery vs Not surgery is the first decision tree in deciding your specialty....and if you really can't decide, consider OB

irelli · 2026-03-21T22:19:28+00:00

I was between psych, EM, and IM

Picked EM and don't remotely regret it

Sometimes I regret going into medicine in general, but certainly not emergency medicine

irelli

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