The Essential Guide to Pre-Match Communication for DO Graduates in EM Match

Understanding Pre-Match Communication for DO Graduates in Emergency Medicine

Pre-match communication can feel like a confusing gray zone—especially as a DO graduate targeting emergency medicine (EM), where timing, program culture, and regional preferences vary widely. You may hear about “pre-match offers,” “early commitment,” or unofficial “signals” from programs and feel pressure to respond quickly or interpret hidden meaning.

For DO applicants to emergency medicine residency, understanding how to communicate with programs before Match Day is essential—not only to stay ethical and NRMP-compliant, but also to maximize your chances in a competitive EM match environment.

This guide breaks down what pre-match communication really is, how it applies to DO graduates in EM, and how to navigate everything from thank-you notes to “we’re ranking you highly” messages and informal pre-match offers.

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1. The Rules: What’s Allowed in Pre-Match Communication?

Before you decide how to communicate, you need to know what the rules are—both for you and for programs. Most EM residency applicants in the US now participate in the NRMP Match, including almost all ACGME emergency medicine residency programs.

1.1 NRMP and ACGME Basics

Most DO graduates now apply to ACGME-accredited emergency medicine residencies via ERAS and enter the NRMP Match. For these programs:

• Formal pre-match contracts/offers are not allowed
• Coercive behavior (pressure to reveal rank lists or make commitments) is prohibited
• Both sides may express interest, but no one can demand or guarantee ranking positions

Always verify whether a program is participating in the NRMP Match. The vast majority of EM programs are; if any program suggests a separate, non-match track, investigate carefully and seek guidance from your advisor or dean’s office.

1.2 What You Can Say and Do

As an applicant, you are allowed to:

• Communicate interest, enthusiasm, and preferences
• Send thank-you emails after interviews
• Ask clarifying questions about program structure, schedule, or culture
• Let a program know if they are your top choice (truthfully)
• Update programs with substantial new information (new publication, improved COMLEX/USMLE scores, leadership role, significant EM experience)

You are not allowed to:

• Ask a program, “Where will you rank me?”
• Enter into any side agreement to rank each other in a certain spot
• Sign any contract that interferes with the NRMP Match outcome

1.3 What Programs Can Say and Do

Programs may:

• Express general interest (“We were very impressed with you”)
• Ask if you are still interested in their program
• Clarify whether you would consider ranking them highly
• Send “love letters” to strong candidates (“You will be ranked highly on our list”)

Programs may not:

• Request that you disclose your rank list
• Guarantee a match position (“You will 100% match here if you rank us first”)
• Require any verbal promise as a condition of ranking you

If a program’s message makes you uncomfortable, speak with your dean, EM advisor, or an experienced mentor before responding.

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2. Communication Timeline: From Application to Rank List

Pre-match communication in emergency medicine follows a general timeline. Understanding the phases can help you plan what to say and when to say it.

2.1 Before Interviews: Limited but Strategic Contact

Typical purposes of pre-interview communication:

• Application clarification:
  • You notice an error in your ERAS application
  • You have a late letter of recommendation that just became available
• Targeted interest (especially important for DO applicants):
  • You have a strong geographic tie or a clear reason for interest in that specific EM program
  • You want to ensure programs know you’re a DO graduate with genuine interest in ACGME EM training

Tips for pre-interview communication:

• Keep emails short, specific, and professional
• Avoid generic “I love your program” messages to 100+ programs
• Highlight concrete fit factors:
  • “I grew up in this region and my long-term goal is to practice emergency medicine in this community.”
  • “Your strong ultrasound curriculum aligns with my interest in POCUS as a DO graduate with prior OMM training in anatomy and procedure comfort.”

Example pre-interview email (DO applicant to EM program):

Subject: Continued Interest in [Program Name] – DO EM Applicant

Dear Dr. [PD Last Name],

My name is [Your Name], a DO graduate from [School] applying to emergency medicine this cycle. I wanted to briefly express my strong interest in [Program Name], particularly your emphasis on [specific feature: ultrasound, community exposure, toxicology, etc.].

I have strong ties to [city/region] through [family, prior work, rotations], and my long-term goal is to practice emergency medicine in this area. I would be honored to be considered for an interview at your program.

Thank you for your time and consideration.

Sincerely,
[Your Name], DO
AAMC ID / Contact Info

Use this sparingly—focus on your top targets rather than broadcasting broadly.

2.2 After the Interview: Thank-You Notes and Clarification

For most EM programs, post-interview thank-you emails are acceptable, though not always required. Some programs explicitly ask you not to send them—if so, honor that request.

Goals of post-interview communication:

• Express appreciation
• Reinforce specific aspects of fit
• Clarify anything you forgot to ask
• Maintain a professional presence in the program’s memory

Example post-interview email:

Subject: Thank You – [Your Name], EM Interview on [Date]

Dear Dr. [Interviewer Last Name],

Thank you for taking the time to speak with me during my interview at [Program Name] on [date]. I particularly appreciated learning about your approach to [specific item: off-service rotations, wellness initiatives, ED flow, ultrasound, etc.].

As a DO graduate pursuing emergency medicine, I value [something specific they offer, e.g., strong procedural training, community rotations], and I can see myself thriving in your program’s learning environment.

Thank you again for the opportunity to interview.

Sincerely,
[Your Name], DO

If you’re unsure whether to email all interviewers or just the program coordinator/PD, follow the guidance they provided on interview day.

2.3 Between Interviews and Rank List Certification: The “Interest” Phase

This is where “pre-match communication” most often creates anxiety. Programs may start sending:

• “You’re a competitive applicant and we’re very interested”
• “We plan to rank you highly”
• “You are one of our top candidates”

At the same time, you may be tempted to send:

• “I will rank you highly”
• “You are my top choice” or “You are among my top choices”

Key principle: Tell the truth and avoid overpromising.

You may:

• Tell one program they are your number one choice, if true
• Tell several programs that you are very interested and could see yourself ranking them highly

You should not:

• Tell more than one program they are your #1
• Write anything that feels untrue just to “game” the EM match

Example “you’re my #1” email (for your genuine top choice):

Subject: Strong Interest in [Program Name] – [Your Name], DO

Dear Dr. [PD Last Name],

Thank you again for the opportunity to interview at [Program Name]. After completing my interviews and careful consideration, I wanted to let you know that your program is my top choice for residency training in emergency medicine.

The combination of [specific program strengths] and the supportive culture I observed on interview day make me confident that I would thrive as a resident at [Program Name]. I plan to rank [Program Name] first on my rank list.

Thank you again for your consideration.

Sincerely,
[Your Name], DO

2.4 After Rank Lists Are Submitted: Minimal Contact

Once rank lists are certified, further communication becomes less impactful. If you do communicate:

• Keep it brief and largely appreciative
• Do not ask programs to change anything about their rank list
• You’re mostly maintaining professionalism, not influencing outcomes

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3. Pre-Match Offers and Early Commitment: What They Mean for DO EM Applicants

Historically, some specialties and regions used pre-match offers or early commitment pathways. In modern ACGME emergency medicine, especially under NRMP rules, formal pre-match contracts are rare and usually not allowed.

However, DO graduates may still encounter:

• Strongly worded interest that feels like an offer
• Pressure to verbally commit
• Confusion about “early commitment” terminology

3.1 What Is a Pre-Match Offer?

In a strict sense, a pre-match offer is when a program offers you a residency spot outside the NRMP Match, typically with a contract to sign early. In NRMP-participating EM programs, this is essentially prohibited for standard positions.

But you may experience “soft” pre-match-like scenarios:

• “If you rank us first, you will match here.”
• “You’re our top-ranked DO candidate; we really hope you’ll commit to us.”
• “We’d like to know if you can promise to rank us #1.”

These represent pressure, not real guarantees.

3.2 How a DO EM Applicant Should Respond

Your goal: remain honest, professional, and noncommittal beyond what you truly intend.

If a program asks for a commitment you’re not ready to give:

You can say:

“I’m very interested in your emergency medicine residency and truly enjoyed meeting the team. I am still in the process of finalizing my rank list, but your program is under strong consideration. I’m committed to following NRMP guidelines and will rank programs based on the best fit for my training and goals.”

If you already know they are your top choice and you are comfortable saying so, you may respond:

“I truly appreciated my interview day at your program. After careful thought, I can say that [Program Name] is my top choice, and I plan to rank your emergency medicine residency first.”

But never say this to more than one program.

3.3 Why “Early Commitment” Is Risky in the EM Match

In the NRMP environment:

• The algorithm favors the applicant’s true preferences
• You do not gain advantage by “committing early” informally
• You may lose options if you feel pressured into ranking a program higher than you actually want

Especially as a DO applying to a sometimes-competitive emergency medicine residency match, your best strategy is:

• Build a balanced, realistic rank list (safety, mid-range, reach programs)
• Rank programs in true order of preference, not based on pressure or perceived promises
• Use pre-match communication to clarify fit, not to “negotiate deals”

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4. Strategic Communication as a DO Applicant in the EM Match

As a DO graduate, you may face additional questions:

• Will programs value my COMLEX scores?
• Should I highlight OMM or osteopathic training in my communication?
• How can I stand out without being pushy?

4.1 Addressing DO-Specific Considerations in Communication

Many ACGME emergency medicine residency programs are highly DO-friendly. Still, it helps to gently and confidently frame your osteopathic background as an asset in your pre-match communication.

Examples of ways to incorporate this:

• “As a DO graduate, I value a holistic approach to patient care, which I saw reflected in your program’s focus on wellness and interdisciplinary collaboration.”
• “My osteopathic training has given me a strong foundation in anatomy and hands-on procedures, which I’m excited to build upon in a high-acuity ED like yours.”

If a program requires USMLE but you only have COMLEX, be transparent and focus on your strengths:

“Although I took COMLEX rather than USMLE, my EM rotations, SLOEs, and clinical performance reflect my readiness for rigorous emergency medicine training.”

4.2 When to Send Update Letters

Updates are helpful when you have real, substantive news, such as:

• New EM rotation evaluation or SLOE
• New publication or presentation in EM or related field
• Leadership role, quality improvement project, or EMS-related activity
• Significant score release (e.g., improved COMLEX Level 2 / USMLE Step 2)

Example update email:

Subject: Application Update – [Your Name], DO EM Applicant

Dear Dr. [PD Last Name],

I hope you are well. I wanted to briefly share an update to my application. Since we last communicated, I completed an emergency medicine rotation at [Institution], where I received strong evaluations (now uploaded in ERAS). I also presented a poster on [topic] at [conference].

This experience reinforced my interest in emergency medicine and particularly in programs like yours that emphasize [specifics]. I remain very interested in [Program Name] and appreciate your continued consideration.

Sincerely,
[Your Name], DO

Limit yourself to 1–2 update letters per program, and only when you have meaningful content.

4.3 Tone and Professionalism: Subtle but Powerful

In EM, where culture and teamwork are essential, your communication style becomes part of your “interview.”

Aim for the following:

• Concise: Avoid long, emotional essays in emails
• Specific: Refer to concrete aspects of the program when expressing interest
• Positive: Focus on what attracts you to a program, not what you disliked elsewhere
• Honest: Don’t exaggerate your interest level or make promises you won’t keep

Red flags for programs include:

• Overly frequent emails or messages
• Aggressive or entitled tone (“I expect to be ranked highly”)
• Mass emails obviously copied and pasted without personalization

Remember: being professional and respectful in communication implicitly signals you’ll be the kind of EM resident people want on their team at 3 a.m.

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5. Practical Scenarios and How to Respond

To ground this in reality, here are common pre-match communication scenarios a DO EM applicant may face, with suggested approaches.

Scenario 1: “We’re Ranking You Highly”

Message from program:

“We were very impressed with your application and interview. You will be ranked highly on our list.”

What it means:

• They like you and want you to consider them seriously
• It is not a guarantee of matching
• They likely sent similar messages to multiple applicants

Suggested response:

Dear Dr. [PD Last Name],

Thank you very much for your kind note and for the opportunity to interview at [Program Name]. I truly enjoyed meeting the residents and faculty and was impressed by [specific elements].

I remain very interested in your program and appreciate your consideration.

Sincerely,
[Your Name], DO

You are not required to state where you will rank them.

Scenario 2: “Will You Rank Us First?”

Message from program:

“We are very interested in having you join us. Can you tell us whether you plan to rank our emergency medicine residency first?”

What it means:

• They’re trying to gauge your level of interest
• Phrased this way, it may border on inappropriate, but it’s not uncommon

If they are your top choice:

Dear Dr. [PD Last Name],

Thank you for reaching out. After careful consideration, I can say that [Program Name] is my top choice, and I plan to rank your emergency medicine residency first.

I truly appreciated the welcoming atmosphere among your residents and the strong training in [specifics]. I would be honored to train at your program.

Sincerely,
[Your Name], DO

If they are not your top choice or you’re not ready to decide:

Dear Dr. [PD Last Name],

Thank you very much for your message and for your strong consideration of my application. I remain very interested in [Program Name] and was particularly impressed by [specifics].

I am still in the process of finalizing my rank list and intend to follow NRMP guidelines by ranking programs in the order of my true preferences. Regardless, your program will be under serious consideration.

Thank you again for the opportunity.

Sincerely,
[Your Name], DO

This maintains honesty and professionalism without overcommitting.

Scenario 3: No Communication from a Favorite Program

You loved a program, but they’ve gone silent since your interview, while other programs are sending enthusiastic messages.

What it means:

• Silence does not equal disinterest
• Some EM programs intentionally minimize pre-match communication
• You may still match there if you rank them highly

What you can do:

• Send one reasonable expression of continued interest, especially if they’re in your top choices:

Dear Dr. [PD Last Name],

I hope you are well. I wanted to briefly reiterate my strong interest in [Program Name] following my interview on [date]. I particularly valued [specific aspects], and I can envision myself thriving in your emergency department environment.

Thank you again for the opportunity to interview and for your consideration.

Sincerely,
[Your Name], DO

Then, leave it. Don’t repeatedly follow up. Rank them where you truly want them, regardless of the silence.

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6. Building a Winning Strategy: Key Takeaways for DO EM Applicants

To navigate pre-match communication effectively in the osteopathic residency match context for emergency medicine, keep these core strategies in mind:

1. Know the rules

   • NRMP prohibits binding pre-match offers from participating EM programs
   • You can express interest, but avoid collusion or false commitments

2. Use communication to clarify and highlight fit

   • Before interviews: targeted, selective interest emails
   • After interviews: concise thank-yous with specific reflections
   • Pre-rank phase: truthful expressions of preference and updates

3. Protect your integrity

   • Never tell more than one program they’re your #1
   • Avoid being swayed by “we’re ranking you highly” promises
   • Build your rank list in true order of preference, trusting the algorithm

4. Embrace your DO identity

   • Subtly frame osteopathic training as a strength for EM: hands-on skills, holistic care, adaptability
   • If you lack USMLE, emphasize strong COMLEX scores, clinical performance, and EM evaluations

5. Maintain professionalism

   • Every email, call, or interaction is part of your professional branding
   • Programs want colleagues they can rely on at all hours in the ED—your communication should reflect that reliability, maturity, and respect

Handled well, pre-match communication becomes a tool—not a trap—for DO graduates pursuing emergency medicine. It’s your chance to demonstrate judgment, honesty, and genuine interest in the programs where you hope to train.

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FAQ: Pre-Match Communication for DO Graduates in EM

1. As a DO applicant to emergency medicine, do I need to send “love letters” to match?
No. You do not need to send elaborate “love letters” to match into an emergency medicine residency. Thoughtful, concise communication can help programs remember you and clarify your interest, but the most important factors remain your SLOEs, EM rotation performance, board scores, and interview impression. Overly frequent or insincere emails can actually hurt more than help.

2. Is it okay to tell more than one program they are in my “top three”?
Yes, if it’s true and you phrase it honestly. It’s acceptable to say to multiple programs, “I will be ranking your program very highly” or “You are among my top choices.” What you should not do is tell more than one program that they are your absolute number one choice or make promises you don’t intend to keep.

3. What if I only receive strong interest messages from community EM programs and not academic ones?
That’s common and not necessarily a negative reflection on your application. Academic programs often send fewer personalized messages. If you are seriously interested in academic EM, communicate your interest clearly in your thank-you notes and consider one follow-up closer to ranking time. Then rank programs in your true preference order, mixing academic and community sites as fits your goals and competitiveness.

4. How much does pre-match communication really matter in the EM match for DOs?
Pre-match communication is a secondary factor. It can tip the scales slightly in close decisions or clarify ambiguities (“Is this applicant really interested in us?”). But it rarely overrides the core elements: your clinical performance, SLOEs, board exams, and interview. Used wisely, it can support your application; used poorly, it can raise concerns. Focus on being authentic, professional, and strategic, rather than trying to “game” the system.