Essential Pre-Match Communication Guide for DO Graduates in EM-IM Residency

Understanding Pre-Match Communication in EM-IM as a DO Graduate

Pre-match communication is any contact between you and a residency program that occurs outside of ERAS and the NRMP Match algorithm—emails, phone calls, thank-you notes, updates, or program-initiated outreach. For a DO graduate pursuing Emergency Medicine-Internal Medicine (EM IM combined), understanding how to navigate this communication is crucial, especially because:

• EM-IM spots are few and highly competitive
• Many EM-IM programs are academically oriented and pay close attention to applicant professionalism
• DO applicants may worry about visibility and program perception in a predominantly MD applicant environment

Your goal is to use pre-match communication to:

1. Signal sincere interest without violating NRMP rules
2. Clarify fit with EM-IM combined training (versus categorical emergency medicine or internal medicine alone)
3. Advocate for yourself professionally as a DO graduate
4. Avoid misinterpretation as asking for or offering a pre-match deal

This article will walk you through:

• The rules and ethical boundaries of pre-match communication
• How and when to contact EM-IM programs
• What to say (and what to avoid) as a DO graduate
• How to handle pre-match offers, early commitment, and program communication before match
• Practical templates and strategies tailored for EM-IM applicants

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The Rules and Realities: What “Pre-Match” Means in NRMP and EM-IM

NRMP Rules in Plain Language

Most EM-IM combined programs participate in the NRMP Match and are bound by the Match Participation Agreement. Core principles:

• No coercion:
  Programs cannot require you to reveal rank intentions or pressure you into a “pre-match commitment.”
• No guarantee language:
  Programs should not say “If you rank us first, we will rank you to match” in a binding sense, and you should avoid implying “I will rank you #1 if you promise to rank me to match.”
• You can express interest honestly:
  You may tell a program that you plan to rank them highly or even first, as long as:
  • You are being truthful
  • No one suggests or implies a contract or guarantee

Key point: The NRMP algorithm is designed to honor the applicant’s preferences first. The safest mindset:

“I will rank programs in the true order of my preference, independent of pressure, and communicate in a professional, non-coercive way.”

DO Graduate Context: What’s Different for You?

As a DO graduate, you may experience:

• Concern about being overlooked at university or large academic EM-IM programs
• Need to explicitly highlight your osteopathic training as an asset (procedural skills, holistic approach, manual medicine, community-focus)
• Questions about whether to discuss COMLEX vs USMLE scores and how to frame them

Good news: Many EM-IM programs value DOs for their versatility, work ethic, and broad-based clinical skills—especially useful in combined training. Pre-match communication is a place to reinforce your readiness for the intensity of dual-board eligibility in emergency medicine internal medicine.

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When and How to Reach Out: A Timeline for EM-IM Applicants

Overview of Key Phases

1. Pre-Application (Spring–Summer before ERAS opens)
2. Application Submitted / Interview Invitation Phase
3. Post-Interview / Late Fall–Winter (critical pre-match period)
4. Rank List Finalization / Just Before Rank List Deadline

These phases map to specific communication strategies.

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1. Pre-Application: Quiet, Strategic Information Gathering

At this stage, avoid “cold emailing” purely to self-promote. Focus on information and relationship building:

Actions:

• Attend virtual EM-IM open houses or Q&A events
• Follow EM-IM programs and key faculty on professional platforms (e.g., X, program websites, institutional webinars)
• If you have meaningful connections (e.g., EM-IM alumni from your DO school, mentors with program ties), request brief informational conversations

Professional email example:

Dear Dr. [Last Name],

I am a fourth-year DO student at [School] with a strong interest in combined Emergency Medicine-Internal Medicine training. I’m currently exploring EM-IM programs and would greatly appreciate any advice you might have for DO applicants considering this pathway.

If you have 10–15 minutes available in the coming weeks, I would be grateful for the opportunity to learn from your experience and better understand what makes a strong EM-IM applicant.

Thank you for considering my request.

Sincerely,
[Your Name], OMS-IV
[School]

This is not about asking for special favors or pre-match deals; it’s about understanding expectations specific to EM-IM.

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2. After ERAS Submission: Targeted, Purposeful Outreach

Once ERAS is submitted and applications are under review, communication should be specific and value-adding, especially if:

• You have a genuine tie to the region or institution
• You possess experiences particularly relevant to EM-IM (e.g., critical care research, EMS experience, longitudinal hospitalist work, rural ED experience)
• You are a DO graduate worried that your application might be overshadowed by more traditional MD pipelines

Appropriate reasons to contact a program at this stage:

• Clarify whether the program accepts COMLEX-only scores or prefers USMLE
• Briefly highlight a major application update after ERAS submission (published research, award, leadership role)
• Express specific fit with EM-IM combined training (not just generic “I really like your program”)

Well-structured email example (pre-interview):

Subject: EM-IM Applicant – [Your Name], DO – Interest in [Program Name]

Dear Dr. [PD Last Name],

My name is [Your Name], DO, and I recently applied to the Emergency Medicine-Internal Medicine program at [Institution] through ERAS. I am particularly drawn to your combined program because of its emphasis on [specific features: critical care, global health, urban underserved care, hospital leadership, etc.].

As a DO graduate from [School], I have pursued experiences that I believe align well with EM-IM training, including [1–2 specific experiences: ICU sub-internship, EMS work, longitudinal IM clinic, EM research, osteopathic manipulative medicine in ED settings].

I wanted to confirm that my application is complete and to clarify whether your program is comfortable considering applicants with [COMLEX-only scores / COMLEX plus USMLE Step 2, etc.]. I would be honored to have the opportunity to interview and learn more about your combined EM-IM curriculum.

Thank you for your time and consideration.

Sincerely,
[Your Name], DO
AOA # (optional)
ERAS AAMC ID: [XXXX]

This kind of email is professional, concise, and focused on fit, not on extracting rank promises or early commitment.

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3. After Interviews: The Core of Pre-Match Communication

Once interviews start, post-interview communication is where most DO graduate residency applicants worry about crossing boundaries. In EM-IM, this phase is especially important because:

• Programs are small; often only a handful of EM IM combined spots per year
• Faculty and program directors often remember candidates quite clearly
• Thoughtful follow-up can distinguish you from a similarly strong candidate

A. Thank-You Emails: Basic but Important

Within 24–72 hours, send individualized thank-you messages to the:

• Program Director
• Key faculty or residents you met (if emails are provided or publicly listed)

Example:

Dear Dr. [Last Name],

Thank you for the opportunity to interview for the Emergency Medicine-Internal Medicine residency at [Institution] on [date]. I appreciated learning more about how your program integrates EM and IM training, particularly [specific detail: your ICU months structure, EM-admitting medicine rotations, global health track, EMS involvement, etc.].

Our conversation reinforced my interest in pursuing EM-IM combined training and my sense that [Institution] would be an excellent environment to grow as both an emergency physician and internist. I was especially impressed by [1–2 specific aspects you liked].

Thank you again for your time and consideration.

Sincerely,
[Your Name], DO

You are not required to state rank intentions here. Focus on gratitude, specifics, and professional tone.

B. Update and Interest Letters

Later in the season (December–January), sending an update letter or letter of interest is appropriate when:

• You have new accomplishments (publication, leadership role, new rotation evaluation)
• You remain specifically interested in that EM-IM program
• You want to clarify your fit as a DO graduate

Example of a combined update + interest letter:

Dear Dr. [PD Last Name],

I hope you are well. I wanted to thank you again for the opportunity to interview at [Institution] for the EM-IM combined residency. Since we spoke, I have completed an additional ICU sub-internship, during which I [brief achievement: led daily presentations, managed ventilated patients, worked closely with ED admissions]. I also recently [briefly mention publication, poster, award if relevant].

My experiences continue to confirm that combined Emergency Medicine-Internal Medicine training is the best fit for my career goals, especially my interest in [example: critical care, ED-based observation units, complex medical patients in the ED, leadership in hospital systems]. I remain highly interested in [Program Name] because of [specific program features].

Thank you again for your consideration. Please let me know if there is any additional information I can provide.

Sincerely,
[Your Name], DO

You are still not obligated to discuss rank order. This is about demonstrating sustained interest and growth.

C. “Letter of Intent” – When (and How) to Use It

A letter of intent communicates that a program is your true first choice and that you intend to rank them #1.

Key points:

• Only send one true letter of intent
• Do this after you have completed all interviews and thought carefully about preferences
• Be honest; never tell multiple programs they are your number one

Example of a clear, NRMP-compliant letter of intent:

Dear Dr. [PD Last Name],

I am writing to express my sincere interest in the Emergency Medicine-Internal Medicine residency at [Institution]. After completing my interviews and reflecting on my goals as a future EM-IM physician, I have decided that [Program Name] is my top choice, and I plan to rank your program first on my rank order list.

I believe your program’s [specific characteristics—integrated curriculum, critical care opportunities, strong mentorship, commitment to underserved populations, etc.] aligns best with my long-term goals of practicing as a dual-trained emergency physician and internist. I also felt a strong connection with the residents and faculty, and I can clearly envision myself training and contributing at [Institution].

Thank you again for your time and for considering my application.

Sincerely,
[Your Name], DO

This is allowed under NRMP rules as long as it is not coerced, not conditional, and completely truthful.

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Handling Program-Initiated Communication, Early Commitment, and Pre-Match Offers

This is where many applicants become anxious—particularly in a tight-knit field like EM IM combined.

What If a Program Reaches Out Before Rank List Deadline?

Programs may contact you to:

• Express continued interest (“You remain highly ranked on our list”)
• Ask if you have any remaining questions
• Clarify your level of interest
• Invite you to second look visits (virtual or in-person, depending on institutional policy)

You are allowed to respond honestly about your interest, but avoid:

• Asking, “Where am I on your rank list?”
• Pressuring them for any guarantee
• Making promises you’re not sure you’ll keep

Example response when they say they are very interested:

Thank you so much for reaching out and for your kind words. I remain very interested in the EM-IM combined program at [Institution] and have been impressed by [specific feature]. I will be carefully considering all of my options, and your program is certainly among those I am strongly considering ranking very highly.

If they are truly your #1, you may say so (consistent with your letter of intent), e.g.:

I appreciate you sharing that. After reflecting on my interviews and goals, I have decided to rank [Program Name] first on my list. I am very excited about the possibility of training with you and your team.

Understanding “Pre-Match Offers” and “Early Commitment”

In NRMP-participating specialties, formal pre-match offers are not allowed in the sense of “Sign with us now and skip the Match.” However, some applicants describe “pre-match offers” or “early commitment” as:

• A program informally saying, “If you rank us first, we will rank you such that you are almost certain to match.”
• Aggressive program communication before match implying a mutual commitment

For EM-IM programs in the NRMP Match, you should not sign any contract or binding agreement before Match Day.

If you feel a program is putting pressure on you:

1. Stay calm and professional.
2. Do not commit to any contractual language.
3. You can respond with:

I appreciate your enthusiasm and interest in my application. I plan to submit my rank list in the true order of my preferences, and I’m very grateful that your program is seriously considering me.

4. If the pressure feels unethical or coercive, you may confidentially contact:
   • Your medical school’s student affairs / dean’s office
   • The NRMP (they have a process to report violations)

What If a Program Asks Directly, “Where Will You Rank Us?”

You are not obligated to disclose your rank list. Options:

• If they are your #1:

  I’ve thought carefully about my options, and I do plan to rank your program first.

• If they are highly ranked but not necessarily #1:

  I’m still finalizing my rank list, but I can say that your program will be among my top choices.

• If you don’t want to share:

  I’m still reflecting and will ultimately rank programs in the order that matches my personal and professional goals. I very much appreciate your interest and the opportunity to have interviewed with you.

Be truthful, non-confrontational, and consistent with NRMP expectations.

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DO-Specific Strategies: Standing Out Professionally in EM-IM

As a DO graduate applying to an osteopathic residency match environment that has now largely unified through NRMP, you can leverage your background strategically.

1. Highlighting Osteopathic Training in Pre-Match Communication

In emails and conversations, subtly emphasize:

• Holistic, systems-based approach to complex medical patients
• Comfort with musculoskeletal and pain management, especially useful in ED settings
• Strong procedural foundation from community-based DO rotations
• Experience with underserved populations or rural EM/IM settings

Example phrase for your letters:

As a DO graduate, my training has emphasized a holistic, patient-centered approach and strong procedural skills, both of which I believe will serve me well in the dual demands of Emergency Medicine-Internal Medicine training.

2. Addressing COMLEX and USMLE

If you have:

• COMLEX only:

  • Confirm each program’s policy (sometimes via pre-match email as described)
  • Frame your clinical performance, SLOEs, and rotation evaluations as strengths to compensate

• COMLEX + USMLE:

  • Ensure programs have received both
  • In updates, you can briefly mention a strong Step 2 performance as evidence of readiness

Avoid apologizing for your test portfolio. Focus more on clinical readiness and EM-IM fit.

3. Using Pre-Match Communication to Emphasize EM-IM as a Deliberate Choice

Some programs worry that EM-IM applicants are “undecided” rather than “dual-passionate.” Use your communication to clearly express that:

• You chose EM-IM intentionally, not as a backup
• You understand the workload and length of combined training (often 5 years)
• You have career goals that require both EM and IM (e.g., critical care, ED-based hospital medicine, academic leadership bridging the ED and wards, international or disaster medicine with chronic disease management)

Example phrase:

My goal is to practice at the intersection of acute and longitudinal care, managing complex patients who move between the ED, ICU, and inpatient services. EM-IM combined training is the best path to this role, and I’m excited about the challenge of dual-board preparation.

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Common Pitfalls in Pre-Match Communication (and How to Avoid Them)

1. Over-Emailing or Sending Generic Messages

   • Avoid mass emails to every EM-IM program with the same text.
   • Focus on programs where you have genuine, specific reasons for interest.

2. Dishonest or Conflicting Statements

   • Never tell multiple programs they are your #1.
   • Remember that faculty talk across institutions—credibility matters.

3. Emotional, Anxious Messages Late in the Season

   • Avoid panic emails: “I haven’t heard from you—am I still being considered?”
   • Instead, provide constructive updates, brief and professional.

4. Crossing Professional Boundaries on Social Media

   • It’s fine to follow programs and like informational content.
   • Do not DM PDs or residents with aggressive self-promotion or personal questions.

5. Interpreting Polite Interest as a Guarantee

   • “We really liked you” or “You’d be a great fit” is not a promise.
   • Rank programs based on your true preferences, not on vague assumptions about rank position.

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Final Thoughts: A Grounded Strategy for DO Graduates in EM-IM

As a DO graduate pursuing Emergency Medicine-Internal Medicine, your pre-match communication should:

• Reinforce your unique strengths as a dual-purpose applicant
• Show that EM-IM is a deliberate, informed choice
• Stay squarely within NRMP guidelines—no coercion, no false promises
• Be strategic, specific, and sincere, not excessive or generic

If you remember one guiding principle, let it be this:

Communicate professionally to clarify fit and demonstrate interest, then trust the Match by ranking programs in the true order of your preference.

Used well, pre-match communication won’t “game” the system—it will help programs see clearly why a DO graduate like you belongs in their EM-IM combined residency.

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FAQ: Pre-Match Communication for DOs in EM-IM

1. As a DO applicant, do I need to send more emails than MD applicants to “make up” for bias?

No. You don’t need to flood programs with communication. Instead, send well-crafted, targeted messages:

• Thank-you emails after interviews
• 1–2 thoughtful updates if you have new, meaningful information
• A single, honest letter of intent to your true #1 program (if you choose to send one)

Quality, not quantity, matters.

2. Can I ask a program where I stand on their rank list?

You should not ask directly where you stand. Programs are discouraged from disclosing this, and such questions can feel unprofessional. Instead, focus on:

• Expressing your level of interest
• Asking if they need any additional information from you

Example:

I remain very interested in your EM-IM program and would be happy to provide any additional information that might be helpful during your rank list discussions.

3. Is it okay to tell a program they are my #1 choice?

Yes, as long as:

• You are being truthful
• You communicate this once and consistently
• You understand that this does not create a binding contract

This is typically done via a letter of intent later in the season.

4. What should I do if a program’s communication feels like a pre-match offer or pressure to commit?

• Do not sign any contract or give a binding verbal commitment.
• Respond politely that you will rank programs in the true order of your preferences.
• If pressure persists or you feel the behavior is unethical, discuss it with:
  • Your dean’s office / advisor
  • NRMP support services (they can advise on potential violations)

Protect your autonomy and integrity; the Match is designed to support your preferences first.