Essential Pre-Match Communication for MD Graduates in EM-IM Residency

Understanding Pre-Match Communication in EM-IM

For an MD graduate residency applicant, especially in a combined Emergency Medicine-Internal Medicine (EM IM combined) pathway, “pre-match communication” can feel like a gray zone. You’re told to advocate for yourself, but warned not to cross ethical boundaries. You hear stories about pre-match offers, early commitment, and program communication before match day, but no one hands you a rulebook.

What Is Pre-Match Communication?

Pre-match communication refers to any contact between you and residency programs after you submit your application but before the Match results are released. This includes:

• Thank-you emails after interviews
• “Love letters” to programs indicating strong interest
• Clarifying questions about schedule, curriculum, or research
• Program emails expressing interest or asking about your ranking
• Conversations at second-look visits or virtual open houses

For MD graduate residency applicants from allopathic medical schools, the key is understanding:

1. What is allowed under NRMP rules
2. What is smart strategy (versus unnecessary or risky)
3. What is unique to EM-IM combined programs

NRMP and ERAS Ground Rules (Summarized)

While you should always verify details with the official NRMP Match Participation Agreement, these high-level principles apply:

• No asking or pressuring for rank information

  • Programs cannot require you to state how you will rank them.
  • You cannot be required to disclose your rank list.

• You may choose to volunteer your preferences

  • You may say things like “I plan to rank your program highly” or “Your program is my top choice,” as long as it is truthful and not coerced.

• No binding early commitment or guaranteed pre-match offers in the NRMP main Match

  • For categorical EM, IM, and EM-IM combined programs participating in the Match, programs cannot make binding early offers in exchange for you not ranking other programs.
  • “Pre-match offers” today are usually informal (“we’re very interested in you”) and are not enforceable as contracts within NRMP programs.

• Honesty is required

  • Misrepresenting your intentions to programs, or vice versa, is considered a violation of Match ethics and can lead to serious consequences.

In EM-IM combined training, where spots are limited and programs often recruit intensively, you’ll likely see more nuanced, personalized program communication before match. Your goal is to engage professionally and ethically, without over-promising or misrepresenting your plans.

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Goals of Pre-Match Communication for EM-IM Applicants

For an MD graduate aiming at emergency medicine internal medicine combined training, pre-match communication should serve clear, structured goals, not just “staying on their radar.”

1. Reinforce Genuine Interest

Combined EM IM programs are small and highly selective. Programs often worry:

“Is this applicant truly committed to the 5-year EM-IM combined track, or are they using us as a backup to categorical EM or IM?”

Your communications can:

• Demonstrate you understand the unique identity of EM-IM
• Highlight your long-term dual-practice or academic goals
• Show that you’ve thought concretely about why this specific program fits you

2. Clarify Fit and Logistics

You need information to craft a realistic rank list. Thoughtful questions can help you decide how to rank programs by asking about:

• Proportions of time spent in ED vs wards clinics across PGY years
• ICU experiences and advanced electives
• Longitudinal EM-IM identity and mentorship
• Fellowship and career outcomes (ultrasound, critical care, admin, global health, etc.)
• Wellness, scheduling, and geographic lifestyle considerations

This is not just for your benefit: programs want applicants who have done their homework and will be satisfied with what they sign up for.

3. Signal Priority Without Overstepping

The allopathic medical school match environment is competitive, and EM-IM is a niche. Programs often want to know:

• Are we in this applicant’s top tier?
• Will they realistically rank us in a position where a match is possible?

Pre-match communication lets you signal that they are truly competitive for you—especially useful if:

• You have geographic ties or dual-career considerations
• You’re an MD graduate who may otherwise seem “generic on paper”
• Your board scores or class rank are mixed, and your story is your strength

Done correctly, these signals can push you from “interested” to “highly ranked” by the program.

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Timeline and Strategy: When and How to Communicate

Strategic timing is crucial. Pre-match communication is not spamming; it’s targeted, intentional contact at key points in the cycle.

Phase 1: Post-Interview Thank-You and Clarification (Within 72 Hours)

While some programs explicitly discourage thank-you notes (and you must respect that), many EM-IM combined programs still accept them.

Purpose

• Express appreciation
• Briefly reinforce fit
• Clarify any immediate questions

Key Principles

• Send within 48–72 hours of the interview.
• Address to the Program Director (PD) and/or Associate PD, and occasionally to a resident you connected with.
• Keep it short (1–2 short paragraphs), professional, and specific.

Example Structure

1. Gratitude and reference to something specific
2. Brief statement of interest and fit
3. Optional 1–2 clarifying questions

Example (Adaptable Template)

Dear Dr. [Last Name],

Thank you for the opportunity to interview at the [Program Name] Emergency Medicine-Internal Medicine residency. I especially appreciated our discussion about how your graduates have built dual careers in critical care and ED leadership.

The combination of strong county hospital emergency exposure with robust internal medicine subspecialty training aligns closely with my goal of practicing both emergency medicine and inpatient medicine with a focus on complex, undifferentiated patients. I can clearly see myself thriving in your program’s collaborative culture and dual-identity training model.

If appropriate, I would love to learn more about how your EM-IM residents are supported in pursuing ultrasound or critical care fellowships.

Sincerely,
[Your Name], MD

Phase 2: Mid-Season Clarification and Program Updates (December–January)

After most interviews are complete, you may feel “stuck”—programs are building rank lists, and you’re wondering how to stand out.

This is an appropriate time to send one additional, thoughtful email if:

• You have material updates (new publication, Step 2 score, leadership role)
• You have refined reasons why this program is a strong fit for your EM-IM goals
• You genuinely need more info before ranking

What to Include

• Brief re-introduction (“I interviewed on X date…”)
• One or two important updates
• Focused statement of continued interest
• 1–3 concise questions (if needed)

Avoid:

• Long “essays” repeated to every program
• Vague “Just checking in!” messages with no substance
• Pressure-filled language (“I need to know if I’m ranked to decide…”)

Phase 3: Preference Signaling and “Top Choice” Communication (Late January–February)

This phase is where the ethics and strategy of program communication before match become critical.

Can You Tell a Program They Are Your Top Choice?

Yes—if it is absolutely true. In fact, for EM-IM combined programs, it can be helpful because:

• The field is small, and programs often know that applicants also apply to categorical EM or IM.
• A sincere “You are my top choice” message, sent to one program only, can strengthen mutual ranking if the program was already interested.

Guidelines:

• Do this only if you are 100% certain they will be ranked #1 on your list.
• Send it once to one program; multiple “you are my #1” messages to different programs are unethical and potentially reportable.
• Use careful, honest language that does not claim promises from the program.

Example “Top Choice” Email

Dear Dr. [Last Name],

I hope you are well. As I finalize my rank list for the upcoming Match, I wanted to let you know that I will be ranking the [Program Name] Emergency Medicine-Internal Medicine residency as my top choice.

Since my interview on [date], I have reflected extensively on the type of physician I hope to become—one who practices both emergency medicine and internal medicine at a high level, with a focus on complex, underserved populations. The culture of teamwork I saw among your EM-IM residents, your strong critical care and ED training, and your track record of supporting fellows in ultrasound and academic medicine strongly align with my goals.

Thank you again for the opportunity to interview and learn more about your program. Regardless of the outcome in March, I am grateful for the experience and the mentorship you have already provided.

Sincerely,
[Your Name], MD

You are not asking where they will rank you (which they shouldn’t disclose). You are simply, truthfully communicating your plan.

“We’re Ranking You Highly” – How to Interpret It

You may receive messages like:

• “We were very impressed and will be ranking you highly.”
• “You are a very strong candidate for our program.”
• “We hope to work with you next year.”

These are non-binding expressions of interest. You should:

• Feel encouraged, but not assured. Many applicants receive similar emails.
• Do not rearrange your rank list purely based on flattery. Rank programs in your real preference order.
• Understand these messages help programs keep you engaged, not to guarantee a match.

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Content and Tone: What to Say (and What to Avoid)

Pre-match communication is less about quantity and more about precision and professionalism. As an MD graduate from an allopathic medical school match pathway, your baseline is already solid; what you write can enhance (or erode) that impression.

Elements of Effective Pre-Match Messages

1. Specificity

   • Reference particular aspects of the EM-IM program: dual-board opportunities, ICU intensity, ED volume, global health, research tracks, etc.
   • Avoid generic lines you could paste into any email.

2. Alignment with EM-IM Identity

   • Discuss how you see yourself integrating emergency medicine internal medicine in your career:
     • ED-critical care hybrid roles
     • Academic EM-IM leadership
     • Hospital administration with EM and IM practice
     • Underserved/rural practice where you cover both ED and inpatient

3. Professional Tone

   • Formal greeting, clear structure, proofread grammar.
   • Avoid overly casual language or emotive oversharing.

4. Brevity

   • Aim for 150–250 words for most emails.
   • Respect that PDs receive large volumes of messages.

5. Honesty and Consistency

   • Do not suggest they are your “top choice” unless that is the truth.
   • Ensure what you say in writing aligns with any conversations you have had.

Common Pitfalls to Avoid

1. Overcommunication or Spamming

   • Multiple emails with no new information can become noise.
   • Plan on 1–3 total communications per program (thank you, potential update, top-choice note).

2. Pressuring or Fishing for Rank Information

   • Avoid statements like:
     • “Can you tell me where I stand on your list?”
     • “I need to know if I’m ranked to decide how to order my list.”
   • These cross ethical lines and put programs in an uncomfortable position.

3. Copy-Paste Templates Without Customization

   • PDs recognize generic letters.
   • At minimum, name specific faculty, features, or curriculum details from your interview.

4. Misrepresentation of Other Interviews or Offers

   Steer clear of:

   • Claiming you have “pre-match offers” from programs that cannot legally make them
   • Exaggerating interest from other programs to gain leverage
   • Suggesting you will rank them highly when you do not intend to

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Special Considerations for EM-IM Combined Applicants

EM-IM combined training has unique dynamics that shape how you should approach program communication before match.

1. Dual Applications: Categorical EM and IM

Many EM-IM applicants also apply to:

• Categorical Emergency Medicine positions
• Categorical Internal Medicine positions
• Sometimes EM-CC (EM–critical care) or preliminary years

Programs are aware of this reality. When you communicate:

• Acknowledge your broad interests honestly if asked, but emphasize why EM-IM is your ideal path.
• If writing to EM-IM PDs, focus on how combined training specifically serves your vision better than either single specialty alone.

Example phrasing:

While I also applied to categorical EM and IM programs, my clear preference is to train in a combined Emergency Medicine-Internal Medicine program that allows me to maintain robust skills in both acute resuscitation and longitudinal care…

2. Small Program Size and Close-Knit Culture

EM-IM programs often have 2–6 residents per year, so:

• PDs and chiefs often remember your interview vividly.
• Your communication can more easily influence impressions—positively or negatively.
• You may have more direct contact with residents, making follow-up questions reasonable.

Actionable tips:

• If a specific resident championed your interest or answered many questions, a brief thank-you message to them is appropriate.
• Ask residents practical questions (schedule, wellness, dual-board logistics); PDs for strategic or educational questions (curriculum, fellowship support).

3. Long-Term Career Narratives

Programs want to see a coherent story of why EM-IM is your best fit, not a hedged bet. Use communications to reinforce themes like:

• Interest in critical care, ED/hospitalist hybrid roles, or complex chronic disease in acute settings
• Desire to be a bridge between ED and inpatient services for systems improvement
• Passion for education, research, or leadership that spans EM and IM

Concrete examples you might share briefly:

• A QI project that involved both ED and medicine wards
• A case where you followed a patient from ED stabilization to inpatient longitudinal care
• Interest in being “the person who can stay with the sickest ED patients all the way through their ICU course”

4. Geographic and Personal Factors

For EM-IM, programs may be acutely aware that the time commitment is 5 years. They’re more likely to view seriously:

• Geographic ties to the region
• Partner or family considerations
• Long-term career plans that fit local hospital networks

If relevant and comfortable, you can ethically mention:

My partner has accepted a position in [city], and we are looking forward to building our lives in this region long-term.

This can be meaningful, but only if it’s true and stable.

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Working with Advisors and Staying Grounded

Pre-match communication decisions can be stressful. You don’t have to navigate it alone.

Use Your Home Institution Wisely

As an MD graduate from an allopathic medical school, you likely have access to:

• EM and IM faculty advisors
• A dedicated Student Affairs/Dean’s Office
• Possibly an alum currently in EM-IM training

Ask for help with:

• Reviewing your “top choice” email
• Prioritizing which programs to signal strongest interest to
• Deciding whether program communication you receive is typical or concerning

Managing Anxiety and Expectations

The volume of messages from peers and social media stories about pre-match offers or dramatic program communication before match can distort expectations. Remember:

• The Match algorithm is designed to favor applicant preferences, not pre-match signals.
• Rank programs in your true order of preference, regardless of the interest they’ve shown.
• Pre-match communication optimizes your visibility, but it does not override the fundamental mechanics of the allopathic medical school match.

When in Doubt, Default to Professionalism

Ask yourself before hitting “send”:

1. Is this message truthful?
2. Is it respectful of boundaries (not asking for rank, not making demands)?
3. Does it contribute something new (clarification, update, genuine preference) rather than noise?
4. Would I be comfortable with my Dean or PD reading this email?

If yes to all four, you’re likely on safe ground.

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FAQs: Pre-Match Communication for EM-IM MD Graduates

1. Should I email every EM-IM program I interviewed at to say they are a “top choice”?

No. Reserve language like “top choice” or “I will be ranking you #1” for a single program you truly intend to place first on your rank list. For other programs, you can say:

• “I will be ranking your program very highly”
• “Your program remains one of my top choices”

Use this sparingly and honestly; your goal is to be accurate, not maximally flattering.

2. Can programs offer me a guaranteed spot if I commit early (a pre-match offer)?

In the NRMP main Match, categorical EM, IM, and EM-IM combined programs cannot make binding pre-match offers that circumvent the Match. You might hear strong informal interest (“we would be thrilled to have you”), but these are not contracts. Always confirm that any program you’re considering is participating in the Match, and assume your final Match result is what matters.

3. Is it okay to tell programs that I’m applying to both EM-IM and categorical EM or IM?

Yes. This is common and expected. You are not obligated to list every program you’re applying to, but if asked about your overall strategy, you can say:

I’m applying to EM-IM combined programs as my preferred pathway, with some categorical EM and IM programs as alternatives, but my goal is to practice in a role that uses both skill sets.

What matters is that your stated priorities align with your actions and rank list.

4. How much does pre-match communication actually affect my chances of matching?

Pre-match communication is supportive, not determinative. It can:

• Nudge you up or down slightly on a program’s rank list
• Clarify mutual interest, especially important in small EM-IM programs
• Help you make better decisions about your own ranking

But it cannot compensate for core elements like clinical performance, board scores, letters, and interview impressions. Use it as a tool to polish your application, not rescue it.

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Thoughtful, ethical pre-match communication can help you present your best self to EM-IM programs while preserving your integrity and autonomy in the MD graduate residency process. Approach it with intention, honesty, and respect—and let your genuine enthusiasm for emergency medicine internal medicine training come through.