Thursday, December 15, 2016

The residency couples match

Are you applying as a couple through the residency match? Do you feel confused about how to combine your rank lists? The NRMP algorithm works very smoothly for a couples match, although it is a bit complicated, so I've put together a sample list with some useful details. In this version, the letters of the alphabet each stand for programs, and "partner" is the other half of your couple (it could be a spouse, fiancé, domestic partner, or even a friend; you do not need to have a legal relationship in order to participate in the couples match). You'll also note that I haven't mentioned specialty choices; that's because for the purposes of the NMRP algorithm in this situation, it doesn't matter. So here's a quick look at a potential rank list:

You Partner
A        A
B        B
A        B
B        A
C        A
C        B
A        D
B        D
A      none
B      none
none    A
none    B

In this sample list, you were both interviewed by programs A and B (again, whether it was in the same specialty or in different specialties does not matter here). Only you were interviewed at C, and only your partner was interviewed at D. If you both successfully match into A, then you've matched, and if you didn't *both* match there, the algorithm looks at the next combination, which is this case is both of you at program B. But if that doesn't happen either, you've instructed the algorithm to check if you matched into A and your partner at B, then check if you matched into B and your partner to A, and so on. At the bottom of the list are situations where one of you matched into one of your two favorite programs, deliberately choosing to leave the other one unmatched.

I could have added several more combinations (such as C-D, none-D, and C-none) to the list, but in short, the couples match only works in pairs. You both need to match at a pre-determined combination of your choosing, even if that combination includes one of you not matching anywhere. The match algorithm doesn't care about specialty or location. (Hypothetically, you could design a couples match to deliberately be in different programs on different sides of the country!)

It can be harder to match as a couple in the sense that one of you could drag the other down. Let's say that you only submitted my sample list above with no additions. If you could have matched at C and your partner could have matched at D, but you didn't include that combination (maybe because they were in different cities), you would both end up unmatched. Or if you could have matched at C solo but your partner was never going to match no matter what, there's no combination listed that allows that to happen, so you would both end up unmatched. So to avoid risking anything due to the couples match, if you put every possible combination including each potential where one of you goes unmatched, then if one of you wasn't going to match no matter what, the other will still be able to match.

Going deeper into detail about that, it's worth noting that neither of your lists gets priority; you both need to fit a particular combination for the couples match to work. For a solo match, the algorithm only looks at the top program on your list without risking anything below. Either the condition is met that you match there, or the program filled with other candidates and only then would the algorithm look at the second position on your list, and so on and so on. But for a couples match, *both* of you need to meet the condition that you match to the combination in your top joint match, and either you both succeed or else the algorithm proceeds to the second combination, and so on and so on. 

Also, there's a potential that one of you might "drag the other down" in the sense that one of you might have matched into a better program applying solo. Looking back to the first three lines of my original sample list:

You Partner
A        A
B        B
A        B

If you truly wanted to train at A more than anyplace else in the world, but your partner doesn't match at A, the algorithm would then look at B-B. If you both match there, you'll both be happy in the sense that you'll be training at the same place. But you might be wondering if you would have matched at A on your own, and you might secretly feel like you just were dragged down...but you will never know it for sure. Hopefully that will not become a source of tension for the two of you. That's the only significant downside to a couples match.

Finally, I don't claim that this blog post is an exhaustive list of details about the couples match, merely a helpful perspective on what actually happens. For the official information, please visit the NRMP website.

Monday, March 14, 2016

Switching programs or specialties

What happens if you matched at one of your least-favorite programs? What happens if you matched into your second-choice specialty? Is it possible to transfer?

Matching anywhere isn't easy, so congratulations to everyone who received good news on Match Day! But maybe it's not the result that you dreamed of. For example, you interviewed at a dozen family medicine programs, but matched into your last choice. Or you really wanted to train in anesthesiology, but matched into your backup specialty of internal medicine instead. Or you were chosen for a position after using SOAP, but it's not what you were hoping for at all.

I want to strongly caution you: reapplying might hurt you more than it helps, unless you are very careful. Remember, if you leave, that will create a vacancy in your current program, and if your program director wants to fill it starting next summer, that means he/she has to interview people this year -- at the same time you're applying and interviewing. And if you don't match into a new program, but your program director finds someone, how does that get resolved? It might mean that your contract doesn't get renewed. That's why you and your director need to work this out together before you start applying (or you decide not to reapply, which is usually the best option). In short, would you prefer to complete your training where you already matched, or risk getting discharged after your first year and then not have anywhere new to train?

If you're absolutely determined to reapply, it's incredibly important to have the support of your new program director, and you should get most (perhaps all) of your LORs from your new attendings. After all, you didn't match into the particular program/specialty you desired with your old LORs, so you need to upgrade them to have a better chance. Plus, applying without the backing of your current program would look suspicious. If you don't use any LORs from your current program, you'll still need to include your current program's contact information in ERAS, and if I were a residency committee reviewing your application, that would be my first email or phone call. I can't imagine most applicants successfully transferring to a new residency program without the support of their current training program.

If you can't tell by now, I think that trying to switch is usually not worth the risk. But if you are completely convinced that you need a change, you should sit down with your program director to talk about the situation before you apply or even work on any documents. You would need a very flexible schedule so you can travel for interviews; the other residents will need to pick up the slack when you're not there, and that might cause some tension. If you take too much time off for interviews and second look visits, you might even be violating the terms of your residency contract! Being honest and upfront about this now will help you and your program director develop a good plan. But it also might convince you to stay where you matched and make the best of it, instead of trying to switch before ever giving your program a real chance.

If you need more information, please contact me for a free consultation.

Tuesday, September 15, 2015

September 15 is not an application deadline!

(an update of something I posted back in 2012)

September 15 is *not* the ERAS application deadline! Although it is the first day that you can send out your applications, you are not required to do so. Residency program directors will be downloading applications throughout the rest of the month until they can retrieve the MSPEs on October 1, and quite possibly even beyond that date. I know that some programs don't even log into ERAS on the 15th, partially because the system can be incredibly slow on the first day.

Multiple clients and even some non-clients have been asking for advice recently, wondering what to do if their USMLE Step 2 results aren't ready yet. If waiting until September 16th or 17th will make a difference, you can certainly delay your application, and apply with a more complete set of documents all at once. You won't be seen as "late".

Similarly, several people asked what to do about a letter of recommendation that still wasn't available in ERAS. In this case, it might benefit you to send out your application on the 15th without that missing LOR. late LOR doesn't typically reflect poorly on you; program directors know that even if you request something months in advance, sometimes your attendings just get really busy or distracted. However, you will need to go back into ERAS again to manually assign that LOR to every program that you want to receive it. It's more work for you, but it enables you to get the rest of your application out faster, if it's ready.

Yet there are many other potential applicants who are not ready, and are wondering if they should apply at all. If you're juggling too many things, like final rotations, observerships, research projects, and studying for Step 2CK, then this application may feel like another burden that you're not ready for, particularly if you've never had it professionally reviewed. Many potential applicants should not apply this year, and instead should focus on doing well on their exams and their clinical experiences. People who try to do everything all at once and then don't match get stuck the next year reapplying with lower USMLE scores and weaker LORs from attendings who weren't as impressed as they might have been. Do you really want to spend all of your money on applications this year that have so little chance of success? It's better to develop a strategy for what you should do in the coming months to continue developing your clinical skills, adding relevant experiences to your application, and putting yourself in a position of strength for next year.

There is no general advice that works for all applicants, and a blog like this can't possibly cover all situations. My suggestions for your particular situation might even disagree with what I just wrote above, depending on various factors. Please contact me for advice, preferably sharing copies of documents like your personal statement, LORs, ERAS application, and MSPE, and I'll do my best to give you some personalized guidance.

Sunday, February 8, 2015

Letters of intent

As you prepare your NRMP rank list, it can be very helpful to send your final thoughts to the program directors you met. You were able to start working on your online rank list on January 15, 2015, and you need to finish that process by February 25. Residency directors have the exact same date range to develop rank lists, so this is an ideal time to write to them.

A great way to approach this letter is to write it from the perspective of having finished all of your interviews. You're looking back, thinking about all of the programs you visited and people you met. Why does this particular program stand out for you? Why exactly do you want to train there? What should the residency director realize that you have to offer the team at that program?

Do *not* tell multiple programs that they are your number one choice. Although NRMP rank lists are never made public and it may seem safe, lying to a residency program could be discovered quite easily if a program has ranked you high enough that you would have automatically matched there had your statement been true. Residency committee members can have long memories, and when you are applying to fellowship or attending positions, submitting articles to journals where they serve as reviewers, attending conferences, or interacting with them in other capacities, I would hate for them to remember you in a negative light. It's even possible for the program where you *did* match to discover that you had lied to other prospective program directors, leading to an uncomfortable discussion about ethics.

If you send this letter via email, and you're wondering what to use as the subject line, many of my clients use one of these:

  • letter of intent
  • letter of interest
  • ranking plans

(There's no official rule about what to title the email, so if you want to use something different, that's fine. Many people don't pay close attention to subject lines anyway.)

Monday, March 3, 2014

The Waiting Game

You certified your rank list last month, and now you're anxiously awaiting your Match results. You're hopeful or worried, but most of all, you're determined to succeed and want to be prepared. What can you do?

1) Update your personal statement. You don't need to make sweeping changes, but you wrote this back in the summer or fall. What have you done since then that you wish the residency directors knew about you? Remember, your ERAS Common Application Form is certified, meaning that it can't be changed or updated in any way. So if you have recently completed an observership or externship, had a paper accepted for publication, participated in a volunteer experience, or learned a new language, adding a new paragraph just before the conclusion of your personal statement might be the best way to share this information. Try starting with "Recently, I..."

2) Transmit your newest USMLE scores. Since you originally applied, perhaps you finally took Step 2 (or if you're an international graduate, Step 3). Depending on the options you checked in ERAS last fall, the residency programs might not have your most recent scores. If you think that's the case, go to the Documents section of ERAS and look for the USMLE Transcript tab. Open that page, then click to "Retransmit" your scores, which will also transmit any new scores (as well as information about recent failed attempts) to all of your programs.

3) Transmit your updated medical school transcript, and maybe even a newer MSPE. If you're still in medical school, you were probably disappointed that so few grades and evaluations appeared on your original school documents when you first applied. Have a copy of your current transcript scanned into ERAS (after checking it for accuracy, of course), usually through your medical school's Registrar. After that, talk to your dean's office, and find out the policy for having an addendum added to your original MSPE. The addition of your newest evaluations might boost the value of your application...if your dean's office can prepare the addendum quickly.

4) Consider getting the support that you need for SOAP or during next year's match. I would be happy to assess your candidacy for residency, so please contact me for a free consultation. Share some information about your application and interviews with me, and also include your personal statement, CAF, list of USMLE scores and attempts, and LORs and MSPE if you have access to them.

Friday, May 31, 2013

United States clinical experience can make the difference

One of my clients recently asked when he should try to schedule observerships in the United States. He thought that because residency interviews don't usually start until October, and might not happen until January, there was no reason to fly to the United States until August at the earliest. But I'll tell you why I disagree. Residency directors think that United States clinical experience (USCE) is incredibly valuable, much more than the training you get in your home country. Even if you would only be an observer here but back home you were allowed to carry your own patients, it's still important to have some USCE on your application, and the earlier, the better.

Timing is crucial. If you're applying to the 2014 Match, you'll be submitting your application in September 2013. If you don't complete your observership until the end of August, there's a good chance that your LOR won't be ready at the time you apply. Remember that your attending has to make time to write the LOR (or will ask you to create a rough draft), and then the letter needs to be processed by the ECFMG. Just like USCE compared to international experience, an American LOR is more valuable. Residency directors trust these letters and they will increase the value of your application.

Of course, USCE in September or even later is better than none at all. If your upcoming observership has been confirmed but has not yet started when your certify your Common Application Form in ERAS, you might consider adding that upcoming training to your CAF. You will need to be very clear that it has not started yet, and never lie about it. If you have not received a confirmation from the clinic/hospital, do not include it in ERAS! You can always share new information with a residency director during an interview.

There are other ways to get USCE. For example, many graduates of the Universidad Autonoma de Guadalajara in Mexico and similar schools have completed the Pre-Internship Program (originally called "Fifth Pathway") at New York Medical College. If you are not a graduate of UAG but you think you meet the program's criteria, I encourage you to contact NYMC for more information. Training there typically starts in either July or January; if you start in July 2013 then you should be able to get several LORs from American doctors in plenty of time to support your 2013-2014 residency application.

Speaking of UAG, there's a great article in the May 13, 2013 issue of The New Yorker about Elmhurst Hospital in New York, and it specifically focuses on diagnostician and clinical educator Dr. Joseph Lieber, who is a graduate of Universidad Autonoma de Guadalajara. He is incredibly knowledgeable, well-respected, and inspirational. Imagine the main character from the television show House, but loved by everyone. Here is a link to the first few paragraphs of the article; if you have access to a library where you can read the entire article, I encourage you to do so. It will inspire you and could be a useful topic of conversation during a residency interview.

As always, please contact me if you have any questions about the residency application process. I am happy to provide a free assessment of your application. I can help you develop your personal statement and CV, advise you about your strengths and weaknesses, and much more!

Monday, March 11, 2013

NRMP / SOAP schedule

Good luck to all of my clients and to residency applicants from around the world! Here's what the NRMP has posted as this week's Match and SOAP schedule (all times are Eastern):


Supplemental Offer and Acceptance Program (SOAP) starts on 03/11/2013

Monday
Send Applicant and Program Match results to ERAS before 12:00 p.m.
11:30 a.m. Schools: Unmatched Seniors Report (R3 System)
12:00 p.m. Programs Did I Fill? by email and R3 System
12:00 p.m. Applicants: Did I Match? by email and R3 System
12:00 p.m. List of Unfilled Programs (R3 System)
12:00 p.m. Regional Match Statistics (R3 System )
1:00 p.m. ERAS opens in SOAP-mode
2:00p.m. ERAS begins sending applications; only eligible applicants can send
applications and only to unfilled match-participating programs
Program-initiated telephone communications between applicants and programs
may begin, but no offers allowed

Tuesday
Applicants and programs communicate by program-initiated telephone interviews
11:30 a.m. Programs can begin preference list in R3 System

Wednesday
11:55 a.m. Program preference list certification deadline for first offer round
12:00 p.m. Electronic offers extended using R3 System
12:00 p.m. School Report on seniors who accepted positions through SOAP
available and updated continuously.
2:00 p.m. Deadline for Applicants to accept / reject offers
2:55 p.m. Deadline for programs to add to and certify preference list for next round
3:00 p.m. Electronic offers extended using R3 System
5:00 p.m. Deadline for Applicants to accept/reject offers

Thursday
Offers extended every three hours beginning at 9:00 a.m. with last offers valid
3:00-5:00 p.m., using same update schedule noted on Wednesday
8:00 a.m. Schools: Match Notification Letters (R3 System)
8:00 a.m. Schools: Electronic Match Results (R3 System)
8:00 a.m. Schools: Match Results (R3 System)
8:00 a.m. Schools: Applicant Choices by Specialty (R3 System)
8:00 a.m. Advance Data Tables (R3 System)
2:00 p.m. Programs: Roster of Matched Applicants (R3 System)
SOAP Schedule
Main Residency Match - 2013 Main Residency Match

Friday
Match Day!
Offers made every three hours beginning at 9:00 a.m. with last offers valid 3:00-5:00
p.m., using same update schedule noted on Wednesday
12:00 p.m. School Ceremonies
1:00 p.m. Applicants: Where Did I Match? (R3 System)
3:00 p.m. ERAS SOAP-mode ends
List of Unfilled Programs posted through May 1 (R3 System)

Monday
12:00 p.m. Match Outcome for All Programs (R3 System)
12:00 p.m. Match Results by Ranked Applicant (R3 System)
12:00 p.m. SOAP Results by Listed Applicant (R3 System)


If you didn't match and can't find a program through SOAP, I encourage you to read one of my earlier blog posts. Please get in touch with me - we can work together to find you the residency program you've been dreaming of!

Friday, October 26, 2012

How the NRMP Match algorithm works

Are you curious how the Nobel Prize-winning NRMP Match algorithm works? Here's my example highlighting the story of three students:


Students Alice, Ben, and Carlos apply to various numbers of IM programs through ERAS. Alice gets ten interviews, Ben gets zero, and Carlos gets two. Again, the NRMP has no idea how many. Alice has some good and some bad interviews, but decides to rank all programs. Ben ranks a dozen programs that he wants to go to, even though none of them interviewed him. Carlos only ranks one program (which happens to be a program that both Alice and Ben have ranked).

The IM program at Tufts will hire five residents, and ranks fifty applicants who interviewed there. Among other people, it ranks Alice at number 6, Carlos at number 14, and doesn't rank Ben at all (unsurprisingly since they didn't interview him). Alice ranked Tufts at number 4, Ben ranked it at number 2, and Carlos ranked it at number 1.

Match algorithm time. Ben has only ranked programs that don't have him on their lists. No matter how many he tries to rank, there's no possibility of a corresponding match, so he ends up unmatched.

The algorithm tries to match every applicant to their top choice and does not "count" how many programs they actually ranked. If an applicant's top choice has an open slot immediately, the match happens. Because Carlos has 13 people ahead of him at Tufts fighting for those five slots, there's no way that the first iteration will work for him. Alice also fails to match at her top choice (Harvard), and let's say that all of the spots there were instantly filled.

On the second algorithm iteration, Alice's top choice of Harvard is completely blocked. Her #2 choice (Stanford) automatically becomes her new #1...the program will not try to match her at Harvard again because it's impossible. It tries and failed to match her this time, but not all Stanford spots are full, so hope isn't lost yet. Concurrently, the algorithm tries to match Carlos to Tufts. He doesn't get matched this time either, but he's moved up to #12, since one person higher than him near the top of the Tufts list matched to her own top choice somewhere else. Interestingly, Alice is now at #5 on the Tufts list, which means the spot is potentially hers, but the algorithm hasn't tried matching her there yet.

A few algorithm iterations later, and Alice's second choice is full without her matching there, Tufts has matched three people out of five, and all of our heroes are still waiting...though it's just been a few microseconds.

A few more iterations and Alice's third choice (UCSF) is full. Carlos moved up a couple of spots. Tufts has matched its original first, second, and fourth choices, with the third matching elsewhere. Alice and the person originally in the ninth rank now have spots "held" for them due to the original fifth, seventh, and eighth on the list matching elsewhere, and the two of them moving up the ladder.

On the next iteration, Alice matches to Tufts. It's her fourth choice, but it was "virtually" her top choice since the three programs above it filled and she had no chance of matching there. She takes the fourth spot. 

A couple more iterations later and the fifth spot is filled (that man had ranked another program higher, and his spot at Tufts was "held" for him while that other match tried and failed to happen). Carlos is unmatched since Tufts was the only program he ranked. Interestingly, the other program he interviewed at had ranked him quite highly, and he would have matched there if he had bothered to rank it. Ben never had a chance of matching since he didn't interview and no programs ranked him. Both men can try to find a spot through the Scramble/SOAP.

And thus concludes a *very* realistic scenario. The NRMP has their own sample scenario on their website if you want to read it.


My congratulations go out to the creators of the current NRMP Match algorithm, who recently won the 2012 Nobel Prize in Economics! Click here for a short and accessible description of this achievement, and click here for the full journal article about the algorithm's history and development.

Friday, September 14, 2012

September 15 is not the ERAS application deadline!

September 15 is not the ERAS application deadline! Although it is the first day that you can send out your applications, you are not required to do so. Residency program directors will be downloading applications throughout the rest of the month until they can retrieve the MSPEs on October 1, and quite possibly even beyond that date.

What does this mean? Instead of submitting a poorly edited personal statement and an incomplete Common Application Form on the 15th, you should take the time to have your application professionally reviewed. Residency directors don't need your application immediately; they would prefer that you take your time and submit your best effort later this month.

I've been supporting medical students since January 2001, and I would be happy to share more than eleven years' worth of expertise with you. I will give you feedback on your personal statement and ERAS application, and if you'd like, I can go deeper and tell you how residency directors might react to your MSPE and letters of recommendation too. Please contact me for a free consultation. It's not too late to have the residency application you deserve!

Tuesday, July 31, 2012

Professional Memberships & Associations

One of my clients recently asked me whether joining professional groups could help her application. She also wanted to know if joining both the American College of Physicians and the American Academy of Family Physicians would help or hurt since they're focused on different specialties.

First, I think that it's most important to question why you are joining a group. Are you still in medical school and you want to learn more about residency in a certain profession? Great; you should definitely join! Are you a graduate who has decided on a field of interest and you want to interact with other professionals? That's another great reason to join.

Or are you only joining this group in order to list it on your CAF? If so, that is a bad reason and you might not want to do this at all. Padding your resume with groups that you've joined simply to impress program directors might actually cause you trouble. What would you do during an interview if someone asked you "Why did you join this group?" You'd have to say that you only joined to strengthen your application. That's not enough.

So before you join, think about what you can get out of these groups. Are you planning to attend conferences, read their journals, collaborate with or learn from members, make professional connections, and learn more about those fields? If you can honestly answer "yes" to some of those, and you will be able to comfortably describe your involvement if asked about it during an interview, then joining might be the right idea after all.

As for joining two different associations, remember that anything you list on your CAF will be seen by all programs you apply to, so FM programs will know that you joined the ACP, and IM programs will know that you joined the AAFP. Is that a bad thing? Not necessarily, since many people openly apply in both FM and IM, and both give you the potential to explore what it means to be a physician in a society increasingly concerned with primary care medicine. But if you're applying in both surgery and psychiatry, but don't want the program directors to know that you're doing that, then listing the American College of Surgeons and the American Psychiatric Association on your CAF might hurt you.

As always, please contact me directly, and I can discuss your specific application during a free consultation. There's no single answer to these questions or for any issues relating to your residency application; let me come up with a customized approach for you.

Saturday, June 30, 2012

The Residency Application Timeline

The 2012-2013 residency application cycle is about to begin! If you're applying for the first time, or even if you've gone through this process before, these are the crucial dates that you should be aware of. Please note that several of these dates have changed from previous years:

  • July 1, 2012ERAS opens its MyERAS website. First, you must request your login token (American medical students and graduates should talk to their deans; international graduates should use the ECFMG/OASIS site). After you register with your token, you can start editing your resume into the Common Application Form style used in ERAS, which not only means adding your educational and USMLE history, but more importantly means changing resume bullet points into full well-written paragraphs for each of your volunteer, work, leadership, and research experiences. You can also work on your personal statement, start requesting letters of recommendation (there's a form to print out for your writers), select programs and specialties, and much more. There's a lot to do and not very much time to accomplish it all, especially since you're studying for the USMLE, completing rotations or observerships, and worrying that your writing isn't as strong as it could be. You only get one chance to have your application make a great first impression! Many applicants realize that it's a great idea to find a residency support professional to help during this time. Please contact me for a free consultation.

  • September 1, 2012 – the NRMP website opens. The NRMP "Match" is processed separately from ERAS. Basically, you use ERAS to select where you hope to interview and to transmit your documents to those programs, but you use the NRMP to rank the programs where you actually get interviews so you can match there. You can save some money by registering for the NRMP early; while you don't need to register on September 1, the last day to register with a discount is November 30, 2012.

  • September 15, 2012 – this is the first day you can pay ERAS to transmit your application to residency programs. Many people will apply on this date, but it is not a deadline. It is much better to apply in late September with a fully reviewed and edited application, instead of sending something out with mistakes on September 15. (for those of you who applied last year, this is a later date!

  • October 1, 2012 – this is the date when your Medical Student Performance Evaluation (the MSPE, also called the "dean's letter") will be transmitted to all programs that you have paid ERAS for. When program directors download your MSPE, they will automatically download all other documents waiting for them, so you should ensure that your letters of recommendation and medical school transcript are in the system already. (for those of you who applied last year, this is an earlier date!)

  • November, December, and January – most interviews are scheduled during this time. Be prepared! Review your answers to common interview questions with a professional, and also ask that professional about the flaws in your application (such as failing the boards or taking a lot of time off) since the program directors will ask about those topics too. Even a great ERAS application means nothing if you don't succeed during the interview.

  • February 20, 2013 – this is the final deadline to register your rank list with the NRMP. You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program. You should rank the programs in the order that you hope to match to each one. Please read this for more information.

  • March 11, 2013 – this is the date when everyone who used the NRMP will find out *if* they matched, but not *where* they matched. If you are unmatched, you will be able to try to "Scramble" into open residency programs during this week.

  • March 15, 2013 – NRMP Match results are released, so people will finally find out exactly where they are going to be residents.

I know this is a lot to process, so please contact me for a free consultation and I'll help you!

Tuesday, February 21, 2012

Your NRMP rank list

Tomorrow is the deadline to submit and certify your final rank list with the NRMP. Here are the key points that you should be aware of:

1) You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program.

2) You should rank the programs in the order that you hope to match to each one. The NRMP algorithm is skewed in the applicant's favor; it will not hurt you to rank your favorite program first, even if you think you have no chance of matching there.

3) The rank list you submit and certify on the NRMP website is a binding commitment. If you match to a program on your list, that's where you're going.

4) The deadline for submitting and certifying your rank list to the NRMP is 9:00 PM Eastern time on February 22, 2012. However, I strongly suggest that you certify your list well in advance of that deadline. Power failures and bad Internet connections have caused trouble for applicants in the past, and if you don't meet that deadline, there is nothing that anyone can do for you.

UPDATE: Yesterday, I posted the text you see above, and today the NRMP website went down for over two hours (see screenshot below), but they did not change the final rank list deadline. Imagine if you had only set aside those two hours to work on your list!

Friday, December 30, 2011

"Second look" visits

Sometimes you do get a second chance to make a great first impression. A "second look" visit to a residency program can be an amazing way to show just how interested you are. During a second visit, you will be more relaxed and comfortable, and the people you meet will sense that. Typically, it's a chance for the original interviewers to get to know you better in a less stressful setting. Sometimes other faculty members will be there who weren't available during your first interview. At some programs, you might even be able to join a team during rounds.

Not everyone gets invited for a second look; it's a sign that the program director liked you a lot. Remember that the interview process isn't just about you asking for a job; it's about the program trying to convince the right residents to match there. Adding an applicant to a rank list is taken seriously; it's a multi-year commitment, and the program director wants to find residents who will be great long-term additions to the team, both on and off the wards. Although a second interview visit is an added expense, you ought to think of it as an investment in your future, and accept all offers. Remember that even if you aren't invited for a second look, you can also ask to return for a second visit.

Even if you've only interviewed at one or two residency programs in total this year, the residency director doesn't need to know that. Remember, as much as you want to match anywhere, the interviewers will assume that you're evaluating multiple programs, and will try to convince you to rank that program first.

Second look visits are often a good time to ask residents about lifestyle issues (how good/bad is it really), official work hours versus unofficial expectations, would they choose this program all over again if they had the chance, what aspects of the program are their favorites, and all sorts of questions like that. You should ask where people live, how often they hang out outside of work, what kind of things they do in the area, etc. You can also ask about things like maternity leave policies, but that allows the program director to use that information when ranking you, so be very careful. Sometimes asking questions like "Do you have any relatives nearby" will let people tell stories about their own spouses and kids without you sharing information that you legally can't be asked about.

One of my clients was recently invited for a second look visit on a date when she already had a first interview scheduled somewhere else. I'll tell you the same thing that I told her: although second look visits are important, if you need to choose, you should keep your appointment for a first interview. Most of you can't afford to skip any first interviews; you want to visit as many programs as possible to increase your chances of matching. Plus, what reason would you give for rescheduling that first interview? Instead, you should see if there are any other dates available for that second look visit. You can honestly tell the program director that you want to honor the commitment you already made to another program (although you don't need to share specifically where else you are interviewing), but that coming back for a second visit is also a priority for you.

Good luck! Please contact me if I can provide any more information.

Friday, October 14, 2011

Your online identity

What does your Facebook profile tell the residency directors about you, and is it helping you or hurting you? What types of quotes, photos, and "likes" are on your page? Do you start the day by posting how much you had to drink the night before? Are your posts full of profanity, or do you constantly complain about your boss? Is there a photo of you smoking tobacco from a hookah that could be misinterpreted as smoking marijuana from a bong? These could all stop you from getting invited for an interview, and even if you do get invited, do you really want to waste time during the interview giving excuses about your online profile rather than talking about what a great resident you would be?

Let's say that a typical residency director gets 1000 applications, schedules 100 interviews, and can only match 10 people at that program. These people are looking for an excuse to narrow that list, either by not granting you an interview at all, or deciding not to put you on their NRMP rank lists after they interview you. Searching for information about you online happens more frequently than you think! There are many qualified applicants out there who have professional-looking online profiles, and they could very easily move ahead of you in the applicant pool. Don't get rejected because you insist that your Facebook page is a place to "be yourself." You're a doctor, and it's time to be professional. Take down the worst photos, and clean up your online presence. Privacy settings are not enough, especially since Facebook seems to change its format and settings every few months.

This is also a great time to create a professional profile for yourself. There are many sites out there, but I'll mention LinkedIn specifically since I've heard that some residency search committees search it. You've already done all of the work creating your Common Application Form in ERAS; why not create a professional resume on LinkedIn using the same descriptions from the CAF that you spent so much time editing? Give the residency directors something positive to find about you online.

Right now, residency directors are continuing to review the huge numbers of applications that they have received. After you get interviewed, the residency search committees will continue to seek out more information about you before making final rank list decisions. Yes, they will contact your letter writers, but it's very easy to go online to search for more information. Although residency directors have invited some applicants, they're still deciding what to do about the rest of you. Your MSPEs (formerly known as the "dean's letters") will be released on November 1, and many residency directors don't make final interview decisions until they read what your medical school dean has to say about you. There's still time to clean up your online profile, which will hopefully lead to more interviews and might enhance your chance of matching. What are you waiting for?

Friday, August 19, 2011

Spelling and grammar in ERAS

Spelling mistakes and grammatical errors can ruin your residency application. Even if you have great USMLE scores, strong letters of recommendation, and lots of U.S. clinical experience, the residency directors will read your personal statement and Common Application Form to learn what kind of person you are. If they see that you didn't take the time to spellcheck everything in ERAS, or if you use poor grammar in your personal statement, the residency directors might think that you're lazy or sloppy. Would you hire a lazy or sloppy doctor?

This is a professional application for the most important step of your medical training so far. This is not Twitter; this is not Facebook; this is not a text message. Proper capitalization, spelling, punctuation, and grammar are extremely important from now through Match Day. That includes everything you send through ERAS, as well as all email correspondence and thank-you notes.

This is also true for your letters of recommendation. Sometimes your advisors and mentors will ask you to prepare a rough draft. Do you know what should be included in a letter of recommendation, and what should not be there? Are you able to write a proper and professional LOR? I can help you with that too.

If English is not your first language, or even if you've been speaking English your entire life but were too busy learning medicine to focus on the rules of grammar, you need to have your entire application reviewed. I am happy to offer you a free consultation; send me your CAF and personal statement, and I will share my preliminary thoughts with you at no charge.

Monday, July 4, 2011

July 15 is not the new ERAS deadline

If you log into ERAS this week, you will see a MyERAS Alert on the main page:

Applicants will not be able to certify their applications until July 15, 2011 when programs have the ability to download applications. Please use this time to begin the application process, and fill out the information requested within the MyERAS application.

What does it mean? The July 15 date only applies to people applying for fellowships, as well as to people applying to osteopathic programs. The vast majority of you don't need to be concerned about it; you'll still be applying to residency programs on or after September 1.

Personally, I think that the ERAS alert should have been phrased more clearly. There are actually a number of confusing things about ERAS, and it's always best to ask for help and advice. Please feel free to email me with your questions.

UPDATE: I originally posted this on July 4; since then, ERAS has updated the alert to make it a little clearer (new text in red):
Applicants will not be able to certify their applications until July 15, 2011 when July cycle programs have the ability to download applications. Please use this time to begin the application process, and fill out the information requested within the MyERAS application.

Saturday, June 25, 2011

Choices

Everyone wants the strongest residency application, but it's often hard to tell what a program director is looking for. People often ask me to help them choose between two options for a variety of topics, and here are some of my thoughts that might help you. While there are certainly exceptions for specific situations, I strongly believe that the vast majority of you will benefit from this advice when applying to American residency programs:
  • Participating in a hands-on externship is better than shadowing during an observership.
  • A letter of recommendation from an externship is better than a letter from medical school.
    • Recent clinical experience is very valuable! You will enhance your knowledge base and clinical skills during an externship, and that will show in your letters of recommendation.
  • A letter of recommendation from your fourth year of medical school is better than a letter from your third year.
    • The skills and confidence you develop during your fourth year will be reflected in your letters.
  • United States clinical experience is better than international experience.
  • Applying in mid-September with a complete application is better than applying on September 1 with an incomplete application.
    • I really want to emphasize this point. Far too many people rush to send out their applications on September 1. If your application has spelling and grammatical mistakes, is missing key information, or is otherwise incomplete, you have wasted your chance and you have failed to impress the program director. Take the time to have your application reviewed by a professional.
  • Describing your work, volunteer, and research experience in ERAS should be done using full sentences, not the bullet points that you would find on a regular CV.
  • Explaining your non-medical experiences in ERAS is better than having large chronological gaps on your application.
  • Leadership of an organization (such as a student club) is better than casual membership in that group.
  • Primary care specialties (internal medicine, family medicine, pediatrics) are more receptive to applications from international graduates than non-primary care specialties are.
  • Making presentations and/or publications of your research is better than participating in a research project with nothing to show for it.
  • Honesty is always, always, always better than lying on your application.
Also, as you probably know, ERAS opens on July 1 to start the residency application season. If you'd like a free assessment of your residency application, I'd be happy to review what you've already prepared, such as your CV and a draft of your personal statement. I have been advising and supporting residency applicants like you for over ten years.

Monday, April 25, 2011

I didn't match! What should I do now?

Unfortunately, not every applicant matches into a residency program. As bad as this year's situation was with the delayed list of open programs on Scramble Day, you can't just blame the NRMP. And maybe some program directors gave you false hope during your interviews, but they never actually promised you a residency position. Think back. Did you get as many residency interviews as you had hoped for? Now is the time to assess your application and determine how to make it stronger to get those interviews you want:

  1. What specialties did you apply in last time? Did you pin all of your hopes on a competitive specialty like orthopedic surgery? Or did you remember to apply in primary care fields like family and internal medicine, which often have more vacancies and are looking for qualified applicants?
  2. Where did you apply last time? Did you focus your search on states like California and New York, perhaps because that's where you and your family live? Or did you apply to places like Idaho and Nebraska to increase your chances of getting interviewed, since programs there don't always fill during the Match?
  3. What have you done since graduating? Have you been relying on the knowledge base and procedural skills you learned in medical school? Or have you continued to grow as a doctor through externships, medical volunteering, and relevant research?
If you're planning to apply to residency programs again in the fall, you must seriously consider what you can do over the next few months to become a stronger applicant:

  1. A hands-on externship is much more impressive than a simple observership. Admittedly, these opportunities can be hard to find. But if you're serious about improving your application, talk to the doctors in your community to find out about available externship opportunities. There are even companies you can pay to place you into an externship. While it's an expensive option, the knowledge you acquire and skills you practice during that externship will be extremely valuable, should lead to a strong letter of recommendation, and will be prized by the residency directors.
  2. If you graduated from a foreign medical school, and you performed poorly on USMLE Step 1 or Step 2, you should consider taking Step 3 now. Remember that taking the exam is not enough; you need to have your passing score available before you submit your applications to residency programs. Applying with the phrase "awaiting results" in your ERAS Common Application Form is not going to help you; there are plenty of people who have already passed Step 3, and why should a program director look at your incomplete application? Of course, you want to do better than simply passing Step 3; you want to get a great score, so you should strongly consider paying a professional test prep organization to help you study. Additionally, your externship will be a great way to prepare, since there's nothing like real-life experience.
  3. Did you have someone help you with your residency application? A well-written personal statement and detailed Common Application Form can make a huge difference when residency directors are deciding who to invite for an interview. I am happy to provide a free consultation, assessing your old residency application and suggesting some things you can do to improve it. I have over ten years' experience advising and supporting residency applicants like you.

Wednesday, March 9, 2011

How the residency Scramble works

March 15, 2011 at noon (Eastern time) is the first time you will be able to access the dynamic list of Scramble programs with open positions. (it's a dynamic list because as programs fill, the NRMP is supposed to take them off the list - roughly once per hour the list will be cut down, but they don't add new programs) These are only available as PDFs, so you will need Adobe Reader or a similar program to view them.

You and your advisor (having an advisor help you is crucial!) should log into the NRMP website, look through the list of programs, and decide who to contact first. For example, maybe your advisor was a classmate of a program director and chooses to call her first on your behalf. And you might decide that there's no way you would work in Kansas or Nebraska, so you cross those programs off the list. But basically you'll start by reviewing the programs and deciding who to call. This is a long process. It's hard to get through to a program director so you (or your advisor) will be leaving a lot of messages.

If you two do get someone on the phone, there's no single "right" way to proceed. Often the advisor will speak on your behalf, briefly advocating for you, describing your skills and why you'd be a great candidate. Then hopefully you'd be able to have a short phone interview with the program director, who would encourage you to send your application via ERAS. But maybe a program coordinator will answer the phone and say that a Scramble spot has already been filled (some open positions are filled almost instantly, even though the NRMP would still show it as being open until the database was finally updated). Or you might simply be told that the program will not take any international graduates during the Scramble, and you'll never be able to get on the phone to plead your case. Or they might not want to speak to your advisor at all and only want to talk to you. In the end, you'll follow up by transmitting your official application.

According to the program directors I've spoken to over the years, they really want to get your application via ERAS, not by fax or email. That means that paying a company to fax your application is usually a waste of money. But of course you should do whatever you think is best. You will be able to apply to a maximum of forty-five new programs through ERAS (specifically 30 on the first day of the Scramble, 10 on the second day, and 5 on the third day). You cannot pay ERAS to apply to more programs.

But since ERAS limits how many new programs you can send an application to, many people do not send out their applications through ERAS during the Scramble before talking to program directors or program coordinators. If there are more than forty-five open positions in Internal Medicine, you don't want to waste one of your applications by applying somewhere that's already full or a place that doesn't want an international graduate. Forming a personal connection first is crucial. The hope is that the mini phone interview will help them get to know you and want to know more about you by reading your entire application. Remember that during the phone conversation, they basically know nothing about you, so that's why your advisor introduces you, and then you briefly describe yourself and your strengths.

While it's true that some Scramble applicants will get match offers quickly, many others will send out their applications through ERAS and then wait to hear back. Since the program directors don't need to fill the positions blindly, some do take the time to read every page of every new application and then decide who should visit for an interview. Interviews sometimes occur throughout the spring before someone is offered a residency contract.

I wish you the best of luck during the Scramble. If you have trouble matching and need to reapply next year, please let me know if I can help.

Sunday, February 20, 2011

Preparing for the NRMP Residency Match

Every year, the residency application and interview process culminates in the Match. Though you used ERAS to transmit your application materials to residency programs, the NRMP is the organization that administers the Match. In this process, you prepare a list of the programs you interviewed at, putting them in the precise order that you would prefer to go to them for residency training. Here are a few points that explain this confusing process:

1) You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program.
2) You should rank the programs in the order that you hope to match to each one. The NRMP algorithm is skewed in the applicant's favor; it will not hurt you to list your favorite program first, even if you think you have no chance of matching there.
3) The rank list you certify with the NRMP is a legally binding commitment. If you match to a program on your list, that's where you will be going.
4) The deadline for certifying your rank list with the NRMP is 9:00 PM Eastern time on February 23, 2011. However, I strongly suggest that you certify your list well in advance of that deadline. I've heard horror stories in the past about power failures and bad Internet connections, and if you don't meet that deadline there is nothing that anyone can do for you.

Additionally, it can be difficult to decide what criteria to use when ranking these programs. Here is an incomplete list of factors to consider when preparing your rank order list:

  • salary and benefit options
  • geographical location (which part of the United States, as well as urban versus rural areas)
  • population dynamics of the community
  • the program's accreditation standing
  • the PGY-3 pass rate
  • support for professional development (such as attending conferences)
  • the program's academic strengths
  • long-term connections with that program (do you see yourself doing a fellowship there? how many residents become attendings?)
  • opposed/unopposed programs
  • the number of rotations done away from the hospital (which might separate you from your family for lengths of time)
  • the program's individual values
  • your prior contacts within the program (such as medical school alumni)
  • how this move would affect your family
Of course, you need to decide how important each factor is for you. Some might not be important at all, and there might be other considerations specific to your situation that aren't listed here.

I wish you the best of luck during the Match! Please contact me if you don't match successfully, and I will give you a free consultation to help you prepare for next year.

Saturday, February 5, 2011

Join a committee

One great way to strengthen your candidacy for residency is to join a medical school committee. Typically, there are a variety of committees chaired by a dean or faculty member that meet regularly to discuss campus issues, such as ways to improve the curriculum, improve student life, adjudicate legal matters, or prepare for an upcoming re-accreditation process.

There are strong potential benefits to joining a campus committee. You'll learn a lot about how your medical school works, making you better informed and more well-rounded during your interviews. Also, many residency directors assess both the short-term and long-term benefits of your ERAS application. Short term, of course they want to know that you have the knowledge base and patient skills to be a great resident. But long-term, they might hope that you would stay at the hospital after your training and help guide the next version of the residency curriculum. Your committee experience could be an important factor in the residency director's decision.

Committee involvement could help your application in other ways. Your dean would include it in your MSPE, hopefully praising you for your dedication to the medical school community. Additionally, the chair of the committee could be the source of a strong letter of recommendation, especially if you two also worked together in a clinical or research capacity.

However, your academic transcript and USMLE scores need to be a priority! Don't join a committee if you can't balance your life. Many student committee members join in the pre-clerkship years, and leave when they start clinical rotations, and that might be the right plan for you too. There are also certain committees that would greatly benefit from the perspective of a third-year or fourth-year student. So if you're interested in getting more involved, talk to your dean at any time about opportunities.

Monday, January 31, 2011

I'm here to help you

Are you applying to residency programs? Maybe you feel like you're not getting the personal attention you want from your medical school dean, or you've already failed to match on your own and realize that you need more help this year? Perhaps you were trained abroad and now want to practice medicine in the United States, but the process of applying as a foreign graduate seems incredibly complicated? Or you're an osteopath who doesn't know how to present your training to an allopathic residency program? I'm here to help all of you.

In January 2001, I started supporting medical students at the University of California, San Francisco. It was a privilege to develop my advising skills and knowledge of the residency application process while ghostwriting the Medical Student Performance Evaluations ("dean's letters"), organizing workshops on personal statements and using ERAS, and helping to develop a new component of the medical school curriculum. After earning the respect of my colleagues and a major award from the students, I left UCSF in 2007, and since then I've been sharing my skills with people from all over the world.

It's been ten years since I started helping medical students. In that time, I've learned a great deal and have helped a number of people successfully write personal statements, edit Common Application Forms, solicit the right letters of recommendation, share documents with the ECFMG, prepare for interviews, and use the NRMP to match into great programs. Now, I want to help you answer the question, "How do I get into residency?" I plan to use this blog to explore a variety of topics, sharing some of what you need to know to improve your chances of matching.

Of course, this isn't just my passion, but it's also my career. I run http://www.residencysupport.com/ - currently, my clients and advisees are medical students and graduates from all over the world (plus a handful of undergrads getting a head start on their futures who want to know "How do I get into medical school?"). I've helped people from all over the United States, as well as graduates from medical schools in locales including Mexico, South Korea, Iran, and throughout the Caribbean. This year my clients were trained in many of the same locations, plus Canada, India, Egypt, China, Armenia, and more! If you want a personal consultation at any time, please visit my website for more information; I look forward to hearing from you.