How many programs?

Potential clients frequently ask me how many programs they should apply to, but there's no easy answer, and in fact this is one of the few topics that I specifically mention in my contract that I don't handle. Even if I had attended medical school, earned the same grades and USMLE results as you did, and participated in the same experiences, I might approach the problem very differently. I don't think there's a right number, or a good number, or a safe number for any specialty. But if I were a typical IMG interested in family medicine and internal medicine, I might apply:

* To every hospital where I had rotated or completed an externship

* To every hospital where my friends are current residents in one or both of these departments

* To every hospital where my letter writers have professional colleagues in one or both of these departments

* To every hospital where my family and friends have a connection in one or both of these departments

* To every hospital where I've already had good discussions with program representatives (for example if you attended the national AAFP conference in July)

Beyond that? Any other program you pick is your choice, but the less connected you are to it based on the criteria above, the program directors might be less likely to give your application the attention it deserves. If you want to add to your list, first consider how IMG-friendly it is (are there lots of residents from schools like yours in those departments?), and then maybe if it fits other criteria you're looking for (underserved area? rural vs urban?). It's hard to say if simply living in the same state as a program normally helps, but a bilingual applicant from a border state ought to be able to demonstrate their connection to patients in that region.

So your first attempt at creating a list might have 20 programs, but it might have 200. The quantity doesn't matter to me...though it certainly might matter to you! Do you know how expensive ERAS is? After you pick your first 30 programs in a certain specialty (which isn't too expensive), ERAS starts charging you a lot more per program, and the fees add up quickly. They published an online list of fees that I recommend reviewing. 200 programs in your first choice specialty would cost almost $5000.

Applying to more places doesn't automatically get you more interviews, especially if you're seeking out programs that seem out of reach. Because every program director assesses your application separately, then sure, there's a chance at additional invitations, but if you're picking programs that are less IMG-friendly or where no Caribbean student has ever matched before, you could just be throwing money away. I strongly encourage you to contact your medical school and review their match success lists, and talk to former classmates to not only find out where they applied, but where they received interview offers. Use free resources like FREIDA and Residency Explorer to focus your search. Review program websites to see their lists of current residents; do they seem IMG-friendly? Additionally, IMGs from some schools can't get licensed in certain states; it's your responsibility to research this, because these restrictions won't stop ERAS from accepting your money.

Finally, I strongly recommend you sit down with a trusted attending to see what they think about this message and what they can do to help you get interviewed. If you need help actually preparing your application documents, getting ready for interviews, and the overall Match process, please contact me!

SOAP during the pandemic

In December 2020, the AAMC's Chief Medical Education Officer announced she had seen "a maldistribution of residency interview applications" (or to rephrase this like one of my clients did, "interview hoarding"). In short, this meant that top-tier American applicants were accepting far more interview offers than ever, presumably because it was cheap and easy to interview virtually, instead of the normal practice of taking time off from rotations and paying to fly around the country for in-person interviews. Unfortunately, this hoarding led to IMGs missing out on interviews that they might have otherwise received, since some residency committees were so happy that these American graduates wanted to interview at their lower-tier programs, and didn't bother to interview as many IMGs as they usually did. 

But those committees didn't realize that these American graduates weren't likely to rank those programs highly, so they probably won't match there. If those same programs didn't interview enough IMGs to fill the bottom of their rank lists, they might have unfilled positions, which could be a great opportunity for residency applicants like you.

This year, Match Week begins on Monday, March 15, which is when you will find out if you matched, but not where. The week concludes on Match Day (Friday, March 19), when the name of the program you matched to is revealed. In between those two dates is the "Supplemental Offer & Acceptance Program," better known as SOAP. During that week, eligible unmatched applicants can apply for free to a total of 45 programs (it's your choice if you want to apply to all 45 in one specialty, or spread that out among multiple fields, but you can't pay ERAS to apply to more than 45 during SOAP). Be thoughtful about where you apply, and consider following the SOAP advice I've previously posted. For the first time ever, the NRMP has added a fourth "round" when programs will make offers to applicants, so it's more crucial than ever to be prepared for a quick interview during Match Week.

If you don't match next week, either through the main process or during SOAP, please don't give up hope! This was an incredibly tough year for applicants, due to the disruption of USMLE exams (particularly Step 2 CS), and the loss of many in-person training opportunities. I have more than twenty years of experience supporting medical students and graduates, particularly focusing on the needs of the IMG community. I would love the opportunity to help you achieve your dreams. After I review your ERAS application, personal statement, USMLE history, and other aspects of your application, I can try to help you succeed when you reapply next time. I offer a free consultation to all potential clients, so please contact me!