Non-Invasive and Preventative Cardiologist
Interview seasons is stressful and expensive. I hope that with this info-graphic that medical students will be able to have a rough estimate of how much it costs to apply to residency and where they can save some money. Additionally, the timing of my interview invitations and rejections give a rough timeline of when fourth year medical students should be hearing from programs or conversely when they should be freaking out because of a lack of interviews. Enjoy!
After med school comes residency where young doctors learn how to actually be doctors. But not all residencies are the same. In general, there are two types of residencies that students can apply for, ‘categorical’ and ‘preliminary’ positions. Categorical spots offer full residency training for their specific field of choice in order to become board certified. Preliminary positions only offer one or two years of training.
Categorical positions are a guaranteed job and it’s what every applicant shoots for. Earning a categorical position means that your application process is over until you apply for jobs or fellowships in order to further specialize after you complete your residency. Each residency training program has different lengths. Internal medicine, family medicine, and pediatrics are three years a piece. General surgery, and otolaryngology are five years. Psychiatry, pathology, and obstetrics and gynecology are all four years. Technically dermatology, anesthesia, neurology, opthalmology, diagnostic radiology, and radiation oncology are also four years. However, these residencies are actually three years long in their respective specialty after completing a one year preliminary year.
One might apply for a preliminary position for a few reasons. The biggest being that some advanced residencies require a preliminary year, such as those mentioned earlier. For instance, most anesthesia residencies require one preliminary year before a young doctor finishes their final three years of residency specifically training in anesthesia. The other big reason students apply for preliminary positions is as a backup. Prelim positions secure you one year’s worth of paid experience. For instance, a student might apply for both categorical and preliminary positions in their respective specialty depending on the strength of their application. Surgery is a notoriously competitive field so even a strong applicant might go unmatched. Thus, many students apply to both categorical and prelim positions in the hopes that if they don’t match into a categorical position that they will at least have one year to figure out their next move.
But a prelim spot at a program doesn’t secure you a categorical spot next year. Most residencies and programs don’t have second or third year prelim positions and you need a categorical position to finish residency. So if I apply to internal medicine only and receive a prelim spot I would be happy because I have a definite job for one more year but I would still be anxious because my future would not be certain. I would have to go through the match one more time to earn a categorical position somewhere.
If you’re looking for more information on this subject Wash U explains the basics pretty well. So do Doctors in Training (DIT). But my favorite post on this subject is from RK MD- a tech savvy anesthesia resident.
Are you in medical school? Sick and tired of explaining the process of step exams, clinical rotations, the interview process, and the dreaded match algorithm to your friends and family? Send them this post before you go home for the holidays and hopefully everyone will have a better idea as to when they can start calling you doctor if they haven’t done so already.
First let me recap the med school timeline for you so we’re all on the same page. The first two years of medical school are the basic sciences. It’s the classic classroom experience where we learn all of the science behind the medicine. This takes roughly two years and culminates with step 1 of the US Medical Licensing Exam (USMLE). Or the COMLEX (Comprehensive Osteopathic Medical Licensing Examination of the United States) level 1 if you are in an osteopathic school.
Now if you have a friend, family member, cousin, or are simply Facebook friends with a med student then you have likely heard of these exams. Or at least heard us complaining about studying for them. So what can possibly make these tests so important that we take months off to study for them? Although stellar board scores alone won’t secure you an interview they can certainly ‘pose a problem when they are significantly below the mean. Board scores have become ‘a threshold that must be achieved in order to receive an invitation for an interview’ (3). It’s a way to weed out thousands of applicants to a smaller pool of hundreds of interviewees to a handful of residents depending on the program and specialty.
Each specialty can be loosely broken down into highly competitive, moderately competitive, and less competitive specialties based on information obtained from previous residents who matched into each one respectively. Highly competitive specialties including dermatology, neuro surgery, orthopedic surgery, plastic surgery, radiology/oncology, radiology, urology, opthalmology, and otolaryngology. Moderately competitive specialties include emergency medicine, OB/GYN, and general surgery. Less competitive specialties include family medicine, internal medicine, neurology, pathology, and psychiatry (3). One of the important pieces of data used to signify each fields competitiveness is the average board score of matched applicants into those respective fields. More competitive fields can use a higher cutoff. So again, a high board score doesn’t guarantee you anything but a low board score can filter you out of the process.
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For instance, The following graph is taken from the 2014 National Resident Match Program (NRMP) data that is available online here.
This chart “displays the step 1 scores for matched US seniors and independent applicants by specialty. The horizontal bars are median values for successful applicants and the vertical lines show the interquartile ranges (the top and bottom scores of applicants). Scores are generally higher for more competitive specialties, but there is still substantial overlap when specialties are compared” (1). The same thing goes for step 2 scores. You have to do well and, on average, everyone does better on step 2 than step 1. In 2014, the average step 1 score for matched applicants was 230 and the average step 2 score was 243 (1). Here’s the step 2 chart:
And if you were wondering to yourself, ‘what the hell is an independent applicant’ the answer is anyone who isn’t graduating from a US allopathic medical school. That includes students from Caribbean schools and also American D.O. programs (1)
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Okay, so you finished your first two years of medical school, wrote your step 1 exam, finished your third year of medical school, and wrote your step 2 exam. Now what? At this point you start applying for residencies. A survey performed by the American Medical Association (AMA) of 1,000 fourth year medical students from US allopathic programs from the showed that students applied to an average of 36.4 programs.
This is where the dichotomy between ‘US senior applicants’ and ‘independent applicants’ is really staggering. Caribbean medical students are known to apply to upwards of 100 programs. Personally, I applied to 144 programs for internal medicine. So what’s so important about interviews these interviews? To answer that question we go back to the NRMP match data which shows that the greater the number of interviews you have the greater chance you have to match (and not be unemployed come July 1st).
This chart for internal medicine shows an applicants probability of matching based on the number of contiguous ranks. Contiguous ranks means that when it comes time for an applicant to rank programs, that the programs on an applicants match list is in the same specialty. Meaning that programs that you rank one through five are all in internal medicine. Not internal medicine and pediatrics. And in order to get that contiguous rank list you need interviews.
10 interviews seems to be the magic number that most students strive to surpass. What’s the probability of matching if an ‘independent applicant’ like myself gets 12.3 interviews? It’s still above 90% and I’d take those odds any day in Vegas. So 10 interviews seems to be the magic number that most students strive for. That still means that there are students out there who have 10 interviews and don’t match but your likelihood increases with the more interviews that you get.
So how does ‘the match’ work? It’s a complicated computer algorithm similar to what sororities use during rush (you know, minus the computer algorithm). Applicants make a list of the programs they want to go to, each program makes a list of which applicants they want, the information goes into a computer algorithm, and the algorithm spits out the match. Watch this 2-minute video to really understand it:
So in summary, get good board scores so you aren’t filtered out, score at least 10 interviews, don’t be a weirdo on the interview, and hope that you match. On Monday, March 14th applicants find out IF they matched. This gives unmatched applicants a week to participate in the SOAP (supplemental offer and acceptance program) and attempt to fill unmatched residency spots. Then on Friday, March 18th applicants across the country find out WHERE they matched. Then come July 1st, new interns start nationwide. Happy holidays!
1- Charting Outcomes In The Match. Characteristics Of Applicants Who Matched To Their Preferred Specialty In The 2014 Main Residency Match. 5th ed. Washington, DC: NRMP, 2014. Web. 23 Dec. 2015.
2- LWW,. “Going “Fourth” From Medical School: Fourth-Year Medical Stu… : Academic Medicine”. N.p., 2015. Web. 23 Dec. 2015.
3- Katta, Rajani, Samir P Desai, and Samir P Desai. The Successful Match. Houston, Tex.: MD2B, 2009. Print.
This post is for any third year med students watching your fourth year friends or Twitter followers freak out while ERAS crashes and runs at a snail’s pace. Here are my tips to successfully submit your ERAS application.
Finalize and upload your application before ERAS opens
There are thousands of applicants sitting in front of their computers waiting to click submit the second that ERAS opens. When it finally does open, the system is going to operate quite slowly if it doesn’t crash altogether like last year (the 2015 match). The last thing you want to be doing is uploading your personal statement, photo, or assigning documents to programs when the system is running so slowly. So do yourself a favor and finalize your application the night before.
Submit your application sooner than later
My biggest stressor about submitting my application was not knowing how late I could submit my application. Most programs don’t even download your application the first week. Admittedly, my source of information is hearsay and info from the internet and there are bound to be programs that break this guideline. But the majority fall under the bell curve of not downloading your application before the end of the week. Again however, every program is different and some will wait a few days to download your application, some will wait a week, and some might wait longer. It’s frustrating and infuriating that there is no clear-cut answer for when you should submit your ERAS application but the general consensus is the sooner the better.
Here is the dilemma I went through: I only got my step 2 CK score back on Wednesday but applications were able to be sent out on Tuesday. I sent out my application the day ERAS opened on Tuesday and resent my USMLE transcript the following day but I’m fairly certain I could have waited one more day to include my score with my application. It is a different story entirely if you were only getting your score a month or so after your application goes out. At that point the program would need to re-download your application in order to receive your updated USMLE transcript. In my mind, you can apply as soon as you want and get extra documents into ERAS the rest of the week as long as you get your extra documents in before your application is initially downloaded. When that tipping point is I couldn’t tell you. Just get it all in as soon as possible.
At least one of your letter writers will bail on you
One of my letter writers didn’t have the letter uploaded till the day before my application went out (thankfully I already had three others and didn’t even end up using it!). A friend of mine had a letter writer’s secretary forget to upload her letter entirely. It’s a frustrating and anxiety provoking experience. Do your best to gently remind your writers to submit your letter. From your perspective, this is THE most important part of your relationship with your letter writer at the moment. For them, you are likely at the bottom of their priority list. Not to say you aren’t important, but come on…you’ve worked with attendings before. They’ve got shit to do. My best advise is to secure an extra letter or two from people who are willing to write you STRONG letters. That way, if one of them falls through you will have extra ones that you can use and submit. Hopefully your worst case scenario is that you have too many letters and you don’t end up using all of them.
Personal statements are the worst part of the application
It’s hard to humble-brag about yourself while telling a compelling story that illustrates why you will make a perfect candidate for residency. Yeah, try that thesis statement on for size. Start writing your PS early. I wrote three different drafts before it evolved into its final form and those three drafts included dozens of revisions. Not to mention I only had to write a single PS for my internal medicine residency application. Some friends of mine had to write ones for surgery/emergency AND their back up. So start writing those rough drafts and keep on the look out for my follow up blog post about how to write a strong personal statement for residency. It’s a daunting subject and deserves its own post entirely.
I know this doesn’t nearly encompass all of the anxiety inducing questions that med students have on the subject so feel free to comment and ask me a question the process of applying for residency!