Hey folks,
Well, the Main Match is over for this year and once again, General Surgery was very competitive. Since my program has a couple of preliminary slots (Preliminary slot: you are only there for one year and must leave the program after that year) left, we have been deluged with calls and applicants for these slots. There was such a line on Tuesday, that our program coordinator had to leave the office. She had two people following her to her car in the parking garage. We were stepping over people right and left who were trying to get into a slot even though we are filled for everything except the designated preliminary slots (these are for people who are going in specialties like anesthesia, ENT, orthopedic surgery, neurosurgery who already have the second year matched).
Many people who wanted to match in General Surgery were not able to do so because of the increased number of applicants. Many folks who did not match last year were back in the Match this year for categorical slots. It was pretty brutal for those who wanted to match in Surgery or one of the surgical specialties.
For people who did not match, there were only six categorical slots available in the Scramble. These went very quickly. Even now, there slots left are designated preliminary slots and not open to people who do not have a program for their PGY-2 year. The choices left for them are to attempt to spend a year in a preliminary medicine slot and re-apply next year or to look at another specialty.
This year, ERAS allowed people in the Scramble to submit applications through ERAS to programs with opening. This greatly simplified the process from previous years where people had to call programs and then fax materials. Fax machines would jam and people who had cell phones were at a distinct advantage.
Why would someone not match in General Surgery this year? First of all, if you want to be a surgeon, you need to be in a categorical surgical slot(if your start in the program, you are going to be expected to finish five to seven years). There were a record number of applicants for the categorical slots. If you did not apply to enough programs, you could find yourself matched out of a slot if you were not highly ranked by the programs where you were able to secure interviews. Second, there were very few programs that offered positions outside of the Match. Gone are the programs that will not use ERAS. (Electronic Residency Application System). Third, securing a categorical General Surgery residency position is very different from getting into medical school and getting into other specialties. General Surgery program directors were looking very carefully for people who can learn and do well within the confines of the 80-hour work week as well as score high on ABSITE (the American Board of Surgery In-Training Exam) I can tell you from experience, this exam is worse than “no joke”. It is downright brutal and it has become more important as your program can be placed on probation if you and your fellow residents do not score well. Programs will elect to go unfilled as opposed to taking a weak candidate because of this exam.
For the folks who are now third-year medical students and are contemplating matching into General Surgery or one of the surgical specialties: Now is the time to start investigating everything that you can find about the Match process. You need to have a good faculty advisor who can help you choose enough programs where you have a shot at getting a categorical slot. You also need to be getting your letters together.
You also need to be pretty realistic about your chances of getting into General Surgery. If you did not do well on USMLE Step I (COMLEX Step I) and you are in the bottom half of your medical school class, you are going to have difficulty matching into Surgery or the Surgical specialties. The average USMLE score of our categorical applicants this year was 230 (much higher than last year). Even with the higher USMLE scores, people who did not have a good surgical knowledge base were not ranked by my program. This year, the interviewers asked fairly complex surgical management questions and based selections on the answers given by the applicants. Bottom line: make sure you do well in your General Surgical clerkship and enlist your faculty support early.
I can say with great confidence that any of the competitive specialties: Anesthesia, Optho or Derm showed a similiar pattern in having more applicants than slots and virtually nothing available in the Scramble.
Finally, it was pretty sad to see so many people in the office who were looking for a job on Tuesday and Wednesday. The numbers dropped on Thursday and Friday. This was a brutal year and there is no evidence to believe that next year will be better. Learn about the Match process and be prepared early. Meet every deadline and be very proactive once you have identified that you want to go into a competitive specialty.
Natalie 
Hi Folks,
I just got my official AMA News on this years Match with the following results:
Family Medicine Positions on the Decline - Fewer U.S. medical school seniors are seeking careers in family medicine these days. This year, only 8% of seniors graduating from allopathic medical schools picked a family medicine residency. Family medicine residencies have declined now for eight years running.
Family Medicine:
2005 Positions offered - 2,761
2005 Positions filled - 2,275
2005 U.S. seniors matching - 1,117
A record 22,221 U.S. medical school seniors and other applicants were matched to first and second-year residency positions this year, the most in nearly 20 years. Prospective residents continued to flock to substpcialties with dermatology, emergency medicine, general surgery, orthopedic surgery and plastic surgery remaining highly competitive. In family medicine, U.S. seniors took 41% of the available slots filling 82.4% of total family medicine residency slots. In internal medicine, 97% of positions filled with 56% of them going to U.S. seniors.
This just reinterates what took place at my hospital and other General Surgery programs around the country: it was a brutal year for attempting to match in General Surgery for the second straight year running.
Natalie
Hi Folks,
The new interns started today. They have that anxious look already and they haven’t gotten all of their shots yet! Oh well, they go “live” on July 1st and I advance a year. It is going by so fast.
Natalie 
I think alot of this is due to residency directors knowing that they will fill the FP slots with US citizens who went off shore, Europe, or elsewhere. US grads are still looking for the higer paying starting positions, possibly due to debt load, prestige, or the effects of the new regs on work hours. (even though we know that a lot of programs are skirting it without residents calling in a violation for fear that the program will be shut down and then they are out of work.)
Still, it all works out. there will be plenty of positions for myself and others.
Hey there,
We are not taking any offshores that have not done at least two prelim years elsewhere and scored above 230 on USMLE Step I. This usually knocks out any overseas Americans. We have not taken an overseas American in six years.
My interns this year have been great. All but one (and I am riding his rear end daily) have adjusted to the pace and are doing well. My problem child is just lazy. He is a prelim that wants to go into anesthesia. Right now, his main job is learning how to insert central lines. All of the senior residents are assigning him line after line. What was a weakness will be a strength after this month. He is a funny guy though. There is no way he will go off into Anesthesia without being a line expert.
Natalie (becoming more of a surgical personality)
Hi there,
A few applications for residency have come in. As predicted, they are very, very competitive. All are MDs and all are US grads. It is still very early in the process but when the Deans letters go out on November 1st, I suspect that a few more applicatons will be coming in. It is looking like another huge year for General Surgery.
Natalie
Hi Folks,
Today was our last day of interviewing. I have to admit that the first group of applicants were outstanding and these folks are just not as stellar. It is going to be interesting to see how who ends up coming in.
Our latest group of interns has two that are outstanding and one that is totally awful. I predict that if he does not change his course, he is not going to make it out of residency. He is just a lazy and bad physician. On top of being lazy and bad, he lies.
Looking at the crop of applicants that went through this year, I believe that we do not have anyone that is bad; just fairly mediocre compared to previous years. The guys that came in the year before last were outstanding and continue to be.
Well, Match Day is coming up and we will see what happens.
Natalie
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Hi Folks,
Today was our last day of interviewing. I have to admit that the first group of applicants were outstanding and these folks are just not as stellar. It is going to be interesting to see how who ends up coming in.
Our latest group of interns has two that are outstanding and one that is totally awful. I predict that if he does not change his course, he is not going to make it out of residency. He is just a lazy and bad physician. On top of being lazy and bad, he lies.
Looking at the crop of applicants that went through this year, I believe that we do not have anyone that is bad; just fairly mediocre compared to previous years. The guys that came in the year before last were outstanding and continue to be.
Well, Match Day is coming up and we will see what happens.
Natalie
Can you give examples of what a bad resident does? I’m totally curious!
Natalie -
I would also be interested in what kinds of things, in your opinion, made the first group of interviewees “stellar” compared to the later group. Personality? Research? LOR’s? Board scores? Grades?
Amy
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Natalie -
I would also be interested in what kinds of things, in your opinion, made the first group of interviewees “stellar” compared to the later group. Personality? Research? LOR’s? Board scores? Grades?
Amy
Hi there,
An outstanding residency applicant has first of all, the grades and board scores that indicate he or she is capable of getting through a surgery residency. There is an ABSITE (American Board of Surgery In-Training Exam) that is taken every year of your residency and the applicant has to show some promise of being able to get through and pass this exam.
The second thing I look for is high pass or Honors in their Surgery clerkship during third year. A pass is not OK in something that a person has chosen to do for the rest of their life. Pass may equal MD/DO but Pass does not equal surgeon.
The third thing I look for is enthusiam for the profession. You should be able to discuss a case that was memoriable for you from a surgical standpoint. By the time you graduate from medical school, you should be able to relate a surgical case and why that case was of interest in reasonable but consise presentation.
I also have a final “pimp-type” question that I ask of all applicants. The good applicants can answer this question without a blink. The satisfactory applicant can get the answer with some prompting by me and the poor applicant will be clueless. The last group people that I interviewed were clueless.
Am I a tough interviewer? For residency, you bet. This is not an easy specialty and too many people are more in love with the idea of being a surgeon than the actual practice of surgery. If you cannot speak about what you want to do for the rest of your life with passion, you are going to be a very disappointed resident.
Natalie
Natalie,
I’m curious (and this is genuine curiosity and I hope it doesn’t come off as otherwise), but if a High Pass or Honors in Surgery is required to be seriously considered for a surgical residency, and I would think that’s a reasonable criteria (although I wonder where that puts the people at schools where High Pass isn’t available)-- then why would you even interview people who didn’t meet that criteria? (Or perhaps I didn’t understand your post-- do you look for the HP or H, before you even send the invite?)
I bring this up in large part because as a current interviewee (although not in surgery), and I am curious about what is going through the interviewers mind, how they narrow down the candidate field from overwhelming numbers interviewing (at some of the programs I’ve interviewed at) to a small group of residents. Presumably they’ve already screened for the ability to be academically successful-- several of the programs at the more competitive places I’ve interviewed at outright state they wouldn’t invite you if you didn’t have a good chance of matching, so what are they looking at during the interview other than personality and how you interact? Most of my interviews have focused around my experiences, and have been conversational and pleasant in nature.
Also, I wonder how programs view Step I versus Step II? My Step II scores were released a few weeks ago and so are available to programs I already interviewed at, but since they weren’t available at the time of the interview for some of the places, will they still consider them, if they’ve already decided where to rank me? (I would really like them to look at those:))
I guess I’m just getting a little nervous, as while I think I would be quite happy at any of the places I plan to put in my top 5, the paranoid part of me is acting up.
Anyway, just curious, thanks.
Epidoc
Hi there,
We have several ranking meetings before we submit our final list. By the time we submit our final list, we have done enough comparisions to know which applicants we are going to rank very high.
We generally do not invite people who do not have the grades or the board scores that meet our minimum. Occasionally we will invite an applicant that might be lacking a Honors but this is pretty rare. Again, surgery is fairly competitive and most folks had both the clerkship grades and the USMLE/COMLEX scores that we were looking for.
Surgery interviews tend to be a bit more malignant than their medicine counterparts. We DO ask pimp questions and we do look at grades, scores, publications and the like. We are only going to take three categorical interns next year so with the number of applicants, we could afford to be a bit more selective. We got loads of applicants and many were not even close.
We have a rank meeting after each interview session and two final rank meetings before submitting our list. So far, we have not failed to fill and generally have people hanging around on scramble day, looking for preliminary positions.
If you got a good feeling about a program and you really want to be there, then rank that program high. Your ranking outweighs the program’s ranking.
I hope this helps.
Natalie
Good luck with the Match!!
I’m at the other end of the spectrum in family practice (i.e. not malignant!) and have attended one rank meeting so far but Epi, I know what you mean about wanting to know more about how the match list is made up so I’ll offer my experience and then you’ll have an N of 2 
At our “match meeting” we’ll have all the numbers available to us including those that have come in since the applicant interviewed. So if you were applying to OUR program, your Step 2 scores would be considered. Honestly, I can’t imagine why a program wouldn’t bring those scores into play if they’re available, so I think you can count on them being part of your portfolio that’s being evaluated - so good for you.
The interview day is definitely important. Our applicants spend time with all three years’ worth of residents - they tour the hospital with a second-year, have lunch with the interns, do interviews with faculty and third-years. Everyone is asked to comment on the applicant based on those interactions. I distinctly remember one guy who just came off as weird to all of us at the intern lunch, but apparently wasn’t quite as jarring once he got to the office - our concerns were heard and factored into the eventual ranking.
FP is not competitive 
and so we’re not going to be able to be as picky as we’d like about boards and grades. Letters of recommendation and narratives from clinicals included in the Dean’s letter will weigh heavily on who’s invited. Unfortunately the applicant pool continues to dwindle for us - just a few years ago my program did not consider overseas grads but will do so now.
Contact with the program after interview day also is worth mentioning. If you’ve sent a note or called with more questions or returned for a second look, that’s going to reflect favorably on you.
Back when I was doing residency interviews, I heard about how “audition rotations” could come back to bite you and was kind of incredulous: if you KNOW you want to go to a program, wouldn’t you be on your best behavior and work hard to make the best possible impression? However, I’ve since heard of two students who in fact made terrible impressions on their audition rotations - one actually told a patient not to do what an attending had already instructed (!!!) and another did the typical third-year-in-a-late-rotation trick of trying to hide and get out of work as much as possible. Incredible. These people wasted two or FOUR weeks of their senior year making a bad impression. (I know this is not you!)
So there’s my 0.02, worth every bit.
Mary
As always, Nat and Mary, thanks for the incredibly helpful insights you provide. I obviously have no inside knowledge, but just want to add a couple of comments that have been made by Program Directors on the Emergency Medicine Residency forum on SDN (there are two that post regularly).
Step II scores - sounds like next year most programs (at least in EM) are going to require Step II CK and CS scores for a candidate to be ranked. Some programs will be requiring them for interviews. A few programs originally started off requiring them this year, but backed off when they realized that so many people wouldn’t have their scores back in time.
Epidoc - I would imagine that your scores will be noticed, even by the programs you’ve interviewed with. Both PD’s on SDN stated that they would consider it a warning flag if a candidate had taken Step II but not released the scores, or at least viewed as if the candidate is possibly hiding something. So - apparently the programs can see if you’ve taken Step II and do continuously monitor these scores.
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Contact with the program after interview day also is worth mentioning. If you’ve sent a note or called with more questions or returned for a second look, that’s going to reflect favorably on you.
Interesting. The PD’s on SDN said that thank you notes, questions, second looks have no effect on how you will be ranked. One went so far as to say he tells interviewees that thank you notes are not expected and sending them or not will not affect your ranking either way. The view on second looks was pretty neutral.
There was some discussion a while ago on audition rotations, as well. For some people, its incredibly favorable, for others, not so much. Some programs (EM) will not interview students who have rotated there, feeling that, based on the rotation, both parties know what they need to know for ranking purposes. It was recommended that if your school does not have a strong rotation in the specialty you are applying for, that you do an away rotation in the specialty at a better known program.
Something else I found interesting is that the candidates preference outranks the program. So if I interview at program X and Y and rank them 1 and 2, but program Y ranks me as their number 1 while program X ranks me their number 5, as long as I am ranked high enough to match by program X, I will get program X, because I ranked them higher.
It’s great to see this discussion. You see lots and lots of discussion on how to get into medical school, but not so much on how to get into a residency. From what I’ve gathered from my med 4’s, applying for residency is in someways worse than applying for medical school!
Thanks again, Nat and Mary.
Amy
Mary, Nat, and Amy,
Thanks for your input. It’s nice to have some idea how things are being done The application is what it is at this point, and I’ve tried to behave like a sane human being on interview days I’ve sent thank you notes to all programs, whether I plan to rank them or not. I’m thinking of doing a second look at one program that will be in my top 3, more just to remind myself about the program, since I interviewed there in the middle of the process, and I want to make sure my memories are accurate. I didn’t do any true audition rotations. I did a rotation at Mayo, but it wasn’t in IM (however I did discover that my eval from that rotation hadn’t been forwarded to IM like it should have been, so I made sure that happened.) Beyond that, I guess I just finish up my interviews, make the tough decision on who to rank #1, 2 and 3 and then leave it in God’s hands.
March 16th will be interesting!
Epidoc
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Interesting. The PD’s on SDN said that thank you notes, questions, second looks have no effect on how you will be ranked. One went so far as to say he tells interviewees that thank you notes are not expected and sending them or not will not affect your ranking either way. The view on second looks was pretty neutral.
I should’ve made myself clearer - it is not my impression that thank-yous and such will actually affect your ranking, but I did observe that notes were read and commented on and helped to cement a good impression. Such contact comprised the softest of “soft signs” and everything else was far more important.
And everyone wants to be wanted - even competitive programs and top-ranked places like to have their institutional egos stroked, so letting a program know that you really liked them is fine. Programs like to be sure they’ll fill from the top of their rank list, and an applicant’s very strong desire to be at a particular place (which could be stated during the interview, in a note later, at a second look, etc.) is going to be heard.
Epidoc, you’re going to be fine. It’s just harrowing counting down the time until Match Day.
Mary
Hi there,
Sending “thank-you” notes does not affect your rankings at our program. As I said, we hold our ranking meetings later on the day that the applicant interviews. At our final ranking meeting that is held after all interviews are done, we go over the results of the previous ranking meetings and these are finalized by the program director and assistant program director.
It is always appropriate to send an e-mail of thanks or appreciation if someone at the program does something extra for you. For example, one of the program coordinators was able to fax some information for me while I was on the road so that I did not have to have Steve (my fiance) use overnight mail. She faxed the materials to my hotel and I had them more quickly with less expense. I sent a simple e-mail to thank her for her trouble.
In the case of a large number of applicants and a program that you really love, my strategy would have been a second look. By doing this, you stand out for the program and you get more of an idea of how the days and nights go. You should spend as much time with the current residents as possible. If possible, attend a teaching session and get a good idea of the academics.
The things that I looked for in a residency were: good location, good academics and good experiences. (I am really hating Cleveland [winter is downright depressing]) I wanted a program that would enhance my learning style.
We were deluged with applications this year and had plenty of interviews for the few slots that will be filled in the Match. In that deluge of candidates, more than a few were outstanding as I have outlined above. We have had a couple come back for a second look which were in the top choices.
When Match Day comes, we will see what happens.
Natalie
The SF Match website had a decent explanation of how the match algorithm works in the applicant’s favor and gave an example. I’ve attached the word document that I copied the explanation into. Once I read this, I felt much better about my rank list for neurology because I knew I would be very happy at my top 5 and happy still at all 9 programs that I ranked, so I felt less pressure about my top two choices. This Friday part two of my three part match process will be over. And my last prelim medicine interview (actually last residency interview period- all 15 done) is this Tuesday (yipee!!).
Attached files 1137978235-SF Match Examples.doc (123.5 KB)Â
I also have questions about these interviews, since I am “offshore”. While its always been my intention to practice pediatrics, assuming I have a good score on the Step 1, why wouldn’t a program accept me? If the USMLE is a valid indication of a person’s knowledge, and an “offshore” trained US citizen isn’t “considered”, what is the rationale? Is this just “us against them” politics?
Kathy
Kathy,
While I don’t know the details about all programs and why they do or do not accept off-shore grads, let me assure you I have encountered many US citizens who attended schools outside the US at residency interviews, both as fellow applicants, and as residents-- and at some very good programs, I might add.
Deb