Around the end of your third year of medical school, you will be exposed to the residency application process. While very different from the medical school application process, it has un-nervingly similiar aspects too. I am going to relate some key information for getting started and getting it done.
First, if you have made a decision as to which specialty that you would like to enter and have done a rotation there, start to write your personal statement for residency. This statement should give a residency director a clear and accurate assessment of why your are interested in the specialty and what kind of career you anticipate. If you are clearly interested in private practice in a rural environment, steer clear of applications to heavily academic programs that feed residents into fellowships and opt for a program that is strong in clinical education. Always remember that if you are an excellent physician, your patient is never going to ask you where you trained and they will return to your care bringing relatives. The residency personal statement should be very well written and limited to one page. More is not better in this case.
You should have already made contact with the chairman of the department of the specialty that you wish to enter. This contact should have been done as soon as you realize that you have a career interest in a specialty but not later than the end of your third year. If you have decided on a specialty like Anesthesia and your third year did not include an Anesthesia rotation, make sure that your first elective during fourth year is Anesthesia. You should have either a rotation or elective in your chosen field.
Make contact and utilize the experience of the residents and interns in your chosen field. They will help you with a personal statement and give you good information on programs that they applied to but did not match or felt were less of a good fit for them. Word of mouth is a good way to start a list of programs. They also know who the residency program directors are and can give you the “heads-up” on interviewing techniques.
You need to get letters from teaching attendings on every rotation from third year as well as a letter from the chairman of the department. To obtain these letters, you should give them a copy of your CV and personal statement. Most good department chairmen will ask you to come in for an interview to discuss your career plans at this time if not before. The residency director of the specialty at your school is a good person to make an appointment with as you consider programs. Often this person can give you valuable information as to which programs would be a good fit for your interests and abilities.
It is useless to apply to Harvard, Hopkins or Stanford residency programs if your USMLE Board Scores are marginal and your academic record is weak. You are not going to get an interview no matter how glowing your letters of recommendation are. You can do a visiting clerkship and have them take a look at you but your face an uphill battle.
When you pick a residency program, pick programs that are located in an area of the country where you would like to practice. Most physicians remain in the area that they do residency. It is very difficult to join a practice from outside unless someone is already there from your residency program. Also keep in mind, that few physicians remain un-employed. It is just easier to get a position where you are known and where you have made some key contacts during the last couple of years of your residency. A department chairman can help you with this when you are within two years of finishing your residency.
You are allowed to apply to more than one specialty especially if you have not made a solid decision. Once invited to an interview, you may always cancel if something else holds your interest more. Just don’t cancel later than one week in advance.
Remember that flying in and out of multiple cities is expensive and budget money for this process. If you are limited, ask the residency coordinator to put you in contact with residents who might put you up for the night. Some of the larger programs have deals with hotels nearby and will accomodate you. Some programs will pay all of your expenses especially if you are a very strong candidate.
You want to have your ERAS and personal statements completed by the first week in September of your fourth year. For the SF Match, this deadline is one month earlier. The earlier you get this done, the better because you have to take USMLE Step II. You want to get your residency application done early and Step II done early so you can get your interviews done early and a decision made. This is not to improve your chances of getting into a slot but to make your senior year more managable.
Interviewing for residency is very stressful. You have to make a decision based on limited information. You should try to get back to programs that interest you at least once again outside of the interview and speak honestly with the residents. Also, check the http://www.Scutwork.com website for residency interview information.
When you fill out your ranklist (after interviewing at as many programs as you can), be as realistic as possible. If you don’t like a program, don’t rank it. If you rank a program, you could end up as a resident there. It is far better to “scramble” than to rank a program that you don’t like. Every American medical school graduate will get into a residency program if they participate in the match. Your program may be a preliminary program but that is not necessarily a bad proposition. Often after an excellent preliminary year, you can match at a very highly ranked program based on your performance. The downside is that you have to go thought the match a second time.
I put this information out here at this point because you need to think about residency application as you start your third year. If you have been previously exposed to your specialty by action in a specialty interest group, so much the better.
On Match Day, you will be given an envelope with the name of the program that you matched in. By law, you are required to do a residency there. Again, don’t rank any program that you would not want to train at. If you don’t match, you know ahead of time and will be given instructions on how to participate in the “scramble”.
The computer matches your decision with the program’s decision. If the two do not match, your decision outweighs the program’s decision. For example, if you ranked Harvard first and Harvard ranked you third, if the people who were ranked first and second by Harvard did not rank Harvard first and second, you will be matched at Harvard even though you were Harvard’s third choice.
As Match Day approches, I will write about that day and my experience with the process.