Residency Application Process

Hi all,

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 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.

Hi there,

The next hurdle will be Monday(18 March 2002) at noon when NRMP sends me an e-mail letting me know if I have matched or not. The reason for sending this e-mail out earlier than the actual announcements at noon on Thursday (21 March 2002) is to allow students who have not matched an opportunity to get their residency application materials together for the scramble.

Am I having fun yet??? :cool:

(Edited by njbmd at 11:35 pm on Mar. 20, 2002)

Natalie, I have no doubt you ARE having fun! But with the capriciousness of the medical education system, I’m still keeping my fingers crossed for you.

Quote: from JeffCasto on 5:27 am on Mar. 18, 2002
Natalie, I have no doubt you ARE having fun! But with the capriciousness of the medical education system, I'm still keeping my fingers crossed for you.

Hi Jeff,
You know, I really don't care if I have to scramble. I know that I can actually scramble into a great program at this point. The only point of matching for me is that I will not have to move for one year. I hate moving and I have already promised that I am going to toss most of my books from graduate chemistry and biochemistry so I won't have to move them again. I hate to part with Thomas' Protein Chemistry and Jolly's Advanced Inorganic Chemistry but they will have to go. Other than the moving issues, the scramble will be fine for me. :cool:

Hi there,

I got the news today at noon, that I have to participate in the Scramble. For my choices, the scramble is a better situation that matching in a program that I did not like.

Tomorrow, that’s Tuesday, I gather in my Deans office to get my materials together to participate in the “Scramble”. The good thing about this year is that 450 positions in General Surgery are unfilled so I have a chance to scramble into a better postion that I would have matched into. I still have a high probability of getting into my first choice in the Scramble.

This gets more fun everytime I do it. :cool:

Well, it’s good to see you maintaining a positive attitude Natalie. Sounds like you deal with stress and challenges with more grace than most of us have! I know we are all wishing you the best of good fortune in the scramble. Knock 'em dead. :)

Yes, please let us know how it all works out. Very interesting and useful information. Thanks…

Hi folks,

I just wanted to explain my experience with the Scramble and why it was not necessarily a bad situation.
My Dean of Education got word of unmatched seniors on Monday at 10 am. We were notified on Monday at noon but the e-mail reached us at varying times.

Reasons why you may not match: 1) You interviewed and selected very competitive programs 2) You only ranked the programs that you would attend 3) Your chosen programs did not go deep into their lists and the computer was not able to match you with your choices.

If you don’t match, and you have graduated from medical school in the United States and are competitive, the Scramble is going to work out better for you than your original choices, provided you are not trying to get into a very competitive residency with few unfilled slots. In my case, I actually ended up getting into two programs that were higher rated than my first and second choices. The computer generally does not go deep into your list so if you rank a program very low, it is not going to match you there.

For the Scramble: Your Deans office gets the list of programs that you may “scramble into” an hour before they are officially open. If you have a good Dean and administration, they make this list, a fax machine and a phone available to you. After you get word that a program is open, you get your application together and you hit the send button. In my case, I had applied to UVa so they already had my materials through ERAS. They were able to make an acceptance immediately. They actually beat the University of Minnesota by about 20 minutes though Minnesota faxed me a letter to sign before UVa. I was able to confirm UVa before University of Minnesota by a couple of hours.

Was this stressful? In some ways it was because the fax machines tended to jam at the top programs and I had to fight to get materials faxed. I was fortunate that both UVa and University of Minnesota are good programs that have good resources. The residency directors were able to call us to divert our faxes as the machines jammed.

It was a very long day for some folks because programs closed very quickly. I have to admit, I have never seen the Deans office work as rapidly as it did for us yesterday. There were about 10 people who were participating in the scramble. They had a phone, a fax and plenty of paper for all of us. They also had copies of every letter of recomendation, our Dean’s letters and had every Dean available to speak to residency directors if necessary. Four of the 10 people who were scrambling with me were AOA, meaning, at the top of the class.

Would I have preferred to not scramble? At about 1pm yesterday, I would have said yes but after I got the call from UVa, I was very happy that I had scrambled. One of my colleages managed to scramble into Hopkins so there were great programs that needed to fill slots in the scramble. By 6pm, yesterday, the only programs left were preliminary programs or programs that were not going to fill the allotted slots.

If you find that you have to scramble, get all of your materials together, get a fax machine, get two cell phones and get a good land line. If your Dean’s office is willing to help you with the faxing so much the better. Getting your material out from the Deans office or a Department in a Medical School is much better than hanging out a Kinko’s.

Many programs will have unexpected openings and will call your Dean’s office directly. While I was there, ten calls came in from places like UCSF and UCI offering slots in pediatrics and family practice on the spot. If you are trying to “scramble” independently and you wanted one of those slots, you would have missed them. Two people who wanted Internal Medicine had contracts within the hour from great programs that had contacted our Dean before the main list was released. This is why you need to look at the Match list for your prospective medical school if you are trying to make a choice between School A and School B. Often students have an easier time matching at programs where previous grads have matched or where your Dean has some good contacts. :smile:

Even after the scramble, there will be open positions but you run the risk of having to travel across country and you lose some of your options. People who generally have to look for programs outside the scramble are folks who took USMLE Step II late, then were not able to graduate without having a passing score.

Our Deans office also brought in oatmeal cookies, chips, water and juice for us. Again, I was very impressed with Howard’s response to what we needed. It was great. Now I have a little more than a month to hang out and chill before the real responsibility begins. I need a vacation at last! :cool:

(Edited by njbmd at 5:27 pm on Mar. 20, 2002)

(Edited by njbmd at 5:29 pm on Mar. 20, 2002)

(Edited by njbmd at 11:37 pm on Mar. 20, 2002)


Thanks for clarifying the “Scramble” for those that really didn’t undersatnd the process/significance of it. I guess that you’ll be going to UVa in General Surgery so that’s cool…not too far to move I’m sure!!! Congratulations and enjoy you’re much deserved vacation!:biggrin:

Congratulations on working the scramble to your advantage!!! And thanks for the great insight.

Congratulations on getting a residency you wanted and thanks for all this valuable information.

May I ask why you applied UVA and then didn’t rank them. Would I be correct in assuming that if you had ranked them you would have gotten a spot there? Or is is that they didn’t rank you but should have?

Quote: from mpp on 1:32 pm on Mar. 20, 2002
Congratulations on getting a residency you wanted and thanks for all this valuable information.

May I ask why you applied UVA and then didn't rank them. Would I be correct in assuming that if you had ranked them you would have gotten a spot there? Or is is that they didn't rank you but should have?

Hi there,

I didn't rank them because I didn't think I had a shot at UVa. I ranked MCV General Surgery instead of UVa because I fit their profile better and had been invited twice there. MCV did not have to go deeply into their rank list. UVa probably did not go deep enough. It is something of a mystery as to how the process actually turns out but I am elated that I "scrambled" into a program that I had thought was out of reach.

Another indicator I had during the "Scramble" was that I had two top ten programs accepting me within 20 minutes of each other. If I had jumped on the University of Minnesota letter of intent before I heard from UVa, I would have missed out. The UVa position went extremely fast. I can also thank my Dean's office and my General Surgery Chairman who really helped me greatly. :)

The Scramble worked out for me and most of the students who scrambled with me yesterday. At the end of the day, a couple of folks were still in limbo. I was fortunate to be a pretty solid candidate to begin with. I am still hoping that on Thursday, I will find out that they got into great programs.

(Edited by njbmd at 1:58 pm on Mar. 20, 2002)

Congratusaltions Natalie!

And thank you for the explaining the process of the Scramble and sharing your experience - Wow!:shocked: