How to Get into Residency: Part I

Happy holidays to everyone! I appreciate all the feedback on my previous post “5 things to know before choosing a residency program”. Many people have been asking questions about the basic process of applying for residency. Answering this question is very challenging for me, especially since the landscape has changed significantly since the year I applied. For example, many community programs stopped offering ‘prematch’ positions for independent applicants after 2012.

PGY-1 positions have never been more competitive. According to the most recent NRMP match data, 34,270 applicants competed for 26,678 positions in 2014. Between 1999 and 2004, there was a 14.6% increase in applicants, and a 19% increase in PGY-1 residency positions. Although the percentages may look great, the numbers show that applicant growth actually exceeded positions available by 131 in the last 5 years.

What factors determine one’s chances of matching? Let’s crunch some more interesting NRMP stats. In 2014, only about 50% of International Medical Graduates (IMGs) matched, compared to a 94% match rate for US seniors. A US senior that ranked 10 programs would have a 99% chance of matching if he applied to Internal Medicine (IM) and an 88% chance if they were all General Surgery programs. An IMG had a 90% or 59% chance if he ranked 10 programs in IM or General Surgery respectively.

The disparities are even more glaring when you consider the USMLE scores. A US senior with a Step 1 score of 220 had a 96% chance of matching. Conversely, an independent applicant with a similar score had only a 50% chance of matching. A score of 240 would improve would only improve his odds of matching to 73%. Although the USMLE scores are very important (probably the most important), there are many other factors that are important for matching, including publications or presentations, year of graduation and clinical experience for IMGs, additional degrees etc.

The statistics above show that matching for IMGs is very daunting. Do you really need 10 interviews to be guaranteed a high likelihood of matching? By playing the odds, yeah. But how many IMGs get 5, let alone 10 interviews? Obviously, any IMG with 10 interviews has a very competitive profile and would likely match. The reality is that many IMGs, because they don’t have US clinical experience will be sidelined by most programs. I was in a similar situation 3 years ago, and I had to rank only 6 programs. 

Here’s the bottom line: You need to get interviews in order to match. Doing well at the interview is the key to matching, but that’s not the focus of this article. Your application needs to beat the filters that programs have created before you can be considered for an interview. I asked my program director about filters, and he said that it was the most efficient way of selecting the 300 applicants he needed from a pool of 4,000 applications.

Part II of this article will explain the basics of residency application, and common pitfalls to avoid. Keep it locked on for updates.

5 Things to Know before Choosing a Residency Program

This time 3 years ago, I was interviewing for residency positions in Internal Medicine. As a foreign graduate with no US clinical experience, I knew I wasn't going to be cherry-picking at available programs. To make it worse, I had limited my search to the East coast for family reasons. I still remember the frightening experience of refreshing my email 300,000 times for emails from programs. I remember the disappointment of rejection emails, the joy of interview invitations, the what-if-I-don't-match thoughts, the overdrawn credit cards. I remember my excitement when the email read "Congratulations, you matched".

Fast forward to today. I think about my years at Howard and ask myself: what if I had matched elsewhere? How would my life have panned out without the amazing mentors I met? Hard to tell.
Maybe if I knew a few things prior to submitting my rank order list, I would have landed at a different place. Or maybe not.
This piece is directed at those that plan on making a decision soon, or those that still question the decision they made.

1. Are there people like me in the program? This is an important question for minorities. You should talk to people of your culture, color or beliefs in the program after your interview. Remember that every resident you meet will tell you their program is the best. Try to sift through the BS and get a real feel. You want to be at a place where you'd be totally comfortable. You may be more productive at a smaller name program where you're comfortable than at a bigger name where you feel out of place. Point is, understand the situation before you sign up for it.

2. A Yoruba adage says "ona kan o w'oja". This literally means there are many roads to the market. If you are considering a fellowship, you will be better off matching at a University program that has that specialty, so you can work with mentors in the field. If this option is not available to you, an extra year as a Chief resident or research fellow will improve your chances. Additional training in clinical or translational research will improve your chances. A legal permanent residency status will improve your chances. You end up realizing that everyone's profile is different. You should explore the options available to you. This leads to the next point.

3. There are always resources to tap. Some residency programs are highly structured, with specific learning goals and milestones, while others are not. Your goal is to understand what resources are available around you, including renowned mentors, research activities, local and online certificate courses, travel awards, community activities etc. Find out what's unique about your residency program and take advantage of it.

4. Before you start to hate where you match, know this: where you do residency does not matter. Becoming a good doctor depends mostly on you. All residency programs with a good volume of patients are equipped to train you to become a competent internist. Programs with too little volume will not provide the patients you can learn from. Too high volume would not give you time to study and understand the cases you see. The predominant key to success is self motivation, creating learning goals and following through.

5.  The fun does not start after you become a board-certified gastroenterologist. It starts now. Enjoy the programs you interview at, the people you meet at interviews, the cities you get to visit. Most importantly, enjoy the person you are. The interviews help you understand your uniqueness and often give you a clearer idea of what your interests are.

Finally, treat your residency interviews like a first date and you're more likely going to match at the best one for you.

Good luck.