Generic General Surgery Match Advice

[SLUser11]

For the MSIVs:

I've gotten a couple PMs about what to look for, etc on the interview trail, and I am by no means an expert, but I wanted to share some general advice for how to approach the process, and what to look for on interview day. If you don't want it, don't read on.


1. First of all, you can never TRULY know how good a program is until you are there in it, and by then, it's too late. The best thing to do is go to interviews with your bulls@#t meter on high. The residents almost everywhere will lie, so all programs will sound excellent. This is due to 2 factors: 1) They think by landing good students it will improve their programs prestige and secondarily benefit them, 2) They want you to think that not only did they get their first choice, but that they made the right decision.

Common lies:
--We are strictly adherent to the 80 hour rule
--Nobody has ever wanted a fellowship and not gotten it.
--We have excellent resident camraderie.


You have to be able to tell when someone is lying, or when they don't have to lie. The best initial way to do this is to watch the residents from your home institution or place of away rotation lie like a bunch of lying liars, and learn from that.

----A similar point is that the harder they try to sell you the program, the more likely that program sucks. People at good programs know that the program sells itself.

2. Most residents from solid programs can match into the fellowship of their choice. The match rates are almost universally high, with the exception of Three: Plastics, Peds, and Surgical Oncology, the last 2 of which are relatively self-selecting.

Matching into Vascular, CT, Transplant, Trauma/CC, Breast, Hand (god forbid), burn, and Minimally invasive will be relatively easy from the majority of programs. In between specialties of moderate competitiveness likely include Colorectal, and maybe some others I'm not thinking of. Other residents, feel free to contribute.


---My point here is that the ## of residents going into fellowship can't be used to gauge a program. NOT EVERYONE WANTS TO GO INTO THE 3 COMPETITIVE SPECIALTIES! There are plenty of residents who enjoy the other ones, or want to be general surgeons. In my opinion, people who love vascular are crazy, but I promise that they exist (e.g. Castro).

--If you truly want to use fellowships to gauge competitiveness, look at the number going into plastics.

--Exception to my above rule: If you want to do Pediatric surgery, you will have to go to a big name academic program. They almost universally require 2 years of research, and there are only 35 or so spots per year. Most people who go into residency wanting this choose programs for that reason. This represents an overall small but very prestigious group of residents.


3. You need to ask the right questions at your interview to get enough info to make an educated decision. There are plenty of things, including geography, familiarity, prestige, etc, that factor into your decision, but here are some other important things to factor:

-----What are your ABSITE scores? What are your board pass rates? This is extremely important, and a lot of programs won't mention it (especially if their scores suck). Many programs will blame bad scores on lazy residents, but usually its a combo of weak residents (from poor match outcomes) and poor curriculums.

-----What sort of surgical curriculum do you have? How many hours per week are spent with this? Some people have a crappy grand rounds, and that's it, while others have excellent journal clubs, textbook review, ABSITE preps, etc. You can learn to operate anywhere, but you need to make sure you pick a program that focuses on academics.

-----What sort of critical care experience do you have? You need to know how involved the residents will be in critical care. Writing notes and fluffy superficial orders are not enough. If a program consults intensivists for those patients, or pulmonologists to run the ventilators, then you are being robbed of essential critical care experience.

-----Has anyone left the program? Where did they go? This answer will be yes in most instances, especially with surgery's 20% attrition rate. Dropouts heading to anesthesia and ER shouldn't sway you too much. However, if there's a large number, or people are leaving to do GENERAL SURGERY somewhere else, then there's a reason. Either the program fires people too often, or picks crappy residents that need to be fired, or the residents leave on their own accord because the place sucks.

---There's probably more, but I'm sure I'm losing most people's interest, so I'll go on to my final point.


4. Remember that it is still a buyer's market. Every year from now until 2020, you will here, "Surgery is really competitive this year!!" This is true to some extent, as matching now is way more difficult than in the early 2000's. However, a lot of this competitiveness is truly just people applying to a larger number of programs than previously done. In truth, it has hit a plateau, as evidenced by the # of US grads per position and match rates over the last 3 years.

----That means, if you are AVERAGE, then you can still match. Maybe not at your first choice, but stay confident. If you are above average, you are a commodity. You shouldn't ever go into interviews overly cocky or arrogant, but have confidence, and don't make quick decisions out of fear. The match was designed to benefit you, and it can work in your favor if you keep a cool head.

----Definitely a stupid idea is to rank programs that you think love you higher than the programs that you really want, in a stupid attempt to get your #1 and maintain your ego on match day. Rank the programs in the order that you truly like, otherwise you may end up at a #1 piece of crap.


I hope this helps, because it took me 20 minutes to write it out......

[Micro115]

Your post definitely helped! Thanks so much!

[njbmd]

Originally Posted by SLUser11

4. Remember that it is still a buyer's market. Every year from now until 2020, you will here, "Surgery is really competitive this year!!" This is true to some extent, as matching now is way more difficult than in the early 2000's. However, a lot of this competitiveness is truly just people applying to a larger number of programs than previously done. In truth, it has hit a plateau, as evidenced by the # of US grads per position and match rates over the last 3 years.

----That means, if you are AVERAGE, then you can still match. Maybe not at your first choice, but stay confident. If you are above average, you are a commodity. You shouldn't ever go into interviews overly cocky or arrogant, but have confidence, and don't make quick decisions out of fear. The match was designed to benefit you, and it can work in your favor if you keep a cool head.

----Definitely a stupid idea is to rank programs that you think love you higher than the programs that you really want, in a stupid attempt to get your #1 and maintain your ego on match day. Rank the programs in the order that you truly like, otherwise you may end up at a #1 piece of crap.


I hope this helps, because it took me 20 minutes to write it out......

I was with you up until the last numbered statement. If you are above average (grades, USMLE Step I and LORS) then you are likely going to be fine. If you are just average, you are not likely to match unless you have received enough interviews to be able to safely rank at least 10-15 programs. Only ranking 4 or 5 places is not enough because the prospect of a non-match is looming large. If you have not received the interview invitations and have more regrets than invites, add more programs and add them quickly.

Trying to scramble in General Surgery is not a sound practice. If you wind up scrambling, your best case scenario is that you scramble into a solid non-designated prelim position where you can work hard, get good ABSITE scores and get back into the MATCH next year. (The criteria in the original post are excellent points). The worse case scenario is that you scramble into a malignant(crappy) categorical program with poor academics (which you don't have the time or the energy to overcome). It's not really a "buyers market" but a smart (and informed ) "buyers" market out there.

[jc7721]

there's some great, truthful advice in this post. And I'll just emphasize that, yes, interviewing is an extremely biased process with lots of people stretching the truth or just lying.

I'd like to add one piece of information that wasn't included in the above posts, and it's regarding how some programs actually rank/order/separate residents on/after interview day. Obviously, this is coming from a limited perspective, but these are honest observations.

Before you even show up to interview day, most programs have already put some applicants into the 'top/looks incredible on paper/wow' pile, and most others into the 'everyone else' pile. This by no means implies that programs have already chosen who they want, just that they (as was said above) want to look good, hence, pile of applicants that already looks good on paper. Programs do single out applicants they have a high interest in 'getting to know better'. PD who say otherwise are lying.

That said, on interview day, following each interview, the interviewer almost invariably will have a sheet to fill out. Typically this consists of multiple categories with point values assigned to them (i.e. 0-5 scale) or simply 'must have' 'good' and 'do not accept'. This is exactly why the interviews can actually make or break you (don't let anyone tell you otherwise): if you are average but the worlds best conversationalist and interviewee, you are likely to get into that coveted 'must have' spot. If you have a genius-level application, but speak like Palin to Katie Couric, you have put the nails in your own coffin.

I've seen this at my own program: attendings come out of their interview rooms, find the PD, and say something like "I just interviewed so-and-so and they are great, a perfect fit, a must-have". PD nods and takes note. This happens all over the place.

[njbmd]

Originally Posted by jc7721

there's some great, truthful advice in this post. And I'll just emphasize that, yes, interviewing is an extremely biased process with lots of people stretching the truth or just lying.

I'd like to add one piece of information that wasn't included in the above posts, and it's regarding how some programs actually rank/order/separate residents on/after interview day. Obviously, this is coming from a limited perspective, but these are honest observations.

Before you even show up to interview day, most programs have already put some applicants into the 'top/looks incredible on paper/wow' pile, and most others into the 'everyone else' pile. This by no means implies that programs have already chosen who they want, just that they (as was said above) want to look good, hence, pile of applicants that already looks good on paper. Programs do single out applicants they have a high interest in 'getting to know better'. PD who say otherwise are lying.

That said, on interview day, following each interview, the interviewer almost invariably will have a sheet to fill out. Typically this consists of multiple categories with point values assigned to them (i.e. 0-5 scale) or simply 'must have' 'good' and 'do not accept'. This is exactly why the interviews can actually make or break you (don't let anyone tell you otherwise): if you are average but the worlds best conversationalist and interviewee, you are likely to get into that coveted 'must have' spot. If you have a genius-level application, but speak like Palin to Katie Couric, you have put the nails in your own coffin.

I've seen this at my own program: attendings come out of their interview rooms, find the PD, and say something like "I just interviewed so-and-so and they are great, a perfect fit, a must-have". PD nods and takes note. This happens all over the place.

This is correct in terms of the program ranking meetings that I have been a part of. We do rank applicants on the day of the interviews. At the end of all interviews, we have another big ranking meeting (active faculty and PD) where we do rank everyone for the last time. Our PD does not generally override our ranking unless something comes in (only happened once) and that info is shared with us.

Applications are screened by USMLE and grades (sometimes by who write their LORs too). It is the interview that will often raise or lower that ranking so the interview is quite important. Some people can kill their chances by "screwing up" the interview. This is a job interview and you are "on" at everything that involves the interview process.

For example, one applicant who was highly ranked at our after interview ranking meeting, trashed his room at the hotel. He was not ranked at the overall meeting. Another applicant was very rude to the residents who were conducting the tour, again, he didn't get ranked.

[SLUser11]

Originally Posted by njbmd

I was with you up until the last numbered statement. If you are above average (grades, USMLE Step I and LORS) then you are likely going to be fine. If you are just average, you are not likely to match unless you have received enough interviews to be able to safely rank at least 10-15 programs. Only ranking 4 or 5 places is not enough because the prospect of a non-match is looming large. If you have not received the interview invitations and have more regrets than invites, add more programs and add them quickly.

Trying to scramble in General Surgery is not a sound practice. If you wind up scrambling, your best case scenario is that you scramble into a solid non-designated prelim position where you can work hard, get good ABSITE scores and get back into the MATCH next year. (The criteria in the original post are excellent points). The worse case scenario is that you scramble into a malignant(crappy) categorical program with poor academics (which you don't have the time or the energy to overcome). It's not really a "buyers market" but a smart (and informed ) "buyers" market out there.

Okay, I see what you're saying, but maybe I can clarify my point using some hard data.

---In 2007, the US senior match rate for general surgery was about 90% (812/905).

---Mean Step 1 score for a matched applicant=222, which is not much above the recent national mean for that exam. Mean score for a non-matched applicant=204 (very clearly below average).

--Mean number of ranked programs for a non-matcher=4. If you're only going to 4 places, you're not average. (I do agree with you about the magic number 10. This carries a 98% match rate.)

If you are a truly average applicant, not a dressed-up below average applicant, you have an excellent chance of matching.

My point is not that people should only go to 4 places...that is statistically a horrible idea. My point is that the person with multiple interviews and average scores is probably going to match, and above-average applicants have to screw up to not match. Therefore, they should approach the process with confidence, and not let fear dictate their decision making.

I'm with you for the most part, though.





ps Match rate in 2006 was 83%, dispelling the oft-cited "getting more competitive every year" myth. Way back then, in my day..........The magic number 10 carried a 92% match rate.

[Pilot Doc]

My own addition to the above excellent advice:

Realize that the whole process is a crapshoot.

You can't know everything you need to know and both you and your program are going to change over 5 years. Realize that making a great decision is impossible. You might match to a great program ... but that will be luck.

The biggest determinant of your success is the ability to make the best of whatever situation you find yourself in.