A question about med schools and residencies

[AndyR83]

Forgive my ignorance, but I have a very basic question about how the residency process works. If you are accepted to a medical school and complete your four years of study there, do you have to find an affiliated residency through your med school or are you then free to go wherever you want? For instance, if I go to school X in California do I then have to do a residency in California affiliated with school X or can I decide to move to New York the day after graduation and get a residency there instead? Can you apply to a residency in any specialty regardless of the school you went to (meaning there are no schools that will only let you be a family physician etc)? Sorry if this seems like basic info, I have been wondering about this a lot lately and was hoping to touch base with somebody that knows. This will be very important to me in deciding how to go about my med school plans when I am ready to apply in another year or so.

Thanks.

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[badb100d]

You do not have to take a residency affiliated with your school. The gist of it is that you will apply to a bunch of residencies that interest you wherever they may be and in whatever specialty. There will be a long interview process and then you will be asked to rank the programs you applied to and interviewed at. At the same time the programs will rank you. After some crazy computer algorithm you will get matched with a residency program (hopefully one of your top ranked ones) and you will begin your residency there. So depending where you apply and how you rank, you sort of have control over where you will do residency. There's a small chance you won't match into any program, in which case you could end up at a spot affiliated with your med school. However, I wouldn't choose schools solely based on this. With all the vagaries of med school admissions and residency match it's best not to be too attached to any geographical location, although you can always have a preference. Anybody else, feel free to correct me where I may be wrong/add missing info, as I have yet to get to this part!

 

[cabinbuilder]

So you apply to medical school and you go wherever you are accecpted since most students don't really have a choice of where they go.

During the 4th year of medical school during your last rotations you decide what typ of specialty you would like to try to be accepted to and which program interests you. Hopefully you will have researched thies during your rotations and have rotated at hospitals that have the residency you are interested in.

You then apply to multiple residency programs through a central service - ERAS/NRMP. The residency programs then sort through the applicants and decide who they want to interview based on board scores, grades, LOR's, whether you have rotated there, rotation grades, class rank, your dean's letter, etc. Hopefully you will be invited for multiple interviews and then you go where the interviews are. At the end you decide what your top choices are and the residencies decide who their top choices are and a computer tries to match to make both sides happy. This is "match day" when you find out where you will be going. Once you are matched that is a contract and you cannot back out of it so be sure you put on your list places you really would be willing to move to.

If in the event you don't match into a residency then you have to "scramble" and start calling residencies that haven't filled during the match and see if they will take you in an empty slot. This is last resort. YOU DON"T WANT TO HAVE TO SCRAMBLE.

So.... where you go to medical school and where you go to residency is up to you and has no bearing on which school you go to.

 

[QofQuimica]

OP, as the previous posters explained, you are basically starting the whole app process all over again when it comes time to apply for residency. New app service form to fill out, new PS, new LORs, new interviews all over the country if you apply all over the country, etc. etc. You pick the specialty you want to apply for, and some people even apply for multiple specialties with separate PSes, LORs, interviews, etc. So it's pretty analogous to what you have to do to apply for med school. The main improvement on the process compared to applying to med school is that you don't have to fill out any secondaries this time around.

As for the match, what it comes down to is this: you make your rank list, and if there is somewhere you absolutely don't want to go, you don't rank that program. So for example, if you decide there's no way you want to stay at your home school, then you wouldn't include it on your rank list--and you probably wouldn't even apply there in the first place. If you decide you really want to do residency in NYC, you would apply to all the NYC programs in your specialty and go interview at as many of them as invited you. Then you'd rank all the NYC programs where you interviewed at the top of the rank list that you subsequently submit for the match.

At some med schools, it's not possible to stay at your home school for residency even if you do want to. Not every medical school has a residency in every specialty. There are also programs out there in many if not all specialties that are not affiliated with a medical school. These community programs accept med students from all over, just like the academic programs do.

In my case, I don't want to go to a community program, so I didn't apply to any. I also chose programs based on geographic preference and on my perception of their strength in my area of academic interest. That included my home school program, and I did apply there and was invited to interview there--it's my first interview coming up in a few weeks, actually. But I am also receiving invites to interview at programs in other cities and other states.

In your case, focus your med school plans on getting yourself accepted somewhere, wherever you can get in. As cabinbuilder pointed out, not everyone will have multiple choices of schools, especially if you're from a competitive state like CA, and especially if your stats are well below average for the schools you want to attend. If you're a strong candidate and do get into multiple schools, my advice is to pick the one that will let you graduate with the least debt, unless you have a really compelling reason to choose the more expensive school.

Hope this helps, and best of luck.

 

[Law2Doc]

...There's a small chance you won't match into any program, in which case you could end up at a spot affiliated with your med school. ...

Not quite right. If you don't match, you can enter the scramble, which is a free for all where unmatched applicants try to finagle their way into unfilled spots. You generally aren't assured "a spot affiliated with your med school". Although it might happen frequently, technically a med school can't simply give it's own students residency slots when they don't match, they have to make the spots available in the scramble.

 

[Law2Doc]

...

During the 4th year of medical school during your last rotations you decide what type of specialty you would like to try to be accepted to and which program interests you. ...

Also not quite right. You apply for residency starting in September of 4th year for most fields, or before for a handful of early match specialties. So you need to know what specialty you want by very early in 4th year, if not before.

 

[AndyR83]

I see, thanks for your insight everybody. I was arbitrarily using CA and NY in my example. In reality, I was born and raised in RI and did my undergrad work in PA. I am doing post-bacc coursework now to satisfy med school pre-req's and hoping to apply in another year or so. I have no particular affinity to any geographical location at this point in my life. I have, after all, been living in PA for the last few years because I went to college here.

I am a registered nurse with years of ER and trauma resuscitation experience seeking to go back to school to become an ED attending. The reason I inquired about residencies was that some of the med schools I have been reading about seem to market themselves as schools for people that want to be family medicine providers and I am basically trying to clarify if someone like me looking to be an Emergency Physician should avoid such programs. It sounds like this is not the case. I am also more inclined towards osteopathic programs given my non-traditional status and the fact that my research suggests my background as an RN might earn me more brownie points with DO adcoms than MD. My BS is in nursing (with a 3.4) and consequently didn't entail many of the scientific studies med schools require so I'm working on post-bacc courses now to hopefully apply in the near future.

Thanks to all who have contributed!

 

[TriagePreMed]

Now that we're on topic, how does it work for residencies like Neurology where they are advanced placement and you gotta do a year of medicine or surgery first? Do you try to get into 2 separate programs or are you basically going to be assigned a program from your Neurology one?

 

[badb100d]

Not quite right. If you don't match, you can enter the scramble, which is a free for all where unmatched applicants try to finagle their way into unfilled spots. You generally aren't assured "a spot affiliated with your med school". Although it might happen frequently, technically a med school can't simply give it's own students residency slots when they don't match, they have to make the spots available in the scramble.

Thanks for clarifying this point Law@Doc! I actually did know about the scramble, but was rushing my answer. Good to know others are keeping me in check.

 

[cabinbuilder]

Also not quite right. You apply for residency starting in September of 4th year for most fields, or before for a handful of early match specialties. So you need to know what specialty you want by very early in 4th year, if not before.

Well, the OP is still pre-med so I didn't feel I had to be super specific if you want to split hairs about it - so be it. My point I was trying to make is that you have to decide before graduation what field/region of the country you want to be in, no after graduation like inferred in the OP's post.

 

[Law2Doc]

Well, the OP is still pre-med so I didn't feel I had to be super specific if you want to split hairs about it - so be it. My point I was trying to make is that you have to decide before graduation what field/region of the country you want to be in, no after graduation like inferred in the OP's post.

Sure, but folks come on here for advice, so accuracy is important. You don't have up until graduation. You have to make a decision a year before that. It's not a subtle distinction IMHO.

 

[Law2Doc]

Now that we're on topic, how does it work for residencies like Neurology where they are advanced placement and you gotta do a year of medicine or surgery first? Do you try to get into 2 separate programs or are you basically going to be assigned a program from your Neurology one?

If you apply for an "advanced" residency (neurology, derm, anesthesiology, ophthalmology, rad onc, radiology, PM&R, nuclear medicine and probably a few others), you also simultaneously have to apply for (and interview for) preliminary or transitional spots. You will be ranking these in the same match, and will be able to associate your ranks such that you want prelim X to go with advanced rank Y. Some advanced fields allow preliminary intern years in medicine or surgery or a transitional year. Neuro only allows the medicine prelim or transitional (not surgery, like your post suggests). You are "assigned" nothing. You have to interview for and obtain every step along the way. It's entirely possible to match at your advanced program but not get the necessary prelim (and thus have to scramble for one), or vice versa.
It's nice, because you can decide you don't want to move away for a year and do internship local, or try to get the same location for all years, or mix and match (eg do a transitional year in Hawaii for a year before holing up at your advanced residency). It all depends on your application strength, interview skills, contacts, Step scores etc. Nothing is assigned, nothing is set, and all these programs for the most part function independently.