AMA - Matched ortho on the 3rd try (US MD)

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finallymatchedortho

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2nd time reapplicant (3rd time in the match), finally matched yesterday. Prelim year through the SOAP then research year.

Step 1 220 - 225 / Step 2 CK 245 - 250

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This originally came from the ortho spreadsheet so here's a question I got there:
Would you suggest a prelim year or research year? Or both (and in which order?)
There's no good, uniform answer, honestly. I was advised research year by everyone I interacted with in medical school, except for my chairman who suggested a prelim year. So I went with that. His reasoning was that my problem is my Step and I don't have a strong research background so he didn't think I would be productive enough to make a difference in my application. With a prelim year, I could prove to programs that I'm a strong resident and they'd be able to see what they're getting rather than having to extrapolate from my application.

The problem with the prelim year is that you're stuck at one program working long hours and not significantly improving your application (at least on paper). So you're relying on either that program really liking you and advocating for you either through phone calls to get interviews or letting you know about PGY2 spots opening up.

On the other hand, the prelim year opens up more options because now you're eligible for PGY1 and PGY2 positions. I know several people that have slid into a PGY2 spot due to a resident dropping out or a program expanding, so it can work. Also, most PDs I've talked to since then have said they advise doing the prelim year since at least you're moving forward with your career and gaining clinical experience.

There's also a paper out there that shows no difference in match rate between prelim years and research years. It comes down to what you do during that time, and also a heck of a lot of luck.
 
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Do you have any idea as to what held up your match in the first place? Any feedback from program you applied to, etc? I guess what I'm trying to ask is if you could have done something differently in your MS1-MS4 years to better your initial chances, what would it have been?
 
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Do you have any idea as to what held up your match in the first place? Any feedback from program you applied to, etc? I guess what I'm trying to ask is if you could have done something differently in your MS1-MS4 years to better your initial chances, what would it have been?

I would've done better on Step 1, which I recognize is now P/F so it might be a moot point. I was told more times than I can count that I did a great job on a rotation, everyone loved me, blah blah blah, but my Step 1 was too low for them to even consider me. I didn't think I would match this year, either, for that same reason.

Ortho for some reason has an obsession with Step 1 and it's something they can't get over no matter how good the rest of your scores, research, or LOR are. I'm curious how this will play out with it going P/F.

ETA - I realize that's not super helpful because once you get your scores back there's nothing you can do about them (which is a huge point of frustration on my part...I was being judged on a test I took 4 years ago). But it's the single thing that kept me from matching earlier. If everything in my application had been the same and my score was 15+ points higher, I most likely would've matched the first time around.
 
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Currently looking at taking research route ---- so did you stay at your home institution? Go to a big powerhouse for an organized fellowship? How productive were you and how did you ensure your productivity (if you can)?
 
Currently looking at taking research route ---- so did you stay at your home institution? Go to a big powerhouse for an organized fellowship? How productive were you and how did you ensure your productivity (if you can)?

None of the above in that didn't stay at my home institution nor did I go to a big powerhouse. Objectively, you wouldn't say my year has been productive research-wise, but that's also not what I was attempting to do. My goal was to impress the crap out of the people I was working with, whether that meant a lot of research papers or simply keeping them organized. I knew my best shot at matching was at my research program (either to match me directly or make calls for me) so I did everything to make them love me.

Research years come in a lot of different flavors and should play to the weaknesses of your application. For example, if you have an average Step 1 score and are taking a research year between MS3 and MS4, then you should have a very productive year with lots of research output. If you're below average on Step 1 (but not too bad) and also between MS3 and MS4, then you should be productive but also find a program that offers some mentorship so you develop good relationships that can make phone calls for you (phone calls are more essential the crappier your Step 1 score). For both of those situations, it's not as vital to go to a place that has a history of matching its research fellows; you're there to have solid research output and aren't as "desperate" to match since you still have aways, etc.

On the other hand, if you're unmatched and have a crappy Step 1 score (my situation), then you need to go to a program that has a history of matching its research fellows. That should be your number 1 priority in a program. It doesn't matter if they match at where they're doing research or elsewhere, as long as the program has shown that it cares about that research fellow enough to get them to match ortho. You need an advocate more than anything!

I knew my application was going to be lost in a sea of 800 apps for 4 spots, so I needed my program to love me enough to advocate for me, and make phone calls so someone would lay eyes on my application and see past the Step score. This was advice I got from another applicant I met during my first reapplication cycle and it stuck with me. It worked for him and seemed to work for me as well.

For those reasons, I didn't go to my home program since they had told me for years that they wouldn't match me due to my Step score. "We love you, we'd hire you as an attending, but we won't train you," were their words to both me and my dean. I had also done a prelim elsewhere prior to the research year so I was already a year removed from that department. I also didn't go to a powerhouse because I wanted a closer/more intimate mentorship model since I thrive on being a big fish in a little sea.

My research year has been relatively unproductive in that I don't have many papers to show for it. But I did my job well, schmoozed up the wazoo, and did everything and anything anyone asked of me. Can you walk the mail over to clinic because you're headed that way anyway? Sure, no problem! Want to do this IRB for a RCT? Definitely, even though you have a bunch of other stuff on your plate and you're not even working with that attending.

Mostly, I made myself available whenever an extra hand was needed, since everyone was so stretched thin. I won over the executive director of the department (the chairman's right hand man) this way, as well as other research project managers, attendings, and clinic and inpatient staff. I was EVERYWHERE and it showed based on the support I received during the interview season and awaiting match results.
 
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Also, to ensure productivity (I do have a few papers and projects in the works but nothing in the double digits like some people have), I kept my ears open and got on any project I heard about. Whenever a resident talked about running data or writing up a project, I offered to help, or wrote up an introduction / methods without being asked. Same with projects from other attendings I wasn't directly working with. Mostly, I was proactive about finding projects and doing work without being directly asked to do something. I just did it, sent it over, and hoped something would come of it. Oftentimes it did.
 
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Why not add gen surg into the mix in ERAS #2 and #3? Cutting on bones really so much better that you'd take a third failed match before you'd change up the kind of surgery??
 
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Ah I see, so you sort of created a new home where clearly either they took you or so highly advocated for you that you snagged a spot. Nicely done, that's incredible

So I don't want to say I'm a slip through the cracks candidate too soon, before I've dug into why programs didn't want me (22 interview invites, 15 interviews) but I think I may have been. Perhaps I interview poorly. Perhaps my list was not strategic. I do not know. 248-255-All (H) except 2, 19 research items 2 of which manuscripts, 1/2 podiums and 1/2 abstracts.

Where I'm at now is that I am taking the research route but I'm not sure if it is better to stay at home, or go to powerhouse with big name that will then advocate for me. I love the "help wherever you can" mentality though and will assuredly do it wherever I am.
 
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Why not add gen surg into the mix in ERAS #2 and #3? Cutting on bones really so much better that you'd take a third failed match before you'd change up the kind of surgery??

a lot of people gung-ho ortho have a pretty bad taste in their mouth about gen surg. It's a thing. I loved gen surg but not for everyone. So yes cutting on bones is actually far far better to many people lol
 
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a lot of people gung-ho ortho have a pretty bad taste in their mouth about gen surg. It's a thing. I loved gen surg but not for everyone. So yes cutting on bones is actually far far better to many people lol

Exactly, notice how most ortho gunners' second choice is rads, not gen surg. There are so many reasons why I don't want GS and would choose rads over it 10 times out of 10, but I won't derail.
 
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I remember how this general surgeon said that he wanted to do ortho but he had an amazing mentor in gen surg and that's why he ended up in GS. I asked him "What about gen surg do you enjoy?" He said "I ask myself that every day"
So his mentor basically tricked him into going GS looool

I'm sorry, carry on guys lol
 
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So like, what changed drastically from try#2 to try#3? And what gave you the fortitude to even think you had a chance the third time? Many people say that going through the match twice is a death sentence let alone three times for something like ortho. Also what Type of US medical school did you go to? Did they do anything to try to help you match post graduation or was it a You’re on your own type of thing.
 
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Why not add gen surg into the mix in ERAS #2 and #3? Cutting on bones really so much better that you'd take a third failed match before you'd change up the kind of surgery??

Ha! I would rather leave clinical medicine altogether than do general surgery. No joke. I HATED general surgery after my prelim year and could not fathom finishing a full 5 year general surgery residency, let alone working as a surgeon for 30+ years. You couldn't pay me enough.

And yes, cutting bones is so much better than stapling bowels and I was willing to go unmatched yet again to keep trying for ortho. I recognized that it was a huge professional risk and could have career-ending implications if ortho never worked out, but I was willing to give it a shot.

It's a very personal decision and you have to evaluate your priorities and how much risk you're willing to take. Not everyone would've made that decision, and I know many who didn't. To each their own.
 
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Ah I see, so you sort of created a new home where clearly either they took you or so highly advocated for you that you snagged a spot. Nicely done, that's incredible

Exactly. And thank you!

So I don't want to say I'm a slip through the cracks candidate too soon, before I've dug into why programs didn't want me (22 interview invites, 15 interviews) but I think I may have been. Perhaps I interview poorly. Perhaps my list was not strategic. I do not know. 248-255-All (H) except 2, 19 research items 2 of which manuscripts, 1/2 podiums and 1/2 abstracts.

I'm so sorry to hear that! You sound like a solid applicant that should've matched (I'm sure you've already heard that). With those scores and that research output, you may have just slipped through the cracks. I don't know the rest of your application and I'm not an ortho PD so take that with a grain of salt. Sadly, that's average these days so a bad interview day can sink your chances. Working on your interview skills can make a big difference for next year.

Where I'm at now is that I am taking the research route but I'm not sure if it is better to stay at home, or go to powerhouse with big name that will then advocate for me. I love the "help wherever you can" mentality though and will assuredly do it wherever I am.

Will your home program advocate for you? Will they considering matching you next year? They know you the best so that can go either way. My home program flat out told me they wouldn't match me so that decision was easy for me.

Your best shot of matching this year is at the program you do your research. Unfortunately, being a reapplicant is like a scarlet letter so you need someone who is willing to overlook that aspect of your application.

Also, never underestimate the power of a big name in orthopaedics. One of the interviews I got specifically mentioned the LOR written by my research chairman, who is relatively well known. He hadn't called that particular program for me so his name on the LOR and the strong content were instrumental in getting me that interview.

Take the mentality of no task being below you. You have to be willing to mop the floors with a smile on your face if that's what they ask you to do (another piece of advice from a previous reapplicant...and so true).

Good luck!!!
 
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I'll answer this in several parts.

So like, what changed drastically from try#2 to try#3?

The only difference was impressing the crap out of my research program and being indispensable to them. I had impressed the chairman, PD, multiple attendings, all of the research managers, the clinic and admin staff, department director, etc. Literally everyone was rooting for me and had put in good words for me to the match committee. I don't have a ton of research (nothing close compared to the powerhouses) and my Step score hasn't changed. So on paper, my application looks pretty similar, especially since it was due 4 months after I started the research year.

And what gave you the fortitude to even think you had a chance the third time? Many people say that going through the match twice is a death sentence let alone three times for something like ortho.

I honestly didn't think I was every going to match orthopaedics. I'm still in shock that I did. The applicants these days (and my initial application year) are so impressive that I didn't think anyone would take my Step score. Many PDs had said that they wouldn't so I didn't have a lot of hope that it'd work.

What kept me going was avoiding regret. I hadn't exhausted all the avenues into ortho quite yet so I knew I had to keep going until I had nothing else to give, otherwise I would regret it and wonder why for the rest of my life. I had done the prelim year and next was a research year. Many programs require a 2-year research commitment with great match success, so I figured if I didn't match after 1 year then another year of research would be expected for those in my situation.

Also, the dean of my medical school was one of my biggest supporters and had told me that I probably wouldn't match the first time, or the second time, but if I put in 2-3 years of research, I had a decent shot of getting in. So his belief in me also kept me going.

Also what Type of US medical school did you go to? Did they do anything to try to help you match post graduation or was it a You’re on your own type of thing.

I went to a middle of the road medical school. They knew me well since I got involved as an MS1. They liked me, said they'd make phone calls for me, but wouldn't match me because of my Step score. "We love you, we'd hire you as an attending, but we won't train you," were their words. The first time I applied, the chairman and PD called my #1 on my behalf. Obviously it wasn't enough. In subsequent years, the chairman updated his LOR for me while the PD ignored my emails. So essentially I was on my own since they're just not the gung-ho super advocate types, which is what I needed.

They're very good people and I appreciate their honesty about my chances so I hold no grudges at all. I look forward to having them as future colleagues.
 
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I'll answer this in several parts.



The only difference was impressing the crap out of my research program and being indispensable to them. I had impressed the chairman, PD, multiple attendings, all of the research managers, the clinic and admin staff, department director, etc. Literally everyone was rooting for me and had put in good words for me to the match committee. I don't have a ton of research (nothing close compared to the powerhouses) and my Step score hasn't changed. So on paper, my application looks pretty similar, especially since it was due 4 months after I started the research year.



I honestly didn't think I was every going to match orthopaedics. I'm still in shock that I did. The applicants these days (and my initial application year) are so impressive that I didn't think anyone would take my Step score. Many PDs had said that they wouldn't so I didn't have a lot of hope that it'd work.

What kept me going was avoiding regret. I hadn't exhausted all the avenues into ortho quite yet so I knew I had to keep going until I had nothing else to give, otherwise I would regret it and wonder why for the rest of my life. I had done the prelim year and next was a research year. Many programs require a 2-year research commitment with great match success, so I figured if I didn't match after 1 year then another year of research would be expected for those in my situation.

Also, the dean of my medical school was one of my biggest supporters and had told me that I probably wouldn't match the first time, or the second time, but if I put in 2-3 years of research, I had a decent shot of getting in. So his belief in me also kept me going.



I went to a middle of the road medical school. They knew me well since I got involved as an MS1. They liked me, said they'd make phone calls for me, but wouldn't match me because of my Step score. "We love you, we'd hire you as an attending, but we won't train you," were their words. The first time I applied, the chairman and PD called my #1 on my behalf. Obviously it wasn't enough. In subsequent years, the chairman updated his LOR for me while the PD ignored my emails. So essentially I was on my own since they're just not the gung-ho super advocate types, which is what I needed.

They're very good people and I appreciate their honesty about my chances so I hold no grudges at all. I look forward to having them as future colleagues.

Insane. A lot of props and and nothing but respect to you. It must have been quite a feeling to have worked so hard to achieve your dream and after a lot of pain, sweat and tears you did it! Again congrats champ.
 
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This would also not have been possible without the incredible support of my research attendings. They said they'd do everything in their power to get me to match and would feel like they had failed if I didn't match. I really won the jackpot with them.

This is the kind of mentorship and advocacy people in my situation should be looking for. It's honestly the only way to get in as a reapplicant with crappy scores.

Also, my story is the exception, not the norm. By sharing, I wanted to give hope to others in similar situations to show it is possible, though very rare. It does come at the cost of years of uncertainty and buttloads of stress. I'm sure it's taken years off my life. So it's something you have to think long and hard about before deciding to go down this path. For me it was worth it (I think), but that's a decision you have to make for yourself.
 
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Insane. A lot of props and and nothing but respect to you. It must have been quite a feeling to have worked so hard to achieve your dream and after a lot of pain, sweat and tears you did it! Again congrats champ.

Thanks! Truly can't believe it actually happened. I keep rechecking my email to make sure I've read it correctly and that there wasn't a follow-up, "Sike! We made a mistake" from the NRMP.

It's more a relief than anything that this nightmare is finally over. I'm getting to the point where happiness and excitement are slowly starting to creep in. And it feels so damn good!
 
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I'll answer this in several parts.



The only difference was impressing the crap out of my research program and being indispensable to them. I had impressed the chairman, PD, multiple attendings, all of the research managers, the clinic and admin staff, department director, etc. Literally everyone was rooting for me and had put in good words for me to the match committee. I don't have a ton of research (nothing close compared to the powerhouses) and my Step score hasn't changed. So on paper, my application looks pretty similar, especially since it was due 4 months after I started the research year.



I honestly didn't think I was every going to match orthopaedics. I'm still in shock that I did. The applicants these days (and my initial application year) are so impressive that I didn't think anyone would take my Step score. Many PDs had said that they wouldn't so I didn't have a lot of hope that it'd work.

What kept me going was avoiding regret. I hadn't exhausted all the avenues into ortho quite yet so I knew I had to keep going until I had nothing else to give, otherwise I would regret it and wonder why for the rest of my life. I had done the prelim year and next was a research year. Many programs require a 2-year research commitment with great match success, so I figured if I didn't match after 1 year then another year of research would be expected for those in my situation.

Also, the dean of my medical school was one of my biggest supporters and had told me that I probably wouldn't match the first time, or the second time, but if I put in 2-3 years of research, I had a decent shot of getting in. So his belief in me also kept me going.



I went to a middle of the road medical school. They knew me well since I got involved as an MS1. They liked me, said they'd make phone calls for me, but wouldn't match me because of my Step score. "We love you, we'd hire you as an attending, but we won't train you," were their words. The first time I applied, the chairman and PD called my #1 on my behalf. Obviously it wasn't enough. In subsequent years, the chairman updated his LOR for me while the PD ignored my emails. So essentially I was on my own since they're just not the gung-ho super advocate types, which is what I needed.

They're very good people and I appreciate their honesty about my chances so I hold no grudges at all. I look forward to having them as future colleagues.

That to me is mind boggling. I would never make a phone call for someone who I wouldn’t take in my program. Your home programs obsession with step 1 score is unreal. Your step score, while below average, is not a 200.
 
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That to me is mind boggling. I would never make a phone call for someone who I wouldn’t take in my program. Your home programs obsession with step 1 score is unreal. Your step score, while below average, is not a 200.

Right? It's so messed up! Especially since you can't retake it. It's one and done and you're hosed if you screw it up.

I have since learned they're not the only Step 1 sticklers, hence my lack of bitterness/frustration with them. At least they were honest about it from the beginning and found other ways of supporting me, at least initially.

2 of my aways were just as strict about Step 1 but I didn't find out until after I arrived for the rotations since their cutoffs were unofficial. Same with my prelim program. My GS PD even apologized at the end of the year for taking me (he knew I was doing the year to reapply ortho), saying he had no idea how strict ortho was about Step scores and he didn't realize I had had no chance there.

At another place, they had an ortho spot open up and a PGY3 general surgery from that same program expressed interest in switching. He was one their best GS residents, everyone loved him, and he had solid GS in-service exam scores. The ortho department wouldn't even consider him due to his Step 1 score. It was a test he had taken 5 YEARS earlier at that point, with 3 years of residency under his belt where he had clearly proven himself.

I have no problem with places having cutoffs when looking at applications because it's nearly impossible to sift through 800 of them to offer interviews. But when you get to know somebody, like them, and see their character through their work, programs should put a little less emphasis on the score and more on the rest of the application.
 
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Exactly. And thank you!

I'm so sorry to hear that! You sound like a solid applicant that should've matched (I'm sure you've already heard that). With those scores and that research output, you may have just slipped through the cracks. I don't know the rest of your application and I'm not an ortho PD so take that with a grain of salt. Sadly, that's average these days so a bad interview day can sink your chances. Working on your interview skills can make a big difference for next year.

Will your home program advocate for you? Will they considering matching you next year? They know you the best so that can go either way. My home program flat out told me they wouldn't match me so that decision was easy for me.

Your best shot of matching this year is at the program you do your research. Unfortunately, being a reapplicant is like a scarlet letter so you need someone who is willing to overlook that aspect of your application.

Also, never underestimate the power of a big name in orthopaedics. One of the interviews I got specifically mentioned the LOR written by my research chairman, who is relatively well known. He hadn't called that particular program for me so his name on the LOR and the strong content were instrumental in getting me that interview.

Take the mentality of no task being below you. You have to be willing to mop the floors with a smile on your face if that's what they ask you to do (another piece of advice from a previous reapplicant...and so true).

Good luck!!!


Totally get you on the interview technique front, I've already heard how re-apps do a lot of interview coaching just to be safe next time around anyway.

I really don't know where I am in my home program's eyes except that they did not want me this year. I am meeting with home PD very soon to see if there is still potential.

I will say I felt I had that sort of LOR this cycle and I know it's why I got interviews. However I think exactly what youre getting at is why so many people recommend I go to a powerhouse, for the big name. That's the path Im leaning towards now.

WIll do all you recommend, thanks for the motivation :)
 
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OP if you're from NYC, I'm pretty sure I know who you are. Either way, this is awesome! Congrats.
 
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