Applying to residency years after graduation

[upontherocks]

I'll keep it short best I can. I graduated US MD in 2020 wanting to go into a ROAD specialty. It didn't work out and I did a civilian TY and currently in the US military as a GMO. I'm planning to get out next year as I can't take it anymore and take more control over life. I've spoken with the people in charge of mil med for my group who pretty much said to beat it and weren't too interested in retaining me. I've more or less been working as a PCP in the military (for anyone in the know, my duty description is a residency trained doc, only cause they don't have enough real docs, seeing about .5 FTE (mostly back pain but do get the occasional bread and butter adult medicine) along with other duties like public health, briefings, occupational health stuff). Working in the clinic has kept me too busy to do any real residency prep. That's the background.
After reflection and being in "practice", I've found that outpatient medicine I can do for the rest of my life, not cut out for ROAD anymore, if ever, so I'm hoping to go into IM, FM, (or even psych, managed a lot of that in the military). I've heard prev med and occ med are common for people in my position and sound interesting but again I'm not that competitive. I would be applying for 2026 residency. Since none of this happened the way I wanted it to, I recognize I'm in real tough spot, so I'm looking for really any advice. I've been humbled, and any residency no matter how toxic is better than none.

The stats: step 1 230s, step 2 240s, step 3 210s, no fails. Couple honors here and there, my name is on a research project from my TY.

Some things I lose sleep over:
- I did a civilian TY, so that takes up a year of GME funding. The way I understand it, even though I wanted to do 4 years of residency, if I go to a 3 year program starting as a PGY-1, I would only have 2 years of funding. One the other docs I worked with did a military internship which I understand does not affect funding so I can't exactly compare my situation to theirs.
- A lot of residencies I've looked at have specific graduation requirements, mostly within 2 years, some 5. Rarely do I see any that say they consider unique circumstances. Is it worth reaching out now to explain my situation?
- It's possible I'll deploy later this year. I may be deployed during interview season. Some programs seem to be doing virtual only which would be my only saving grace.
- People have said if the match doesn't work stay in military and don't starve. I don't really have much a choice in that regard as I would have to submit my resignation prior to the match.
- My classmates are now attendings. Is it worth asking them to put in a good word with their programs?
Appreciate any insight, thoughts, suggestions.

---

Members don't see this ad.

 

[ThoracicGuy]

I think the fact that you've been doing this in the military will make you a bit different than someone else in a similar kind of situation. Given your scores, I suspect you'd be able to get an IM or FM spot.

 

[CopaceticOne]

Unless you have a giant red flag you will match into IM or FM. Maybe not at the country’s top program, but you will match. Why can I be certain about this?

1) you have been practicing as a physician for a few years. This means that the program won’t have to worry about the professionalism problem of you being responsible and showing up for the JOB and doing the WORK. Every year there is at least one resident who struggles with this because they’ve only ever really been a student.

2) your military experience is a positive

3) you have a reason for wanting to pursue the speciality that can be well articulated

So - get strong & supportive LORs from people who you’ve worked with over the past few years. Look around at the various programs in areas of the country you have interest in being. Also, check out programs that people you know say might be a good fit for you. Apply broadly and let the process play out. Be upfront to programs about being deployed during interview season, if that happens, so that arrangements can be tried to be made. Just remember to always be polite to everyone even if frustrated by the process.

Good luck!

 

[spideydoc22]

You’ll be fine applying for civilian residencies. I don’t think the funding piece is going to be an issue. Hospitals make SO much money off of GME that you’re funding isn’t going to realistically affect them (for background, a program gets paid along the lines of 150k for a resident per year. You get paid 65k/year. Basically that means the hospital is getting paid 85k for a free laborer who requires supervision (instead of paying 100k for a NP or PA to fill the exact same role) …not a bad gig).

Anyway, I just applied after getting out as a Navy GMO (flight surgeon) and I got interviews at 85% of the programs I applied to (all academic/university based), and am surely going to match. My military experience was seen as a major positive, I was told, among other things, I bring “maturity” to my incoming class. My scores were average, but my experience was something that no med student could compare to. For you, your step scores aren’t really helpful except they show you passed your tests. Med students need their scores to be good to prove they are more likely than others to be able to practice medicine well. You’ve already proved it as a GMO, they don’t need to rely on your scores to deduce that info.

Every interview I had was basically the program director asking me “how do we get you to come here?”, even at the top programs I interviewed at.

Also, I applied for many programs that said “do not apply if you are outside 2 years of graduation”. I contacted the programs before I applied and they said that didn’t apply to me. Those lines are for folks who graduate med school and don’t go on to practice medicine.

You’ll do great, thank you for serving our country and enjoy the prospect of being able to enjoy civilian life on the other side!

 

[OEM doc]

Given your background, would strongly consider Occupational and Environmental Medicine (OEM), aka Occ Med. You mentioned this in your initial post but then seemed to dismiss it, saying "I'm not that competitive." Not sure I understand that comment. While OEM is very competitive in the Navy, it isn't particularly competitive among civilian programs. It is a great fit for a prior UMO, given that you are basically already practicing in a niche Occ Med field. You could potentially match directly into a "reserved" PGY-2 slot, negating the concerns about funding if you had to start over again at the PGY-1 level.

You could always apply for OEM in the Navy (if that interests you) and on the outside via NRMP at the same time, and take whatever you can get. Again, usually much harder getting OEM in the Navy.

I'd at least recommend checking out The OEM Info Page for more good info about the specialty. The site has specific pages for OEM in the Military as well as a Profiles page of actual OEM physicians and what they do. Good luck!

 

[shaggybill]

I agree with OEM doc, you'd likely be a great fit and almost certainly very competitive for occ med (as long as there aren't any glaring red flags not mentioned). You'd be competitive for FM/IM too though if you are more inclined to go that direction.

 

[DogRescuer]

Would love a followup next year🙂 Wishing you much success and thank you for your service!

 

[shaggybill]

Just an update on OEM stuff, many Occ Med residency programs are in limbo with funding issues since the current administration has cut finding to NIOSH significantly. I know of some that aren't sure if they will be accepting residency applications next year because of it. These programs are not paid for through CMS like other ACGME residencies, so if you apply to occ med, make sure you're getting the most updated information on funding status.

 

[upontherocks]

Thanks for the responses everyone. Military has kept me very busy and now finally have time to work on my application. In short I ended up being deployed and plan to be back in time for interview season. My school is thankfully helping me prepare and putting me in touch with the associate dean for advice. To update:

-I thought about occ med and prev med, but I don't really feel it when doing shop visits, occupational health exams, etc. Don't know any docs in either field so no LORs, and being deployed no time to "show interest". Also heard about the possible funding problems.
-After thinking about it, I'm planning on dual applying to psych and FM (considering triple applying with IM if that won't bite me as being perceived negatively as a backup, I just need to be a residency trained doctor, financially comfortable to drop several thousands, and 5 years as a gmo is too much lost time to not be a doctor anymore). I feel I would be content in any of these fields. Can't do much deployed outside of making my application as strong as I can. Got letter writers accounted for. Would appreciate any other advice from anyone with more knowledge about the process. I can't find it right now but the military forum "GMO and out" threads have been a good read.

-I'm wondering if I should message program coordinators. I'm not really sure what would be worth asking that's not entirely on the website or would impact applications, if that makes sense. I hope my application speaks for itself and if I get automatically screened out, only $30 lost, I've wasted more money on dumber things.

 

[OEM doc]

Thanks for the responses everyone. Military has kept me very busy and now finally have time to work on my application. In short I ended up being deployed and plan to be back in time for interview season. My school is thankfully helping me prepare and putting me in touch with the associate dean for advice. To update:

-I thought about occ med and prev med, but I don't really feel it when doing shop visits, occupational health exams, etc. Don't know any docs in either field so no LORs, and being deployed no time to "show interest". Also heard about the possible funding problems.
-After thinking about it, I'm planning on dual applying to psych and FM (considering triple applying with IM if that won't bite me as being perceived negatively as a backup, I just need to be a residency trained doctor, financially comfortable to drop several thousands, and 5 years as a gmo is too much lost time to not be a doctor anymore). I feel I would be content in any of these fields. Can't do much deployed outside of making my application as strong as I can. Got letter writers accounted for. Would appreciate any other advice from anyone with more knowledge about the process. I can't find it right now but the military forum "GMO and out" threads have been a good read.

-I'm wondering if I should message program coordinators. I'm not really sure what would be worth asking that's not entirely on the website or would impact applications, if that makes sense. I hope my application speaks for itself and if I get automatically screened out, only $30 lost, I've wasted more money on dumber things.

You are getting out and applying for civilian residency programs? You can apply to as many programs and specialties as you want on NRMP and there is no downside to doing that. Programs don't see how many other places you are applying to, and the matching algorithm just moves down your rank list one by one. There is no penalty for applying to a bunch of programs, other than I guess having to pay more. No risk from a matching perspective.

 

[upontherocks]

You are getting out and applying for civilian residency programs? You can apply to as many programs and specialties as you want on NRMP and there is no downside to doing that. Programs don't see how many other places you are applying to, and the matching algorithm just moves down your rank list one by one. There is no penalty for applying to a bunch of programs, other than I guess having to pay more. No risk from a matching perspective.

I've heard that applying to multiple specialties appears as if you're not serious about one, treating like a backup, etc, and that impacts the overall impression of the application. A way to avoid that I've also heard is to not apply to the same specialty at the same program, so applying for 2 specialties already, would be applying to a lot of programs with not a lot of places left that haven't been applied to. I will be applying be applying broadly, running numbers it'll be several thousand which stings but gotta do what I gotta do and can afford. If anyone has more insight on this, would appreciate to hear those thoughts.

 

[gutonc]

I've heard that applying to multiple specialties appears as if you're not serious about one, treating like a backup, etc, and that impacts the overall impression of the application. A way to avoid that I've also heard is to not apply to the same specialty at the same program, so applying for 2 specialties already, would be applying to a lot of programs with not a lot of places left that haven't been applied to. I will be applying be applying broadly, running numbers it'll be several thousand which stings but gotta do what I gotta do and can afford. If anyone has more insight on this, would appreciate to hear those thoughts.

There is a bit of truth to this, but I think it's somewhat overblown. IIRC, PDs can only see where you matched if they had you on their rank list and can't see anything else about where you applied and for what. Sure, PDs of different programs at a particular hospital can talk to each other and compare applications lists, but they don't have time for it and really don't care. The big issue is that most applicants have a CV that is clearly tailored for one particular specialty, so if they're applying Derm, with IM as a backup, it's pretty obvious, and nobody likes sloppy seconds. That said, derm is hypercompetitive and everyone knows most applicants have a backup specialty. But psych and FM or FM and IM, or Psych and IM, aren't all that far apart from an intellectual perspective, and IM and FM can be easily done and justified if your CV has a clear primary care focus.

Back in the days of in-person interviews, you would run the risk of being seen by faculty/residents of one program while interviewing for a different program at the same hospital and that could cause you trouble. Now that everyone just does stupid Zoom interviews (which, IMO is worse than no interview at all), it's not really a problem.

That said, if you're focused on psych (or FM or whatever), just go all in on that specialty. You'll find out pretty quickly if you're competitive. If you send 50 apps and get 20 IIs, you'll be fine. If you only get 2, then that's the time I'd consider dropping some apps for a backup specialty. It's probably worth having a 2nd PS and LORs in your pocket (uploaded to ERAS) and ready to send if that becomes the case since you want to be able to do it in a matter of minutes rather than days.

 

[AlbinoHawk DO]

I see no reason why you wouldn't be competitive with that profile. There are no red flags and you served in the military. Funding is uncommonly a problem. Yes, you'll have 2 years of full funding, but the program would receive about 80% or so for a 3rd and 4th year. Very few programs would even care about that reduced funding. FM and IM should be quite easy to match for you, so I would only apply to one of the two. You can add psych too. Nobody is going to know that you're applying to both. Even within the same institution, PDs don't sit around together and compare their applicant lists

 

[HemeOncHopeful19]

I think you’d be fine for IM, FM or Psych or whatever moderately competitive field you’d be interested in.

I wouldn’t sell yourself short the whole XYZ years from graduation thing doesn’t apply to you at all IMO. Residency funding is irrelevant in 2025

 

[abc123412]

Thanks for the responses everyone. Military has kept me very busy and now finally have time to work on my application. In short I ended up being deployed and plan to be back in time for interview season. My school is thankfully helping me prepare and putting me in touch with the associate dean for advice. To update:

-I thought about occ med and prev med, but I don't really feel it when doing shop visits, occupational health exams, etc. Don't know any docs in either field so no LORs, and being deployed no time to "show interest". Also heard about the possible funding problems.
-After thinking about it, I'm planning on dual applying to psych and FM (considering triple applying with IM if that won't bite me as being perceived negatively as a backup, I just need to be a residency trained doctor, financially comfortable to drop several thousands, and 5 years as a gmo is too much lost time to not be a doctor anymore). I feel I would be content in any of these fields. Can't do much deployed outside of making my application as strong as I can. Got letter writers accounted for. Would appreciate any other advice from anyone with more knowledge about the process. I can't find it right now but the military forum "GMO and out" threads have been a good read.

-I'm wondering if I should message program coordinators. I'm not really sure what would be worth asking that's not entirely on the website or would impact applications, if that makes sense. I hope my application speaks for itself and if I get automatically screened out, only $30 lost, I've wasted more money on dumber things.

Don't worry about the lack of an occupational medicine letter of recommendation; most programs don't expect it. Many occupational medicine physicians are mid-career physicians such as yourself who transition into Occupational Medicine from other fields.

Most of occupational medicine doesn't entail on-site visits; so, don't let your lack of interest in shop visits/on-site visits be a deterrent.

Anyway, I would pick the field that you're most interested in and apply to it.

It doesn't make sense to dual apply as none of the specialties in question are completive.

In all honestly, you should have no problem matching in any of the specialties discussed (Internal Medicine, Family Medicine, Occupational Medicine, or Psychiatry).