Failed to match NSG. Reapplying to Radiology-Diagnostic. Chances?

[emdee_inside]

4th year US MD, failed to match neurosurgery, did not SOAP into anything (probably bc my app was so specific to nsgy). Going to delay graduation for med school by 1 year and apply to radiology in the Match 2021. What should I do before ERAS opens for submission? Looking for guidance, friends!

I'm thinking of taking an IR rotation (already took DR) and getting involved in some radiology research but what about away rotations? Should I include that I did not match in my personal statement or just write about my interest in radiology? If I want to settle down as a private practice (diagnostic or interventional) radiologist in the midwest or south, should I truly pick a community program for the geography or still try at notable academic centers (emory, duke, cleveland clinic, vanderbilt,, utsw, uab, mayo, mallinckrodt/washu, etc)?

Stats: 250+ Step 1/2, 4 peer-reviewed pubs (in nsg), total pubs/posters/pres = 13 (in nsg), clerkship grade high pass in IM, Surgery.

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[longhaul3]

Man, that's tough. I hate to hear when people with strong apps don't match.

Do you have a home neurosurgery department? What's your relationship like with them? If they like you and would be willing to talk to their neuroradiology colleagues (most nsg departments are very close with a few trusted brain and spine radiologists) on your behalf, that might help. If I were in your shoes I might also do a month of neuroDR if your school allows it, like a 1-on-1 preceptorship with the division chief or whoever is the most influential neuroDR person. Most neurosurgery applicants who have done one or more sub-is are pretty good at the basics of neuroimaging, and far better than almost all other med students, so you may have a chance to impress and show why you're interested in radiology.

I will leave it at that because I don't know anything about the actual process of applying in DR. Good luck.

 

[throwaway1000000]

You will match as long as you have a home department (even if you don't you likely will). Best bang for your buck would be to take a ton of home rotations and impress them. You have nothing else to do right now. Do a lot of research with them, go to all their conferences, talk to your home PD, just show a ton of interest.
Once you do that, if you have time and money for aways, sure do them. But from what I know from my friends that matched into radiology, away rotations are not necessary at all.
You should not include in your personal statement that you didn't match unless they ask you. You can say you changed your mind late in 4th year so you took an extra year in order to boost your radiology application with research and introduce yourself more to the field.
Don't think this should be a complicated year. Do a ton of home radiology rotations, attend their conferences, do research, get good letters and apply.

 

[radsisrad]

Agree that you should definitely not mention that you didn't match. Make up some stuff about how you discovered the beauty and tech of medical imaging, blah blah blah. We all know that unmatched surgical applicants often end up in DR, but the stories are awkward to read/hear.

You'll match. You should probably aim for top-notch programs, given your CV. Community programs can sometimes feel insecure with applicants who are "overqualified." Getting a job in South or MW won't be a problem, regardless of where you trained.

 

[Chlorini]

I'm sorry you didn't match! But radiology is a great choice!

I know you said you were planning on applying DR, but if you decide you actually like IR after you have the rotation, consider dual-applying DR and IR. One thing I didn't know prior to applying was that it is relatively easy to switch from DR into IR but a bit harder to switch from IR to DR (you'd have to switch with a DR resident in your class). A lot of programs have ESIR integrated into their programs and can make you an IR spot should you decide to do IR (from what I understand, you can choose to do ESIR around the end of your second year). However, this is very program dependent and usually only applies to some of the larger academic programs. One program I interviewed at said they had 5 residents one year that wanted to do IR and they were able to make it work. If you lock-in to IR early on you have to continue with IR unless you get a DR applicant to switch with you.

With your stats you would probably match into a top 25 radiology program. Away rotations aren't necessary unless you really want to go to a certain location/program. I'd recommend applying broadly to figure out what you want and where you want to go, but all the programs you listed above are excellent places to train if you can get a spot! Residents from some of the big name radiology programs can usually get a job in any geographical area they want (from what I understand--I'm just a newly matched MS4 rads applicant). There are certain practices that pick employees from certain programs. If you already know where you want to live, I'd look at the private practice groups in that area and see where their employees trained.

Good luck!

 

[efle]

Did you get a bunch of interviews?

Why DR instead of gensurg as your backup career plan?

 

[longhaul3]

Did you get a bunch of interviews?

Why DR instead of gensurg as your backup career plan?

I can't answer for OP, but it's extremely common for neurosurgery applicants to favor DR as a backup. A few common reasons:

• Imaging is probably more central to the practice of neurosurgery than any other specialty except rad onc (but that's a totally different situation).
• People are drawn to neurosurgery by the brain and neuroanatomy, which you can still build a career on in DR, but not in gen surg.
• By the time you do 3-4 neurosurgery sub-i's, you've had more exposure to neuroradiology than to gen surg, despite whatever required 3rd year clerkships you did.
• The surgery lifestyle is not worth it if you're not doing exactly what you're interested in.

Edit: And while I agree that you shouldn't advertise that you didn't match, I don't think you should lie about it and say your passion changed, etc. You should be prepared to be asked whether you didn't match and answer truthfully (then you can add some spin about finding your true passion).

 

[emdee_inside]

Thanks, y'all! I'll try to clarify some questions here:
- Home Department: yes, I have a home nsg dept and the relationship is good to where I guess I could pivot into neurorad.
- Interest in Radiology: @throwaway1000000 , okay will buckle down and get some facetime with the rad dept. This COVID situation has caused suspension of all clinical rotations and even walking into the hospital as a medical student without necessary cause for my school. But hopefully things will calm down soon and I'll get into immersing myself.
- Interviews: I got 18 interviews (@efle ). Applied to 80+ programs.
- Gen Surg: yeah, this is actually a great question. So, @longhaul3 hit the nail on the head - I was so passionate about neurosurgery that I thought going through a 5-year hell of gen surg residency and then 2-yr fellowship in something NOT central nervous system-related is just not worth it for me. Although I'm thinking of doing my PGY-1 in gen surg just to get that cocaine high of being in the OR and working with my hands.

 

[efle]

I got 18 interviews

there is no god

Maybe you can still end up mucking around in the brain via rads into interventional neurovascular work?

 

[libertyyne]

OP i feel for you, i low key threw up after reading this.

Just a question, but any reason you opted not to soap into rads?

 

[emdee_inside]

OP i feel for you, i low key threw up after reading this.
Just a question, but any reason you opted not to soap into rads?

When I found out I didn't match, my brain was basically mush. I had not expected this in the slightest, so didn't spend anytime on preparing for it. So basically I was figuring out how to even apply for the SOAP and how to navigate ERAS. I applied to a few rads programs but not enough because I was so scatter-brained and all the advice I was receiving was so not applicable to my particular situation so I applied to random IM-prelims and TYs and neurology categoricals and anesthesiology - just all over the place. Got a few phone calls but after no offers in Round 2, I decided to withdraw because I didn't want to start a PGY-1 and try to get everything together in 2 months time (Jul, Aug --> app submit in Sept). So I decided to take a chill pill, gather my emotions and thoughts, and after a ton of discussions with friends, family, and deans of my med school, arrived at this conclusion.

 

[emdee_inside]

there is no god
Maybe you can still end up mucking around in the brain via rads into interventional neurovascular work?

Haha, nope; there is not. Yeah, I mean interventional neuroradiology could be cool but at that point, 6 years in my future, I hope I'll stop loving the nervous system so much so the decision is easy - take the money and live your life.

 

[zero0]

Not much to add but I feel for you OP. I applied anesthesia, got 17 interviews, went on 14, and failed to match. I managed to SOAP into radiology by some miracle but I really don't feel qualified to advise you. Maybe in a year lol

I think you'll be successful in radiology next year though. You definitely have the scores. Then there's always NIR which has a bright future imo.

 

[cybermed2424]

Any chance you’ll reapply nsg?

 

[Rads4lyfe]

Thanks, y'all! I'll try to clarify some questions here:
- Home Department: yes, I have a home nsg dept and the relationship is good to where I guess I could pivot into neurorad.
- Interest in Radiology: @throwaway1000000 , okay will buckle down and get some facetime with the rad dept. This COVID situation has caused suspension of all clinical rotations and even walking into the hospital as a medical student without necessary cause for my school. But hopefully things will calm down soon and I'll get into immersing myself.
- Interviews: I got 18 interviews (@efle ). Applied to 80+ programs.
- Gen Surg: yeah, this is actually a great question. So, @longhaul3 hit the nail on the head - I was so passionate about neurosurgery that I thought going through a 5-year hell of gen surg residency and then 2-yr fellowship in something NOT central nervous system-related is just not worth it for me. Although I'm thinking of doing my PGY-1 in gen surg just to get that cocaine high of being in the OR and working with my hands.

I think you have a great shot at getting into a solid radiology program. Its not uncommon for people to switch out of surgery into rads. It’s a great field and you may find a happy home in neurorads/neuro IR.

I would spin your story into wanting to do neurorads/neuro IR or something since at least it relates to your background. I would contact your rads faculty for advice, since you will need letters anyways. Maybe get on a neurorads project.

I think equally important is to re-evaluate your strategy. 18 interviews is a lot. There’s a reason you didnt match. It may stem from your interviews, and it’s important to figure out what went wrong. Talk to an advisor and do some mock interviews if possible.

I’ve been on both sides of the interview trail now. Let me tell you. We didnt rank people from great schools with stellar scores because their interviews were off. Maybe it was bad luck on your case, but it’s worth reevaluating.

Gl

 

[deleted393595]

We didnt rank people from great schools with stellar scores because their interviews were off.

Socially awkward? Creepy? Interested only in the field due to their Step scores?

 

[Splenda88]

Not much to add but I feel for you OP. I applied anesthesia, got 17 interviews, went on 14, and failed to match. I managed to SOAP into radiology by some miracle but I really don't feel qualified to advise you. Maybe in a year lol

I think you'll be successful in radiology next year though. You definitely have the scores. Then there's always NIR which has a bright future imo.

Maybe that is a blessing in disguise. Better salary, better lifestyle and no pesky patients

 

[doyouhaveaflag]

Socially awkward? Creepy? Interested only in the field due to their Step scores?

You'd be surprised some of the dumb stuff people do and say at their interviews. We ended up not ranking something like five people of the ~35 we interviewed. One said to multiple residents that our program was his backup compared to one of the other plastics programs in our city. Another asked our chairman why he hadn't hired a more diverse group of faculty. We also have a history of not ranking students from the med school associated with our program if they chose not to rotate with us. If you go to our med school and the PD and/or chair has never heard of you or talked to you, it isn't well received at the rank order list meeting.

 

[Chelsea FC]

Another asked our chairman why he hadn't hired a more diverse group of faculty.

I get why you wouldn't want to say this to the chairman. But if its in a diverse community ur serving and all the docs don't match it then its a valid question. Or if you're a student who wants to work in a diverse group. We all seen resident classes that look like a carbon copy of themselves.

 

[Moose A Moose]

Why not have at it one more round? A lot of neurosurgery residents fail to match the first time.

 

[Chelsea FC]

There is a time and place. I want to work with diverse colleagues. I can look at the residents and attendings and tell if the program matches what I'm looking for. If you stir things up at the interview, you are only shooting yourself in the foot.

Agreed with the time and place but it's a valid critique to level at a program. Is it because they not getting a large enough crop of diverse applicants or is it something they dont care about. But it's best to ask a cool resisent who gives out their contact these deets.

 

[throwaway1000000]

I mean it's how you ask it. Can you tell me about the diversity in your program vs why is your program not diverse

 

[doyouhaveaflag]

I get why you wouldn't want to say this to the chairman. But if its in a diverse community ur serving and all the docs don't match it then its a valid question. Or if you're a student who wants to work in a diverse group. We all seen resident classes that look like a carbon copy of themselves.

It was mostly her delivery. The interview is not the time or place to criticize the chairman.

There also doesn't exist much diversity among the plastic surgery faculty throughout the country. Our residents are diverse but the older generation isn't. Is it better to specifically recruit faculty from the small pool of underrepresented people so that you can achieve diversity of staff? That's probably a topic for another thread.

 

[Dr. Anonymouss]

OP I am sorry to hear about your situation. It sounds like you were more than qualified for NSGY residency. As someone who has not participated in the match yet but is considering a competitive residency (ortho), may I ask why you didn't apply to a less competitive back up specialty? I was under the impression that it is wise to throw in some less competitive residency options (gen surg) when applying for something highly competitive. Is this not common practice? For what it's worth, I do not understand the SOAP process which I know is what many unmatched students participate in.

 

[emdee_inside]

Not much to add but I feel for you OP. I applied anesthesia, got 17 interviews, went on 14, and failed to match. I managed to SOAP into radiology by some miracle but I really don't feel qualified to advise you. Maybe in a year lol
I think you'll be successful in radiology next year though. You definitely have the scores. Then there's always NIR which has a bright future imo.

Wow, that's upsetting because I thought I was just a random lottery winner but if 17 interview invites doesn't guarantee an anesthesia spot, the system may truly be faulty. Thanks for the encouragement, mate.

 

[emdee_inside]

Any chance you’ll reapply nsg?

Honestly, don't know. I think about it every so often. As time goes on, I think I'll be less and less inclined to reapply neurosurgery but if for some reason I can't shake the passion, then I'll do it but in a smarter way (eg dual apply, apply to every program, etc). I'll let you know in a few months @cybermed2424 @Moose A Moose

 

[emdee_inside]

OP I am sorry to hear about your situation. It sounds like you were more than qualified for NSGY residency. As someone who has not participated in the match yet but is considering a competitive residency (ortho), may I ask why you didn't apply to a less competitive back up specialty? I was under the impression that it is wise to throw in some less competitive residency options (gen surg) when applying for something highly competitive. Is this not common practice? For what it's worth, I do not understand the SOAP process which I know is what many unmatched students participate in.

You are under the correct impression - I was not. It was a combination of (1) I didn't have eyes for any other woman besides nsgy ie very committed, (2) foolishness to go so headstrong without taking the time to create a safety net, and (3) poor advice from people who I thought would have given better advice (deans, PD). Wish you much success in ortho but yeah, definitely apply to backups because being unmatched is not a situation I wish upon anyone.

 

[emdee_inside]

I think you have a great shot at getting into a solid radiology program. Its not uncommon for people to switch out of surgery into rads. It’s a great field and you may find a happy home in neurorads/neuro IR.

I would spin your story into wanting to do neurorads/neuro IR or something since at least it relates to your background. I would contact your rads faculty for advice, since you will need letters anyways. Maybe get on a neurorads project.

I think equally important is to re-evaluate your strategy. 18 interviews is a lot. There’s a reason you didnt match. It may stem from your interviews, and it’s important to figure out what went wrong. Talk to an advisor and do some mock interviews if possible.

I’ve been on both sides of the interview trail now. Let me tell you. We didnt rank people from great schools with stellar scores because their interviews were off. Maybe it was bad luck on your case, but it’s worth reevaluating.

Gl

Thanks for your concern and insights. I'll def try to get on a neurorads project soon. Regarding the interviews, I have talked to multiple people - advisors, med school deans, my home program director (and these people have known me for 4 years now) and they all are quite surprised. I did some mock interviews before heading on the trail and received only positive feedback (respectful but demonstrates sincere enthusiasm). I will continue to reevaluate for sure per your advice.

@Pepe18 the reason my home program might have not ranked me high enough was because I showed my PD my list of programs to ask for advice in ranking them. Just wanted to get his 2 cents. He saw my list and even though I said I would be ranking my home program in the top 5, I remember him saying something like "oh these are some good programs". So maybe he bumped me down on his rank list because he thought I would match elsewhere? I do know some of these PDs like to play the bragging game of how high they matched. Again, all speculation and no hard evidence, but could answer your question. In any case, I plan on making phone calls to other highly ranked programs on my list to ask for feedback. Thanks

 

[Splenda88]

OP I am sorry to hear about your situation. It sounds like you were more than qualified for NSGY residency. As someone who has not participated in the match yet but is considering a competitive residency (ortho), may I ask why you didn't apply to a less competitive back up specialty? I was under the impression that it is wise to throw in some less competitive residency options (gen surg) when applying for something highly competitive. Is this not common practice? For what it's worth, I do not understand the SOAP process which I know is what many unmatched students participate in.

You don't want to understand it... I have seen one friend going thru the SOAP. It is just a nightmare.

I am not sure why they have not changed the SOAP yet. Just have the 1st match in February and have another application process right after the match for 1 month for the remaining spots. Conduct interviews via Skype etc..., ROL for a week and have these people match in April end.

There has to be a better way to do that.

 

[deleted393595]

You'd be surprised some of the dumb stuff people do and say at their interviews. We ended up not ranking something like five people of the ~35 we interviewed. One said to multiple residents that our program was his backup compared to one of the other plastics programs in our city. Another asked our chairman why he hadn't hired a more diverse group of faculty. We also have a history of not ranking students from the med school associated with our program if they chose not to rotate with us. If you go to our med school and the PD and/or chair has never heard of you or talked to you, it isn't well received at the rank order list meeting.

Out of curiosity, do y'all have advising meetings with students from the med school at which rotating through the home program is strongly recommended? Every one of our departments as a "general" advisory meeting and then 1-on-1 meetings to go over your application

 

[throwaway1000000]

You don't want to understand it... I have seen one friend going thru the SOAP. It is just a nightmare.

I am not sure why they have not changed the SOAP yet. Just have the 1st match in February and have another application process right after the match for 1 month for the remaining spots. Conduct interviews via Skype etc..., ROL for a week and have these people match in April end.

There has to be a better way to do that.

No place for common sense in medicine

 

[zero0]

Maybe that is a blessing in disguise. Better salary, better lifestyle and no pesky patients

I'm definitely relieved I'll never have to deal with CRNAs haha, unfortunately I'll still have to deal with surgeons though

 

[Splenda88]

I'm definitely relieved I'll never have to deal with CRNAs haha, unfortunately I'll still have to deal with surgeons though

I am not a radiologist, but I don't think it will be same dealing with surgeon as a radiologist vs. anesthesiologist... These surgeons/proceduralists don't even call the anesthesiologists by their names. They just refer to them as "anesthesia." It's a very strange dynamic!

 

[throwaway1000000]

I am not a radiologist, but I don't think it will be same dealing with surgeon as a radiologist vs. anesthesiologist... These surgeons/proceduralists don't even call the anesthesiologists by their names. They just refer to them as "anesthesia." It's a very strange dynamic!

That is very true haha. The surgeons and anesthesiologists at my institution rarely talk

 

[zero0]

I am not a radiologist, but I don't think it will be same dealing with surgeon as a radiologist vs. anesthesiologist... These surgeons/proceduralists don't even call the anesthesiologists by their names. They just refer to them as "anesthesia." It's a very strange dynamic!

Yeah the anesthesiologists think they're smarter than the surgeons and the surgeons think anesthesiologists are overpaid nurses. In retrospect the OR was a really toxic environment. I can't say I'll miss it.

 

[doyouhaveaflag]

Out of curiosity, do y'all have advising meetings with students from the med school at which rotating through the home program is strongly recommended? Every one of our departments as a "general" advisory meeting and then 1-on-1 meetings to go over your application

The med students here are each assigned advisors but to my knowledge they're not typically an advisor in the specialty the student plans to go into. I'm not sure if the students are being encouraged to rotate at their home program specifically by their advisors.

In plastics, and I think among most surgical subspecialties in which away rotations are an unspoken requirement, you typically rotate at your home program then do 2-3 away rotations. The surgical subs are very small communities. There's only something like 180 plastics spots in the country. At least in my experience, students going into surgical subs know that they need to be getting together with the PD or chairman regularly to get set up with advising, research, letters of recommendation, etc in addition to whatever the general advising the med school is doing.

Among the people at this med school who have chosen not to rotate with us, it's usually because they've done a rotation at another program in town before doing their aways and considered that their "home" rotation. That's essentially akin to the student telling us we're their back up or less preferred program here. For better or worse, our leadership only wants to rank people genuinely interested in being here.

 

[efle]

It'll never stop blowing my mind that PDs prioritize matching high on their list, above matching the strongest/favorite possible cohort. It's like they'd rather have a gold medal in junior varsity, than see what happens playing with the big boys

 

[Chelsea FC]

It'll never stop blowing my mind that PDs prioritize matching high on their list, above matching the strongest/favorite possible cohort. It's like they'd rather have a gold medal in junior varsity, than see what happens playing with the big boys

The difference in the applicant pool at the top isnt that different so I doubt they are losing much at all

 

[Neopolymath]

It'll never stop blowing my mind that PDs prioritize matching high on their list, above matching the strongest/favorite possible cohort. It's like they'd rather have a gold medal in junior varsity, than see what happens playing with the big boys

When you realize that academic docs are usually not the best and you realize by sheer virtue of endurance one can become PD and start making stupid decisions is when you realize that the residency rat race is even more absurd than first glance. Hopefully most people have spoken to PDs in 3rd year and realized that their advice is not some holy text compared to every other succesful physician.

 

[doyouhaveaflag]

It'll never stop blowing my mind that PDs prioritize matching high on their list, above matching the strongest/favorite possible cohort. It's like they'd rather have a gold medal in junior varsity, than see what happens playing with the big boys

Lol wait why are we assuming these people we didn't rank are the strongest applicants (I assume this was in response to my post)? Someone who has never met with anyone in our department typically has other issues like lack of research or not being socially savvy. One of these applicants that we didn't rank from our med school ended up not matching at all.

In general yes, of course, programs should rank the strongest applicants in order of their application strength. I think we generally do strive for that other than not ranking people who have made it pretty clear they don't want to be here. Which, if they genuinely don't, both parties will be unhappy if they're here and six years is a long time. I agree it's an issue to massage your ego by ranking people who are most likely to match.

 

[AnatomyGrey12]

Lol wait why are we assuming these people we didn't rank are the strongest applicants (I assume this was in response to my post)

I think he is saying that in response to this below. PD's definitely play this stupid game, I've already seen one post about not matching and then being offered a prelim spot at a place they interviewed with the PD there telling them they really liked them but didn't rank them highly because they thought that person would match "somewhere bigger."

@Pepe18 the reason my home program might have not ranked me high enough was because I showed my PD my list of programs to ask for advice in ranking them. Just wanted to get his 2 cents. He saw my list and even though I said I would be ranking my home program in the top 5, I remember him saying something like "oh these are some good programs". So maybe he bumped me down on his rank list because he thought I would match elsewhere? I do know some of these PDs like to play the bragging game of how high they matched. Again, all speculation and no hard evidence, but could answer your question. In any case, I plan on making phone calls to other highly ranked programs on my list to ask for feedback. Thanks

 

[deleted393595]

The med students here are each assigned advisors but to my knowledge they're not typically an advisor in the specialty the student plans to go into. I'm not sure if the students are being encouraged to rotate at their home program specifically by their advisors.

In plastics, and I think among most surgical subspecialties in which away rotations are an unspoken requirement, you typically rotate at your home program then do 2-3 away rotations. The surgical subs are very small communities. There's only something like 180 plastics spots in the country. At least in my experience, students going into surgical subs know that they need to be getting together with the PD or chairman regularly to get set up with advising, research, letters of recommendation, etc in addition to whatever the general advising the med school is doing.

Among the people at this med school who have chosen not to rotate with us, it's usually because they've done a rotation at another program in town before doing their aways and considered that their "home" rotation. That's essentially akin to the student telling us we're their back up or less preferred program here. For better or worse, our leadership only wants to rank people genuinely interested in being here.

Thanks for that @doyouhaveaflag. Our 1-on-1 advising meetings are with our PDs. We can't sign up for 4th year electives without having an official form signed by them. Maybe it may benefit your med school to have a similar system to prevent misunderstandings like this from happening

 

[NotAProgDirector]

I think he is saying that in response to this below. PD's definitely play this stupid game, I've already seen one post about not matching and then being offered a prelim spot at a place they interviewed with the PD there telling them they really liked them but didn't rank them highly because they thought that person would match "somewhere bigger."

There are also plenty of posts on SDN saying "I matched at this place, it's not where I wanted to be. Can't believe I fell so low on my rank list. Can I leave after 45 days? Can I transfer somewhere else?" So not all of it is PD ego, some of it is wanting happy residents.

 

[efle]

It's all speculation though. My program knew I wasn't ranking them highly, but they ranked me highly because I had a good relationship with attendings/residents and they have my back. I think it's very uncommon that PDs prioritize matching high. I think it's very very uncommon that a PD prioritizes matching high on their list to having the back of a home student with a strong application who they like.

Small surgical fields, like neurosurgery, have <15 residents total. Faculty at one of the programs I rotated at said they had 1 resident with a bad personality out of a recently graduated 2 resident/year class. That one resident ruined the program for the years he was there. A neurosurgery PD isn't going to change their list based on who is most likely to rank them; they are going to base it on application and fit (granted, part of fit is wanting to be there). When programs tell applicants that they weren't ranked highly because they thought they would match somewhere else, I think it's as likely that they feel awkward and that's the easy/nice thing to say as it is to be the truth

Everything you say makes sense, but we had a surgical subspecialty applicant get burned by our department and fail to match this year, and ProgDirector has commented in other threads that not only do PDs often prioritize matching high on their list, others they answer to will use it to judge their performance as PD.

Unlike with admission to medical school, there's no committee involved in your fate now. It's up to one person with final say on the rank list. Shouldn't surprise us at all that yield shenanigans are common

 

[libertyyne]

It's all speculation though. My program knew I wasn't ranking them highly, but they ranked me highly because I had a good relationship with attendings/residents and they have my back. I think it's very uncommon that PDs prioritize matching high. I think it's very very uncommon that a PD prioritizes matching high on their list to having the back of a home student with a strong application who they like.

Small surgical fields, like neurosurgery, have <15 residents total. Faculty at one of the programs I rotated at said they had 1 resident with a bad personality out of a recently graduated 2 resident/year class. That one resident ruined the program for the years he was there. A neurosurgery PD isn't going to change their list based on who is most likely to rank them; they are going to base it on application and fit (granted, part of fit is wanting to be there). When programs tell applicants that they weren't ranked highly because they thought they would match somewhere else, I think it's as likely that they feel awkward and that's the easy/nice thing to say as it is to be the truth

I think fit means a lot of different things to a lot of different people. It could mean, how well does this person mesh with other residents, how likely is this person to come here and stay happy? How likely is this person to take on projects in my lab?
PDs are people as well and are not infallible, especially in these hypercompetitive specialties where conversations like " we never go below 4 on our ROL" are not uncommon occurrences. Part of it is probably pride, or competition, part of it is if a person is going to be happier there and mesh well with the program who cares if they have 3 vs 4 publications or if their step score is 250 vs 260.

Fit is probably more important than the application itself. Since at the point you are being evaluated for fit you have already passed all the screens for applications.

 

[longhaul3]

Part of what makes an applicant to any given program desirable is the extent to which they want to be there. It is not necessarily in a weaker program's best interest to rank the superstar applicants the highest, because on the off chance they match there, they will be miserable and resentful. This outcome is not in the best interest of the program.

Although this gets mentioned every time rank lists come up, I think it's a finer point that goes overlooked. It is different from "fit," etc., and is not related to PD vanity or job performance. It is more about the interest of the department and is a legitimate input to the metrics of what makes an applicant desirable. When we rail on PDs for not acting "rationally" i.e. just ranking the "best" candidates at the top, I think we are overlooking the possibility that it is entirely rational not to want the highest-scoring, most widely published people if they don't want to be there.

 

[Dr. Anonymouss]

Part of what makes an applicant to any given program desirable is the extent to which they want to be there. It is not necessarily in a weaker program's best interest to rank the superstar applicants the highest, because on the off chance they match there, they will be miserable and resentful. This outcome is not in the best interest of the program.

Although this gets mentioned every time rank lists come up, I think it's a finer point that goes overlooked. It is different from "fit," etc., and is not related to PD vanity or job performance. It is more about the interest of the department and is a legitimate input to the metrics of what makes an applicant desirable. When we rail on PDs for not acting "rationally" i.e. just ranking the "best" candidates at the top, I think we are overlooking the possibility that it is entirely rational not to want the highest-scoring, most widely published people if they don't want to be there.

I have to disagree and say those students would be grateful. They may be resentful towards those programs they believe should have matched them, but they should be thankful they inevitably matched. I don't think this would lead to a less productive or happy resident because I guarantee not matching in your desired field is worse than matching at your lowest-ranked school.

 

[slowthai]

Part of what makes an applicant to any given program desirable is the extent to which they want to be there. It is not necessarily in a weaker program's best interest to rank the superstar applicants the highest, because on the off chance they match there, they will be miserable and resentful. This outcome is not in the best interest of the program.

Although this gets mentioned every time rank lists come up, I think it's a finer point that goes overlooked. It is different from "fit," etc., and is not related to PD vanity or job performance. It is more about the interest of the department and is a legitimate input to the metrics of what makes an applicant desirable. When we rail on PDs for not acting "rationally" i.e. just ranking the "best" candidates at the top, I think we are overlooking the possibility that it is entirely rational not to want the highest-scoring, most widely published people if they don't want to be there.

I guess this is an area where the match process can be improved. If there was an objective way of signalling serious interest aside from those often ignored love letters, then programs wouldn't have to be doing this guesswork/making assumptions as to who really wants to be there. It seems like many people have gotten burned over the "You're too good for us, so I'm gonna yield protect and rank you low" thing over the years.

They've discussed an option like this in the ortho literature. You get to flag your "top 3". Only you and those programs know about it. One downside of this is the 100% guaranteed "Why weren't we in your top 3?" on interviews.

 

[FindersFee5]

I guess this is an area where the match process can be improved. If there was an objective way of signalling serious interest aside from those often ignored love letters, then programs wouldn't have to be doing this guesswork/making assumptions as to who really wants to be there. It seems like many people have gotten burned over the "You're too good for us, so I'm gonna yield protect and rank you low" thing over the years.

They've discussed an option like this in the ortho literature. You get to flag your "top 3". Only you and those programs know about it. One downside of this is the 100% guaranteed "Why weren't we in your top 3?" on interviews.

You know how you could demonstrate serious interest? Capped application numbers! Then you're clearly demonstrating serious interest with every application you send out.

 

[slowthai]

I have to disagree and say those students would be grateful. They may be resentful towards those programs they believe should have matched them, but they should be thankful they inevitably matched. I don't think this would lead to a less productive or happy resident because I guarantee not matching in your desired field is worse than matching at your lowest-ranked school.

I don't think longhaul3 would necessarily disagree, it's just that programs want to minimize that as much as possible. One bad apple (someone that doesn't really want to be there) is enough to spoil everything. These surgical subs are generally smaller programs, so when you have one person with a poor attitude it can really affect things. Plus no one wants to work with someone that doesn't want to be there for 5+ years.