Geographic bias in residency interviews

[monkeyfeet]

I've seen mentioned a few places that there can be a strong geographic bias in EM residency interviews, e.g. if I'm at a med school on the east coast, programs on the west coast won't even bother interviewing me unless I've done an away there. How much truth is there to that? I'm a non-trad, have lived all over, and have no particular ties to where I'm currently in school. I like new places, and would ideally like to end up somewhere I haven't lived before for residency. Would I need to do multiple aways to open up various parts of the country? (As much as I love EM, I'd rather spend 4th yr doing stuff I won't be doing for the rest of my career, rather than doing 3 or 4 EM sub-Is. And I already have a soul-crushing mountain of debt, so the idea of multiple aways is also less appealing from a cost standpoint.) I'd appreciate any insight!

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[phriendlymed]

The geographic points that programs will see on your application are:
1. Medical School location
2. Undergraduate
3. Locations of items on your CV
4. "Permanent" address
5. Current address
5.5 POSSIBLY things on your personal statement if read in-depth.

The east coast, west coast, and to a lesser extent Texas, all have biases. If you aren't a top 5-10%ile applicant and want interviews in those places, doing an away is most likely the best way to ensure that happens.

I was an above average midwest applicant. Did an away on east coast and got many interviews there. Was approximately 1/10 in getting invites on the west coast.

 

[EMedGrrl]

Would I need to do multiple aways to open up various parts of the country?

Yes. Especially if your perm address / undergrad / med school are all in the same region.

 

[KinesiologyNerd]

If you're a rockstar you'll get interviews essentially wherever you want. If this does not describe you then you'll need more compelling reasons for programs to interview you.

Anecdotally- my school (midwest) has close to 20 people going into the EM. 2 of us did rotations in Philadelphia. 2 of us had interviews in Philadelphia.

 

[monkeyfeet]

Thanks for the replies! Looks like I need to suck it up and plan on doing more than one away. (If it's sub-I grades/SLOEs that primarily determine how competitive you are, seems like it would be hard to know potential rockstar status before actually doing aways? Or should I just assume my decidedly average step 1 score has eliminated all prospects of stardom from my future? Probably that second thing...)

 

[HooliganSnail]

I've seen mentioned a few places that there can be a strong geographic bias in EM residency interviews, e.g. if I'm at a med school on the east coast, programs on the west coast won't even bother interviewing me unless I've done an away there. How much truth is there to that? I'm a non-trad, have lived all over, and have no particular ties to where I'm currently in school. I like new places, and would ideally like to end up somewhere I haven't lived before for residency. Would I need to do multiple aways to open up various parts of the country? (As much as I love EM, I'd rather spend 4th yr doing stuff I won't be doing for the rest of my career, rather than doing 3 or 4 EM sub-Is. And I already have a soul-crushing mountain of debt, so the idea of multiple aways is also less appealing from a cost standpoint.) I'd appreciate any insight!

Speaking from the other side of the match, programs are nervous about the match just as much if not more than the students.

We always match someone, but we want to match the best students. We only have so many interviews, rotations, and resources to grant to a student, so we want to allocate wisely.

Geography does matter to us, but not because we are biased against a certain coast. We want to know if a student is genuinely interested, or just going on the interview....We can't just ask, so we have to look for trends.

Generally students who are more interested in us are:

1. Did base rotations at our hospital
2. Is from a local medical school
3. Rotated at our program
4. Has some sort of tie to the area (family, significant other, lifelong dream to live in the midwest (not typical haha)

The match is biased toward the students (as it should be), but that means that the programs have to choose our ROL very carefully. Where students should rank the place they most want to go regardless of their chance, programs can NOT do this. If we rank someone very highly, and they aren't interested, we can (and have) fallen a long ways down our ROL.

ie. Student (Jenny Overacheiver) - Harvard grad. 4.0. Honors everything. USMLE 2 million....Nobel peace prize winner, double black belt, speaks 12 languages.....most amazing medical student EVER. We would LOVE to have her at our program, and she would be our top choice any day, but we there is NO WAY IN HELL she will ever pick our program. We tend to rank those candidates way down our list, because if we use that number 1 slot on her, we may miss out on other great candidates who will rank with us.

I hope that helps explain things. It's not that we don't like "those east coast folks" here, it's just that we don't want to be stood up for the prom....

 

[SamtheWise]

Speaking from the other side of the match, programs are nervous about the match just as much if not more than the students.

We always match someone, but we want to match the best students. We only have so many interviews, rotations, and resources to grant to a student, so we want to allocate wisely.

Geography does matter to us, but not because we are biased against a certain coast. We want to know if a student is genuinely interested, or just going on the interview....We can't just ask, so we have to look for trends.

Generally students who are more interested in us are:

1. Did base rotations at our hospital
2. Is from a local medical school
3. Rotated at our program
4. Has some sort of tie to the area (family, significant other, lifelong dream to live in the midwest (not typical haha)

The match is biased toward the students (as it should be), but that means that the programs have to choose our ROL very carefully. Where students should rank the place they most want to go regardless of their chance, programs can NOT do this. If we rank someone very highly, and they aren't interested, we can (and have) fallen a long ways down our ROL.

ie. Student (Jenny Overacheiver) - Harvard grad. 4.0. Honors everything. USMLE 2 million....Nobel peace prize winner, double black belt, speaks 12 languages.....most amazing medical student EVER. We would LOVE to have her at our program, and she would be our top choice any day, but we there is NO WAY IN HELL she will ever pick our program. We tend to rank those candidates way down our list, because if we use that number 1 slot on her, we may miss out on other great candidates who will rank with us.

I hope that helps explain things. It's not that we don't like "those east coast folks" here, it's just that we don't want to be stood up for the prom....

I get the frustration, but my question is, why is it such a negative thing to 'fall down the rank list'? What is your reasoning for not ranking Jenny overachiever #1? How is that a 'wasted' slot, because if she decides not to go to your program, your #2 student (we'll call him Bobby McAverage, who you're saying you would rank #1 ahead of Jenny overacheiver) matches there anyway? Unless you're promising Bobby McAverage that he's #1 as a carrot to entice him to your program. Which is sort of distasteful.

And using your higher up spots on your rank list on better candidates doesn't mean that you're 'missing out' on other great applicants. These same applicants will still come to your program, they'll just have been ranked lower. Who cares? The rank algorithm is designed specifically so you don't have to prioritize mediocre applicants over applicants that are less likely to rank you highly, but are objectively better.

 

[BoardingDoc]

We would LOVE to have her at our program, and she would be our top choice any day, but we there is NO WAY IN HELL she will ever pick our program. We tend to rank those candidates way down our list, because if we use that number 1 slot on her, we may miss out on other great candidates who will rank with us.

This statement shows a complete lack of understanding about how the match algorithm works.

 

[gutonc]

This statement shows a complete lack of understanding about how the match algorithm works.

It does. And I hope @HooliganSnail 's PD understands it better than s/he does.

 

[HooliganSnail]

This statement shows a complete lack of understanding about how the match algorithm works.

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

 

[HooliganSnail]

I get the frustration, but my question is, why is it such a negative thing to 'fall down the rank list'? What is your reasoning for not ranking Jenny overachiever #1? How is that a 'wasted' slot, because if she decides not to go to your program, your #2 student (we'll call him Bobby McAverage, who you're saying you would rank #1 ahead of Jenny overacheiver) matches there anyway? Unless you're promising Bobby McAverage that he's #1 as a carrot to entice him to your program. Which is sort of distasteful.

And using your higher up spots on your rank list on better candidates doesn't mean that you're 'missing out' on other great applicants. These same applicants will still come to your program, they'll just have been ranked lower. Who cares? The rank algorithm is designed specifically so you don't have to prioritize mediocre applicants over applicants that are less likely to rank you highly, but are objectively better.

Because a huge chunk of medical students make crappy lazy residents, and you are stuck with them

we need to fill the spots, so we rank a certain amount of applicants....period.

 

[CliveStaples]

I understand that given the fact that a program has a limited amount of interviews to offer that you must be judicious in who you select so you end up inviting good future residents who stand a reasonable chance at matching to your program.

But once you have somebody there interviewing, all bets are off. Rank the applicants in terms of your personal preference. If miss Harvard peace prize winner is the resident you want more than anybody else, rank her number 1! Even if she doesn't rank you, it functionally doesn't hurt the odds of your matching other good applicants who are at the spots below her. She isn't "wasting" your number 1 spot because the way the match works it isn't going to keep more qualified applicants from matching with you - this is why you rank them in order of preference with zero regard to your feelings as to how they will rank you. Watch some videos on how the match algorithm works.

You say that you rank the way that you do because you don't want to fall down your rank list and end up with poor quality residents - ranking high quality applicants lower on your list does not serve to solve this problem.

 

[jw3600]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

Soooo anecdote over algorithmic/statistical certainties. Basically anti-vaxxer logic.

 

[Psai]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

That's not how the match works.

You should always rank in the order that you're interested in. You won't "miss out" on applicants. If you put that girl #1 and the rest of your list is the same, you will match exactly the same except that you will end up one rank lower on your rank list which doesn't matter at all for anything except your ego.

 

[deleted109597]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

Again, no. It's not like you lose the spot. You could rank 99 "unicorns" as your top 99, and pick the person you expect to come there as 100th. And you know what, they'll match there. Unless they pick somewhere else number one. Sorry, but you're just wrong here. You aren't missing out on people by ranking them lower, unless the people above them actually end up at your residency. In which case you aren't "missing out" on them by getting better candidates by your own rank system.

 

[SamtheWise]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

So then why even interview them? Ugh I don't get your system, but I hope it works for you.

 

[BoardingDoc]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants.

Correlation != causation.
If your PD is actually doing this, for the sake of your program, please educate yourselves about this. From your previous posts it seems like you might not think you need to, but right now you're walking confidently in the wrong direction.

 

[tux4]

So then why even interview them? Ugh I don't get your system, but I hope it works for you.

This is it right here. Why even bother dishing out these interviews. If a program only gives out a certain amount then they should not waste it on all of these "unicorns." This is why there are people getting 25-35 interviews. If you won't even rank some of these people then the whole first half of this process seems like wasted time. A program should interview who they truly think will want to go there based on said trends mentioned earlier.


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[Arcan57]

Our practical experience through the years has been that if we place someone we have no chance at in a high spot, we tend to miss out on other applicants. Maybe we are just the recipient of several years of exceptionally similar coincidences, but that that is what has happened to our program....You can only touch the electric cheese and get shocked so many times....

I am only explaining how our program evaluated applicants, and we very highly take into consideration whether they are actually interested in us.

So you may be explaining a (sort of legit) phenomenon with some magical thinking. There are (sort of) valid reasons to consider likelihood of ranking when making a program's ROL. One is to minimize how far down the list you happen to go before you fill. Some PDs view it as a prestige thing to only go a double handful of spots more than class size down the list to fill. Some PDs may be concerned that someone that seems excellent but not that into the program will do worse if they match then an above average candidate that's been working their whole life to land in that program's city. And other PDs just rank the candidates without using geographic criteria and don't care if they go down 100 spots.

 

[rkmoto121]

Do programs care if you want to be in their region after residency? Like say you'd want to live in a certain area for residency just to get a change of pace but then you would want to return to where you are from afterwards.


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[HooliganSnail]

Do programs care if you want to be in their region after residency? Like say you'd want to live in a certain area for residency just to get a change of pace but then you would want to return to where you are from afterwards.


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Some do seem to care, but it depends

There is a program at my hospital that is NOT interested in training any future competition for the attendings, and almost all residents come from out of state...

 

[HooliganSnail]

So then why even interview them? Ugh I don't get your system, but I hope it works for you.

Im pretty sure the ACGME requires you to interview a certain amount of applicants for every spot.

 

[HooliganSnail]

This is it right here. Why even bother dishing out these interviews. If a program only gives out a certain amount then they should not waste it on all of these "unicorns." This is why there are people getting 25-35 interviews. If you won't even rank some of these people then the whole first half of this process seems like wasted time. A program should interview who they truly think will want to go there based on said trends mentioned earlier.


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Ok let me clarify our way of thinking a little more...keep in mind the question posed on this thread is "why do some programs care about geographical locations?", and then OP cited a situation in which a west coast program would not interview an east coast person unless they rotated with the program as a student.

My example was basically the worlds most amazing med student from Harvard.......I said we would rank her lower because we knew she wasn't going to match with us, but in reality we would never even interview her.

- This student has submitted an application to our program
- This student has NOT set up a rotation at our program
- Upon review this student appears to have no tie to our area, is not from out area, and is currently residing 1000 miles away in a cool swanky city in one of the best med schools in the nation
- We are not terribly concerned about filling our spots, we have tons of applications, and tons of rotating students who do have a tie to our area, and we have not scrambled a spot in living memory. ie. We are not desperate.

Why is this student submitting an applications to our community midwest program when every thing in her past would indicate she gravitates toward the cream of the crop?

Most likely answer: She is applying broadly to increase her chances of a favorable match on her terms. She is not very interested in our program, probably doesn't know anything about it, but she has decided that she would much rather match to our unknown community not terribly academic midwest ER residency than not match at all.......she is playing the game, and playing it well....

What to do? Do we even interview her?

Most Likely Answer....NO

- Interviews use a lot of resources, and we genuinely want to get a chance to know the people who interview with us
- We don't want to waste our time, and we don't want to waste the applicants time either.
- She is just plain out of our league

 

[kenjixshadow]

- We don't want to waste our time, and we don't want to waste the applicants time either.

Then your PD should put these statements on the program home page. S/he would also save many students from wasting their money applying to your program.

 

[Lexdiamondz]

Then your PD should put these statements on the program home page. S/he would also save many students from wasting their money applying to your program.

Thats what your medical school advisors are for dude.

 

[doggydog]

Thats what your medical school advisors are for dude.

Lol, they are so good at advising too...

 

[gutonc]

Im pretty sure the ACGME requires you to interview a certain amount of applicants for every spot.

Your understanding of this whole process is really pretty poor. There is no such requirement.

 

[SamtheWise]

Im pretty sure the ACGME requires you to interview a certain amount of applicants for every spot.

With the amount of mis- and disinformation you gleefully spew, I can without doubt say that you sir are headed for an extremely successful career in administration.

 

[deleted109597]

Im pretty sure the ACGME requires you to interview a certain amount of applicants for every spot.

Nope. You can interview 1 for every spot for all they care.
Hell, before SOAP, there were programs that simply didn't interview. They just scrambled every class. Not EM programs, but it doesn't make it any less valid.

 

[deleted109597]

Ok let me clarify our way of thinking a little more...keep in mind the question posed on this thread is "why do some programs care about geographical locations?", and then OP cited a situation in which a west coast program would not interview an east coast person unless they rotated with the program as a student.

My example was basically the worlds most amazing med student from Harvard.......I said we would rank her lower because we knew she wasn't going to match with us, but in reality we would never even interview her.

- This student has submitted an application to our program
- This student has NOT set up a rotation at our program
- Upon review this student appears to have no tie to our area, is not from out area, and is currently residing 1000 miles away in a cool swanky city in one of the best med schools in the nation
- We are not terribly concerned about filling our spots, we have tons of applications, and tons of rotating students who do have a tie to our area, and we have not scrambled a spot in living memory. ie. We are not desperate.

Why is this student submitting an applications to our community midwest program when every thing in her past would indicate she gravitates toward the cream of the crop?

Most likely answer: She is applying broadly to increase her chances of a favorable match on her terms. She is not very interested in our program, probably doesn't know anything about it, but she has decided that she would much rather match to our unknown community not terribly academic midwest ER residency than not match at all.......she is playing the game, and playing it well....

What to do? Do we even interview her?

Most Likely Answer....NO

- Interviews use a lot of resources, and we genuinely want to get a chance to know the people who interview with us
- We don't want to waste our time, and we don't want to waste the applicants time either.
- She is just plain out of our league

I'm pretty sure your PD would like you to stop talking now. Just saying.

 

[Psai]

Jesus christ, for the sake of your program please read up on how the match works. I don't know where you're at but you guys don't know what the hell you're doing.