Is it possible or common to stay at one’s home institution for residency?

[AnatomyGrey12]

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I’m glad people don’t want to move to Missoula. Let’s keep it that way...

OP I wouldn’t suggest applying to a bunch of different specialties. That strategy will fail. People want to know you are committed to the field. “Anything with procedures” isn’t very compelling.

 

[907914]

Not moving family around?

Exactly. My daughter will be entering kindergarten in M2 (if I get in) and it would be nice for her to stay in the same spot for schooling. Plus it would be nice for my wife to be able to have a consistent job - 4 years at a job is right around the time when a good amount of promotions etc. can happen, just would be nice not to make her move and start at a new place.

We fully recognize that these are both likely possibilities. Would just be nice is all.

 

[907914]

I’m glad people don’t want to move to Missoula. Let’s keep it that way...

OP I wouldn’t suggest applying to a bunch of different specialties. That strategy will fail. People want to know you are committed to the field. “Anything with procedures” isn’t very compelling.

Kinda picking that up, makes sense. Not out of the ordinary to apply say gen surge and vascular or IM and FM, but if we are talking applying only (gonna be extreme here) Psych and IR, then you are likely not compelling enough for either.

 

[AnatomyGrey12]

Exactly. My daughter will be entering kindergarten in M2 (if I get in) and it would be nice for her to stay in the same spot for schooling. Plus it would be nice for my wife to be able to have a consistent job - 4 years at a job is right around the time when a good amount of promotions etc. can happen, just would be nice not to make her move and start at a new place.

We fully recognize that these are both likely possibilities. Would just be nice is all.

As someone with kids I understand the dilemma, however you’ve chosen medicine where having to move a lot for training is just part of the game in most instances.

 

[AnatomyGrey12]

Kinda picking that up, makes sense. Not out of the ordinary to apply say gen surge and vascular or IM and FM, but if we are talking applying only (gonna be extreme here) Psych and IR, then you are likely not compelling enough for either.

Exactly. Stuff like Vasc and GS are ok because they are similar, and another way to get to VS is through GS + fellowship. Even stuff like ortho and GS would be frowned upon because of how different they are.

 

[907914]

Exactly. Stuff like Vasc and GS are ok because they are similar, and another way to get to VS is through GS + fellowship. Even stuff like ortho and GS would be frowned upon because of how different they are.

Do programs know when you are applying to different ones at the same place or the like?

 

[AnatomyGrey12]

Do programs know when you are applying to different ones at the same place or the like?

No, but if they find out it can be a death sentence in a lot of fields. If people do apply they usually apply to different places for each specialty and have totally separate applications (different letters, personal statement, etc).

 

[907914]

No, but if they find out it can be a death sentence in a lot of fields. If people do apply they usually apply to different places for each specialty and have totally separate applications (different letters, personal statement, etc).

Oh, wow...that is surprising. Not in an ‘unexpected’ Kind of way...but like a ‘didn’t think it was that big of a deal’ kind of way. But not like the examples we used earlier (IM/FM, GS/VS, PMR/Neuro, that sort of thing as they can be perceived as fairly similar?)

 

[CyrilFiggis]

“In any capacity” is a bit of an exaggeration.

Not really.

Not out of the ordinary to apply say gen surge and vascular or IM and FM, but if we are talking applying only (gonna be extreme here) Psych and IR, then you are likely not compelling enough for either.

You were kind of on track, but also off. For certain surgical subspecialties, there are now categorical programs, but many are still GenSurg with a fellowship. IR is the same way. However, IM and FM are not. You need state unequivocally in the PS why you are going and why you will succeed in your given residency and future career. Programs get thousands of applicants, so if they hear or see that you're also applying into another speciality, they will put you at the bottom of the pile

Finally, the NRMP has published data showing that applicants who apply into multiple specialties perform worse in the match.

Again, I can't state enough how far off this problem is for you. I get the location issue. I have a family and a working spouse. We don't really want to move again for residency, but not matching is worse than the temporary inconvenience to your family.

 

[DNAJB6]

No, but if they find out it can be a death sentence in a lot of fields. If people do apply they usually apply to different places for each specialty and have totally separate applications (different letters, personal statement, etc).

Why?

 

[DNAJB6]

I may be biased in this due to working and having most of my shadowing there , but I agree that specialties like Urology are dope. Half clinic (mostly procedures) and half surgery. Gonna sound lazy, but I am just not about that 70 hours a week average through all of residency.

Are most residencies 80-85 hours a week anyway regardless of specialty?

 

[907914]

Not really.


You were kind of on track, but also off. For certain surgical subspecialties, there are now categorical programs, but many are still GenSurg with a fellowship. IR is the same way. However, IM and FM are not. You need state unequivocally in the PS why you are going and why you will succeed in your given residency and future career. Programs get thousands of applicants, so if they hear or see that you're also applying into another speciality, they will put you at the bottom of the pile

Finally, the NRMP has published data showing that applicants who apply into multiple specialties perform worse in the match.

Again, I can't state enough how far off this problem is for you. I get the location issue. I have a family and a working spouse. We don't really want to move again for residency, but not matching is worse than the temporary inconvenience to your family.

Oh yah, definitely a far off ‘problem’ (not really a problem) and not even a secondary concern at this pre-acceptance stage. More just curious about that process so I can let my wife know how it works, what to expect etc.

Would you mind linking to that data?

 

[907914]

Are most residencies 80-85 hours a week anyway regardless of specialty?

From everything I can tell, absolutely not and that is an exaggeration. I think it is on the 70 hour side for most intern programs, then coast at that or more for surgery, gradually decreasing each year for most others, with many that are also just 55ish or less hours pretty consistently (such as Derm, psych, PMR, EM). But regardless of specialty it will also depend on individual program.

That is my understanding. I hope this is accurate, but someone please correct me if I am wrong..

 

[DNAJB6]

From everything I can tell, absolutely not and that is an exaggeration. I think it is on the 70 hour side for most intern programs, then coast at that or more for surgery, gradually decreasing each year for most others, with many that are also just 55ish or less hours pretty consistently (such as Derm, psych, PMR, EM). But regardless of specialty it will also depend on individual program.

That is my understanding. I hope this is accurate, but someone please correct me if I am wrong..

If 70+ is an outlier, then why do so many residents and attending physicians reminiscing on their residency days whine about it so much? The work load you describe hardly sounds grueling. I hope you're right and I am wrong.

I can see derm being light, but you better rock Step 1, be at the top of your class, and have a lot of research. A lot of people go into medical school gunning for a top specialty end up in IM or other field where residency is rumored to be hell.

P.S. My number comes from the ACGME Duty Hour Limit of 80 hours averaged over 4 weeks. I assumed most residency programs abused you and used you for cheap labor. Many residency directors were griping about limiting it to 80, and I have read reports of residents being forced to lie about their hours when they work more than 80 or risk being fired. Of course my numbers all include "on call" hours so that could be misleading.

 

[CyrilFiggis]

Are most residencies 80-85 hours a week anyway regardless of specialty?

Duty hour laws limit you to 80/week, but that has been known to be broken. You are seeing a lot more programs work below that due to pressures of resident burnout and physician happiness.

Don't be fooled by a program that says 55-60 hours a week. Thats clinical hours. That doesn't include conference days or other requirements. It also doesn't take into account charting.

 

[DNAJB6]

Duty hour laws limit you to 80/week, but that has been known to be broken. You are seeing a lot more programs work below that due to pressures of resident burnout and physician happiness.

Don't be fooled by a program that says 55-60 hours a week. Thats clinical hours. That doesn't include conference days or other requirements. It also doesn't take into account charting.

How many hours a week would you add for "on call" time, conference days, charting, etc.?

 

[Cornfed101]

How many hours a week would you add for "on call" time, conference days, charting, etc.?

The remaining 20-25 hours 😉 . Also, I found this graph on reddit that is interesting. I guess there aren't many pediatric emergencies??

 

[CyrilFiggis]

4-6 for conference, 3-10 for charting (depending on speciality and patients).

 

[CyrilFiggis]

I guess there aren't many pediatric emergencies??

PEM is a fellowship and besides stand alone PedEDs at childrens hospitals, most of them are not open 24 hours, mostly 7a-2a and then they are handled by the main ED. This is why a solely pediatric EM doc gets paid 80-100k less than a regular EM doc.

 

[Cornfed101]

PEM is a fellowship and besides stand alone PedEDs at childrens hospitals, most of them are not open 24 hours, mostly 7a-2a and then they are handled by the main ED. This is why a solely pediatric EM doc gets paid 80-100k less than a regular EM doc.

Makes sense. This graph is for attendings anyway

 

[AnatomyGrey12]

Why?

People take it as you not being committed to the field.

 

[AnatomyGrey12]

From everything I can tell, absolutely not and that is an exaggeration. I think it is on the 70 hour side for most intern programs, then coast at that or more for surgery, gradually decreasing each year for most others, with many that are also just 55ish or less hours pretty consistently (such as Derm, psych, PMR, EM). But regardless of specialty it will also depend on individual program.

That is my understanding. I hope this is accurate, but someone please correct me if I am wrong..

You should expect to work 80 hours a week in most residency programs.

If 70+ is an outlier, then why do so many residents and attending physicians reminiscing on their residency days whine about it so much? The work load you describe hardly sounds grueling. I hope you're right and I am wrong.

Because there used to not be an 80 hour limit? When many attendings trained they frequently did over 100 hours a week. Also remember it’s an average, so it’s not unheard of to have a 120 hour work week some weeks.

How many hours a week would you add for "on call" time, conference days, charting, etc.?

Depends on how efficient you are at it. But never be fooled by a program that says they work 55 hours a week. That’s just physical time doing clinical work. And there is no limit on time outside the hospital spent charting etc, you don’t just get to stop charting because you hit your 80 hours for the week.

 

[993444]

The remaining 20-25 hours 😉 . Also, I found this graph on reddit that is interesting. I guess there aren't many pediatric emergencies??

View attachment 278121

Is this referring to attending life or resident life?

 

[Cornfed101]

Is this referring to attending life or resident life?

This is attending work hours over a year period

 

[CidHighwind]

Like I said earlier OP, you can apply to multiple fields, but you better be able to explain why. You can apply to both FM and Med/Peds residencies, for example, and be able to accurately justify things you like about both during interviews and it sound authentic. Same with applying to both IM and FM programs. Now if you do a bunch of Plastic surgery research, did a SubI/Elective in it, were president of the Plastics club at your school, and you’re applying to something like OBGyn, with no letters, electives, or anything indicating interest in the field other than “they both do procedures”, then most OBGyn programs would probably think you really weren’t committed and not take you seriously. People dual (sometimes triple) apply to residencies, but you need to be able to justify it. To give you an example, you can apply to both Ortho and Neurosurgery programs and justify to both that your main interest is spine surgery, and both residencies are pathways to doing that.

PDs aren’t dumb, they can tell how interested you really are in their specialty based on your ECs.

 

[907914]

People dual (sometimes triple) apply to residencies, but you need to be able to justify it.

By this do you mean submitting completely separate applications or simply towards multiple specialties? But yah, I def are what you are saying. Looking like an Ortho failure who didn’t score high enough step and now going for OBGYN as a backup is likely not a good look.

 

[CidHighwind]

By this do you mean submitting completely separate applications or simply towards multiple specialties? But yah, I def are what you are saying. Looking like an Ortho failure who didn’t score high enough step and now going for OBGYN as a backup is likely not a good look.

If you’re going to take the time and money to apply to and interview at enough programs to feel good about matching, you may as well write different personal statements for both. But again, if they think/know you’re dual applying, you need to be able to at least justify it.

 

[907914]

PDs aren’t dumb, they can tell how interested you really are in their specialty based on your ECs.

Outside of research areas, shadowing, and clubs - what other ECs are we/you doing in med school? Obviously some schools have free clinics you can run but...what else?

 

[AnatomyGrey12]

Outside of research areas, shadowing, and clubs - what other ECs are we/you doing in med school? Obviously some schools have free clinics you can run but...what else?

Research is pretty much it. The rest of that is completely fluff.

 

[907914]

Research is pretty much it. The rest of that is completely fluff.

Should one do research in their intended field?

Again, it feels rushed to be starting and finishing research and demonstrate sufficient interest in a specialty in the 4-9 months between core rotations and the match....

Outside of day-one/M1 gunners, how do people demonstrate sufficient interest? Seems silly.

 

[907914]

Should one do research in their intended field?

Again, it feels rushed to be starting and finishing research and demonstrate sufficient interest in a specialty in the 4-9 months between core rotations and the match....

Outside of day-one/M1 gunners, how do people demonstrate sufficient interest? Seems silly.

Like...from an undergrad perspective, we need 3-6 years of experiences to even demonstrate that we wanna see patients.

How do you show you wanna spend the next 40 years playing with valves and vasculature in only <1 year?

 

[Jeremy Bearimy]

Should one do research in their intended field?

Again, it feels rushed to be starting and finishing research and demonstrate sufficient interest in a specialty in the 4-9 months between core rotations and the match....

Outside of day-one/M1 gunners, how do people demonstrate sufficient interest? Seems silly.

I actually wonder about this, too. If most people go into med school undecided, or change their mind halfway through, how do you have time to do research in your intended field?

 

[AnatomyGrey12]

Should one do research in their intended field?

Again, it feels rushed to be starting and finishing research and demonstrate sufficient interest in a specialty in the 4-9 months between core rotations and the match....

Outside of day-one/M1 gunners, how do people demonstrate sufficient interest? Seems silly.

Field specific is best, but having research in general is always a plus.

Like...from an undergrad perspective, we need 3-6 years of experiences to even demonstrate that we wanna see patients.

How do you show you wanna spend the next 40 years playing with valves and vasculature in only <1 year?

Sub-I rotations, show up to their didactics, build a relationship with your home program (research is often how this is started), shadowing like you say, you can go to that field's national conferences, etc. There are lots of ways to show interest.

I actually wonder about this, too. If most people go into med school undecided, or change their mind halfway through, how do you have time to do research in your intended field?

In general this mostly just applies to people applying to the competitive fields. Neurosurgery, ortho, plastics, derm, etc... they expect you to show your interest by going out of your way to do field specific research.

Also remember medical school research is generally not bench research, which is what most undergrads think of when we say research. Clinical, translational, or meta-research goes by much much faster. I got multiple publications out of my 6 weeks or so of research the summer after M1. It's really not terribly difficult to slowly work on a project during school either.

 

[907914]

Field specific is best, but having research in general is always a plus.


Sub-I rotations, show up to their didactics, build a relationship with your home program (research is often how this is started), shadowing like you say, you can go to that field's national conferences, etc. There are lots of ways to show interest.



In general this mostly just applies to people applying to the competitive fields. Neurosurgery, ortho, plastics, derm, etc... they expect you to show your interest by going out of your way to do field specific research.

Also remember medical school research is generally not bench research, which is what most undergrads think of when we say research. Clinical, translational, or meta-research goes by much much faster. I got multiple publications out of my 6 weeks or so of research the summer after M1. It's really not terribly difficult to slowly work on a project during school either.

So, outside of the hyper competitive, “Got honors on that rotation and went shadowing and have a good letter” seems to be sufficient (note: I personally am not really interested in anything really competitive but advice on the competitive stuff would probably benefit any readers).

 

[AnatomyGrey12]

So, outside of the hyper competitive, “Got honors on that rotation and went shadowing and have a good letter” seems to be sufficient (note: I personally am not really interested in anything really competitive but advice on the competitive stuff would probably benefit any readers).

You don't need shadowing. And honestly not getting honors on a rotation isn't an app killer either. Obviously it's nice, but not an app killer because of how much variety there is with how honors are given out.

 

[907914]

You don't need shadowing. And honestly not getting honors on a rotation isn't an app killer either. Obviously it's nice, but not an app killer because of how much variety there is with how honors are given out.

Gotcha. It totally makes sense now why even in the most competitive specialties like 80% or more of people who want it match somewhere (with a couple exceptions I think?) So, all else equal, the difficulty lies not in matching anywhere, but in matching/convincing a particular location?

 

[AnatomyGrey12]

Gotcha. It totally makes sense now why even in the most competitive specialties like 80% or more of people who want it match somewhere (with a couple exceptions I think?) So, all else equal, the difficulty lies not in matching anywhere, but in matching/convincing a particular location?

Yes and no. Obviously matching specific locations that are considered desirable is difficult in most specialties, but in some fields just matching at all is the difficulty. Remember a lot of the statistics are a bit skewed because people are much less willing to apply to a competitive field knowing they are below average in competitiveness for it.

 

[electropartyogram]

Yes and no. Obviously matching specific locations that are considered desirable is difficult in most specialties, but in some fields just matching at all is the difficulty. Remember a lot of the statistics are a bit skewed because people are much less willing to apply to a competitive field knowing they are below average in competitiveness for it.

Because the medical school counselors for residency applications actually help you have a focused application and apply to good programs based on your application? Unlike undergrad where they just screw you backwards and tell you to pack sunscreen.

 

[907914]

Yes and no. Obviously matching specific locations that are considered desirable is difficult in most specialties, but in some fields just matching at all is the difficulty. Remember a lot of the statistics are a bit skewed because people are much less willing to apply to a competitive field knowing they are below average in competitiveness for it.

Gotcha, so the people who aren’t matching are likely the ones who probably shouldn’t have applied those fields, so the statistics are based predominantly on those who are already competitive. Got it.

For regional applications, will connections to area be taken into consideration? For example, if you grew up in WA state or NorCal, move to Michigan for MED school, will UW or UCSF (respectively) consider you more strongly - even though they are competitive - for the match because you have a reason to go (family, support, know the area, whatever)?

 

[CidHighwind]

Research is pretty much it. The rest of that is completely fluff.

Probably depends on where you apply. Some places that value commitment to underserved populations would like to see volunteering and things that demonstrate that versus just saying it in your personal statement. Also even though it’s not as strong as research, having leadership positions in clubs and committees looks good. But what would help the most from this is a strong LOR from whatever faculty supervises said committee. Especially for residency programs that boast about training “leaders in their field”. You’re right in that research is the most important.

 

[AnatomyGrey12]

Because the medical school counselors for residency applications actually help you have a focused application and apply to good programs based on your application? Unlike undergrad where they just screw you backwards and tell you to pack sunscreen.

Eh no. Counselors in medical school are only slightly less worthless than undergrad.

Gotcha, so the people who aren’t matching are likely the ones who probably shouldn’t have applied those fields, so the statistics are based predominantly on those who are already competitive. Got it.

Haha I'm saying this a lot but yes and no. You're getting closer, but some people who are very qualified still don't match. There could be various reasons for this. Sometimes in the super competitive stuff it really is just bad luck with how the match works out, it's rare, but it happens.

For regional applications, will connections to area be taken into consideration? For example, if you grew up in WA state or NorCal, move to Michigan for MED school, will UW or UCSF (respectively) consider you more strongly - even though they are competitive - for the match because you have a reason to go (family, support, know the area, whatever)?

Probably depends on the region. Some locations have more people trying to get back to them than residency spots entirely.

 

[907914]

You’re right in that research is the most important.

Are undergrad, gap year, and preundergrad ECs ever taken into account? Military experience, employment or management, research experiences etc.?

 

[AnatomyGrey12]

Probably depends on where you apply. Some places that value commitment to underserved populations would like to see volunteering and things that demonstrate that versus just saying it in your personal statement. Also even though it’s not as strong as research, having leadership positions in clubs and committees looks good. But what would help the most from this is a strong LOR from whatever faculty supervises said committee. Especially for residency programs that boast about training “leaders in their field”. You’re right in that research is the most important.

Sure. But honestly most programs in most fields simply don't care. How much volunteering someone has isn't what will get them into, or keep them out of, any residency program. This isn't medical school where that stuff is heavily emphasized.

 

[AnatomyGrey12]

Are undergrad, gap year, and preundergrad ECs ever taken into account? Military experience, employment or management, research experiences etc.?

Oh yeah. You'll see "work experiences" on charting outcomes. Most of that is undergrad. Publications in undergrad definitely count, although given less weight than research done in medical school of course. Military experience will always be a consideration in your favor.

 

[LeaveNoTrace]

If you can express interest, no. FM is weird with that. You can submit separate PS’s to programs. You can do auditions to programs. All these show why you’d want to be at a program and dont think of it as a “safety” program.

Can you submit separate personal statements to psych programs?

 

[ciestar]

Can you submit separate personal statements to psych programs?

Yep, you can

 

[LeaveNoTrace]

Will they still read your PS from ERAS, or can you send completely separate personal statements to different programs if you so choose?

 

[ciestar]

Will they still read your PS from ERAS, or can you send completely separate personal statements to different programs if you so choose?

You upload your PS. It isn’t like AMCAS where you copy in the text. You can then assign that document to programs.

 

[LeaveNoTrace]

Thanks for the information! It certainly allows one to write different personal statements for different programs. That means that you can use a high-variance, riskier personal statement if you’re shooting for the moon and a less risky PS for programs where you don’t want to take as much risk.