MD & DO Main reasons people don't match?

[MDorBust97]

Seeing all these threads on here, and reddit about the number of people not matching/having to soap makes me feel a bit nervous about the future after med school. Seems the number of people applying to match goes up each year, including additions from first ever classes of new MD programs, while no substantial increase in PGY-1 spots.
Just wondering, whats the main reason people don't match. I get the stats are in my favor as an incoming USMD student, but how many truly "fall through the statistical cracks of the algorithm" or a lot is just aiming too high/not wanting to settle, not great clerkship grades? Or is everything going to irrelevant with the pending DO MD merger next year or two and a whole new system will settle into place?

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[mw18]

People don't match because of red flags or relative red flags (a borderline app for that specialty), and to a much smaller extent, truly bad luck with the algorithm. Another issue is poor advising in the types of programs to apply to resulting in low interview yield. Red flags are what you would expect: low/failing board scores, clerkship grade failures or grades too low for that specialty, bad interviews, unexplained or poorly explained leaves of absences.

Advice would be to study hard in your clerkships and classes, study really hard for boards and have a sense of where you'll score before you take it, and find an advisor who will absolutely give it to you straight and let you know if you're st risk of not matching in a specialty.

 

[anon6134]

That's an impossible question to answer and there are way too many variables outside of what you can already reasonably guess. People applying to specialties too competitive for their stats, ranks lists too top heavy, a bad SLOE (EM) or LOR for whatever reason, grades, behavioral issues and on and on and on.

Every year people fall through the cracks, don't match for legitimate reasons, small ROL. More people will unfortunately experience this as schools proliferate nearly out of control. Different specialties look for different things that aren't always score/grade related and that will continue to evolve through the next years up until you match.

Start school, work hard to never have any red flags, and have a strong mentor in the field you are interested when it comes time to start thinking about your application. More competitive specialties will require this earlier than others. You'll be alright, plenty of time to worry about this later down the line

 

[longhaul3]

I don't know if you could pinpoint the number one reason people don't match, but poor risk management is a big one. Lots of people overestimate their application and end up applying in super competitive specialties either against the advice of their deans/advisors or without dual applying when they are at risk. There's a danger zone that swallows really solid med students with board scores in the 240s or so with pretty good grades who just cannot live with not going into ortho, etc. These are the people who don't get enough interviews and can't rank enough programs to really give themselves a good shot—considering they are not going to be anyone's #1 because they are at the bottom of the ortho pool, even though they are above average overall. These people's stories scare junior med students because no one wants to hear that someone scored 245 on Step 1 and didn't match, but it's mostly self-imposed.

When a specialty has more applicants than spots and people don't want to double apply, you're bound to have a population that doesn't match. Fortutnately, this cause of not matching is mostly within your control if you manage your risk and play conservatively.

 

[libertyyne]

I don't know if you could pinpoint the number one reason people don't match, but poor risk management is a big one. Lots of people overestimate their application and end up applying in super competitive specialties either against the advice of their deans/advisors or without dual applying when they are at risk. There's a danger zone that swallows really solid med students with board scores in the 240s or so with pretty good grades who just cannot live with not going into ortho, etc. These are the people who don't get enough interviews and can't rank enough programs to really give themselves a good shot—considering they are not going to be anyone's #1 because they are at the bottom of the ortho pool, even though they are above average overall). These people's stories scare junior med students because no one wants to hear that someone scored 245 on Step 1 and didn't match, but it's mostly self-imposed.

When a specialty has more applicants than spots and people don't want to double apply, you're bound to have a population that doesn't match. Fortutnately, this cause of not matching is mostly within your control if you manage your risk and play conservatively.

I think higher risk tolerance is the ultimately the reason people do not match. Here is a simple example if you are below the median step 1 score of all matched applicants, you are taking a gamble when you apply to specialties that are even slightly more competitive compared to the median.

The rate of going unmatched goes up in every score subgroup below the median.
this pattern holds true for the most part for the other specialties with the highest number of unmatched students.

If you are below 230 and are applying to any specialty which has a median score above 230 you are taking a higher risk of going unmatched.

Now are there people with steller scores that are going unmatched? Absolutely, I wonder what type of programs these people applied to , and what other red flags they came with.

 

[afib123]

Like people commented not 1 reason, but major things:
1) how competitive they are. You will note most 250+ scorers match into a speciality than a few.
2) Those few 250+ scorers that didn't match and others are either not competitive or have red flags as mentioned above.

I haven't really researched the correlation between number of interviews and match rate, but if you get 15+ interviews, you are probably solid for most specialities.

 

[longhaul3]

I think higher risk tolerance is the ultimately the reason people do not match. Here is a simple example if you are below the median step 1 score of all matched applicants, you are taking a gamble when you apply to specialties that are even slightly more competitive compared to the median.

If you are below 230 and are applying to any specialty which has a median score above 230 you are taking a higher risk of going unmatched.

Now are there people with steller scores that are going unmatched? Absolutely, I wonder what type of programs these people applied to , and what other red flags they came with.

Exactly. Interesting that in the figure you posted for ortho the % unmatched is almost the same for the 251-260 group and the >260 group (~10%) and only slightly higher for the 241-250 group (12%). In a lot of the competitive specialties, the % matched plateaus around 90% at the highest Step 1 scores.

 

[ciestar]

I feel like overestimating your application strength is huge here. Also not applying broadly enough. With my step score and regional preference, my options aren’t the best so I have to be realistic. Many specialties would be open to me if I were to apply broadly everywhere.

Multiple PD’s mentioned to me in the past that if you’re applying a specialty as a backup (FM, IM, GS..) make damn sure your application to those programs don’t say that you are.

 

[lalalaaaaaa]

These are my impressions of why people don't match based on having just gone through it.

1) Not interviewing at enough programs. Most of the people not matching have very few interviews and are not ranking enough programs in the match (ie <6) while people who match have >13. Go check out that NRMP data posted above, but look at number of programs ranked. The vast majority of unmatched people did not rank enough programs.
2) Board scores. DO WELL ON STEP1! Hard to get interviews without good scores. Wont be ranked as high after the interview. But if you have poor board scores, you can make up for it by applying smart!
3) Not applying smartly. You need to rank programs where you are competitive in addition to reaches. Apply and interview broadly. Be honest about how competitive your app is.
4) Weak application other than boards. Get research, get leadership, check all the boxes.
5) Poor LOR. This can sink an application.
6) Poor advising. You need people to look over your shoulder to make sure you are doing this right.
7) The algorithm. Sometimes the numbers don't work out. You can be a solid applicant, but you just didn't get ranked high enough at all the programs so you fall through. This is probably the exception, but I 100% know amazing applicants who didn't match. It happens.

 

[Goro]

People don't match because of red flags or relative red flags (a borderline app for that specialty), and to a much smaller extent, truly bad luck with the algorithm. Another issue is poor advising in the types of programs to apply to resulting in low interview yield. Red flags are what you would expect: low/failing board scores, clerkship grade failures or grades too low for that specialty, bad interviews, unexplained or poorly explained leaves of absences.

Advice would be to study hard in your clerkships and classes, study really hard for boards and have a sense of where you'll score before you take it, and find an advisor who will absolutely give it to you straight and let you know if you're st risk of not matching in a specialty.

To add to this, I've had grads not match due to poor lists (meaning unrealistic ones, or ones that were too small). Bad MSTPs also have an effect. One of of our "site killers" didn't match

Keep in mind that not matching seems to be one of those SDN train wreck type of subjects that are like those people who get kicked out of med school...they're rare.

 

[ginsengreset]

So let's say you're one of those people who slightly overestimated their competitiveness for the match (applied derm/plastics/NSG/etc with a 235 step, good letters but writers aren't very well-known in the field, decent but not mind-blowing amount of research). Would your app be one of the more competitive ones in SOAP, or would you be scrambling in uncertainty like other people who are SOAPing?

 

[longhaul3]

These are my impressions of why people don't match based on having just gone through it.

1) Not interviewing at enough programs. Most of the people not matching have very few interviews and are not ranking enough programs in the match (ie <6) while people who match have >13. Go check out that NRMP data posted above, but look at number of programs ranked. The vast majority of unmatched people did not rank enough programs.

I agree with you but want to point out that this is sort of a chicken-egg situation. They don't rank enough programs because they don't go on enough interviews, but most of the reason they don't go on enough interviews is that they're not getting enough interviews because their applications are weaker (which goes back to your other points). In every specialty, NRMP data show that unmatched students ranked fewer programs than matched students, but I think this is more of an effect than a cause.

So let's say you're one of those people who slightly overestimated their competitiveness for the match (applied derm/plastics/NSG/etc with a 235 step, good letters but writers aren't very well-known in the field, decent but not mind-blowing amount of research). Would your app be one of the more competitive ones in SOAP, or would you be scrambling in uncertainty like other people who are SOAPing?

I'm not and never have been involved in SOAP, but I'm quite sure the answer is yes. There are lots of IMGs and low-stat students in the SOAP, so anyone with generally above-average (or at least around-average) stats is going to be attractive. But if you're trying to SOAP into gen surg after not matching neurosurgery (knowing that you have borderline stats at best), it would have been a lot smoother to have just dual applied to begin with. Not matching is to be avoided at all costs.

 

[Lawpy]

7) The algorithm. Sometimes the numbers don't work out. You can be a solid applicant, but you just didn't get ranked high enough at all the programs so you fall through. This is probably the exception, but I 100% know amazing applicants who didn't match. It happens.

Maybe it's response bias but it seems lately the increasing number of "I didn't match!" threads pertain to this particular exception. This would make people think as to whether there's a red flag but these incidents are still pretty terrifying to see.

 

[MDorBust97]

Maybe it's response bias but it seems lately the increasing number of "I didn't match!" threads pertain to this particular exception. This would make people think as to whether there's a red flag but these incidents are still pretty terrifying to see.

I think this is what is kinda of making me nervous. In the future years, there's going to be more USMD grads, and the entire merger of DO grads into the Match. I'm nervous this means more of this kind of thing.

 

[puahate]

Is Medicine worth it? are we reaching the downward slope ?

 

[raiderette]

I actually know a very competitive ob/gyn candidate who didn't match. She and I knew one another and I know she had similar (250+) Step 1scores. I read the SOAP threads with dread, since I am taking a research year due to pregnancy. I will never again dismiss those who didn't match, since too many amazing people fell through the cracks.

 

[tekkenman11]

It seems like a bigger deal than it is because the people who don't match will vent on the internet and seek advice. It's unfortunate and a shame that not every US allopathic senior matches but unless you bomb step 1 and had high aspirations or end up with red flags you should fine. It's also important to "reach within reason" and some people just don't get that. My school/campus generally ends up with a 98% match rate (1-2 don't match) but this year we were 100% (and the person from last year who didn't match ended up doing so this time around into the same specialty), which is great considering how competitive certain specialties this year were as compared to previous years. So while it's disheartening to read about SOAP posts and whatnot I am personally not worried since I am confident in my abilities and school's education/guidance.

 

[Innocent2]

I actually know a very competitive ob/gyn candidate who didn't match. She and I knew one another and I know she had similar (250+) Step 1scores. I read the SOAP threads with dread, since I am taking a research year due to pregnancy. I will never again dismiss those who didn't match, since too many amazing people fell through the cracks.

Dismiss I would suggest is an inappropriate way to view this. The residency process is very costly in terms of time as well as money.
1) Choosing the appropriate specialty
2) Applying to enough programs
3) Selecting, preparing and crushing enough interviews.
4) Ranking every possible program you want.
Too many amazing people sometimes take shortcuts without putting forth their best efforts. It’s a marathon for most. Residency ranked you #30 and you ranked them #20. The algorithm is your friend, you MATCHED!
Amazing people scramble or make sure to avoid any shortcuts. Those with significant red flags attempt to overcome.

Good luck with you new addition next year.

 

[longhaul3]

It seems like a bigger deal than it is because the people who don't match will vent on the internet and seek advice. It's unfortunate and a shame that not every US allopathic senior matches but unless you bomb step 1 and had high aspirations or end up with red flags you should fine. It's also important to "reach within reason" and some people just don't get that. My school/campus generally ends up with a 98% match rate (1-2 don't match) but this year we were 100% (and the person from last year who didn't match ended up doing so this time around into the same specialty), which is great considering how competitive certain specialties this year were as compared to previous years. So while it's disheartening to read about SOAP posts and whatnot I am personally not worried since I am confident in my abilities and school's education/guidance.

I agree that there's a sensationalist bent to it because the people who match high on their lists are out drinking champagne and not sharing their woes on the internet. The preliminary match data don't suggest that there were any major differences this year writ large. But school match percentages can be misleading—do you know that 100% matched something on their ROLs, or could it be that a number didn't match on Monday and subsequently landed something in SOAP?

 

[shaosoldier]

Part luck, part playing the game, part grinding. The algorithm works out for most people, but there will be some that will fail to match. My word of advise, which is easier said then done, is to not see it as a failure, review, fix and try again. We all take different paths prior, during and after medical schools. Best of luck next year man!

 

[Cassowary]

You already know the answer. Most unmatched people applied poorly, and a small minority were unlucky. I feel like you’re asking for reassurance that you WILL match. Sadly, i cant give it to you. You sound like an anxious person a lot like me, and i could see myself asking the same question, wanting someone to tell me “dont worry, you’ll match”. I feel the same way haha.

Try not to worry reading all these soap threads on reddit. They are horribly for our anxiety.

But lets be honest to ourselves, as a USMD student, if you do well on step and apply smartly, very low chance of not matching. Hope that helps, friend.

 

[751866]

...
Start school, work hard to never have any red flags, and have a strong mentor in the field you are interested when it comes time to start thinking about your application. More competitive specialties will require this earlier than others. You'll be alright, plenty of time to worry about this later down the line

To be fair, your ability to obtain a strong mentor is limited by where you go to school. You can find a good advocate but "strong" needs to also encompass well known and active in the specialty, especially if you're more competitive. Having someone go to bat for you isn't nearly as good as someone who goes to bat but also has some sort of pull.

 

[751866]

To add to this, I've had grads not match due to poor lists (meaning unrealistic ones, or ones that were too small). Bad MSTPs also have an effect. One of of our "site killers" didn't match

Keep in mind that not matching seems to be one of those SDN train wreck type of subjects that are like those people who get kicked out of med school...they're rare.

How do you define an unrealistic ROL (since you've put too short in it's own slot)?

 

[ortnakas]

People I know who ended up in SOAP or Scramble usually had one (or more, which is the real problem) or the following:

• Red flags like a boards failure or multiple course failures
• Unrealistic specialty choice for their application with no backup plan
• Geographic restriction to a small and/or competitive region

 

[longhaul3]

How do you define an unrealistic ROL (since you've put too short in it's own slot)?

It would be hard to end up with an "unrealistic" ROL because you're only ranking programs you interviewed at, and on some level if you interview at a program you have a realistic chance of matching there. I guess if you only rank the top programs you interview at and just decide not to rank the lesser ones at all you would end up with an unrealistic ROL, but that would also be a short ROL unless you go on a zillion interviews.

 

[kelminak]

@Goro Is there an expected % of students that end up not matching for a DO school pre-SOAP? My school had what seems to be a fairly high number, but I only have a pre-SOAP number.

 

[Goro]

@Goro Is there an expected % of students that end up not matching for a DO school pre-SOAP? My school had what seems to be a fairly high number, but I only have a pre-SOAP number.

From year to year we have a pool of students whom we worry about the most. Some Classes are simply stronger than others. I'd ballpark it at 5% of the Class.

These are people are consistently at the bottom of the Class, no matter what intervention we use. Mental health issues are common to these kids, followed by physical health issues, then poor coping skills or time mgt skills or motivation.

Only 1-3% of the Class, tops, fail to Match even after SOAP.

 

[Cath Up]

I feel like overestimating your application strength is huge here. Also not applying broadly enough. With my step score and regional preference, my options aren’t the best so I have to be realistic. Many specialties would be open to me if I were to apply broadly everywhere.

Multiple PD’s mentioned to me in the past that if you’re applying a specialty as a backup (FM, IM, GS..) make damn sure your application to those programs don’t say that you are.

Is it possible to apply to a backup specialty and have all programs of both specialties not know?

 

[Goro]

How do you define an unrealistic ROL (since you've put too short in it's own slot)?

Meaning, having a median to < median Board scores and competitive residencies and/or specialties targeting UCLA, Harvard and Yale

Having too few schools on the list.

It's pretty much like people who make poor lists for med school.

 

[DokterMom]

It would be hard to end up with an "unrealistic" ROL because you're only ranking programs you interviewed at, and on some level if you interview at a program you have a realistic chance of matching there. I guess if you only rank the top programs you interview at and just decide not to rank the lesser ones at all you would end up with an unrealistic ROL, but that would also be a short ROL unless you go on a zillion interviews.

Not really -- Let's assume your STEP scores are exactly average for your specialty, that you apply to a large number of programs clustered around the middle of the rankings for that specialty, and that you get a generous number of interview invitations. Great so far, right? As often happens, some of your interview dates will conflict, so when that happens, you choose the program you prefer based on either location or ranking for the best program list possible. Only reasonable, right?

Now let's go to the Lizzie M staircase analogy and place you (initially) on the staircase based strictly on your STEP scores. If you dropped the less-preferred interview in every case, your mean staircase placement would now be a bit below average because you've dropped the interviews where you'd be above the average. Let's further assume that some of the 'started below you on the staircase' applicants interviewed better and moved up and that your interviews knocked you down a stair or two. (down, not out.)

Now you're potentially in trouble because even with a reasonable number of decent interviews at suitable programs, you could easily be just below the cutoff point for every program.

Bottom line - Include a couple 'safety' programs that are more attractive to you than to most other people -- places where an "OK" interview performance still leaves you well above average.

 

[longhaul3]

Not really -- Let's assume your STEP scores are exactly average for your specialty, that you apply to a large number of programs clustered around the middle of the rankings for that specialty, and that you get a generous number of interview invitations. Great so far, right? As often happens, some of your interview dates will conflict, so when that happens, you choose the program you prefer based on either location or ranking for the best program list possible. Only reasonable, right?

Now let's go to the Lizzie M staircase analogy and place you (initially) on the staircase based strictly on your STEP scores. If you dropped the less-preferred interview in every case, your mean staircase placement would now be a bit below average because you've dropped the interviews where you'd be above the average. Let's further assume that some of the 'started below you on the staircase' applicants interviewed better and moved up and that your interviews knocked you down a stair or two. (down, not out.)

Now you're potentially in trouble because even with a reasonable number of decent interviews at suitable programs, you could easily be just below the cutoff point for every program.

Bottom line - Include a couple 'safety' programs that are more attractive to you than to most other people -- places where an "OK" interview performance still leaves you well above average.

I get what you're saying. I interpreted the question of "unrealistic ROL" as how one constructs a bad ROL from all ROL possibilities; that is, having a set of programs you've interviewed at and somehow organizing them in a way that gives you a bad chance at matching. There's not really a clear way to do this that I can think of unless you simply don't rank the lesser programs. If you rank all your programs somewhere on the list and don't match, it's not due to the order of the rank list.

I agree that it is eminently possible to screw yourself over in choosing which interviews you go on, as it is in choosing which programs to apply to.

 

[ciestar]

Is it possible to apply to a backup specialty and have all programs of both specialties not know?

Yeah, but you have to make sure your letters dont specify a specialty and you’d need two PS’s for that as well. It’s tricky.

 

[Cath Up]

Yeah, but you have to make sure your letters dont specify a specialty and you’d need two PS’s for that as well. It’s tricky.

Thank you.

Is it common for residency applicants to be asked about how many specialties they are applying to, by programs?

My thinking is if you're telling a program you love specialty x for all these reasons then they discover you are applying to specialty y, they might think you were being disingenuous.

 

[751866]

Meaning, having a median to < median Board scores and competitive residencies and/or specialties targeting UCLA, Harvard and Yale

Is it really unrealistic for a ROL to list programs someone interviewed at, though?

Having too few schools on the list.

You seemed to define this separately before.

 

[751866]

I get what you're saying. I interpreted the question of "unrealistic ROL" as how one constructs a bad ROL from all ROL possibilities; that is, having a set of programs you've interviewed at and somehow organizing them in a way that gives you a bad chance at matching. There's not really a clear way to do this that I can think of unless you simply don't rank the lesser programs. If you rank all your programs somewhere on the list and don't match, it's not due to the order of the rank list.

I agree that it is eminently possible to screw yourself over in choosing which interviews you go on, as it is in choosing which programs to apply to.

Exactly this (or even in choosing who you rank out of who you interviewed with, in terms of programs)- hence, why I tried to clarify how you can call a materialized list of programs "unrealistic". Schools don't typically interview students "just 'cuz" so I think @Goro and @DokterMom have conflated the idea of unrealistic (some combination of the applicant doing something with the ordering-- which we know doesn't matter for failure to match) with poor strategy (thinking you should only accept top tier interviews, assuming you actually received a spectrum), although it's still not very clear what Goro meant, but DokterMom is definitely conflating the two.

 

[ciestar]

Thank you.

Is it common for residency applicants to be asked about how many specialties they are applying to, by programs?

My thinking is if you're telling a program you love specialty x for all these reasons then they discover you are applying to specialty y, they might think you were being disingenuous.

No idea. Im a third year still!

 

[Goro]

Exactly this (or even in choosing who you rank out of who you interviewed with, in terms of programs)- hence, why I tried to clarify how you can call a materialized list of programs "unrealistic". Schools don't typically interview students "just 'cuz" so I think @Goro and @DokterMom have conflated the idea of unrealistic (some combination of the applicant doing something with the ordering-- which we know doesn't matter for failure to match) with poor strategy (thinking you should only accept top tier interviews, assuming you actually received a spectrum), although it's still not very clear what Goro meant, but DokterMom is definitely conflating the two.

As explained ot my by my Clin Ed Dean, if you look at the numbers of apps people submit to the numbers of interviews they get for residencies, there is a particular rule of thumb that the more interviews you get, the higher the likelihood you have of matching.

So it seems, that at least for my problematic students, those people who have "poor lists" don't get interviews, mainly because they aim too high, or too few.
Capeesh?

 

[differentiating]

Thank you.

Is it common for residency applicants to be asked about how many specialties they are applying to, by programs?

My thinking is if you're telling a program you love specialty x for all these reasons then they discover you are applying to specialty y, they might think you were being disingenuous.

I was never asked this. I don’t think it’s a very common question, since I haven’t heard of any of my friends getting asked that either.

My understanding is that people usually get caught out if they don’t change letters/PS, or if they apply both programs at one institution. And yes, the times I’ve heard PDs discuss it, it definitely gives them the impression that you’re not serious about their specialty.

 

[afib123]

Main reason talking to upperclassmen: applying to a competitive speciality (putting aside the students with major red flags). If someone doesn't match into IM, pediatrics, Family etc with average boards scores, it's their fault for not applying broadly. In competitive specialities, you can be average (240+), apply to 100+ programs and still fail to match

 

[libertyyne]

Failing to match neurosurgery is different compared to failing to match into fm. When a person applies to a competitive specialty even with above average scores there is a real chance of not getting a spot even after doing everything right. It is a risk any applicant to these specialties takes.on the other hand not matching fm means something either went very wrong, or there is something concerning in the app.

 

[MSTPlease]

According to the Association of American Medical Colleges (AAMC), the top seven reasons this year’s seniors failed to match were:

1. Had low scores on a United States Medical Licensing Exam (USMLE)
2. Weren’t competitive for their first choice specialty
3. Didn’t have an appropriate backup/alternative plan
4. Didn’t follow guidance from their faculty adviser or dean’s office
5. Had poor interviewing/interpersonal skills
6. Did not rank enough programs
7. Failed a USMLE exam

Of these unmatched students, nearly one-half had been discussed in promotions committees at their schools, indicating they had performance problems,

Why medical students aren't matching--and what happens next?

 

[moisne]

You need to rank programs where you are competitive in addition to reaches.

I Just want to stress... rank all programs based on your preference. Does not matter if it's the most competitive of the reach school... the nrmp ranking system favors the students. Never let a program influence your choice (when they call and say they are ranking you #1 or whatever).

Failing to match neurosurgery is different compared to failing to match into fm. When a person applies to a competitive specialty even with above average scores there is a real chance of not getting a spot even after doing everything right.

It's very common and should be done for super competitive specialty to dual apply. Wouldn't hurt a NSGY applicant to apply to 10 IM spots.

 

[afib123]

I Just want to stress... rank all programs based on your preference. Does not matter if it's the most competitive of the reach school... the nrmp ranking system favors the students. Never let a program influence your choice (when they call and say they are ranking you #1 or whatever).


It's very common and should be done for super competitive specialty to dual apply. Wouldn't hurt a NSGY applicant to apply to 10 IM spots.

Easier said than done to dual apply. With most applicants doing 3 aways in Neurosurgery in addition to 1 home sub-i, there is no place in the schedule to fit in an IM sub-I and get IM letters of rec (possible to get 3rd year rotation letter of recs but those will suck with the professors having no memory of you other than the eval they filled out). Also, probably hard to convince the 3rd year letter writers about why you are not doing an IM-subinternship, why you are asking them for letters of rec instead of 4th year rotation preceptors. Also hard to convince interviewers about liking IM without a single rotation in it during 4th year.
I guess you can just apply to mediocre IM programs and say you changed mind last minute. Hard to sell but they might take you because of good board scores as a neurosurgery applicant.
If anyone has ideas on how to dual-apply, would be happy to hear since I will be in this position come September.
Other option is to apply to gen surg, which is easier to spin

 

[751866]

As explained ot my by my Clin Ed Dean, if you look at the numbers of apps people submit to the numbers of interviews they get for residencies, there is a particular rule of thumb that the more interviews you get, the higher the likelihood you have of matching.

So it seems, that at least for my problematic students, those people who have "poor lists" don't get interviews, mainly because they aim too high, or too few.
Capeesh?

Yeah, there's not much complicated about this. There's also nothing you said that really indicates an unrealistic ROL but more poor strategy from the start. The whole context was revolving around a ROL rather than a general application list. A good example of an actually unrealistic list would be to rank programs you never interviewed at while ignoring those you did interview with.

 

[VincentAdultman]

It's very common and should be done for super competitive specialty to dual apply. Wouldn't hurt a NSGY applicant to apply to 10 IM spots.

Except that then you’d be an IM doctor.

 

[libertyyne]

Easier said than done to dual apply. With most applicants doing 3 aways in Neurosurgery in addition to 1 home sub-i, there is no place in the schedule to fit in an IM sub-I and get IM letters of rec (possible to get 3rd year rotation letter of recs but those will suck with the professors having no memory of you other than the eval they filled out). Also, probably hard to convince the 3rd year letter writers about why you are not doing an IM-subinternship, why you are asking them for letters of rec instead of 4th year rotation preceptors. Also hard to convince interviewers about liking IM without a single rotation in it during 4th year.
I guess you can just apply to mediocre IM programs and say you changed mind last minute. Hard to sell but they might take you because of good board scores as a neurosurgery applicant.
If anyone has ideas on how to dual-apply, would be happy to hear since I will be in this position come September.
Other option is to apply to gen surg, which is easier to spin

IIRC IM subI are not necessary, the letters should be coming from IM core rotation writers and department chair. During interviews as you implied one should lie through their teeth in stating that they had a last moment change of heart during one of the rotations. Also never apply to backup at the same instiutiton. The point is not matching Harvard IM, rather any IM, or you could take the SOAP gamble which sounds like a crazy way to go, but might end up in a worse or a much better situation since it is a complete gamble.

Also talking to some people that matched Neurosurgery two SubIs seemed sufficient.

 

[mrbreakfast]

Is it common for residency applicants to be asked about how many specialties they are applying to, by programs?

No, unless perhaps there's a reason to think so and you're applying to a surgical subspecialty.

If anyone has ideas on how to dual-apply, would be happy to hear since I will be in this position come September.

You'd need to get letters from M3 rotations, and will likely have to get a letter from a rotation during which the ERAS submission deadline falls.

Assuming IM + NS dual application, and you can take 4 rotations as an M4, one of which ends late September:
-take IM sub-I and 3 NS aways = 3 NS letters and 2 IM letters. For whichever rotation falls in September, tell them you're going to ask them for a letter in 2 weeks on day one, and that you'll work as hard as possible in the meantime.
-M3 IM = 1-2 IM letters
-M3 elective in NS = 1 letter if you needed it
-chair letters = shadow them for a day or two then ask for a chair letter
This puts you over the # of letters you need for both specialties

 

[VincentAdultman]

Is IM a thing that neurosurg applicants apply for as a backup? I never would’ve guessed.

 

[longhaul3]

IIRC IM subI are not necessary, the letters should be coming from IM core rotation writers and department chair. During interviews as you implied one should lie through their teeth in stating that they had a last moment change of heart during one of the rotations. Also never apply to backup at the same instiutiton. The point is not matching Harvard IM, rather any IM, or you could take the SOAP gamble which sounds like a crazy way to go, but might end up in a worse or a much better situation since it is a complete gamble.

Also talking to some people that matched Neurosurgery two SubIs seemed sufficient.

In IM you still need a home sub-i in something, usually ICU/CCU. In neurosurgery the current standard is a home sub-i plus two aways for average and competitive applicants. Some will do three aways; few will do one.

Is IM a thing that neurosurg applicants apply for as a backup? I never would’ve guessed.

I don't think so.

 

[libertyyne]

Is IM a thing that neurosurg applicants apply for as a backup? I never would’ve guessed.

I know some applicants that soaped into categorical IM. So I guess they found it OK. Some people who didnt make it went into Neurology. Not everyone prefers gen surg i guess. and IM is just the default.

In IM you still need a home sub-i in something, usually ICU/CCU. In neurosurgery the current standard is a home sub-i plus two aways for average and competitive applicants. Some will do three aways; few will do one.


I don't think so.

Yes, two aways and home, but the home one can usually be done during a time when aways are restricted, atleast at my program.
@mrbreakfast
Hypothetically if someone wanted to apply Neurosurgery and Rads as a backup how would one work that in? would the backup application just be late considering there is no year core rads rotation.