Matching into competitive specialty in desirable location from low tier MD

[nadiasp980]

Hi all, I just started med school at a low-tier US MD near a large city with prestigious med schools. I'm interested in competitive specialities (ophtho, ENT, derm, rad). My school has home programs in all of these but they take like 1-2 students MAX every year. I looked at the match list for the most recent years and it looks like most students who do end up matching into competitive specialities end up in less desirable locations. I would really like to be back home in CA or in a large city on the East Coast for residency, but I'm not sure whether these goals are realistic coming from a low-tier school. I understand it is early, but I would like to have realistic expectations as I start med school and figure out exactly what I want to do and how to become the best candidate for my chosen field. With this in regard, I have some questions that I would like to ask:

- I have connections from my gap year position to doctors at a well-known institution that conducts research on one of the specialties I am interested in. I was part of these research studies as a CRC. How can I best utilize these connections? Should I try to do summer research with them instead of the researchers at my home program?
- Should the research year be conducted at my home school or in another, more prestigious location? Does it need to be complete between M2 and M3 or M3 and M4?
- Should I opt to do a Master's program between M2 and M3 instead of a research year? Or even concurrently with my research year?
- Should I conduct summer research in more prestigious locations?
- I'm within a reasonable distance from more prestigious med schools and hospitals. I know this would be super difficult, but would it be more favorable for me to try to find research opportunities in other locations?
- How important are research years and away rotations if I wanted to match into competitive specialties in desirable locations?
- How do most people prepare for their back-up specialities? Is it necessary to conduct research in both my main and back-up specialty? And what would be some reasonable back-up specialities? For context, I'm also interested in psychiatry, PM&R, and EM.

I'm so sorry I have so many questions haha, I'm a confused M1 trying to figure things out. Thanks everyone!

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[altblue]

Your specialty interests are very diverse with little in common with each other. Sure, developing interest early can be useful in more competitive specialties, but maybe you could take a step back and start to consider what you'd actually enjoy doing. Truly though, you have plenty of time to do this. First semester is probably better spent maybe dabbling into a bit of research/shadowing, focusing on your academics and developing your social life in med school.

Maybe someone else can chime in, but the answers to many of your questions depend on the specific strengths of your local programs. It's difficult to say whether x home program is better to build connections at versus more prestigious local y program without the context of specialty or knowledge of how strong each program actually is. You're probably better off reaching out someone more knowledgeable in real life.

 

[the shretiology]

What exactly are you prioritizing with those specialty choices? Money, prestige? Find an interest first. Then look for research opportunities. Look for internships at locations you would like to go (eg summer activity). Do well in school and rotations. Kill step 2. Do aways at preferable location and make connections. You're far away from that ahead and should probably focus on making sure you can do well in school. Doing research for the sake of it being your backup specialty is silly.

 

[Browns99]

Regardless of school ranking or "prestige", tons of students from low-to-mid tier schools match in competitive disciplines every cycle, so don't be intimidated. You need to create a well-rounded application that consists of; honoring clerkships(if possible), crushing step 2, securing outstanding letters of rec., connecting with well-known mentors in the field you are applying to(maybe more so in the region you want to be in), perform well during your aways and start research early (that is to say after you are comfortable in your first year or so of school). Research years are speciality dependent, i.e. neurosurgery and plastics data reveals that their matched applicants come with a ton of research, so if you are planning for one of these fields and start research early, you may not need a year, but may be very likely, as more and more are taking a year of research.

Don't stress, and don't pick a field because it's prestigious, pick something that you fall in love with because you will be doing it for the next 30+ years.

Best of luck!

 

[guytakingboards]

People do match into competitive specialties in desirable places from lower tier schools; it's by no means an impossibility.

That being said, saying that at this point is equivalent to a high school freshman saying he/she wants to go to Harvard. There's a ton of academic achievement to accomplish and honestly you'll need a few good breaks in research and mentors.

Say you wanted ENT. There were 361 spots in the 2022 match out of 39,205 total positions offered. So slightly less than 1% of applicants matched to ENT. Of that number, lets generously say 40% are in desirable areas. So now you're looking at 0.4% of applicants in the match ended up at desirable ENT programs. Obviously 39,205 people didn't apply to ENT but the point is to highlight the numbers game. To match ENT at a desirable place your application will have to be elite. Grades/Scores/LOR's/Research.... the total package.

Your post put a ton of emphasis on research. Research is important for some fields, but research is always going to be secondary to grades/scores/LOR's first. Focus on those basics and you'll have a chance at any field. Good luck!

 

[GoSpursGo]

Step 1 is do well in school and make sure you're at the top of your class if you want any of those specialties. So many people get focused on all of the "other" stuff early on and totally stumble on the academics piece. Once you get through your first round of exams and you show you can handle the material, then worry about the rest.

Just to address a few of your specific questions:
-As others have said, you need to narrow your focus. Figure out what specialty you want.
-There are advantages and disadvantages to working with your home program vs. another more prestigious program. On the one hand, if you can be successful with the more prestigious program, it will undoubtedly help your application for other prestigious programs. On the other hand... it would probably take a lot of work to coordinate, the logistics of doing a research year at another institution are difficult (your school is unlikely to pay you to go do research somewhere else whereas they might give you a research stipend if you're working in one of their labs), and while a lesser concern your home program could get miffed that you're snubbing them which could hurt your letters. Regardless, I recommend you start making connections in whatever specialty you choose at your home institution.
-The exception to the above is competitive funded med school fellowships like the NIH MRSP. Those would certainly help.
-Nobody cares about a masters.

 

[nadiasp980]

Hi all, thanks for the comments and advice! I wanted to start asking questions about research so that I can reach out to the appropriate places/people early enough, but I will make sure to be on top of my academics as well

To be quite honest, I don't really have any passions lol. I think medicine, in general, is cool, and I liked the specialty my clinical research was in, but I'm not like DYING to be in this specialty over any other competitive specialty. I know there is a stigma against folks like me, but I'm mostly looking for a specialty that will give me good work-life balance in the future as I want to start a family with my partner. Right now, the specialty I'm most interested in pursuing is the one I did my gap year clinical research in, but that's mostly because I already have connections to high-profile researchers in the field.

I would appreciate it if I could get advice on maintaining this connection to my old PIs and utilizing this connection. Due to the way the clinical research office was structured, the PIs did not hire the CRCs directly and therefore, usually didn't feel obligated to publish us. The most I got was an acknowledgment. Should I try to pursue summer research with these PIs directly after M1 year instead of doing research at my school? I'm not sure how else I can use these connections, but I would love any other suggestions.

I'm also happy to DM people the institution I'm at haha, if that helps in evaluating the strength of the program.

 

[voxveritatisetlucis]

Based on the lower tier match lists I’ve studied, it seems like even strong students from these schools need to pick 2 of the following

-strong and non-malignant program
-competitive specialty
-good location

Now, I think that it also depends on what you mean by “lower tier.” and what you mean by “desirable East coast city”

Obviously it will be more difficult from a school with a PD ranking of 130 than a PD ranking of 60. Also if by “desirable East coast city” you mean Boston, NYC, or Washington DC, this will be much more difficult than if you want to include Charlestown, Morgantown, Richmond etc.

Lastly, I’ll also note that it’s important to remember than people from low tier schools absolutely have connections (meaning son or daughter, god son/daughter etc.) to high profile people. So when there is an anomalous match (ie somebody from 120+ matching at MGH, it’s always good to ask what connections did he or she have?). In some cases it’s just hard work, but it’s important to keep in mind that nepotism exists in medicine too.

All of these points are going to be accentuated by p/f step 1 and that’s exactly how it was designed

 

[pierty]

All of these points are going to be accentuated by p/f step 1 and that’s exactly how it was designed

You should take a step outside. I think you've had enough of this site for several lifetimes (and I mean this out of genuine concern - this is not real life. Everything here is exaggerated. You are about to start med school - if you keep up with this mentality and view life through this lens, you risk hurting yourself a lot and burning out very quickly).

OP - like you, I hear a lot more pre-meds and incoming M1's nowadays be incredibly anxious about matching into specialities before they even have their first day of med school. Take a deep breath - you haven't even started yet. It's clear that you don't know what specialty you want to go into right now, and that is ok - the vast majority of med students are the same. You'll be exposed to different specialities over time, and you might be surprised with what you resonate with. Spending time and nerves anxiously planning every step for a path you are not even sure you want yet is a fast track to burnout.

Keep an open mind throughout med school, and surround yourself with a friend group that is low-stress and fun (and talk more about the interesting stuff they are learning about, and their hobbies, rather than their obsessions with the future and competition). Work hard throughout your studies to become the best doctor you can be - not to outdo others, or "gun" for a specific career path - and you'll find that you'll not only be successful, but also much happier and more likable to both your friends, and mentors. It will reflect very well on you - and you won't even be pursuing that validation.

When it comes time to apply, you'll have a better sense of what you want to do. But until then, try to spend some time off of sites like these - you'll be in a much better place in your happiness, and career.

 

[Mdcsmitty]

Id echo what others have said and worry about doing well your first semester or at least making sure you have acclimated to your first round of exams. Focus on doing things that you are interested in and things will fall in place. To be fair im a what is supposed to happen will happen type of individual. With that being said I had a list of specialties that I was interested in when I started med school. Did some shadowing and that list quickly changed. While im still interested in surgery it is a subspecialty that was no where on my radar when I started. Im only an M2 so obviously my specialty can still change but based off what I am currently interested in I have been meeting with faculty in that department to get on research projects and do some general shadowing. I ended up shadowing an attending who is part of the admissions committee for the residency program and the topic of applications arose. What he told me regarding research basically went against a lot of what I was reading online. Keeping it short what he explained was basically its a crap shoot we know its not fair, while they value research they really aren't concerned if it is in their specific specialty but that you understand the research process and can see a project through from beginning to end. While this is ONE conversation that I had with ONE individual I have heard similar sentiments from others. Being at a institution even if it is "low teir" that has programs is going to be a huge benefit to you and a opportunity that not every med student has. Take advantage of that and enjoy the ride. I went to a zoom meeting about matching in this subspecialty and what they showed seemed to be that it was inconclusive as to whether research years helped or not. You also have to look at the reason they took the research year in the first place. I don't think you can take someone who took a research year after a unsuccessful match and then matched the second time, and then say that that research years help across the board in all situations. They aren't starting from the same place especially if the reason that they didn't match was that it was a particularly rough year and they happened to slip through the cracks without any red flags on their application. Also there is time to do research in med school im not getting multiple publications a month but I got one done my first year and am in the process of wrapping up 2 projects and starting a 3rd so you definitely have the time to get it done if you want to without having it be your entire life and without extending your training, and another year of tuition if you don't have to. Your program directors know what it takes to match so reach out to them without being annoying. People want to train people who want to be there so if you are generally interested and hard working im sure they will be willing to help guide you.

 

[voxveritatisetlucis]

Thank for for the concern (genuine appreciation not being sarcastic) i will be posting here much less now that I am busy with school tbh. Main reason I was so active for past year is having a desk job (stay logged in on computer) and not using Reddit/misc bodybuilding (forum closed)/Wall Street oasis/solitaire

You should take a step outside. I think you've had enough of this site for several lifetimes (and I mean this out of genuine concern - this is not real life. Everything here is exaggerated. You are about to start med school - if you keep up with this mentality and view life through this lens, you risk hurting yourself a lot and burning out very quickly).

OP - like you, I hear a lot more pre-meds and incoming M1's nowadays be incredibly anxious about matching into specialities before they even have their first day of med school. Take a deep breath - you haven't even started yet. It's clear that you don't know what specialty you want to go into right now, and that is ok - the vast majority of med students are the same. You'll be exposed to different specialities over time, and you might be surprised with what you resonate with. Spending time and nerves anxiously planning every step for a path you are not even sure you want yet is a fast track to burnout.

Keep an open mind throughout med school, and surround yourself with a friend group that is low-stress and fun (and talk more about the interesting stuff they are learning about, and their hobbies, rather than their obsessions with the future and competition). Work hard throughout your studies to become the best doctor you can be - not to outdo others, or "gun" for a specific career path - and you'll find that you'll not only be successful, but also much happier and more likable to both your friends, and mentors. It will reflect very well on you - and you won't even be pursuing that validation.

When it comes time to apply, you'll have a better sense of what you want to do. But until then, try to spend some time off of sites like these - you'll be in a much better place in your happiness, and career.

 

[operaman]

A strong performance in Med school is really the key regardless of tier. The bar is definitely a bit higher when coming from a lesser known place but not insurmountable.

-strong academic performance. Try to honor everything if you can.

-strong board scores. This means CK and prep starts early because you need a solid foundation. Prep for step 1 like it’s scored so you develop the foundation.

-summer after M1 is a great time for research at another Place. If you work hard and are liked it could help grease the wheels later.

- research year also an option. The benefit is less about a long CV and more about letters from important docs as well as potentially getting an inside track on a spot at a top program. We had some people who were FMGs from lesser know foreign schools who ended up matching with us because they crushed it as research fellows.

- away rotations. These are double edged swords and most people hurt themselves more than they help, but if you are very strong clinically and very well liked it can help elevate your app quite a bit.