My Experience of the Orthopedics Residency Application Process...

[Wahoos]

This is for the Pre Med people who are interested in Orthopedics and also to give you guys a glimse of what the residency process is like. One of the SNDers posted a message on the Allo forum asking about what the residency process encompasses. So I reposted my response here because I think alot of people here would be interested to read about the residency match process. Go to the original post at

http://forums.studentdoctor.net/showthread.php?p=2785539&posted=1#post2785539

njbmd wrote a great post on the general process of obtaining an residency. My post is about the Ortho match.

hey CS321,
I can give you a little glimse of the Orthopedics application process. I agree with what njbmd posted. It is a very good general overview of the residency process. The Orthopedics application differs a little from a lot of the other specialities in terms of what the PD (Program Director) looks for. (It is probably similar to the ENT, Derm, Plastics, Optho, or the more competitve specalities). First, your personal statement is bearly look at. It can hurt you but not help you that much. Most PD don't even look at the PS or maybe at the most, skim through it. Almost all of the programs that I went for interviews last year had a USMLE and/or AOA cut off. From talking to people on the interview trail, the magic cut off for ortho at a lot of programs is somewhere between 220-230, I know several programs will trash your app if you are not above a 230 on the step 1, unless you were a rotator or home school applicant. (230 is pretty hard to get on step 1, it is probably in the 65-70th percentile of all MED STUDENTS taking the exam). AOA is also something Ortho PD likes. Being AOA can help alot, but not required. Research is also huge with Ortho, Most of the PD like the applicant to have some kind of research background and or publications. Where you went to medical school is very important, as the top tier med school tend to have more famous orthopods that can write LOR for you. Your EC are somewhat looked at, depends on the PD, but I know having played varsity college sports can help you, since almost half of the people in my program was ex college athletes. But just having college sports but doing bad/average in school will probably not land you a spot.

Most Ortho applicant will apply to 40-60 programs (>$1000 for the ERAS, plus interviews where you have to fly, hotel, food, rent car. So if you go to 15 interviews, you will likely to spend >$4000), people will tell you that they applied to 10 or 20, these people either is lying or they are a "superstar" applicant = jr AOA, >260 step I, tons of ORTHO research and pubs, Tier I med school, with strong LOR from very famous professors, etc. To give you an example, one of my best friend this yr applied to 60+ programs with a 245 step I, all As in clinical and 1st 2 years except for 2 classes and 1 rotation, research, very very strong LOR, and received only 14 interviews from that, he was not AOA, but was in the top 1/4 of our school (Top 25 med school). So it is very competitive. Another guy that I rotated with at a Chicago program, went to U of Chicago, had 250 step I, missed AOA by a few spots, great LOR, and research, also tossed in 50 or so apps and received about 15 interviews.

Now, assume that you have made the cutoff and your app actually made on to the PD's desk, which is pretty good since most programs get between 100-150 apps per spot, my home program received about 600 this year for 5 spots. Whether you get an interview or not depend on alot of things, but now the LOR comes into play, who wrote them matters as much as how good they are. Because Ortho is a small field and alot of the Program directors know each other and other attendings in your school. If they see one of their close friends wrote you a strong letter and you had a strong app, the PD might pick up the phone and call... this happens alot in Ortho, where one attending call the PD of another program to push for his student. From what I have seen, most of the programs will interview 8-10 people per spot = about 40-50 interviews out of 400-500 apps for 4-5 spots.

Now you have got all of the interviews lined up, well in Ortho, alot of programs offer interviews on the same day, weekends, etc, so if you are a strong applicant, and get mult interviews, you will have interviews that land on the same day and you will have to cancel one, which is something very hard to do. And if you call the secretary to re schedule, alot of times, they will say tough luck, you either come on that day or we will invite someone else to come. Our school gived us 2 months of vacation/interview/USMLE step II time in 4th year.

So now you have arrived at the interview... well, in ortho, you have to do some ridiculous things at interveiws. Nothing like peds or IM, where people will just be like "how can I convince you to come to our program... do you have any question for me... is there anything I can do for you...etc" I have had programs where the attending threw up X rays that I had to interpret, id what kind of fracture, my management plans, etc. One of the PD was faking an traumatic injury, where I had to exam him, ask him questions, and then I had to present the case to the PD with my management plans, all in the interview. I have been asked travia questions, what kind of animal would you like to be and why, how would you find touch a ball in a box with a stick and the help of a C arm Fluro machine, one program/the residents took it's applicants to the gym just to see how much they can bench, another program in the midwest have touch football games after the interview for the applicants (that was kinda fun and the only 2 girls that was there on the interview also play football), at a program in florida, after the interview, the residents took the applicants to a strip club. Another place had the applicants go into a room to assemble a drill and asked the people to drill 45 degrees into a PVC piping (so this is kinda hard, you need to drill at a 90 degrees first and then dril in the 45, otherwise the drill head will slide off), one of my friends told me one of the attendings gived him a nut and bolt and asked him to screw the nut on with his non-dominant hand, but the trick is that the nut did not fit the bolt and the attending just wanted to see how long it took the applicant to figure it out (this was done while the interview was taking place). My Best friend went to a program in NY where the attending had him do wrist curls with a 10 lb wt for 1min to see how many he can do, then had him draw a self portrait after that... But these are some extreme examples, alot of the interviews that I went on was very benign. It is kinda fun to go to these interviews.

Ok, say now the program have finished interviewing all of the applicants for the season, it is time to make the rank order list. This is when all the attendings come together to rank the people they have interviewed. Most programs will not go past 15 for 4 spots, in fact most places will fill the 4 with their top ten. Another words, if you interviewed at 15 places and was ranked in the 20s to 40s at all places, you will not match with 15 interviews. And this have happened over and over again to very good applicants. This happened to a good friend of mine this year. While the programs are making their list, you also make a rank list of the places you have been interviewed. Then a huge computer , will match you to the program based on the LIST.
So on match day, you get an envelop in your hands that will tell you where you will be for the next 5 yrs. And you can end up at your 1st place or last place,... you can never be sure.

Anyways, I am glad I have gone through this process, and I would not have repeated it again if you paid for my medical school expenses. I think in this process, it takes a lot of hard work in med school, who you know, and a bit of luck to get a spot. This is just my experience with the application process last year, so take it with a grain of salt.

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[akpete]

Hi Wahoos. Thanks for the post. I'm about to be an M1 at MCW. I am definitely interested in orthopedics. I'm an athletic trainer right now, so I would be really surprised at myself if I ended up choosing something different. Anyway, my question for you is about what you saw concerning female ortho applicants. I'm a girl, so naturally, I'm a little worried. (Well, first I need to worry about doing well in school, but worried about this too )

Thanks Wahoos.

 

[45408]

Aoa?

 

[Centinel]

Aoa?

[I'm cutting out my wildly inaccurate guess; the real answer is explained below]

 

[AJM]

Aoa?

AOA is alpha omega alpha - it's the med school honor society.

 

[gujuDoc]

AOA is alpha omega alpha - it's the med school honor society.

This is the Phi Beta Kappa of medical school pretty much.

 

[YFR]

Wahoos, thanks for the perspective which is of course rare on this part of the forum. Your posts have been very enlightening and motivating. I'm curious about this comment:

Anyways, I am glad I have gone through this process, and I would not have repeated it again if you paid for my medical school expenses.

What do you mean by this? You don't think med school was worth all the effort, or you would do a less competitive specialty if you had to do it all again... or was it intended as just a figure of speech? My bro went through the same sentiments during residency but is now very happy with his job (in IM).

By the way, did you apply for a residency position at your med school? If so, did that process differ much from other sites?

 

[Wahoos]

Ak Pete,

With an athletic trainer background, that will help you when you apply and plus for the PS. Ortho is the only field that you can do OPERATIVE sports medicine, which means that you will rarely send anyone out who has an athletic injury that was refered to you. ACL, Shoulder, Ankle, Meniscus, etc. That is why I really like Ortho is that I want to be the guy that can take care of specific problems and to know the most in a specific field. Anyways, regarding your question about woman in Ortho, I think it is great to have more woman in the field. You don't see it much, about 8% of all residents in the US doing Ortho are woman. It is a field that many people preceive as only Jocks who are ex football players with crappy grades but a huge bench press apply. But that is so far from the truth. However, when I go to interview last year, usually, there are about 2-4 woman in a room of 30 interviewees. I think as a woman, it might help you to apply since this field needs more, but also depends on the program. There are some programs that will not take woman into the program. One of the reasons is that sometimes that a woman reisdent might takes a 4-5 wks maternity leave and that will put some pressure on the residents to cover, so instead of every 4th night on call, for 4-5 wks, the other res might be on call every 3rd night (and that is a big difference). So that is one reason that some PDs are not willing to take a woman into the program. Anyways, I just got paged to the ER for a guy with osteomylitits, so I will finish this post later. (On call is cool, when things are slow, you can read and check email, but when you are slammed, then you will be SLAMMED)

 

[gujuDoc]

Ak Pete,

With an athletic trainer background, that will help you when you apply and plus for the PS. Ortho is the only field that you can do OPERATIVE sports medicine, which means that you will rarely send anyone out who has an athletic injury that was refered to you. ACL, Shoulder, Ankle, Meniscus, etc. That is why I really like Ortho is that I want to be the guy that can take care of specific problems and to know the most in a specific field. Anyways, regarding your question about woman in Ortho, I think it is great to have more woman in the field. You don't see it much, about 8% of all residents in the US doing Ortho are woman. It is a field that many people preceive as only Jocks who are ex football players with crappy grades but a huge bench press apply. But that is so far from the truth. However, when I go to interview last year, usually, there are about 2-4 woman in a room of 30 interviewees. I think as a woman, it might help you to apply since this field needs more, but also depends on the program. There are some programs that will not take woman into the program. One of the reasons is that sometimes that a woman reisdent might takes a 4-5 wks maternity leave and that will put some pressure on the residents to cover, so instead of every 4th night on call, for 4-5 wks, the other res might be on call every 3rd night (and that is a big difference). So that is one reason that some PDs are not willing to take a woman into the program. Anyways, I just got paged to the ER for a guy with osteomylitits, so I will finish this post later. (On call is cool, when things are slow, you can read and check email, but when you are slammed, then you will be SLAMMED)

Thanks for the response.

You are awesome for posting your actual experiences. These are the most fun sort of threads to read.

 

[AxlxA]

Wahoos, seriously, thank you so much for sharing with us. I am also thinking of ortho, like the thousands out there. And i wanted to see what it takes to be an ortho and judging from what u told us, it is pretty hard.

 

[Wahoos]

To Continue on the post.... Finally the floor is a little slower and no ER consults.. Also to talk more about woman in Ortho. I think another reason why there are less woman (other than the fact that the # of apps from woman to ortho each year is a lot smaller vs men, but that figure has been increasing recently with the 80 hr work wk, more and more people are applying to surg sub specialities now than ever), I think another liability that can prevent an woman to do ortho (in the PD's eyes) can be strength issues. I know alot of people will argue with me that strength does NOT come into play in ortho surgeries.... but I can assure you that during some operations, there are a lot of strength that is needed to do things properly. Like to seperate the Hip from the socket for a total hip replacement or to relocate the hip back in for a traumatic dislocation or just to do a close reduction takes a significant amount of strength, to ram an acetabular joint with a drill can be tiresome (the drill is pretty heavy and to be able to hold it in mid air with a 1.5 foot long drill bit for a few mins is tough, even for a guy). But I have worked with a few woman Ortho residents before and they were great, had no problems what so ever. So if you are a woman and interested in Ortho surgery, you should definitely check it out. I think it is the BEST surgery sub Speciality ever!!!!!!!!!! But hey, I am a little biased. Just the procedures are very cool, you work with your hands, lots of fun tools in the OR, and in the end, you really do alot for the patients.

To YFR,
Sorry man, I think you mis understood that statement completely. I enjoyed my medical school experence very much and would not do anything to change it. And also I will be working about 70-90+ hours for the next 5 years as an Ortho resident, and I do not regrat anything. I always liked to work hard and also play hard. Even if you are in the hospital 80 hours per week, you still find time to do things like going out, work out in the gym, read, cook with friends, etc. It is definitely do able.

What I mean by that statement is that if you were to give me $150,000 (my med expenses, I was out of state) and tell me to go through the Medical School or Orthopedics Residency Application process again, I won't do it!! Medical School is awesome and being a surgical intern/resident is even sweeter (because you are actually applying what you learn and have the responsibility for your patients, which is really the big difference between a med student and a resident and also a resident vs attending/who makes all the decisions). Just I think the application process sucks for both the med school and residency. But there is nothing in this life time that I would have done as a career other than medicine (considered professional tennis after my college career, but realized that my backhand was not good enough ). (also I am not the type that only read and study... I have alot of other things that I enjoy outside of the hospital)

 

[Wahoos]

I forgot to add that when you go through the Match process. On the Monday before the Match Day (usually on the Thursday), you will get an email saying either "congrats you have matched, or Sorry, try again next year". But this day is called "Black Monday" and for medical students that are applying to very competitive residencies, this day really sucks and also very nerve wrecking. But if you matched on monday, then you know when you get the envelope on Thursday, you will be going to one of the places on your list. But if you don't match, then on tuesday at High Noon, , all of the programs that have open spots (AKA the program did not match all of their spots) are sent to you on a list. Alll of the people in your school that did not get a spot come to the Dean's office and sit next to a phone that is used to call each of the programs that you are interested in that have an open spot. You will fax your CV, Board scores, Transcript, etc, to the program and hope that the PD will call you. But it is very competitive to get an spot in Ortho scrambling. To give you an example, out of the 580-590 ortho spots this year, only 1 spot was open for scramble, and from what I heard, that program literally received about 300 apps in the mater of a couple of hours, and mult. phone calls to the PD from attendings that know the program and trying to push a canidate. To compare this to the Internal medicine match, out of the 7500 PGY-1 spots in IM this year, about ~800 spots was open for scramble. So that is a pretty big difference.

 

[akpete]

Thanks for your insight Wahoos. I appreciate it. Your posts are great in general too.

 

[californiabruv]

Hi Wahoo, thanks a lot for the info. Okay so here goes,
I am a MS3 in Florida. My board score is 230 with 96 percentile. I honored most of my classes in first year, but none in my second. I published one ppr in Neuro in college (UCLA) and one ppr in Ortho spine surgery in btw my first and second year at Cedar Sinai hospital in beverly hills. Now I am in a bind, because I want to go back to UCLA for ortho residency.
I feel like I am at the cutoff for ortho, or maybe just below it. I have contacts back at UCLA and Cedar Sinai. My preceptor from Cedar is a big shot in SPine surgery.

What do you suggest, Do i do more research to boost my app. Do I do more research in the school where I want to end up, or in my medical school? I am not sure about the process and any advice/help would be great,

Thanks

 

[ChubbyChaser]

Hi Wahoo, thanks a lot for the info. Okay so here goes,
I am a MS3 in Florida. My board score is 230 with 96 percentile. I honored most of my classes in first year, but none in my second. I published one ppr in Neuro in college (UCLA) and one ppr in Ortho spine surgery in btw my first and second year at Cedar Sinai hospital in beverly hills. Now I am in a bind, because I want to go back to UCLA for ortho residency.
I feel like I am at the cutoff for ortho, or maybe just below it. I have contacts back at UCLA and Cedar Sinai. My preceptor from Cedar is a big shot in SPine surgery.

What do you suggest, Do i do more research to boost my app. Do I do more research in the school where I want to end up, or in my medical school? I am not sure about the process and any advice/help would be great,

Thanks

how is a 230 the 96%ile...when 220 is the average and it has a SD of about 15...I think.

 

[costadelsol]

Hey Wahoo, just wondering about doing research to be a competitive applicant for ortho residency, does it matter what field your research is in? It's still early for me but I'm very interested in a few fields (ortho included), so if I did a lot of research in cardiology for example, would that still be looked favorably upon if I decide I wanna shoot for ortho?

 

[spyderracing32]

Bench competition? I'm in!

 

[ImNotBritish]

Hi Wahoos-
Thanks for all of your info. I knew less about match than I thought! So, if you don't end up matching, and you don't get (or want) one of the scramble spots, what should one do during that year off?

 

[Lokhtar]

Love it - they asked you to bench.

 

[copingmethods]

Hey Wahoo, just wondering about doing research to be a competitive applicant for ortho residency, does it matter what field your research is in? It's still early for me but I'm very interested in a few fields (ortho included), so if I did a lot of research in cardiology for example, would that still be looked favorably upon if I decide I wanna shoot for ortho?

It might take him a while to answer - this was 2005.