Need Input Regarding Ranking

[Postictal Raiden]

I was naive to 1) not realize that I could potentially fall in love with an advanced program 2) underestimate the competitive nature of prelims.

Now I am in a pickle. Two of the programs I interviewed at, that are advanced, are among my most desirable ones. I have only been able to secure 3 prelim interviews.

Should I continue to rank programs purely based on how much I like them with disregard to the fact I have very few prelims? Or should I play it safe, and rank these two programs lower?

Some of my interview mates told me that it's customary for advanced programs to help their matched applicants secure a prelim spot during and after the scramble process. Is this true?

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[TorusTubarius]

If I were you, I would rank the categoricals over the advanced programs. I think you have a good shot at not matching your prelim with just 3. I've heard of prelims going up to their 5th and 6th choice.

 

[Postictal Raiden]

@TorusTubarius Thanks for replying.

I remember you posted few months ago that you weren't getting enough prelims. How many did you end up getting? Are you ranking categorical higher than advanced?

 

[MudPhudHopeful]

I am also stuck with only three prelims and I’m in a similar boat regarding falling in love with advanced places, though in my case each has a certain number of guaranteed spots.

I’m wondering if anybody could comment on if three independent prelim interviews is sufficient when considering them along with the linked positions. Would a program with 6/8, 7/8, or 6/11 guaranteed spots be safe to rank highly?


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[Postictal Raiden]

I am also stuck with only three prelims and I’m in a similar boat regarding falling in love with advanced places, though in my case each has a certain number of guaranteed spots.

I’m wondering if anybody could comment on if three independent prelim interviews is sufficient when considering them along with the linked positions. Would a program with 6/8, 7/8, or 6/11 guaranteed spots be safe to rank highly?


Sent from my iPhone using SDN mobile

Your situation is a lot better that mine. Since I'm a math freak, let's run the numbers:

Your chances of going unmatched at all of your 3 prelims are (2/8) x (1/8) x (5/11) times 55%^3 (NRMP states that one's chances to match at one program is 45%, so your chances of not matching a program is 55%. So your chances of not matching the non-linked spots at each of these program are 55%). Therefore, the odds of not matching any position of these three prelims = 1.4% x 16.6% = 0.2%.

My odds aren't as nice since all of my prelims are true prelims so my odds are 17% I won't match a prelim. That's a significant number if you ask me, especially given that I'm a DO.

 

[bengx]

Just wondering, what will happen if you match the advanced, but fail to match any preliminary?

 

[Postictal Raiden]

Just wondering, what will happen if you match the advanced, but fail to match any preliminary?

You will need to scramble for a prelim med year during SOAP. Given that you’ll be competing with Derm RadOnc and other competitive applicants, chances of finding a spot during SOAP are slim. This would put you at a horrible situation and that’s why I created this thread, to find out what happens if you fail to secure a pgy1 before July.

 

[curiousneuro]

I was actually in a similar position when I went through the match a few years ago. Although initially I thought I wanted to go to an advanced program, I loved the categorical program that I matched in and ranked #1. I think I had around 5-6 prelim interviews, and I was still nervous about not matching, to the point that I ranked other categorical programs above my advanced programs in the end.

In summary - unless you are ok with potentially scrambling for a prelim spot, I would rank the categorical's first.

 

[Postictal Raiden]

I was actually in a similar position when I went through the match a few years ago. Although initially I thought I wanted to go to an advanced program, I loved the categorical program that I matched in and ranked #1. I think I had around 5-6 prelim interviews, and I was still nervous about not matching, to the point that I ranked other categorical programs above my advanced programs in the end.

In summary - unless you are ok with potentially scrambling for a prelim spot, I would rank the categorical's first.

What scares me is that, as a neuro applicant, I don't have the luxury to fall back on prelim surgery. These positions are abundant and scrambling into one of them is relatively easy. Scrambling into medicine prelim is a nightmare.

 

[curiousneuro]

What scares me is that, as a neuro applicant, I don't have the luxury to fall back on prelim surgery. These positions are abundant and scrambling into one of them is relatively easy. Scrambling into medicine prelim is a nightmare.

Exactly...sometimes the advanced program would help you get a spot at the institution you matched in, but honestly I wouldn't count on that.

 

[DokterMom]

Would you need a medicine prelim or would a surgical one do? Always lots of surgical prelims in the SOAP...

 

[Postictal Raiden]

Would you need a medicine prelim or would a surgical one do? Always lots of surgical prelims in the SOAP...

Not sure if you read the above comments.

Neurology programs are for the most part categorical (have built-in internship year). Some are advanced (requiring an internship prior to starting your 3 years of neurology). The neurology accreditation body requires resident to do at least 8 months of inpatient experience during internship, 6 of which have to be in IM. Preliminary medicine and few of Transitional Year programs fulfill this requirement. Surgical prelims don't. Therefore, anyone going into an advanced neuro program must apply to either medicine prelim or one of these few TY's. Scrambling into either is very difficult due to the high demand to supply ratio.

 

[W19]

I would rank the categorical ones higher... Not the time for one to gamble with his/her future.

Are there any TRI that are dual accredited? if so, maybe you can rank your advanced programs higher and scramble into a TRI if you fail to match into an ACGME preliminary medicine...

By the way, why can't all residency be categorical?

 

[Postictal Raiden]

I would rank the categorical ones higher... Not the time for one to gamble with his/her future.

Are there any TRI that are dual accredited? if so, maybe you can rank your advanced programs higher and scramble into a TRI if you fail to match into an ACGME preliminary medicine...

By the way, why can't all residency be categorical?

Except that most TRIs won’t meet the ACGME neurology requirement of having 8 months of inpatient rotations, six of which are IM.

 

[W19]

Except that most TRIs won’t meet the ACGME neurology requirement of having 8 months of inpatient rotations, six of which are IM.

It's a hard decision to make then... Now I understand why SDN posters talk a lot about 'fit' and 'gut feeling' in this process. I started my IM interviews thinking that one particular community program was going to be at the bottom of my ROL but after interviewing at said place, I find myself debating whether it should be #1 (over a good university program that is located about 1/2 hr from where I reside)... I understand what your are going thru.

 

[rgb123]

Do the 8 months of IM need to be inpatient?

Not sure if you read the above comments.

Neurology programs are for the most part categorical (have built-in internship year). Some are advanced (requiring an internship prior to starting your 3 years of neurology). The neurology accreditation body requires resident to do at least 8 months of inpatient experience during internship, 6 of which have to be in IM. Preliminary medicine and few of Transitional Year programs fulfill this requirement. Surgical prelims don't. Therefore, anyone going into an advanced neuro program must apply to either medicine prelim or one of these few TY's. Scrambling into either is very difficult due to the high demand to supply ratio.

 

[W19]

Do the 8 months of IM need to be inpatient?

Post #14 answers your question

 

[mcribbits]

I have 6 prelim interviews and all my advanced programs have a partially linked prelim year as well (effectively 7 prelims).

I am ranking 2 advanced programs with a partial link very highly, I feel like 6 prelim interviews should be enough for me.

Caveat: Most of my prelims are in programs that aren't being sought out by ROAD specialties as much because they don't offer as chill of a year compared to other nearby options in the same location, and they tend to be at satellite academic sites or community hospitals. I also have strong research and personal ties to one of my prelim programs as well.

Your answer will vary based on how many prelim spots each of your programs is offering, how competitive the prelim program is, and how well your interview went. I think 3 is a little dicey, and I also think the "safe amount" is something that is too variable to give a concrete number.

The other thing I considered was, if I didn't try and rank these two advanced programs that I really liked highly, I would forever ask myself "what if."

 

[Postictal Raiden]

I have 6 prelim interviews and all my advanced programs have a partially linked prelim year as well (effectively 7 prelims).

I am ranking 2 advanced programs with a partial link very highly, I feel like 6 prelim interviews should be enough for me.

Caveat: Most of my prelims are in programs that aren't being sought out by ROAD specialties as much because they don't offer as chill of a year compared to other nearby options in the same location, and they tend to be at satellite academic sites or community hospitals. I also have strong research and personal ties to one of my prelim programs as well.

Your answer will vary based on how many prelim spots each of your programs is offering, how competitive the prelim program is, and how well your interview went. I think 3 is a little dicey, and I also think the "safe amount" is something that is too variable to give a concrete number.

The other thing I considered was, if I didn't try and rank these two advanced programs that I really liked highly, I would forever ask myself "what if."

Yeah, that's the thing. I don't want to spend the rest of my career thinking "I could've gone to that place". On the other hand, I'm a very risk averse person. I am a planner and don't like losing control. It's a tough decision, I tell you.

One of my prelim programs has tons of spots (20+), the other has ~10, and the third one has 6. Two of them are very rigorous and I'm sure only desperate ROAD folks would consider. The third one is an undesirable city. But nothing is guaranteed.

 

[typhoonegator]

This is why I liked it better when neurology was in the SF match (early), so if you matched categorical you could strategize your prelim ranking more carefully.

Life is all about calculated risks. I know people who matched at a Harvard advanced program and then couldn't get a prelim spot. Anywhere. They had to take a gap year and re-apply. If you can't imagine living that life, then rank your categoricals first.

 

[W19]

This is why I liked it better when neurology was in the SF match (early), so if you matched categorical you could strategize your prelim ranking more carefully.

Life is all about calculated risks. I know people who matched at a Harvard advanced program and then couldn't get a prelim spot. Anywhere. They had to take a gap year and re-apply. If you can't imagine living that life, then rank your categoricals first.

That sounds like a nightmare...

 

[mcribbits]

I think the other thing I took into account was asking the PDs during my interview about the prelim issue (I framed it as a worst case scenario) at interviews and seeing how many times they have run into this situation, and if they had any failsafes/support in case it did happen. I got good answers which also helped.

I think in the end you do have to be comfortable with taking somewhat of a risk. It’s kind of like seeing someone beautiful at the bar in that sense, when you’re working up the courage to make a move and realize you just have to go for it even though it might not work out.

 

[NeurologyHopeful2018]

This is why I liked it better when neurology was in the SF match (early), so if you matched categorical you could strategize your prelim ranking more carefully.

Life is all about calculated risks. I know people who matched at a Harvard advanced program and then couldn't get a prelim spot. Anywhere. They had to take a gap year and re-apply. If you can't imagine living that life, then rank your categoricals first.

Are you making this up? People matching to Harvard but unable to get prelim PGY-1??

The credentials to match at Harvard is 1) High board scores 2) Top quartile class ranking 3) Exceptional research 4) Exceptional charachter

Yet they could not obtain enough interviews to match prelim ANYWHERE?

 

[CarlosDanger]

I also have 6 prelims and am considering ranking advanced programs highly. I've been thinking a lot about these factors:

Does your home institution have a prelim?
Does an institution you rotated at have a prelim? Either of those factors could give you a big leg up
Did you meet other neuro prelims on your interviews? Where did those people match for their advanced program? How many were there?
Is there a truly large difference between the advanced programs you like and the categorical ones?

I've worked with very competitive ROAD interns at less conventionally desirable prelim programs because of other factors like being near family. Same goes for even neurology prelims who matched at places I didn't even interview. Sometimes they also end up at more rigorous prelims because they have better than average salary, or more elective time than others.

 

[Freeinfinity]

In the end, this is your decision. I can tell you that I had 5 prelim interviews. Didn't get a spot. Did the SOAP for about 3 days, 3 very terrifying days. Then ultimately felt big relief and gratitude once I got a spot a day before match day. Needless to say, I knew exactly where I was going before pretty much everyone else. If your home institution has prelim spots, then that's a good safety net. If not, then the risk becomes enormous.

 

[Postictal Raiden]

In the end, this is your decision. I can tell you that I had 5 prelim interviews. Didn't get a spot. Did the SOAP for about 3 days, 3 very terrifying days. Then ultimately felt big relief and gratitude once I got a spot a day before match day. Needless to say, I knew exactly where I was going before pretty much everyone else. If your home institution has prelim spots, then that's a good safety net. If not, then the risk becomes enormous.

That's the thing. I go to a DO school with no "home institution".

I always wonder, what happens if one can't secure a prelim spot in the SOAP? What do you think would have been your options had you not gotten your prelim spot? Is there a possiblity to lose your neuro spot to someone else and you wind up with no residency at all?

 

[Neuroapplicant20182022]

This is why I liked it better when neurology was in the SF match (early), so if you matched categorical you could strategize your prelim ranking more carefully.

Life is all about calculated risks. I know people who matched at a Harvard advanced program and then couldn't get a prelim spot. Anywhere. They had to take a gap year and re-apply. If you can't imagine living that life, then rank your categoricals first.

That's terrifying. Was it Partners or Beth Israel? Beth Israel has a linked medneuro prelim year, which not everyone gets, but the neuro dept tells you before rank lists are due what the medicine department's decision was (i.e, if you match neurology here, you are guaranteed a prelim spot if you would like it, or if you match neuro here, you will have to go elsewhere for prelim). But for Partners, their associated med-neuro prelims don't tell you anything before hand....so there is literally no way to rank Partners without the associated risks of not matching prelim.

 

[Freeinfinity]

I dunno. I would've contacted my neurology program and told them the situation. If either they or my home institution couldn't help me out, then I would've likely forfeited my spot.

 

[NeurologyHopeful2018]

Even if your home institution has prelim spots - there is no guarantee you will get it. We have 4 prelim slots - no more no less based on budget.

 

[Postictal Raiden]

Ugh. I guess I’ll have to go with categoricals then.

 

[Thama]

In 2018 the continued existence of advanced-only positions is an insult to applicants. The answer is to not rank them at all.

 

[Postictal Raiden]

In 2018 the continued existence of advanced-only positions is an insult to applicants. The answer is to not rank them at all.

I feel such programs are missing out on genuinely interested applicants. I know few high caliber people ranking categorical above advanced despite wanting the advanced programs more

 

[IslandStyle808]

How many preliminaries did you all apply to? This is scaring me like hell.

 

[Postictal Raiden]

How many preliminaries did you all apply to? This is scaring me like hell.

I was an idiot. I applied to only 9.

However, my friends who applied to 30+ still got less-than-ideal number of invites (5-7). The competition for prelims rises every year with the increasing number of those applying to radiology/Ophthalmology/RadOnc/PMR/Anesthesiology/neurology/Dermatology while the number of prelims themselves is held the same.

The annoying part is that a good number of the so-called prestigious neurology programs are still advanced, so it's very hard for ambitious applicants to avoid this headache.

 

[MudPhudHopeful]

I don't know the exact number, but I also applied to 20-30 at least.

 

[Postictal Raiden]

I don't know the exact number, but I also applied to 20-30 at least.

It's ridiculous.

I don't know your stats, but given you are an MD/PhD with crapload of invites from solid neuro programs, I'd say you should at least get 10 prelim interviews.

 

[IslandStyle808]

I was an idiot. I applied to only 9.

However, my friends who applied to 30+ still got less-than-ideal number of invites (5-7). The competition for prelims rises every year with the increasing number of those applying to radiology/Ophthalmology/RadOnc/PMR/Anesthesiology/neurology/Dermatology while the number of prelims themselves is held the same.

The annoying part is that a good number of the so-called prestigious neurology programs are still advanced, so it's very hard for ambitious applicants to avoid this headache.

Holy crap...

This is getting insane. Thank you for your response.

 

[Thama]

The annoying part is that a good number of the so-called prestigious neurology programs are still advanced, so it's very hard for ambitious applicants to avoid this headache.

A few are, but it's more of a "big city" problem and especially a "big city in the northeastern corner of the country" problem. Big names outside of NYC and Boston have mostly fixed this problem, the programs there seem to be banking on their location to outweigh how hard they are screwing their applicants due to their policies. There are elite programs in the west coast and midwest that more than rival anything in the NE, and even the south has good options. If you aren't absolutely tied to a particular city for family reasons, you'd have to be an extraordinary location snob to risk not matching prelim medicine instead of ranking top categoricals over advanced positions.

 

[Postictal Raiden]

A few are, but it's more of a "big city" problem and especially a "big city in the northeastern corner of the country" problem. Big names outside of NYC and Boston have mostly fixed this problem, the programs there seem to be banking on their location to outweigh how hard they are screwing their applicants due to their policies. There are elite programs in the west coast and midwest that more than rival anything in the NE, and even the south has good options. If you aren't absolutely tied to a particular city for family reasons, you'd have to be an extraordinary location snob to risk not matching prelim medicine instead of ranking top categoricals over advanced positions.

Your point is taken. The two programs Im referring to are in CA though.

 

[TorusTubarius]

I applied to about 30 prelims and only got 6 interviews. I don't think I'd feel comfortable with that many interviews, but luckily I liked my categoricals more anyways. One interviewer hinted that they had trouble attracting neurology applicants for their prelim spot because most have the option of doing categorical programs. Might result in programs ranking neurology applicants lower than similar applicants in other specialties.

 

[mcribbits]

So after discussing with both medicine and neurology advisors, I got their blessings for my rank list with 6 standalone prelims and the partially linked neuro prelim spots. They said that they only made this recommendation to me based on the programs I interviewed at and individual factors.

Your target number of prelims will vary, so talk to people who have been advising applicants from your school yearly for a long time and have experience with this issue.