Neurosurgery — Failed to Match. Questions

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

FutureDoctorHopefulK

Full Member
5+ Year Member
Joined
May 23, 2018
Messages
11
Reaction score
63
Hello,

I’m not sure where to post this for thoughts. I received 6 interviews for neurosurgery. Initially, I only received 2, but after emailing program directors and positions opening up after a couple of months, I received 2 more interviews. I thought they all went great and I was generally well received.

I scored 261 on STEP 1 and 267 on STEP 2. I had excellent LORs. I had only 2 major publications, and my medical school did not have a home neurosurgery program. I also only did one away rotation.

Two major problems that I think happened are that I was not able to take STEP 2 until 2 months after I submitted my application, which some institutions like Mississippi would not invite me to interview until this was submitted, and my third LOR took a month to get uploaded due to unforeseen circumstances. I was thinking that because of these two problems I was screened out initially for not having a complete application, and by the time my application was complete many institutions had filled their interview slots.

So my question is—is it worth it to apply to prelim surgery at an institution that has a neurosurgery program in order to foster further connections and to try again for neurosurgery in a year? Any thoughts are truly appreciated.

Members don't see this ad.
 
One option that is available would be to become a pre-residency fellow, which is a route many people, especially non-traditional applicants, have taken to obtain positions later, often outside of the Match, as positions open up. You can get experience functioning as a junior neurosurgery resident, which can often help improve your candidacy, as some people who matched might later drop out, creating openings. Feel free to message me if you would like more information.
 
  • Like
Reactions: 2 users
One option that is available would be to become a pre-residency fellow, which is a route many people, especially non-traditional applicants, have taken to obtain positions later, often outside of the Match, as positions open up. You can get experience functioning as a junior neurosurgery resident, which can often help improve your candidacy, as some people who matched might later drop out, creating openings. Feel free to message me if you would like more information.
Thank you so much for your time. I messaged you directly
 
Members don't see this ad :)
Did you apply only to top places? With your numbers, even with 2 pubs, you should've matched somewhere if you applied broadly.

You need to do some soul searching and figure out why you didn't match. The step numbers certainly didn't affect you. While the publication numbers are low, it doesn't preclude someone from matching. So you need to figure out whether it was your clinical skills, personality, letters, or interviews which precluded you from matching. I understand not having all the ducks in a row certainly didn't help in the process.

Pre-residency fellowships are usually dead end stuff that are designed for FMGs. You could provide years of cheap labor and may or may not match into the program. In your case, I would recommend against it.

Figure out what you need to work on, then reapply.
 
  • Like
Reactions: 1 users
Did you apply only to top places? With your numbers, even with 2 pubs, you should've matched somewhere if you applied broadly.

You need to do some soul searching and figure out why you didn't match. The step numbers certainly didn't affect you. While the publication numbers are low, it doesn't preclude someone from matching. So you need to figure out whether it was your clinical skills, personality, letters, or interviews which precluded you from matching. I understand not having all the ducks in a row certainly didn't help in the process.

Pre-residency fellowships are usually dead end stuff that are designed for FMGs. You could provide years of cheap labor and may or may not match into the program. In your case, I would recommend against it.

Figure out what you need to work on, then reapply.
I think I received horrible advice. I was told with my numbers I only needed to apply to 40 places to secure 15ish interviews with my scores. Actually, I was told to only apply to 30 places but this person said they knew I would apply to 40 anyway. I applied mainly regionally, northeast, as that was my desired location. I applied to maybe 5 newer programs, 25 established programs, and 10-15 “reach” programs. After a month when I realized my third letter wasn’t coming and I only received 2 interviews, I then applied to basically every program. I knew at this point all interview slots were most likely filled, but I simply emailed every program director every two weeks. Eventually, I received 4 more interviews over the course of the 3 months in late November - January. This gave me hope, however unreasonable, that my application was indeed good enough that if I were to apply again with everything in place that I would receive more interviews during the first three weeks if I applied to every single institution.

During the SOAP process I’ve been told that the only knocks on my application were my subpar research portfolio and that, although my LORs spoke of me highly, they weren’t tailored to neurosurgery program directors. Ie, they weren’t written with key buzzwords or phrases that program directors purportedly look for. Additionally, my mentor, who wrote me a glowing recommendation letter as I worked with him since my first year of medical school, passed away, so I’m not sure how that letter will work for future applications.

I was told during my interviews that I was a “good interviewer” and that even program directors “love[d] to hear me talk”. I think there were simply better fits than I at these programs, but maybe if I had double the amount of interviews there could be a perfect fit. I’m a hopeless optimist in this regard possibly, I’m not sure. I haven’t had the benefit of any program directly telling me what I could have done better since I’m currently in the SOAP process until tomorrow night. I’ve received one very solid interview as a preliminary general surgeon intern, and if I were offered this position I would accept it. I would then work my ass off to establish connections with the neurosurgery department, I would have 2 months of rotations with them, try to publish some papers, and I would also most likely discuss applying to radiology for backups as a separate application as I don’t want to go through this process again. So many thoughts and plans, but ultimately I’ll know more by tomorrow night for my tentative future
 
  • Like
Reactions: 1 users
I think I received horrible advice. I was told with my numbers I only needed to apply to 40 places to secure 15ish interviews with my scores. Actually, I was told to only apply to 30 places but this person said they knew I would apply to 40 anyway. I applied mainly regionally, northeast, as that was my desired location. I applied to maybe 5 newer programs, 25 established programs, and 10-15 “reach” programs. After a month when I realized my third letter wasn’t coming and I only received 2 interviews, I then applied to basically every program. I knew at this point all interview slots were most likely filled, but I simply emailed every program director every two weeks. Eventually, I received 4 more interviews over the course of the 3 months in late November - January. This gave me hope, however unreasonable, that my application was indeed good enough that if I were to apply again with everything in place that I would receive more interviews during the first three weeks if I applied to every single institution.

During the SOAP process I’ve been told that the only knocks on my application were my subpar research portfolio and that, although my LORs spoke of me highly, they weren’t tailored to neurosurgery program directors. Ie, they weren’t written with key buzzwords or phrases that program directors purportedly look for. Additionally, my mentor, who wrote me a glowing recommendation letter as I worked with him since my first year of medical school, passed away, so I’m not sure how that letter will work for future applications.

I was told during my interviews that I was a “good interviewer” and that even program directors “love[d] to hear me talk”. I think there were simply better fits than I at these programs, but maybe if I had double the amount of interviews there could be a perfect fit. I’m a hopeless optimist in this regard possibly, I’m not sure. I haven’t had the benefit of any program directly telling me what I could have done better since I’m currently in the SOAP process until tomorrow night. I’ve received one very solid interview as a preliminary general surgeon intern, and if I were offered this position I would accept it. I would then work my ass off to establish connections with the neurosurgery department, I would have 2 months of rotations with them, try to publish some papers, and I would also most likely discuss applying to radiology for backups as a separate application as I don’t want to go through this process again. So many thoughts and plans, but ultimately I’ll know more by tomorrow night for my tentative future
For whatever it’s worth, I’ve heard through the grapevine that this year was particularly rough for neurosurgery applicants as there were many qualified people. I’m not sure how that bodes for any future years as I’m well aware that second time applicants have around a 20% match rate as compared to 80% first time around
 
I think I received horrible advice. I was told with my numbers I only needed to apply to 40 places to secure 15ish interviews with my scores. Actually, I was told to only apply to 30 places but this person said they knew I would apply to 40 anyway. I applied mainly regionally, northeast, as that was my desired location. I applied to maybe 5 newer programs, 25 established programs, and 10-15 “reach” programs. After a month when I realized my third letter wasn’t coming and I only received 2 interviews, I then applied to basically every program. I knew at this point all interview slots were most likely filled, but I simply emailed every program director every two weeks. Eventually, I received 4 more interviews over the course of the 3 months in late November - January. This gave me hope, however unreasonable, that my application was indeed good enough that if I were to apply again with everything in place that I would receive more interviews during the first three weeks if I applied to every single institution.

During the SOAP process I’ve been told that the only knocks on my application were my subpar research portfolio and that, although my LORs spoke of me highly, they weren’t tailored to neurosurgery program directors. Ie, they weren’t written with key buzzwords or phrases that program directors purportedly look for. Additionally, my mentor, who wrote me a glowing recommendation letter as I worked with him since my first year of medical school, passed away, so I’m not sure how that letter will work for future applications.

I was told during my interviews that I was a “good interviewer” and that even program directors “love[d] to hear me talk”. I think there were simply better fits than I at these programs, but maybe if I had double the amount of interviews there could be a perfect fit. I’m a hopeless optimist in this regard possibly, I’m not sure. I haven’t had the benefit of any program directly telling me what I could have done better since I’m currently in the SOAP process until tomorrow night. I’ve received one very solid interview as a preliminary general surgeon intern, and if I were offered this position I would accept it. I would then work my ass off to establish connections with the neurosurgery department, I would have 2 months of rotations with them, try to publish some papers, and I would also most likely discuss applying to radiology for backups as a separate application as I don’t want to go through this process again. So many thoughts and plans, but ultimately I’ll know more by tomorrow night for my tentative future
Tough situation.

If it was 2007 match, then that advice might have hold up. Things are getting tougher. There are well qualified applicants across the board. In my year, average step 1 score of matched applicants was close to 250.

Keep an eye out for any open pgy2 positions. If you are lucky, you might be able to roll in as a pgy2 after your preliminary year. Network as you mentioned. Beef up research. Apply to every program. Another option would be to delay graduation and reapply as a 4th year. I honestly don't know how this gets viewed as opposed to reapplying out of preliminary residency.

There are some nuances in letters. Some prefer personal, well written letters over generic neurosurgeon chair/PD letter. But coming from a place with no home program, you do need some neurosurgery support from other institutions. Covid surely F'd things up in multiple ways.

I think you have a good shot at matching next year. Keep your head up and keep working hard. Stay humble and be proactive. I'll be happy to answer any further questions either here or thru PM. Gluck
 
  • Like
Reactions: 1 user
I think I received horrible advice. I was told with my numbers I only needed to apply to 40 places to secure 15ish interviews with my scores. Actually, I was told to only apply to 30 places but this person said they knew I would apply to 40 anyway. I applied mainly regionally, northeast, as that was my desired location. I applied to maybe 5 newer programs, 25 established programs, and 10-15 “reach” programs. After a month when I realized my third letter wasn’t coming and I only received 2 interviews, I then applied to basically every program. I knew at this point all interview slots were most likely filled, but I simply emailed every program director every two weeks. Eventually, I received 4 more interviews over the course of the 3 months in late November - January. This gave me hope, however unreasonable, that my application was indeed good enough that if I were to apply again with everything in place that I would receive more interviews during the first three weeks if I applied to every single institution.

During the SOAP process I’ve been told that the only knocks on my application were my subpar research portfolio and that, although my LORs spoke of me highly, they weren’t tailored to neurosurgery program directors. Ie, they weren’t written with key buzzwords or phrases that program directors purportedly look for. Additionally, my mentor, who wrote me a glowing recommendation letter as I worked with him since my first year of medical school, passed away, so I’m not sure how that letter will work for future applications.

I was told during my interviews that I was a “good interviewer” and that even program directors “love[d] to hear me talk”. I think there were simply better fits than I at these programs, but maybe if I had double the amount of interviews there could be a perfect fit. I’m a hopeless optimist in this regard possibly, I’m not sure. I haven’t had the benefit of any program directly telling me what I could have done better since I’m currently in the SOAP process until tomorrow night. I’ve received one very solid interview as a preliminary general surgeon intern, and if I were offered this position I would accept it. I would then work my ass off to establish connections with the neurosurgery department, I would have 2 months of rotations with them, try to publish some papers, and I would also most likely discuss applying to radiology for backups as a separate application as I don’t want to go through this process again. So many thoughts and plans, but ultimately I’ll know more by tomorrow night for my tentative future

A few things:
  • All the surgical specialties are becoming more competitive due to volume of applicants (i.e., new medical schools). Anyone planning to do surgical specialties has to be prepared to put in the time to make connections, do research and get vouched to be accepted.
  • NSGY is research-intensive. Research >>> STEP scores. 2 publications is sub-standard for that field. For NSGY, those publications are expected to be in NSGY.
  • NSGY is tight-knit. You don't have a home program. You only had the opportunity to do one away. Your LORs weren't effective for that field. You haven't been vouched for by people in your field, which is pretty critical in applying to competitive residencies.
  • Next steps: Going into another field is the path of least resistance. I hope you don't have to SOAP into Surgery Prelim because you will be facing a rough year and an uphill battle to just get into a PGY-2 categorical spot in General Surgery. It's also going to be very hard to do research during a clinical intern year, especially in Surgery. It is also very unlikely that NSGY program will interview someone in a Surgery Prelim program. I'd recommend against doing a research internship in NSGY because the path will be long and hard, but the outcome far less than certain. But YOLO. Good luck.
 
Last edited:
  • Like
Reactions: 1 users
Tough situation.

If it was 2007 match, then that advice might have hold up. Things are getting tougher. There are well qualified applicants across the board. In my year, average step 1 score of matched applicants was close to 250.

Keep an eye out for any open pgy2 positions. If you are lucky, you might be able to roll in as a pgy2 after your preliminary year. Network as you mentioned. Beef up research. Apply to every program. Another option would be to delay graduation and reapply as a 4th year. I honestly don't know how this gets viewed as opposed to reapplying out of preliminary residency.

There are some nuances in letters. Some prefer personal, well written letters over generic neurosurgeon chair/PD letter. But coming from a place with no home program, you do need some neurosurgery support from other institutions. Covid surely F'd things up in multiple ways.

I think you have a good shot at matching next year. Keep your head up and keep working hard. Stay humble and be proactive. I'll be happy to answer any further questions either here or thru PM. Gluck
I’ll PM you tomorrow I’m going to sleep soon thank you for your responses
 
A few things:
  • All the surgical specialties are becoming more competitive due to volume of applicants (i.e., new medical schools). Anyone planning to do surgical specialties has to be prepared to put in the time to make connections, do research and get vouched to be accepted.
  • NSGY is research-intensive. Research >>> STEP scores. 2 publications is sub-standard for that field. For NSGY, those publications are expected to be in NSGY.
  • NSGY is tight-knit. You don't have a home program. You only had the opportunity to do one away. Your LORs weren't effective for that field. You haven't been vouched for by people in your field, which is pretty critical in applying to competitive residencies.
  • Next steps: Going into another field is the path of least resistance. I hope you don't have to SOAP into Surgery Prelim because you will be facing a rough year and an uphill battle to just get into a PGY-2 categorical spot in General Surgery. It's also going to be very hard to do research during a clinical intern year, especially in Surgery. It is also very unlikely that NSGY program will interview someone in a Surgery Prelim program. I'd recommend against doing a research internship in NSGY because the path will be long and hard, but the outcome far less than certain. But YOLO. Good luck.
Are the only two options you would deem viable would be switching paths or pre residency? I’ve heard so much conflicting opinions on pre residency. My neurosurgeon attendings here say it is the best route to becoming a neurosurgeon since usually FMGs apply and I’ll be in an advantageous position in that regard
 
I previously worked at a program that had residents and pre residency fellows. We were able to get a lot them positions, including taking 2 into our program. That said, the ones who didn’t get spots were flat out not cut out to be surgeons. A few were outright disasters. A couple went into Medicine. Selection of fellows that have a decent shot of getting a position increases odds of successfully helping them find spots.
 
  • Like
Reactions: 1 user
Are the only two options you would deem viable would be switching paths or pre residency? I’ve heard so much conflicting opinions on pre residency. My neurosurgeon attendings here say it is the best route to becoming a neurosurgeon since usually FMGs apply and I’ll be in an advantageous position in that regard

10% of medical students don't match now.

Listen up, you're going to make decisions in the matter of a few days that are going to impact your entire medical career. Here are your options:
  1. Switch fields by SOAP-ing into a categorical spot. Upside: You have a pathway into becoming a board-certified physician. Downside: You may hate the field you are in.
  2. Pre-residency / research internship. You will toil for years on the chance that the program converts you into an NSGY resident. Think about this for a minute. You will have to pay your medical school loans while earning $30,000/yr gross to do research, do scut, and of course kiss ass. You will be on a multi-year audition under a lot of scrutiny. You may never be offered a spot. That's a huge risk. If things don't work out, what are you going to do? Go back into the Match as a re-applicant? The time to do a research internship would have been between MS3 and MS4.
  3. Prelim Surgery. There is a reason why there are so many positions that go unfilled. This is a dead-end. You will get worked like a dog and you will be gone at the end of the year. Clinical interns everywhere have no time to sleep, never mind do research.
The current match is going to be your best chance to find a categorical spot. If it were me, I would SOAP into the best option out there. With your STEP scores, you likely will get one of the best options out there.
 
  • Like
Reactions: 1 users
Delay your graduation and do a research year and reapply.
 
Update:

I did a pre residency fellowship year and matched into neurosurgery this year!
 
  • Like
  • Love
Reactions: 45 users
Update:

I did a pre residency fellowship year and matched into neurosurgery this year!
Congrats! Where was the pre-residency fellowship? I'm a US MD who failed to match this year for the first time applying and am between that and a prelim gen surg position. Worried that I have to decide between the two during SOAP week so any advice wiuld be great
 
  • Like
Reactions: 1 user
Top