Ranking advanced Vs Categorical...my experience and thoughts

[nero2282]

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I posted this response on another thread "Exception to General Ranking Rule - Order of Preference"...I just wanted to share my experience and thoughts....if you have any suggestions or thoughts on how to better rank advanced Vs Categorical Neuro prog, please post them here...

on my interview trail I met 3 applicants (2 IMGs and 1 USMG) NOT matched in PGY 1/Prelim in 2009 b/c they ranked advanced positions on top and were told by the Neuro prog PDs that thy will help out with the prelim spot if necessary. IMGs had 1 prelim lined up and USMG had 2 prelim lined up. They matched in Advanced Neuro but could not secure Prelim spot even in the scramble...These students were going through the match again for 2010 and were strongly suggesting to me to rank categoricals first to ensure that i match regardless if i like them or not.

Even though with this in mind, i'm ranking an advanced position on #1, b/c that prog i really liked. Now, honestly I have only solid 3 prelim interviews lined up. but even with that i'm taking a chance to rank advance prog first. Do you think it's a good idea with only 3 prelims? any suggestions anyone?

my thoughts on the MATCH:
I totally hate the matching system where the computer decides your fate for the residency, and that there are more advanced neuro prog out there vs. categorical. I also hate the fact that neuro students have to compete with rads, derm and anesthesia for prelim spots, i mean come on...these specialties can totally get by with transitional yr esp. rads and derm...why do they have to get prelim doesn't make any sense. i think fishing for a prelim spot makes it tough to get into neuro, but the specialty itself is not that tough to get into.

 

[medsRus]

I posted this response on another thread "Exception to General Ranking Rule - Order of Preference"...I just wanted to share my experience and thoughts....if you have any suggestions or thoughts on how to better rank advanced Vs Categorical Neuro prog, please post them here...

on my interview trail I met 3 applicants (2 IMGs and 1 USMG) NOT matched in neuro in 2009 b/c they ranked advanced positions on top and were told by the PDs that the prog will help out with the prelim spot if necessary. IMGs had 1 prelim lined up and USMG had 2 prelim lined up. They matched in Advanced Neuro but could not secure Prelim spot even in the scramble...These students were going through the match again for 2010 and were strongly suggesting to me to rank categoricals first to ensure that i match regardless if i like them or not.

Even though with this in mind, i'm ranking an advanced position on #1, b/c that prog i really liked. Now, honestly I have only solid 3 prelim interviews lined up. but even with that i'm taking a chance to rank advance prog first. Do you think it's a good idea with only 3 prelims? any suggestions anyone?

my thoughts on the MATCH:
I totally hate the matching system where the computer decides your fate for the residency, and that there are more advanced neuro prog out there vs. categorical. I also hate the fact that neuro students have to compete with rads, derm and anesthesia for prelim spots, i mean come on...these specialties can totally get by with transitional yr esp. rads and derm...why do they have to get prelim doesn't make any sense. i think fishing for a prelim spot makes it tough to get into neuro, but the specialty itself is not that tough to get into.

I'm so glad that you created this thread since I think that some mask this important fact about categorical vs. advanced programs for neuro applicants. Thank you!

 

[nero2282]

no prob

 

[cyneuron]

I totally hate the matching system where the computer decides your fate for the residency, and that there are more advanced neuro prog out there vs. categorical. I also hate the fact that neuro students have to compete with rads, derm and anesthesia for prelim spots, i mean come on...these specialties can totally get by with transitional yr esp. rads and derm...why do they have to get prelim doesn't make any sense. i think fishing for a prelim spot makes it tough to get into neuro, but the specialty itself is not that tough to get into.

thanks you so much for creating this thread....more input from other people will be really helpful for all us neurology aspirants....

so correctly said...neuro isn't difficult to get in otherwise...but the prelim requirement and less number of categorical programs makes it really difficult....

does somebody know number of neurology categorical programs out there ?

 

[neurochica]

The truth is that every resident and attending in this room has gone through this. There is nothing to mask. If you feel you are a strong candidate and interviewed well during your interview, then there is nothing to fear. However, if you feel like you are a weaker candidate and you bombed your interview, then go ahead and rank a lesser program.
Think about it….you already won half the battle- you were granted an interview. At this point, if you did well in your interview, you are in equal footing with everyone else. I just don’t see the point of settling for a lesser program when you have given up so much during med school.
To each its own I guess…good luck…..

 

[medsRus]

Think about it….you already won half the battle- you were granted an interview. At this point, if you did well in your interview, you are in equal footing with everyone else.

I would never agree to your assertion that all applicants invited to interview are at an "equal footing." Many of the neuro applicants I know that didn't match to a PGY-1 spot even though they had above average scores/grades/recs and were quite personable. I think there are still many PDs that will rank candidates/interviewees based on raw stats, not to mention that some of those applicants (e.g. optho) have already matched into their advanced program before ranking lists are due for PGY-1 positions.

 

[nero2282]

The truth is that every resident and attending in this room has gone through this. There is nothing to mask. If you feel you are a strong candidate and interviewed well during your interview, then there is nothing to fear. However, if you feel like you are a weaker candidate and you bombed your interview, then go ahead and rank a lesser program.
Think about it….you already won half the battle- you were granted an interview. At this point, if you did well in your interview, you are in equal footing with everyone else. I just don't see the point of settling for a lesser program when you have given up so much during med school.
To each its own I guess…good luck…..

I totally agree with you medsRus...

Some clarification in my original post - The candidates that did not match PGY 1/Prelim in 2009 - one IMG was a neurologist in Philippines with PhD in neuroscience. Other IMG with scores in high 90s and with research and 6 publications in Neurosurgery...USMG with research experience but don't know the score info. I felt these candidates were nice people and would be a good fit to any prog.

Again, the point of this thread is that getting a PGY 1 yr for neuro has become increasingly competitive esp. in last 2-3 yrs and my original dilemma is that if it is wise to rank an advanced program higher than categorical, knowing that I have only 3 prelim interviews lined up...

Not to brag or anything but in response to member "neurochica" post - I do feel i'm a strong candidate with excellent LORs, very good scores, with confidence of well performance in all of the interviews...but question for me is not settling for a lesser program but it is of "should I take a risk of waiting one more year if I match into an advanced prog but not in Prelim, even though i could have matched into a categorical prog?"...I have already put in 4 yrs in med school and now looking at 5 more for residency w/ fellowship...I'd hate to add an extra year just b/c i didn't get a prelim spot but matched into an advanced prog. From what i've heard is that scrambling for PGY 1 is like winning a lottery. it's tough. any thoughts/experience/feedback on scrambling for PGY 1 anyone? 😕

As we all know, the longer you wait to get a residency spot, harder it will get ea. year to match. Don't forget that US med schools have increased their quota of medical students by about 50-100 per entering class in last 3-4 yrs (esp. north east and mid central regions)...but the residency is funded by the state government and these slots have stayed the same and will be the same in near future...which only means that for the next couple of years it's gonna be competitive to get a residency spot for everyone 😱...even for USMGs regardless of good scores, LORs etc.

Also, it always looks questionable on your transcript that you have a gap in your training. I can still recall from where I did my IM Core, the PD repeatedly said "if you have a gap, make sure you have a damn good solid reason and that you have done something productive with your life related to medicine, otherwise many good prog will just throw out ur application."

sorry my post is very long...but just wanted to share my knowledge and shed light on some issues

 

[neurochica]

All I can say is that I was part of this current interview season committee and I can honestly tell you that we did not ranked candidates based on scores only- USMLE scores are 1 part of the equation...for example I know for a fact that we ranked this candidate higher, who by the way had lower USMLE scores but was more personable during the interview, compared to the other candidate who came from a top 10 med school with great USMLE scores.
Good luck with your math this year!

 

[nero2282]

All I can say is that I was part of this current interview season committee and I can honestly tell you that we did not ranked candidates based on scores only- USMLE scores are 1 part of the equation...for example I know for a fact that we ranked this candidate higher, who by the way had lower USMLE scores but was more personable during the interview, compared to the other candidate who came from a top 10 med school with great USMLE scores.
Good luck with your math this year!

In this yr's match, many other specialties (i.e. ophtho, rads, anesthesia, derm etc.) are competing with neuro for prelim spots.

I understand what you are saying and I agree with you...But what is your answer to my question? Please give us some input as you are a resident and have gone through this process and are in an interview committee.

Is it wise to rank an advanced program higher than categorical if an applicant has few prelims (2-3) lined up and the applicant wants to make sure to match this year? (Applicant is confident in his interview performance - that they've gone well including Prelim interviews.)

 

[cyneuron]

anyone on number of categorical programs in neurology ?

 

[neurochica]

In this yr's match, many other specialties (i.e. ophtho, rads, anesthesia, derm etc.) are competing with neuro for prelim spots.

I understand what you are saying and I agree with you...But what is your answer to my question? Please give us some input as you are a resident and have gone through this process and are in an interview committee.

Is it wise to rank an advanced program higher than categorical if an applicant has few prelims (2-3) lined up and the applicant wants to make sure to match this year? (Applicant is confident in his interview performance - that they've gone well including Prelim interviews.)

In every match, not just this match, neuro competes with other specialties (i.e. ophtho, rads, anesthesia, derm etc.). This year match is not special.
No one can guarantee you will match. Again, select the program that YOU want to go to. I also had 2-3 prelim interviews and ended in the program of my choice. According to the PD from another tread, if a program has 6 spots and historically fills their spots down the list within the 1-30 range, you are considered rank-to match. That is, 30 applicants are ranked to match, although there are only 6 spots with such program.
I wish I can give you an answer and tell you that you will match in X program, but I can’t. I was biting the bullet last year too and debating if I should select a categorical or an easier program instead. Obviously, I choose an advanced program and it worked out for me and many other candidates. Prelims are hard to come by and again, I’ll say this with experience, if you were granted an interview, you have won half the battle.
Good luck with your rank list

 

[neurochica]

I would never agree to your assertion that all applicants invited to interview are at an "equal footing." Many of the neuro applicants I know that didn't match to a PGY-1 spot even though they had above average scores/grades/recs and were quite personable. I think there are still many PDs that will rank candidates/interviewees based on raw stats, not to mention that some of those applicants (e.g. optho) have already matched into their advanced program before ranking lists are due for PGY-1 positions.

While I agree that some programs grant interviews based on USMLE cut-offs scores, I can guarantee you that when it comes to ranking candidates, USMLE scores play a small role.
For example, if a program has a cut-off score of 220- that means that every candidate granted an interview is qualified and met the initial criteria and thus the USMLE scores criteria is met. The PD and his committee will thus look for other attributes in the applicant. Anyways, good luck

 

[Algor]

It's very risky to rank advanced program on the top having just three prelims done. Why you did not apply to more prelim programs??? Most of the community prelim spots will be given by prematches and university based PGY1s are very hard to get for IMG. I can guarantee you that all AMGs will be ranked higher than you. So, rank categorical programs higher or be prepared for the next year Match. Nobody will tell you "Magic secret" here just because it does not exist.

 

[stochastic]

anyone on number of categorical programs in neurology ?

According to http://www.nrmp.org/data/resultsanddata2009.pdf, there were 47 neurology programs offering a total of 196 PGY-1 positions. You can see the individual programs on the linked pdf. Keep in mind that some programs offer both advanced and categorical positions (i.e. UCSF).

 

[timcc23]

Whoever mentioned above that it is hard to match into a prelim medicine spot and that this is not discussed enough is exactly correct. I never heard from my advisors that it could be difficult to match into a prelim medicine spot. It wasn't until towards the end of interview season when I was sitting in a room full of radiology and ophtho candidates all vying for four spots that I realized this could be competitive. There are two things you can do:

1) Apply broadly to prelim medicine spots and perhaps try to do a fourth-year rotation at an institution of interest to show them that you are a hard worker. If you might want to go to an advanced neurology program, this is the way to go.

2) Favor your rank list towards categorical neurology programs. This will give you piece of mind, but you might miss out on an advanced program that was a good fit and offered good training.

Compared to my match last year, programs are offering more categorical positions or guaranteed prelim spots this year. I'm not sure if this is the case across the board, but hopefully it is a trend that will help out future neurology candidates.

 

[nero2282]

According to http://www.nrmp.org/data/resultsanddata2009.pdf, there were 47 neurology programs offering a total of 196 PGY-1 positions. You can see the individual programs on the linked pdf. Keep in mind that some programs offer both advanced and categorical positions (i.e. UCSF).

Since I have only 3 prelims lined up...I just changed my ROL to categoricals on top and advanced to later spots...5-6 categoricals on top should do the trick i think looks like i will have to make sacrifice on one advanced prog that i really liked...😱

According to the NRMP data...87 advanced prog offering 385 advanced/PGY2 positions...that's ~2:1 ratio on advanced:categorical positions offered...i feel that's a huge disadvantage to neuro applicants...

I agree with timcc23 and it would be wiser to rank categoricals first vs. advanced if you want to assure 100% matching guarantee...if you have 5-6 categorical I would rank them higher than advanced, but if you have many prelims lined up than go with advanced higher on ROL only if you like them.

 

[fowleri]

This whole problem would be solved if the NRMP had an optional check box saying "Check here if you'd like to go to the next program on your rank list if you are not matched completely". That way, people who have few prelim interviews or are unsure about their chances of securing an internship would just click it and take their chances, knowing that if they don't match for all of the 4 years on their top choice, they will go to their second categorical choice.
And people who really really want to go to the advanced program and prefer to match there even if they have to scramble could simply not select the option.

Personally, as an IMG, if I matched at my first choice in an advanced program and not the prelim, I would prefer to go down to my second choice and have the 4 years secured. I think the scramble is too risky for me, and I met several people on the interview trail who matched last year for neuro but not for prelim (IMGs and AMGs), didn't get anything in the scramble and are doing it all over again.

This is particularly true for IMGs, who not only do they get very few prelim interviews but also don't have "prelim back-ups" at their home school, are more likely to not match AND will not have help from their medical school for the scramble. I think trying to scramble on your own, just dialing to random unfilled community hospitals in North Dakota from your cell phone, or worse, from your Skype in India or Argentina or Singapore, without any guidance, connections, or people in your US medical school helping you, would be very very hard.

Having that NRMP option would also favor the programs, because it's also terrible for a program to have a matched resident, who didn't get an internship not even in the scramble, so they loose the applicant, and now the match is over, the scramble is over and they still have an unfilled position that they have to fill somehow...

Considering that the match algorithm is so well designed and works so well to favor applicants, I am truly surprised that the engineers behind it haven't done this yet. I am definitively sending feedback to the NRMP suggesting that they make this option available, we should all do it, it won't help us anymore, but it would be a lot better for the people after us...

 

[Reemas Lapog]

im in the same boat. Only 3 prelim programs. and was going to rank an advanced program #3 but now im chickening out and ranking other categoricals ahead....

 

[Rogue Synapse]

im in the same boat. Only 3 prelim programs. and was going to rank an advanced program #3 but now im chickening out and ranking other categoricals ahead....

I'm with ya. My favorite program is advanced, and I only have a handful of prelim interviews. I have plenty of perfectly good categoricals to fill out the list, but I do get nervous at the prospect of scrambling for a prelim (especially because it would probably mean a year apart from my wife - we're couples matching). Still, I can't help but think I would always wonder what could have been - it's still possible for everything to work out perfectly, but only if I rank the program in question highly.

 

[popula]

This whole problem would be solved if the NRMP had an optional check box saying "Check here if you'd like to go to the next program on your rank list if you are not matched completely". That way, people who have few prelim interviews or are unsure about their chances of securing an internship would just click it and take their chances, knowing that if they don't match for all of the 4 years on their top choice, they will go to their second categorical choice.
And people who really really want to go to the advanced program and prefer to match there even if they have to scramble could simply not select the option.

Personally, as an IMG, if I matched at my first choice in an advanced program and not the prelim, I would prefer to go down to my second choice and have the 4 years secured. I think the scramble is too risky for me, and I met several people on the interview trail who matched last year for neuro but not for prelim (IMGs and AMGs), didn't get anything in the scramble and are doing it all over again.

This is particularly true for IMGs, who not only do they get very few prelim interviews but also don't have "prelim back-ups" at their home school, are more likely to not match AND will not have help from their medical school for the scramble. I think trying to scramble on your own, just dialing to random unfilled community hospitals in North Dakota from your cell phone, or worse, from your Skype in India or Argentina or Singapore, without any guidance, connections, or people in your US medical school helping you, would be very very hard.

Having that NRMP option would also favor the programs, because it's also terrible for a program to have a matched resident, who didn't get an internship not even in the scramble, so they loose the applicant, and now the match is over, the scramble is over and they still have an unfilled position that they have to fill somehow...

Considering that the match algorithm is so well designed and works so well to favor applicants, I am truly surprised that the engineers behind it haven't done this yet. I am definitively sending feedback to the NRMP suggesting that they make this option available, we should all do it, it won't help us anymore, but it would be a lot better for the people after us...

WORD. I'm in the same boat of wanting 4 years or not bothering at all. It's especially irritating because some programs I really like are mixed (5 categorical and 1 advanced, or 3 categorical and 2 advanced, etc.). Also, because of this very problem, I was unable to rank UIC at all even though I preferred them to some programs I did end up ranking.