MD & DO Reapplication advice

[blipsnchitz]

Howdy everyone!
I am an unmatched graduate from a upper-mid-tier USMD school who applied to a competitive surgical subspecialty. I also was unable to secure a prelim position in the SOAP. My app at a glance looks like: step1/2 - 25x/25x; honored all clerkships/top of class in clinical curriculum; was active in leadership positions throughout medical school; minimal research experience; no red flags (other than now being a graduate and going unmatched *sad*).
Since going unmatched, I have been reaching out to various faculty members at my home institution trying to hop on as much research as possible.
I'm posting here hoping to get some guidance on some questions I have:
1) is it acceptable to re-use letters or is that a no-no?
2) if I am unable to participate in some sort of clinical-related activities will that be received poorly? (hard to get opportunities for patient interaction now that I am not covered by the school)
3) I am going to likely end up dual applying to a much less competitive specialty to try to avoid ever being in this position again, is it taboo to apply to two different specialties at the same institution?
4) is there a good source/point-of-contact for re-application advise? Like professional advisors or stuff of that nature?
5) other: please provide any other advice you feel one in my position could benefit from

Sorry for the long first post, this has been quite an overwhelming experience with surprisingly scarce literature/guidance on the matter. Thank you to anyone still reading or pitching in their 2 cents!!!

---

Members don't see this ad.

 

[Lawpy]

Wow, this is rough i'm sorry. It's also really surprising to me. Going to tag @Lem0nz @NotAProgDirector for advice

 

[jadfaweradfasd]

I'm a naive, incoming med student but I am wondering how it is possible for someone with an app like this not to match? Outside of minimal research, it's basically perfect correct?

 

[Lem0nz]

Howdy everyone!
I am an unmatched graduate from a upper-mid-tier USMD school who applied to a competitive surgical subspecialty. I also was unable to secure a prelim position in the SOAP. My app at a glance looks like: step1/2 - 25x/25x; honored all clerkships/top of class in clinical curriculum; was active in leadership positions throughout medical school; minimal research experience; no red flags (other than now being a graduate and going unmatched *sad*).
Since going unmatched, I have been reaching out to various faculty members at my home institution trying to hop on as much research as possible.
I'm posting here hoping to get some guidance on some questions I have:
1) is it acceptable to re-use letters or is that a no-no?
2) if I am unable to participate in some sort of clinical-related activities will that be received poorly? (hard to get opportunities for patient interaction now that I am not covered by the school)
3) I am going to likely end up dual applying to a much less competitive specialty to try to avoid ever being in this position again, is it taboo to apply to two different specialties at the same institution?
4) is there a good source/point-of-contact for re-application advise? Like professional advisors or stuff of that nature?
5) other: please provide any other advice you feel one in my position could benefit from

Sorry for the long first post, this has been quite an overwhelming experience with surprisingly scarce literature/guidance on the matter. Thank you to anyone still reading or pitching in their 2 cents!!!

Can I ask some clarifying questions? You can choose to answer all of these, some, or none. What is the subspecialty? Is this NSG, Ortho, or are we talking ENT/Uro? Is your backup plan gen surg, and if not, what is it? Lastly, in your opinion and really reflect, what do you think went wrong? What happened in SOAP as well?

 

[blipsnchitz]

Can I ask some clarifying questions? You can choose to answer all of these, some, or none. What is the subspecialty? Is this NSG, Ortho, or are we talking ENT/Uro? Is your backup plan gen surg, and if not, what is it? Lastly, in your opinion and really reflect, what do you think went wrong? What happened in SOAP as well?

Ask whatever you like. The more clear my situation is, the more specific the insight I can receive. The subspecialty I applied to was ortho. My backup plan is actually to apply to internal medicine.
I think that a number of things could have played a factor: I decided relatively late to apply to ortho vs other interests of mine, I did not have any ortho specific research at all (literally zero, not a smidge), and I think my interview performance could have been better (I won't give specifics because that would easily make myself identifiable, but some unfortunate events went down immediately prior to interview szn and it messed me up pretty good).

 

[Lawpy]

Going to tag @OrthoTraumaMD @VincentAdultman for advice as well

 

[Lem0nz]

Ask whatever you like. The more clear my situation is, the more specific the insight I can receive. The subspecialty I applied to was ortho. My backup plan is actually to apply to internal medicine.
I think that a number of things could have played a factor: I decided relatively late to apply to ortho vs other interests of mine, I did not have any ortho specific research at all (literally zero, not a smidge), and I think my interview performance could have been better (I won't give specifics because that would easily make myself identifiable, but some unfortunate events went down immediately prior to interview szn and it messed me up pretty good).

Yea we don't need to know about personal events, that's fine. What was your research in (you answered that)? Why IM? What happened with SOAP? I feel like you should have found something in SOAP but, to be frank, I think it may be better that you didn't. I think you'll do much better just repeating the match.

I guess what I'm getting at is why not a less competitive surgical track? You would crush in a general surgery program I bet and have your pick of fellowships. Same with anesthesia/IR. Just trying to understand better.

 

[blipsnchitz]

Yea we don't need to know about personal events, that's fine. What was your research in (you answered that)? Why IM? What happened with SOAP? I feel like you should have found something in SOAP but, to be frank, I think it may be better that you didn't. I think you'll do much better just repeating the match.

I guess what I'm getting at is why not a less competitive surgical track? You would crush in a general surgery program I bet and have your pick of fellowships. Same with anesthesia/IR. Just trying to understand better.

My research when I applied was pretty much exclusively related to meded (I enjoy mentorship and want to work in an academic setting). My decision to apply to IM was influenced by those personal events and something I never even considered prior to the match. I used all 45 of my tokens in the SOAP on medicine and surgery prelims, only got a few call backs, some of which unofficially offered me a spot over the phone only to not extend me an offer during any of the offer rounds.
To be transparent I had never even considered a surgical specialty until switching to ortho at the last second, which is why I had never considered a career in another surgical field. I like many of the general surgery fellowships, but the ones I like are all competitive unfortunately, and from where I'm standing now just appear as another opportunity to go unmatched.

 

[blipsnchitz]

Going to tag @OrthoTraumaMD @VincentAdultman for advice as well

Thank you so much for facilitating this post, you da (wo)man

 

[Lem0nz]

My research when I applied was pretty much exclusively related to meded (I enjoy mentorship and want to work in an academic setting). My decision to apply to IM was influenced by those personal events and something I never even considered prior to the match. I used all 45 of my tokens in the SOAP on medicine and surgery prelims, only got a few call backs, some of which unofficially offered me a spot over the phone only to not extend me an offer during any of the offer rounds.
To be transparent I had never even considered a surgical specialty until switching to ortho at the last second, which is why I had never considered a career in another surgical field. I like many of the general surgery fellowships, but the ones I like are all competitive unfortunately, and from where I'm standing now just appear as another opportunity to go unmatched.

👍🏻 Will post a longer reply and answer your questions as best I can once I get a minute to sit down.

 

[NotAProgDirector]

All fields, especially the competitive surgical ones, want to see a commitment to the field. Last minute changes in interest tend to be looked at skeptically, as it's unclear that you really are interested / understand the field. In general, switches to less competitive fields tend to be viewed more positively -- a chance for IM to rescue a great medical student from the mistake of becoming an orthopedic surgeon is seen as a big win.

The answer to your questions depends on whether you plan to re-apply to ortho or not. From your posts here, it appears that you are -- that will make applying to IM more complicated. if you want to do well in the IM application process, you'll need to say that you've "seen the light" and realize that you want IM and not ortho. Continuing to do ortho research won't support that storyline -- and ideally you'd get a letter from Ortho stating that you've changed to IM. Some IM programs might still consider you, but your options will be more limited.

Getting at your questions:
1. In general, best avoided. You should get updated letters if possible. Your old letters were written at the beginning of 4th year, hopefully you did more clinical work and can get updated letters.
2. As a well performing US grad, will not be that big of a deal with a 1 year break. Anything you can do clinically, you should try to do. This will become a bigger problem if you fail to match again.
3. Maybe. Some programs might check. Some are too busy and won't. If either program checks, likely both will decline to interview you (although ortho will likely assume you're more interested in them, they may not care. But they may also see it as a sign of non-dedication to the field).
4. You don't really need anything more. You will need to reach out to your schools IM department and get a departmental summary letter from them. They may be able to offer you some advice. But as mentioned, applying to both Ortho and IM won't be taken kindly by many academic IM groups. You'll need to apply broadly, expect a poor IM interview return rate as everyone will see your ongoing ortho research.

You need to decide how important ortho is. If it's what you really want, then you need to go all-in, do ortho research, try to get some ortho clinical experience (even if it's just shadowing). All of this would increase your chances of getting Ortho, but will decrease your options in IM.

Or, drop Ortho and go for IM. Stop ortho research, do IM (or Med Ed) research. Get IM clinical experience and connections. Talk with your IM Dept from school. Build the story that you've switched your interests to IM. You would then apply to IM, and you'd be able to take an outside-the-match spot that starts early if there are any openings, or wait for the match. With a clear app towards IM, you'd do really well.

 

[Lem0nz]

NAPDs advice is sound and more worthwhile than mine. I'll add some thoughts. First is to agree with him that your best chance of matching the best program in either scenario is to commit to one or the other. The reason I asked about all the other sub specs is because lots of people try to go for ortho, don't get into ortho, and then opt to choose a different moderately less competitive surgical specialty (like general surgery). The integrated programs are not really that much more amazing than general surgery+fellowship track, they're just faster. And you don't have any research that would get you into an integrated program so if you want to be a surgeon, I 100% believe you could match both competitively and extremely well in general surgery if you spend this year and rebuild your application for that. In five to seven years CT, vascular, and plastics would all be open to you and if you commit to research given your ability to do well academically I suspect surg/onc or HPB would be as well. You certainly don't have to go into general surgery or do any of that, I just want to point out that its a great option if you want to be a surgeon.

If you want to go all in on ortho, NAPD is correct. You need to just go all in on ortho. Do research all year, AND find clinical opportunities in ortho again, AND get updated letters. I will say that if you're reapplying ortho you can use one or two letters if you really need to and don't have enough new updated opportunities to get an entire panel of them (say, you can only get one research letter this year and one clinical letter), that would be fine I think. Ortho will not be a guarantee, you will probably need to apply to prelim surgery as a backup, and then you need some actual backup plans for what comes next.

If not Ortho then IM is the part I'm confused about. I don't know what drew you to ortho (or away from it) so strongly but the mentality that if I can't do this than I want to just match IM is odd to me. Maybe you can elaborate on that more. If you're totally fine with IM, even would be happy just doing IM (which WILL be a better lifestyle) and pursuing some fellowship or even just being a generalist out of IM, to be frank you should just go into IM. At the end of the day the most valuable currency we have is time and what we love is usually sleep, sex, and food (not necessarily in that order) followed by friends, family, and hobbies. Medicine comes third, so you should always pick the thing that gives you the most time to do what you love. Internal medicine will >>>>>> that over ortho in every possible permutation of practice both during residency and after residency.

At the end of the day your best shot is to commit. If you commit to either internal medicine, or general surgery, your stats are absolutely fantastic enough that you can match and match well with a very VERY low chance that you would not match. Bordering on zero. If you go hard for Ortho, who can say. If you get a lot of research this year your stats certainly don't suck and you could certainly pull it off. But you also might not and if you're applying half assed to IM as a backup plan the odds are you will not match at as good of a program as you otherwise could have if you had just said "screw this, IM".

Anyway, I hope that is helpful, and I hope that clarifies my questions in trying to determine if you want to be a surgeon or a medical doctor. Either is a great, amazing career. From everything I've read and with knowing nothing about the personal issues you've eluded to, I would probably lean towards just going hard on IM and not looking back or having regrets and matching a top tier program with your really good board scores. Use the year to do research in whatever you think sort of fellowship you might want coming out of IM and get new letters. Clinical opportunities are everywhere for IM. But if you're meant to be a surgeon, I would ask yourself seriously if it has to be ortho, and go from there.

Happy to answer any additional questions if you have them.

 

[blipsnchitz]

All fields, especially the competitive surgical ones, want to see a commitment to the field. Last minute changes in interest tend to be looked at skeptically, as it's unclear that you really are interested / understand the field. In general, switches to less competitive fields tend to be viewed more positively -- a chance for IM to rescue a great medical student from the mistake of becoming an orthopedic surgeon is seen as a big win.

The answer to your questions depends on whether you plan to re-apply to ortho or not. From your posts here, it appears that you are -- that will make applying to IM more complicated. if you want to do well in the IM application process, you'll need to say that you've "seen the light" and realize that you want IM and not ortho. Continuing to do ortho research won't support that storyline -- and ideally you'd get a letter from Ortho stating that you've changed to IM. Some IM programs might still consider you, but your options will be more limited.

Getting at your questions:
1. In general, best avoided. You should get updated letters if possible. Your old letters were written at the beginning of 4th year, hopefully you did more clinical work and can get updated letters.
2. As a well performing US grad, will not be that big of a deal with a 1 year break. Anything you can do clinically, you should try to do. This will become a bigger problem if you fail to match again.
3. Maybe. Some programs might check. Some are too busy and won't. If either program checks, likely both will decline to interview you (although ortho will likely assume you're more interested in them, they may not care. But they may also see it as a sign of non-dedication to the field).
4. You don't really need anything more. You will need to reach out to your schools IM department and get a departmental summary letter from them. They may be able to offer you some advice. But as mentioned, applying to both Ortho and IM won't be taken kindly by many academic IM groups. You'll need to apply broadly, expect a poor IM interview return rate as everyone will see your ongoing ortho research.

You need to decide how important ortho is. If it's what you really want, then you need to go all-in, do ortho research, try to get some ortho clinical experience (even if it's just shadowing). All of this would increase your chances of getting Ortho, but will decrease your options in IM.

Or, drop Ortho and go for IM. Stop ortho research, do IM (or Med Ed) research. Get IM clinical experience and connections. Talk with your IM Dept from school. Build the story that you've switched your interests to IM. You would then apply to IM, and you'd be able to take an outside-the-match spot that starts early if there are any openings, or wait for the match. With a clear app towards IM, you'd do really well.

NAPD, thank you for such a thorough and elaborate response. You definitely put to rest some of my worries about most of my questions. I agree with you that the strongest course of action is just to commit to one or the other. The issue I have been running into with fully committing to ortho is the fact that it has been near impossible to establish a solid relationship with an orthopedist in my area post-match. I can't convince myself to go all in on a field without knowing I have someone in my corner advocating for me. The same goes for medicine as well, but considering its much less competitive, I am less worried about not having that advocate there to vouch for me. Regardless, you're right; I need to commit to something.

 

[blipsnchitz]

NAPDs advice is sound and more worthwhile than mine. I'll add some thoughts. First is to agree with him that your best chance of matching the best program in either scenario is to commit to one or the other. The reason I asked about all the other sub specs is because lots of people try to go for ortho, don't get into ortho, and then opt to choose a different moderately less competitive surgical specialty (like general surgery). The integrated programs are not really that much more amazing than general surgery+fellowship track, they're just faster. And you don't have any research that would get you into an integrated program so if you want to be a surgeon, I 100% believe you could match both competitively and extremely well in general surgery if you spend this year and rebuild your application for that. In five to seven years CT, vascular, and plastics would all be open to you and if you commit to research given your ability to do well academically I suspect surg/onc or HPB would be as well. You certainly don't have to go into general surgery or do any of that, I just want to point out that its a great option if you want to be a surgeon.

If you want to go all in on ortho, NAPD is correct. You need to just go all in on ortho. Do research all year, AND find clinical opportunities in ortho again, AND get updated letters. I will say that if you're reapplying ortho you can use one or two letters if you really need to and don't have enough new updated opportunities to get an entire panel of them (say, you can only get one research letter this year and one clinical letter), that would be fine I think. Ortho will not be a guarantee, you will probably need to apply to prelim surgery as a backup, and then you need some actual backup plans for what comes next.

If not Ortho then IM is the part I'm confused about. I don't know what drew you to ortho (or away from it) so strongly but the mentality that if I can't do this than I want to just match IM is odd to me. Maybe you can elaborate on that more. If you're totally fine with IM, even would be happy just doing IM (which WILL be a better lifestyle) and pursuing some fellowship or even just being a generalist out of IM, to be frank you should just go into IM. At the end of the day the most valuable currency we have is time and what we love is usually sleep, sex, and food (not necessarily in that order) followed by friends, family, and hobbies. Medicine comes third, so you should always pick the thing that gives you the most time to do what you love. Internal medicine will >>>>>> that over ortho in every possible permutation of practice both during residency and after residency.

At the end of the day your best shot is to commit. If you commit to either internal medicine, or general surgery, your stats are absolutely fantastic enough that you can match and match well with a very VERY low chance that you would not match. Bordering on zero. If you go hard for Ortho, who can say. If you get a lot of research this year your stats certainly don't suck and you could certainly pull it off. But you also might not and if you're applying half assed to IM as a backup plan the odds are you will not match at as good of a program as you otherwise could have if you had just said "screw this, IM".

Anyway, I hope that is helpful, and I hope that clarifies my questions in trying to determine if you want to be a surgeon or a medical doctor. Either is a great, amazing career. From everything I've read and with knowing nothing about the personal issues you've eluded to, I would probably lean towards just going hard on IM and not looking back or having regrets and matching a top tier program with your really good board scores. Use the year to do research in whatever you think sort of fellowship you might want coming out of IM and get new letters. Clinical opportunities are everywhere for IM. But if you're meant to be a surgeon, I would ask yourself seriously if it has to be ortho, and go from there.

Happy to answer any additional questions if you have them.

Lem0nz, thank you for your advice and insight. I think I could probably explain my newly found interest in internal medicine better through a direct message where I don't have to be as cautious about making myself identifiable.

What do you think of theoretically dual applying to GS and ortho? The issue I have with applying to prelim programs is that if I only partially match, I will essentially be in the exact same position again, and there is nothing I want less in the entire world than to be a reapplicant again. I would be interested in picking your brain a bit about the prospect of general surgery if you would be willing.

Regardless, thank you very much for such a thoughtful response. I am already glad that I decided to make an account and reach out on sdn.

 

[VincentAdultman]

FWIW I dual applied Gen surg and ortho back in 2008 and matched ortho.

It’s tough because you basically have to make two applications and regardless of what you’re backup specialty is no ones going to look too favorably at being your “backup plan.” It comes down to how bad you want ortho as NAPD said. I loved ortho but at the same time putting my life on hold while everyone around me had a good idea what they’d be doing career wise took a toll. Even if it wasn’t ortho I wanted to move on. Thirteen years later I’m REALLY glad it worked the way it did.

 

[blipsnchitz]

FWIW I dual applied Gen surg and ortho back in 2008 and matched ortho.

It’s tough because you basically have to make two applications and regardless of what you’re backup specialty is no ones going to look too favorably at being your “backup plan.” It comes down to how bad you want ortho as NAPD said. I loved ortho but at the same time putting my life on hold while everyone around me had a good idea what they’d be doing career wise took a toll. Even if it wasn’t ortho I wanted to move on. Thirteen years later I’m REALLY glad it worked the way it did.

VincentAdultman, thank you for sharing! I'm glad it worked out for you, its refreshing to hear stories like yours.
So did you dual apply as a reapplicant, or did you dual apply even the first time around? If it was as a reapplicant, would you mind sharing what you did to make yourself a stronger applicant and prepare for interviews that second time around?

 

[VincentAdultman]

VincentAdultman, thank you for sharing! I'm glad it worked out for you, its refreshing to hear stories like yours.
So did you dual apply as a reapplicant, or did you dual apply even the first time around? If it was as a reapplicant, would you mind sharing what you did to make yourself a stronger applicant and prepare for interviews that second time around?

A dual applied the second time.

The biggest difference in my application was doing more research and getting published. Other than that a little bit of luck. Maybe also not really having anything to lose the second time around made me more relaxed and “myself” on interviews lol.

 

[blipsnchitz]

A dual applied the second time.

The biggest difference in my application was doing more research and getting published. Other than that a little bit of luck. Maybe also not really having anything to lose the second time around made me more relaxed and “myself” on interviews lol.

Well 13 years later and your career appears to still be kicking, so perhaps it was fate disguised as some luck! Did you do research 'formally' as a research fellow or some other appointed position, or was it all through voluntary efforts? Also, was your publication related to orthopedics? Thanks again!

 

[VincentAdultman]

Well 13 years later and your career appears to still be kicking, so perhaps it was fate disguised as some luck! Did you do research 'formally' as a research fellow or some other appointed position, or was it all through voluntary efforts? Also, was your publication related to orthopedics? Thanks again!

It was after medical school but before my prelim year started. That was a case report that got published in a big ortho journal.

I also did some Orthopaedic research during my prelim year, but it goes without saying that’s a lot harder to do.

 

[mcat_taker]

NAPDs advice is sound and more worthwhile than mine. I'll add some thoughts. First is to agree with him that your best chance of matching the best program in either scenario is to commit to one or the other. The reason I asked about all the other sub specs is because lots of people try to go for ortho, don't get into ortho, and then opt to choose a different moderately less competitive surgical specialty (like general surgery). The integrated programs are not really that much more amazing than general surgery+fellowship track, they're just faster. And you don't have any research that would get you into an integrated program so if you want to be a surgeon, I 100% believe you could match both competitively and extremely well in general surgery if you spend this year and rebuild your application for that. In five to seven years CT, vascular, and plastics would all be open to you and if you commit to research given your ability to do well academically I suspect surg/onc or HPB would be as well. You certainly don't have to go into general surgery or do any of that, I just want to point out that its a great option if you want to be a surgeon.

If you want to go all in on ortho, NAPD is correct. You need to just go all in on ortho. Do research all year, AND find clinical opportunities in ortho again, AND get updated letters. I will say that if you're reapplying ortho you can use one or two letters if you really need to and don't have enough new updated opportunities to get an entire panel of them (say, you can only get one research letter this year and one clinical letter), that would be fine I think. Ortho will not be a guarantee, you will probably need to apply to prelim surgery as a backup, and then you need some actual backup plans for what comes next.

If not Ortho then IM is the part I'm confused about. I don't know what drew you to ortho (or away from it) so strongly but the mentality that if I can't do this than I want to just match IM is odd to me. Maybe you can elaborate on that more. If you're totally fine with IM, even would be happy just doing IM (which WILL be a better lifestyle) and pursuing some fellowship or even just being a generalist out of IM, to be frank you should just go into IM. At the end of the day the most valuable currency we have is time and what we love is usually sleep, sex, and food (not necessarily in that order) followed by friends, family, and hobbies. Medicine comes third, so you should always pick the thing that gives you the most time to do what you love. Internal medicine will >>>>>> that over ortho in every possible permutation of practice both during residency and after residency.

At the end of the day your best shot is to commit. If you commit to either internal medicine, or general surgery, your stats are absolutely fantastic enough that you can match and match well with a very VERY low chance that you would not match. Bordering on zero. If you go hard for Ortho, who can say. If you get a lot of research this year your stats certainly don't suck and you could certainly pull it off. But you also might not and if you're applying half assed to IM as a backup plan the odds are you will not match at as good of a program as you otherwise could have if you had just said "screw this, IM".

Anyway, I hope that is helpful, and I hope that clarifies my questions in trying to determine if you want to be a surgeon or a medical doctor. Either is a great, amazing career. From everything I've read and with knowing nothing about the personal issues you've eluded to, I would probably lean towards just going hard on IM and not looking back or having regrets and matching a top tier program with your really good board scores. Use the year to do research in whatever you think sort of fellowship you might want coming out of IM and get new letters. Clinical opportunities are everywhere for IM. But if you're meant to be a surgeon, I would ask yourself seriously if it has to be ortho, and go from there.

Happy to answer any additional questions if you have them.

Strangely enough a lot of Ortho leaning people could never see themselves doing gen surgery. Maybe its the specific nature of the field or just the anecdotal feedback I've heard but lots of the ortho residents I've spoken with and asked if they didn't do ortho what would they do the answer is never gen surg.