Scramble Advice

Discussion in 'ERAS, SOAP, and NRMP Match' started by leorl, Dec 6, 2006.

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  1. leorl

    leorl Moderator Emeritus Lifetime Donor 10+ Year Member

    5,559
    9
    Jan 2, 2001
    Physician
    From Username: aProgDirector

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    I have seen this process from both ends. I've had to scramble a few slots in my program, and I've helped med students (and PG-1 interns trying to re-match in a new field) in the scramble. It's ugly on both ends, and it really brings into focus how well the match works.

    Several pieces of advice:

    Just to clarify the timeline:
    Monday March 12 at noon all applicants who are unmatched are notified, either through their Dean's office or through the NRMP website (or email, I guess)
    Tuesday March 13 at 11:30 AM, programs with unfilled slots are notified.
    Tuesday March 13 at 12 Noon, the list of unfilled programs is released to all unmatched candidates, and the scramble begins.
    If you are unmatched, you have 24 hours to figure out what you want to do. You should seriously consider all of the above advice. The golden rule is this: Do not accept a position in a field you are not interested in. You will likely be very sorry if you do.
    To scramble as best as possible, you need the following:
    a quiet room that is out of the way. Do not scramble in the middle of the Student Affairs office.
    a helper, preferably a faculty mentor who knows you and what you are interested in, and who knows something about the programs you are interested in. If your med school is associated with a residency in your field, someone from the residency program is a great choice.
    TWO land/cell phone lines for outgoing calls -- get several disposable cells if needed and charge them up with minutes.
    One land/cell phone line for incoming calls (that you know will not be busy) OR a pager for returning calls OR both. You can use the main number for your student affairs office (or similar) for this purpose.
    a computer from which to run ERAS (better if you have 2)
    a dedicated FAX machine for YOUR USE ONLY (if possible). I kid you not -- go buy one at WalMart if needed - cheap is fine, it needs to last for 24 hours. Don't forget that you will need a phone line for your fax machine, and you can't easily plug a FAX into a cell.
    paper copies of all of your application materials.
    The good slots in the scramble fill VERY quickly. I would like to think that I run a quality program -- the few years where I have had an open categorical or prelim slot, I have almost always filled it within the first 20minutes of the scramble.
    Due to #4, you must prioritize your calls to programs. Be careful "overshooting", you may simply be wasting time while other, less competitive slots fill. Remember that the scramble is first come, first served!
    Once the list of unfilled programs is posted, you and your mentor should quickly scan the entire list to find those spots that you are most interested. You must make these decisions very quickly. If you have a significant other who would like some say in where you go, they need to be present.
    Many programs use ERAS in the scramble. You should forward your application to ALL programs on your list immediately. An additional helper (friend) can do this for you while you are on the phone.
    Choose the top two slots on your list. Your mentor calls #1 while you call #2 on your two phone lines. Expect busy signals, make sure your phone has a redial button. If you have choices #3-5, cycle through the phone numbers until you get through.
    Having a faculty member call on your behalf, especially if it's a Dean or an Assoc Dean, is a very good idea. Those calls usually get routed from the program assistants to the Prog Director, and that's usually in your favor.
    If you get through and they say they will "get back to you", you should assume you are not getting a spot there and plan accordingly (this is not always true, but sitting and waiting for a call back is a bad idea). Leave them a number you know will not be busy, or a pager number to page you.
    Blindly faxing materials to programs without calling is a gigantic waste of time, IMHO.

    As far as a Prelim year vs Research vs Something Else, my advice is:
    If you are applying to a very competitive field (Rads, Derm, Ortho, etc), then research with someone who is well known in the field is probably the best option if you remain dedicated to training in that field. Be prepared to work very hard, as you have to have something to show for your research by application time (Nov 1st). 3-4 months of prelim experience seem unlikely to impress a Rads PD.
    If you are applying to a less competitive field (i.e. Gen Surg, Medicine, OB etc), then some clinical experience in a prelim year may be of some benefit. This is especially true for IMG's with no US experience. I would suggest asking your PD to front-load your schedule with inpatient rotations (so that you can generate some letters) and schedule a rotation that can handle leave for interviews in Dec or Jan. Your best shot for a categorical spot will be at your prelim program.
     
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  3. Buyito

    Buyito

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    Dec 14, 2006
    Thank you for taking your time and explain it very well.

    I definitively will follow up your instructions and advice.
    Now, base on your experience, what do you think on paying a company to help you at the scramble day.
    I am a IMG and apply to late for the match, so far I have gotten 2 interviews line up for OB-GYN (Meharry, Tennessee. Phoenix,Az). Is it worth it, or is too risky. Please let me know what do you think.

    Have a wonderful day....
     
  4. Benbin

    Benbin 2+ Year Member

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    Jan 15, 2007
    Does anyone know the scrumble success rate in IM or FM? I am planning to scrumble in March for IM or FM. I just got 2 interviews for IM so far. Thanks.
     
  5. Benbin

    Benbin 2+ Year Member

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    Jan 15, 2007
    I forgot to tell that I am IMG. What chance to find a position in IM or FM during scrumble ? I just got two interviews for IM. By the way, do you guys know what chance to get a spot with only 2 ROL in IM specialty. Thanks a lot.
     
  6. mmed

    mmed New Member 7+ Year Member

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    Mar 1, 2006
    The answer is not that simple. It is difficult, being an IMG, to secure a position in scramble, from my opinion it may be much easier post scramble. The chance to match with 2 ROL depends on many factors; how competitive those 2 programs is an important factor, since you have only 2 interviews, I assume that those programs are in the low tier group and your chance is still high. The other factors for sure; how competitive are you (from the opinion of the programs), your performance in the interviews, your visa …..etc
     
  7. Benbin

    Benbin 2+ Year Member

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    Jan 15, 2007
    Thanks for the reply. If I go unmatched in IM, can I get a spot in Prelim IM position for one year training first even I do not know what I am going to do after that (maybe it 's much easier to get in Categorical IM Program after Prelim training for IMG) ? Just I do not know if the program directors would like to accept someone who did not match in IM C program.
     
  8. mmed

    mmed New Member 7+ Year Member

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    Mar 1, 2006
    As I said it depends. It is very difficult to impossible to match in categorical program without good credits. The scramble is terrible and the chance is minimal. I am sorry to disappoint you but if you don’t match in the regular match then the chance in scramble is minimal, but no one knows.
     
  9. Benbin

    Benbin 2+ Year Member

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    Jan 15, 2007
    Thanks for your opinion. For IMG/FMG scrumble chance is very little. Any chance I will try. But I need to be prepared for scrumble.
     
  10. sleepygrumpydoc

    sleepygrumpydoc

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    Hello,
    I am a MSIV who did not match in neurosurgery and have had to reconsider my options. I am very grateful for your advice above and will be implementing it.

    I have decided to pursue neurology. Do you know anyone who has been in this position? I am assuming I should change my personal statement. I also wondered if I should obtain letters from my neurology rotations. I had taken one earlier this year and was able to switch into one for this month.

    Any advice would be helpful.

    Thanks
     
  11. BitterPill

    BitterPill 2+ Year Member

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    Oct 17, 2006
    As I prepare myself for the possibility that I may have to scramble, here's a stupid (& oft-repeated) question: Can I scramble for open positions in any specialty or am I limited to only the specialty that I applied to during the regular match?
     
  12. mmed

    mmed New Member 7+ Year Member

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    Mar 1, 2006
    You can scramble to any specialty you like.
     
  13. shirya

    shirya New Member

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    May 6, 2003
    Guys,
    The truth is that you will never ever find anything through scramble! Ever! It's just wasting time and disappointment. Please don't put any illusions on it.
    My advice: you have about 4 months after scramble and before residency starts (and very often even after). During that time so many changes happen in the residencies. Someone disappointed with one's match and was looking for something else, someone died/got sick/pregnant, someone couldn't get a visa or a training license, etc. That is your only chance! I'm pretty sure you will find something. I don't know anyone who couldn't find any position if not this year, then next one. Good luck.
     
  14. honeygold822

    honeygold822 7+ Year Member

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    Dec 22, 2006
    i don't much about matching..through ERAS, how many residencies can you apply for? do they have within a specific field or vary like IM and OB? what do people mean when they talk about matching in top 3? Thanks ...
     
  15. mig26x

    mig26x Senior Member 7+ Year Member

    1,216
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    Apr 15, 2004
    Miami, FL

    You have the opportunity to scramble in any specialty that has spaces available, but lets be real. Alot of the competitive specialties are filled during the match, others have like 10-20 spaces (middle competitive) and the non-competitive have alot of spaces but those numbers have been declining every year, for instance IM had only 99 spaces available and thousands of IMG's didnt match last year, so its very difficult, phone's are busy all the time and also the fax.

    Like a PD that has spoken in this forums, he says that when his program has gone to the scramble they fill that spot in 20 minutes!! and thats an IM program, its a very hectic procedure.

    I know, i particpated in the scramble last year and didnt find a place, doing a one year MPH right now.
     
  16. trisomy55

    trisomy55 2+ Year Member

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    Sep 28, 2006
    I may have to scramble for a prelim IM spot this year.

    Right at 12pm, which is the best use of time? Trying to phone programs, faxing, or submitting applications through ERAS?

    For those that have done this before, is there much chance of getting through by phone or is it busy signal 99% of the time?

    Thanks!
     
  17. VuDOo

    VuDOo 2+ Year Member

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    Sep 20, 2006
    IA

    READ THE FIRST POST!!!!!!!!!
     
  18. Sugar72

    Sugar72 Senior Member 10+ Year Member

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    Jul 22, 2001
    Tucson
    I scrambled for a prelim spot last year and found the most success through emailing the department secretaries. I had great board scores so i shamelessly just emailed the secretaries with my board scores and they called me...got 2 offers that way.

    I scrambled from home with a dedicated fax line, 3 other phone lines, my mom answering calls and the program director form my advanced match calling people. I didn't talk to anyone or get any kind of resonse or anything for about 45minutes and it was the longest 45 minutes of my life!
     
  19. trisomy55

    trisomy55 2+ Year Member

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    Sep 28, 2006
    Thanks for the tips. What is needed exactly to fax to programs? Anything besides CV, transcripts, Dean's letter, board score reports, and a letter of recommendation or two?
     
  20. Venus21pam

    Venus21pam Freakin' peachy 5+ Year Member

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    MA
    I have a question regarding the LORs for scramble:
    how will I get my letter so I can scan them and send them to programs?
    I mean all my letters went directly from the letter writers to ECFMG so I don't have any copies. Will ERAS let me print the letters if I find out I don't match or how does that work???
    Same thing with the USMLE transcript. All I have is copies of the papers that I got when I passed my steps. I don't have my transcript...
    Anyone knows how to deal with that as a FMG?
     
  21. sahara

    sahara New Member 5+ Year Member

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    earth
    Can I have my husband make calls too on my behalf :confused:
     
  22. sga430

    sga430 Banned Banned

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    Jan 29, 2006
    i have not done anything to prepare for the scramble as i have ranked 42 programs. i feel this should be enuff to match. what do u fellows think?
     
  23. familyfirst

    familyfirst Junior Member 5+ Year Member

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    Mar 23, 2006
    Don't give up neurosurgery if you really love it. Don't settle for neurology. If you really love neurosurgery, you should scramble for prelim spot in surgery. reapply for neurosurgery this coming year. I know one person who successfully matched into neurosurgery after the second try.
     
  24. Underworld80

    Underworld80

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  25. luckyDO

    luckyDO Junior Member 5+ Year Member

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    I'm not sure what to do! I still can't find a positition.... :scared:
     
  26. miss senioritis

    miss senioritis 2+ Year Member

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    Oct 31, 2006
    i just wanted to thank the PD who posted the original tips for the scramble. i did my homework in advance and had a verbal offer by 12:30 and a signed contract by 1pm yesterday for a good peds position. it pays to be the early bird :D
     
  27. miss senioritis

    miss senioritis 2+ Year Member

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    Oct 31, 2006
  28. fedupme

    fedupme 2+ Year Member

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    Dec 1, 2006
    ANy answers to that? I have the same question!:confused:
     
  29. pjsson

    pjsson

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    New York, NY
    DO you have to send LOR? Can the program you scramble for download from ERAS?
     
  30. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    Many programs use ERAS for the scramble. Because you don't run into the FAX machine jam (all program fax machines are usually jammed by these companies that, for a fee, offer to fax your documents to every open program, or maybe its just individuals faxing all their documents to every open program, you get the picture)

    Trick is, you can only scramble in ERAS to 30 programs or so, so you have to choose carefully where you want to send your information.
     
  31. forex

    forex 2+ Year Member

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    Sep 27, 2007
    You are interested in IM, but do not match in the matching. Then in order to save one year, you plan to apply for some prelim programs in the scramble. How do you present yourself the best for prelim position in scramble (to make your case strong)? Also what to say in the PS? Thanks
     
  32. dmitrinyr

    dmitrinyr Senior Member 10+ Year Member

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    May 25, 2003
    I might be in need of the scramble and if so I'll be applying for a prelim in medicine. So am I understanding this correctly, you can use ERAS exclusively to scramble without actually faxing any documents to programs (that is if I don't plan to apply to more than 30 programs)? I only ask because I have no way of obtaining my LORs as the letter writers sent them directly to ERAS, nor do I have a copy of my dean's letter (who does?) and my transcript. Thanks
     
  33. Dr McSteamy

    Dr McSteamy sh*tting in your backyard 2+ Year Member

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    Oct 22, 2006
    question.

    in order to scramble, you must have had at least one interview or one program ranked?
     
  34. anamarylee

    anamarylee A la grande le puse Cuca 10+ Year Member

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    Aug 2, 2002
    Treasure Coast, FL
    '
    You must've ranked at least one program in order to participate in the scarmble.
     
  35. AlternateSome1

    AlternateSome1 Dismembered 10+ Year Member

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    Aug 2, 2002
    NY
    Physician
    Not true.

    "5. You are NOT matched because you did not submit a certified rank order list!

    This message will be displayed for any applicant who registered to participate in the Match but did not certify a rank order list prior to the rank order list certification deadline. Applicants who receive this message will have access to the Dynamic List of Unfilled Programs and are eligible to participate in the post-Match Scramble for any category of unfilled positions."

    http://www.nrmp.org/res_match/faq/ind_apps_faq.html#new04
     
  36. Tippmann

    Tippmann 2+ Year Member

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    California
    I definitely want to pursue a prelim year if I fail to match in a very competitive field. How would that proceed in terms of timing?

    I would do my prelim year, I assume it finishes around July of the next year. And then participate in research for 3-5 months and apply by Nov 1st?
     
  37. just a member

    just a member

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    I am an IMG. Could anyone tell whether you have to be in USA for scramble.
    Second If you are not here. How can you sign the contract? IF you get one:confused:
     
  38. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    No, you can scramble from anywhere. Of course, you need to factor in the time difference. And the fact that calling from oversease can be expensive and difficult -- although Skype can help with that.

    You can sign a contract and fax it, or scan and email it.
     
  39. Taurus

    Taurus Paul Revere of Medicine 10+ Year Member

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    This is the best article I've read describing the match and scramble.

    Surviving the Match

    For thousands of fledgling doctors like Adam Warren, the future hinges on a single day in March.

    By Monya De

    Every year on the third Monday in March, medical school deans across the nation warn their senior students to stay alert for a pager call. Worse than a late-night code blue, that ring, if it comes, portends terrible news.

    Stanford medical student Adam Warren's pager went off that Monday in 2004, and when he saw the number of the dean's office on its screen, the blood drained from his face. He called the office, and the staffer on the other end confirmed his fears: After six years of intensive medical training, he'd struck out in the lottery that places students in residency training positions. Without a residency, Warren had no job, no prospects for becoming a surgeon, and no salary to pay off his massive student debt.

    Warren had dreamed of being an orthopedic surgeon since high school. An energetic and muscular athlete, he was then a track standout who later played football for UC Berkeley. Between his own inevitable injuries and those of his teammates, he developed close relationships with the athletic trainers and sports medicine specialists, which only strengthened his career ambition. During his pre-med dance at Cal, Warren developed an interest in immunology and supported himself by working in labs, including a stint at Emeryville's Chiron Corporation. His scientific aptitude earned him a slot in Stanford's prestigious medical program.

    Warren kept an open mind about his prospects. When Stanford researchers, noting his lab skills, urged him to get a Ph.D, he pursued it for two years. But then he returned to med-school classes, concluding he didn't want to be a scientist.

    Pediatric surgery also tempted Warren, and he so impressed Stanford doctors during his third year that one pediatric transplant surgeon offered him a general surgery residency a full year before anyone else could apply. But the job came with strings attached. "There was an unwritten rule that I'd have to first go and prove myself on their surgery trips to the developing world," Warren recalled. "Plus, neither Stanford nor general or pediatric surgery felt right." He would have had to toil for five years on adult gallbladder removals and amputations before getting to operate on kids.

    Orthopedic surgery was what Warren really wanted. So he did what every medical student must do. He entered the Match.

    The Match is the complex lottery used to place medical students in residency programs at the nation's teaching hospitals. It's a make-or-break moment in a young doctor's career. These programs are where physicians are trained in their specialties and become eligible for certification by the state medical board. Across the nation this week, tens of thousands of budding MDs receive the match results that will profoundly affect their life direction. The news will in large part dictate where they live and work for the next three to seven years, what field of medicine they practice, and their future earning potential.

    While a medical school acceptance letter is popularly seen as a ticket to autonomy and financial comfort, the Match turns the nation's future neurosurgeons and cardiologists into hapless supplicants compelled to juggle their hospital duties with applications, interviews, and cross-country hospital visits. The process can be nerve-racking, exhilarating, or devastating. And for those who think strong scores and great letters of recommendation are tickets to success, the inherent subjectivity of the Match can come as a rude awakening. The results can alternatively jumpstart a glorious career at a prestigious hospital or place a fledgling physician in an inferior training program far from where he or she wants to be.

    "The Match is stupid," says David Goldenberg, a journalist whose wife, Sara Thierman, is preparing for the 2007 Dermatology match. The San Francisco couple wants to live near family in Alabama or New York City, but they know they could end up anywhere. "Its full purpose is to drive students crazy. It's a load of pressure — you may end up here, you may not; might match, might not. Pretty much everyone is unhappy."

    Even in the best-case scenario, the Match sentences recent med-school grads to at least three years of low wages for the privilege of treating the patients of attending hospital physicians at all hours of the night.

    In Warren's case, it left him unemployed.

    The Match

    The National Resident Matching Program was established in 1952 to make the residency application process less chaotic. Before that, top contenders might sit on offers from multiple programs while holding out for their first choices, leaving less-competitive applicants in limbo for months. For the latter group, this meant eleventh-hour moves across the country as the cards fell where they might. Like pro sports teams, hospitals would compete for prime students by extending offers as early as the sophomore year of medical school. Some sent "exploding" offers that would expire in 24 to 48 hours if the applicant did not reply.

    The Match is actually several matches. The largest, which takes place this week, is that of the National Resident Matching Program, catering to internal medicine, family practice, pediatrics, and other specialties. The American Urological Association runs its own match for urology programs. Finally, the San Francisco Matching Program handles ophthalmology, neurosurgery, pediatric neurology, and plastic surgery. Hopefuls submit their applications in the fall, and the newly minted doctors typically start their residencies the following July.

    The system compels participants to accept a binding contract. Unlike, say, third-year law students, Match applicants must train at whatever program chooses them. Conversely, hospitals must accept the doctors they are assigned. But the house has the clear advantage: While a law student can negotiate salary and perks, would-be residents have no say regarding pay and working conditions. "It's not really a free market," Thierman says. "You don't get to negotiate job offers."

    That's too bad for the residents, who in most cases earn between $40,000 and $60,000 annually for grueling eighty-hour weeks, and that's assuming their program respects the recently instituted cap on working hours. Acknowledging the grind, some programs try to sell themselves as a bit more enlightened: "Residency is hard work. However, a few key features of our program mitigate needless suffering you might be exposed to elsewhere," promises the Web site for Stanford's psychiatry residency.

    Fairly recently, residents pushed back a bit. In 2002, a group of them filed a federal class-action lawsuit against the Accreditation Council for Graduate Medical Education, which regulates the training programs. They claimed price-fixing, as evidenced by universally low pay for extremely long hours. One month later, the council hastily reversed decades of resistance and implemented an eighty-hour-maximum workweek for residents, although the price-fixing suit was ultimately dismissed.

    Despite the Match's drawbacks, Philip Pizzo, the dean of Stanford Medical School, says it helps students and hospitals achieve their mutual goals. "I believe it is a fair and proven mechanism that streamlines a complex process in a manner that favors students and assists training programs," he says.

    But many medical students feel otherwise. Their postings on Web bulletin boards under usernames such as PathHopeful, DrMcNinja, and Arrhythmia7 reflect increasing anxiety in the days preceding the Match. "I am a nervous wreck," one writes. "I wanted to start planning but I feel like my life is on hold until March 15." Another posts a mock prescription for alcohol twice a day for neuroticism. Debate abounds over the Match's value. "I honestly think we could have come up with a better solution," another student opines. "There are plenty of other industries and professions that have to hire graduates in batches, and they seem to function fairly without a Match. It takes months of miscommunication and politicking and other assorted reindeer games to facilitate the Match."

    David Goldenberg favors the MBA model: If the business school lets them, companies extend limited-time job offers to students. "It's not great, but it's better than the Match," he says.

    Getting There

    Simply getting to Match Day requires incredible dedication. After spending two years memorizing anatomy, biochemistry, and pharmacology, medical students embark on hospital rotations, where they get hands-on training in different medical fields. All must learn the basics of obstetrics and gynecology, internal medicine, surgery, pediatrics, and psychiatry. Fourth-year students do rotations in specialties that interest them, spending two weeks to a month with doctors they hope to emulate. Many also do "audition" rotations at their dream hospitals, traveling to distant cities at their own expense, in the hope that they will be noticed by residency program directors.

    Adam Warren wanted to stay in the Bay Area, so he tried to maximize his face time at Northern California hospitals. He did five month-long surgery rotations, including a stint in SF General's trauma unit, and orthopedics rotations at St. Mary's, Stanford, and UC San Francisco. From June through November of 2003, he spent nearly all of his time assisting in operating rooms and tending to patients, showing up early and leaving late. He still paid tuition to Stanford, but essentially worked for the hospitals for free. Knowing he was being scrutinized as a potential resident, he tried to be perfect in every possible way; affable yet academic, compassionate but still competitive.

    UCSF felt like a pressure cooker due to a surge in visiting medical students doing orthopedic surgery rotations that year — fifty or so did stints prior to the Match. During his time there, Warren became friendly with several residents and faculty members. Through them, he learned that the administration considered him clinically superior to the other "rotators," but that most of them had medical board exam scores in the 99th percentile, while his were below the 91st. The latter, according to Warren, is an unofficial cutoff for the hospital's prospective orthopedics residents.

    Warren approached the school's program director to ask what else he might do. The response: More research tailored to orthopedic surgery. So he applied for a research fellowship as a backup. In the meantime, he put in for the Match through the Electronic Residency Application Service, an online system that charges $60 for the first ten applications and progressively more for each additional one. He provided letters of recommendation, medical board exam scores, a personal statement, and his status as a member of the Alpha Omega Alpha honors society. From a list of nearly one hundred orthopedic surgery residencies, Warren applied to forty, as many as he could afford.

    Then it was time to wait. As the weeks went by, his Stanford colleagues filled their calendars with interviews, tried on suits, and spent hours a day looking for cheap airfares. Warren scored interviews with three programs: Stanford, St. Mary's, and UCSF.

    Playing the Game

    In considering a career path, students must seriously weigh their chances of landing their desired specialty. While heart and brain surgery were among the most competitive fields a generation ago for their prestige and high pay, the drive to play God has given way to the drive to play golf. Increasingly, students aspire to specialties that offer more money for less effort. Dermatologists, for instance, are well compensated and rarely get called into the hospital at odd hours. And because patients often pay for skin procedures in cash, dermatologists face fewer of the insurance hassles that plague modern doctors. But there's intense competition for the few available residencies.

    Money isn't always the motivation. Dermatology applicant Josh Spanogle is a nontraditional Stanford medical student who majored in humanities at Yale and dabbled in acting before applying to medical school. He's the author of a medical thriller, Isolation Ward, and is writing a second book.

    Spanogle considered orthopedics, but was drawn to dermatology by its more reasonable work pace, and also the death of his stepfather from melanoma. "If I don't get in, I'm going to do a year of research and apply again," he says. "The life of an orthopedic surgeon would not let me pursue writing."

    He'll be competing against the cream of the crop this year. Many of his rivals boast board scores in the 95th percentile and up. Trying to match in a cosmopolitan city or sunny state requires incredible luck and an unblemished record. That's because a dermatology residency — even in a desert town a long, miserable drive from Los Angeles — is more or less the Holy Grail for California medical students.

    Case in point: Last year, according to one Loma Linda medical student, the dermatology program director at Loma Linda University Medical Center considered only applications with minimum board exam scores around 250 (185 is barely passing; 270 and up is astronomical). And the program rarely interviewed students who didn't have Alpha Omega Alpha status, which less than 10 percent receive.

    Competitive programs often use such cutoffs to filter the deluge of applications, but because they won't tell applicants what those cutoffs are, students waste hundreds of dollars applying for residencies they have no chance of getting. Meanwhile, med-school deans have been known to push top students into the more-competitive specialties, telling them they would "waste" their high board scores on less prestigious fields such as family medicine. The association of high scores with surgical or "lifestyle" specialties has coincided with declining student interest in primary care.

    The programs also receive a "Dean's Letter" from each applicant's school. It summarizes the student's performance over the preceding three years, along with extracurricular and leadership activities. While the Dean's Letter generally tries to put the student in the best possible light, the final sentence often contains a code that conveys class rank. "This student performed outstandingly compared to the rest of the class," for instance, implies a ranking in the top 10 percent. Says David Crandall, a physician at Detroit's Henry Ford Hospital, "If more people from your school are applying to the same program and they all are 'outstanding' candidates, and you're just an 'excellent' candidate, then you could be in trouble."

    Once the residency programs sort through the paperwork, they invite top contenders for interviews. To increase their chances, students visit as many programs as they can — it's not uncommon for applicants to shell out $6,000 or more in the process.

    The interviewees frequently fret that their applications are not taken seriously if they lack connections to the regions where they are interviewing. Residency program directors are wary about wasting their top rankings on a long-shot, and consequently will try to ferret out any hint of reluctance on the students' part.

    UCSF, according to Warren, has been able to fill its slots from among its top-ranked applicants ever since it began to pay closer attention to whether interviewees had any strong reason to live in San Francisco. "Before, a lot of the people who were ranked had no intention of coming to California," he says. "Now [UCSF officials] scrutinize applications for any indication that the person isn't serious about the location." Smart applicants play this game to their advantage. One emergency-medicine resident in Seattle initially got the cold shoulder from her program when she applied as a medical student, so she called the program and mentioned that her fiancé worked in the area. "I got an interview right away," she recalls.

    After the interviews were over, Warren and his rivals ranked the programs they'd visited according to preference — UCSF was his dream, even though he knew at least four hundred people were applying for six spots. The residency programs, meanwhile, submitted their own rankings of interviewees. Then, as happens each year, everyone's preferences were plugged into the complex computer algorithm central to the Match.

    The fates of Warren and thousands of his fellow students were now in the hands of a machine.

    Backroom Deals

    Harrowing and subjective as it may be, the Match might indeed be the fairest way to place medical students were it not for one thing: Parties on both ends sometimes lie and cheat to fulfill their goals.

    Residency programs are highly motivated to recruit their top-ranked applicants. It's embarrassing to a program when a desirable student ranks other ones higher, forcing the program director to look further down the rank list to find a match. That's a big part of why programs favor applicants with local connections, or who show exceptional interest in that program.

    Crandall recalls how, during his interview at Oklahoma State University, administrators made a point of telling him they "never go past eight or nine on their rank list." This type of remark compels many a medical student to write three or more adoring post-interview letters to program directors, each emphasizing: "Your program is my No. 1 choice."

    It's strictly against Match rules for programs to cut advance deals with students, but many do it anyway. Some will assure top candidates that they've been ranked highly in order to ensure the applicant will in turn rank the program highly. But sometimes it's just talk. Warren recalls how two of his student friends were guaranteed to be ranked "high enough to match" by certain programs, and then ended up elsewhere on Match Day. "They're still bitter," he says.

    Unfortunately, he adds, such backroom deals happen all the time, and his friends' experience with dishonesty is not unusual. Crandall has heard of similar behavior by residency directors. One program, he recalls, told four of his medical school classmates that they were ranked No. 1 when there were only three open spots to begin with.

    Crandall also points out that the depersonalized, computer-based system can lead to tragic glitches. He recalls a classmate who was ranked first by her own No. 1 pediatrics program, but ended up elsewhere because the secretary typing up the hospital's rank list accidentally transposed two digits in her application number. The error could not be undone.

    Things get even trickier when people apply to two specialties at once. Some applicants choose a competitive specialty and a "backup," while others are in such a quandary over what kind of medicine to practice that they interview in two fields and let the Match decide. But that's risky. Programs that learn an applicant has interviewed in another specialty may well yank that person from their rankings.

    Black Monday

    Perhaps what medical students most fear is what they call Black Monday, the day would-be doctors receive that fateful pager call. When Warren found himself empty-handed, he contacted the UCSF orthopedic surgery department to find out why he hadn't been chosen. He simply couldn't believe it, especially when he had been in constant contact with the program director.

    Some unmatched students will spend a year doing research and try again. Warren, who had applied for a backup fellowship at the National Institutes of Health, went back to the lab for two. But students truly desperate for a residency put themselves at the mercy of a brutal yearly ritual called the Scramble.

    The day after Black Monday, the unmatched students gather in their deans' offices. The night before, they may have hammered out two or three additional personal statements for alternate specialties, trying to sound passionate about pediatrics or pathology at a moment's notice. The dean gives them a list of programs with positions still open, usually because they didn't rank all the candidates they interviewed. Then, at exactly 9:00 a.m. Pacific Daylight Time, chaos erupts as the students feverishly call programs around the country seeking to apply for those precious spots.

    Hospital fax machines spit out pages and pages of applications, while program secretaries are swamped with desperate phone and e-mail entreaties from all over the world, each would-be resident hoping to be the first. Jackie Sternberg, the dermatology coordinator at Cornell's medical school, recounts the "fluke" that left Cornell with an open position last year. "Trust me, it won't happen again," she says. "My phone was ringing off the hook."

    On Scramble day, simply getting through to programs can be a huge challenge. The slots fill quickly, and participants can see their opportunities dwindle in real time as positions vanish from a Web version of the list the deans hand out. The key is to score a phone interview at a sympathetic program, which might take a few minutes or all day, depending on luck. The luckiest of the unlucky have well-connected senior faculty members to make phone calls on their behalf. Such calls, especially between program chairs, are the most crucial factor in landing a position during Match and Scramble alike, Warren says. If a scrambler can make the proper connections, the appointment letters are faxed, signed, and faxed back, and the exhausted student is hired.

    Thierman, who will be out of the country on Match Day, says she has Dermatology faculty members ready to make calls for her if she doesn't match.

    But beggars can't be choosers. Scramblers often must settle for programs in faraway small towns or poorly compensated specialties. Others sign up for a far more demanding life than they'd anticipated, with night after night on call. Kimberli Cox, a surgeon who moderates an online medical forum, recalls a gay male friend who put only desirable locations on his rank list and didn't match in psychiatry. He entered a harrowing scramble, which ended in a telephone offer from UCSF-Fresno's residency program. The student thought, "'Great, UCSF,'" she recalls.

    Fresno, the student promptly discovered, is a world apart from San Francisco.

    Yet there are worse things than geographic shock. After years of preparation, the scrambler must be ready to switch fields on a dime. "You get to feel like the most worthless pile of crap as you beg for positions and get pushed by your dean's office to try for specialties you don't even like," says Denise Portugal, a resident working in Los Angeles.

    A 42-year-old physician-blogger who calls himself Panda Bear MD recounts how he left his structural engineering career to follow his dream to work as an emergency room doctor. With a wife and children, he didn't have the option of not working after medical school. So when he didn't match, he entered the Scramble and doggedly pursued the few open spots in emergency medicine. But no program would take him that year. "The Scramble," he concluded in an online posting, "is like having four or five rabid badgers shoved up your rectum."

    Applicants who don't find a residency through the Scramble still have a few options. The urology match and SFMatch each provide program vacancy lists. But finding a vacant position in any of the NRMP-match specialties is significantly harder. The organization's Web site maintains no such vacancy list, but rather directs applicants to FindaResident, a Web site run by the Association of American Medical Colleges. Here, vacancies are listed by region and specialty, but don't specify the program. A $75 fee is required to view them, and according to some residents, most programs don't advertise their open positions in any case.

    One New York dermatology resident, posting on an online message board for medical professionals, writes, "It's true there are a few Derm spots that go unfilled or suddenly open up most years for various reasons. They are virtually all filled by those with connections ... either they are top level applicants who didn't match and got their department chairman to go to bat for them, or research fellows who have been waiting patiently for a spot to open."

    Indeed, a common strategy is for applicants to do research for a year, preferably at their top-choice institution, and then reapply, even though programs usually prefer first-time applicants. Mike Javaheri, a current ophthalmology resident in USC's prestigious program, opted for this strategy, making his future uncertain. "I felt like an outcast at my medical school graduation," he said. A year of toiling in a USC research lab finally got him noticed.

    But the research year is no guarantee, and often ends in disappointment. One mistake can make an applicant history in the eyes of the program director, and even productive lab time can prove worthless if it doesn't lead to publication. Given that medical papers often spend three months or more in the editing process, that crucial publication often appears too late to improve a student's application.

    Problems with the Match sometimes thwart even the best of students. Just a few years ago, for example, a glitch in the urology match left six highly competitive programs without any residents at all. Johns Hopkins and other top hospitals refused to accept the scramblers, so the algorithm had to be run again. This left one applicant, who had initially matched at Harvard, completely unmatched in a matter of days.

    This year, applicants using SFMatch experienced mishaps due to a new electronic distribution system. One scored an interview at the well-regarded Kresge Eye Institute in Detroit. Trouble was, he hadn't even applied. The mixup infuriated students who had spent precious student loan cash to apply at Kresge, but never got a callback.

    Struggle Pays Off

    Adam Warren had to work his tail off for it, but he finally got his elusive dream. After two years of research post-medical school, he returned to UCSF for a one-year surgical internship. He was working in the ICU last March when he got the life-changing news: He had matched in orthopedic surgery, and would continue at UCSF as a resident. "It was somewhat surreal," he remembers, "but the excitement came from friends and family realizing I had finally made it."

    Now Warren is taking extra time to continue his research and obtain a master's degree in public health from UC Berkeley while completing his residency. "I think things happened this way for good reason," he says. "I definitely cherish my job a lot more, having struggled to get it. It makes a difference when I am tired and I have to take care of sick and injured people. I'm confident they are still getting my best."

    Of the Match, Warren says he has no regrets. "I think it works for the most part," he says. "It is not entirely fair, but neither is getting into med school for that matter. If you have desire, it forces you to become savvy at the process and do your best. It should not be done away with; it should be improved. I think the advising of medical students and their guidance are the areas that need the most work."

    Warren now supervises medical students vying for a position similar to the one he now holds. His advice to them is less about scores and grades than about networking. "Internal medicine is different, because there are so many spots. But in orthopedic surgery, if you don't have someone advocating for you at that residency committee meeting, you won't get in. Because six other people will have someone advocating," the young doctor says emphatically. "It's the intangibles like that that are really important."​
     
  40. pete27

    pete27 Medical Student 5+ Year Member

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    Jan 23, 2009
    how did u know the PD from the advanced match was calling programs for you when we don't find out our match locations till a few days?
     
  41. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    If you match advanced but not prelim, you can call NRMP and find out what city you matched in. If you only ranked one program in that city, BOOM!, you know where you matched. So now you can call/email the PD, explain the problem and go from there. Your advanced PD has a vested effort in helping you find a prelim spot because if you don't, they will have to scramble next year to pick up someone to fill your spot.
     
  42. pete27

    pete27 Medical Student 5+ Year Member

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    Jan 23, 2009
    is it considered a Match violation if you contact your advanced program PD?
     
  43. medsRus

    medsRus 2+ Year Member

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    Feb 18, 2008
    I was thinking the same thing.
     
  44. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

    7,053
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    Oct 11, 2006
    Sorry, but I can't help but comment on the article posted. A couple of caveats first: I don't know Adam Warren. I'm sure he's a really great guy and will make a great orthopedic resident. None of my comments should be taken as an "attack" on him.

    Let's start here. This is the exact evil the match is designed to address. Adam was offered a spot during his third year -- maybe early in his third year. He had to decide his career then, rather than get a chance to rotate on other services. Maybe he would hate Ortho when he tried it, and want ped surgery instead -- but (without a match) it would be too late by then.

    The match is not exactly a "lottery". A lottery is a completely random process -- everyone has an equal chance of winning. The match is an earned process, based upon your performance in medical school. There are some factors that are not completely under your control -- how well you interview, whether you have a connection to the area, whether your research worked or not, whether someone you worked with has a connection to a certain program, etc. But ultimately, your success in the match is mostly dependent upon your performance.

    "The match is stupid" -- compared with what? The number of derm/ortho/etc training programs is limited. Competition is high. Not everyone is going to get a spot. Even without a match, there is no guarantee (and in fact, it's unlikely) that someone is going to get exactly the program and location they want. That's life. Although students complain that the match makes them "crazy", consider the alternative. The good news is that the match tells you, at a specific and known time, where you will be going. Without a match, we could have the scenario discussed below.

    Low wages are not due to the match. There's unlikely to be much negotiating for salaries, when there's lots of people wanting each spot. In fact, you could end up with the opposite. Let's say I was the PD of an ortho training program, and there is no match. Let's say I have 2 spots. What would stop me from simply contacting 10 people I'm interested in, and saying "I'll give my two spots to the first two people who are willing to do it for free"?

    As I have mentioned here before, I think that resident wages are too low, but the match is not the problem.

    I just want to make sure that people get the sense of how horrible it was before the match. The super-top competitive applicants got early offers -- often in the 2nd or 3rd year. This was "good" in that they knew where they were going relatively early, but bad in that they had to make a decision quickly and perhaps before they had a chance to see all their options.

    For the majority of medical students, it was a horrible situation with no clear timeframe. Imagine waiting at home now, not being sure when (and if) you were ever going to get an offer. You could wait, and wait. You could get an offer right at the last minute -- which if you accepted (and gave up whatever other spot you had filled) would lead to a cascading problem -- as that program now has an open spot at the last minute, they try to woo someone away at the last minute from another program, etc.

    First, I'm not sure that first year law students do much negotiating for their original salaries. Second, comparing law school and med school is frought with problems -- the major one being that law grads from the super top schools seem to do fine (i.e. get job offers from large firms that pay well). However, the vast majority of law and MBA grads, those that don't come from the small number of "top" schools, don't. There's a whole website, JDUnderground, that talks about how miserable it can be for a law grad. For medical students, everyone can get a residency (although not perhaps in the field they might want) and end up with a good paying job in the end.

    Really? So you'd rather have me give you a 3-6 month contract, and then decide whether I like you or not? And if you have any problems, or if someone better simply comes along, I would just drop you then? Again, in the "MBA Model", this works for grads of the top B-schools -- all else are on their own.

    By "working for them for free" we're talking about a visiting medical student. Much of what medical students do is not really "productive" for the hospital (although that can depend upon the location and the position). Still, I expect that all of the surgeries he assisted on would have proceeded just fine without him. It's not clear to me whether the author is suggesting that the student should pay tution to the hospital rather than Stanford, or even be paid by the hospital. Of course, none of that would ever happen in real life.

    First, it's not clear whether we're talking about true "99th percentile" or a two digit score of 99, which are two very different things. But here we get to the crux of the matter. Ortho programs are competitive, and they get to choose people based upon their performance in medical school and on the USMLE. If his USMLE scores were lower, then that's too bad. But it is totally reasonable for a program to decide not to pick him based on this.

    And, I love the statement "the administration considered him clinically superior to the other rotators". If true, then they should have ranked him higher. Most likely, this is simply a nice way of telling someone they won't be ranked highly. Similar to: "It's not you, it's me".

    Three interviews in any field, but especially ortho, should be very concerning to any applicant. This person should not have been surprised not to match. However, he did exactly what he needed to do -- he knew that if he didn't get a spot he needed to do a research fellowship as a backup, which he had set up. Doing a prelim surgery year would have been useless, and it sounds like he didn't want to do another field.

    So, this whole story is really about one thing: someone who wanted ortho but who didn't have the "stats" to get a spot. The match isn't the "evil" here. This person would not have likely gotten a spot no matter how they were distributed.

    Derm is competitive, and if they want to pick people with high USMLE scores, they are welcome to do so.

    The issue with not disclosing cutoffs is a real one. Here's the problem: all programs have some cutoff on USMLE, however for most it's a soft cutoff. So, I won't usually interview someone with less than a 210 (making a number up here folks). BUT, if they rotated at my program OR if they have some amazing extracurricular OR if they have a letter from someone I know, etc, then I might. In addition, sometimes the cutoff is floating -- I wait to see what my applicant pool looks like, and then choose where the cutpoint would be. Although I agree that it would be better if there was more transparency about interview criteria, it's usually much more nebulous than people think.

    If true, this is a crime. Of course "...have been known.." could mean anything -- someone says that their brother's ex-girlfriend's cousin said this happened once. I expect that many dean/advisors simply point out to applicants with high board scores / AOA / etc that they could compete in any field, but respect students who choose to follow their desires.

    The author makes this out to be something sinister. It would seem totally fair to me that those who do better in medical school get some documentation / credit for that. This is life. And yes, you're competing with your colleagues for spots. That's also life.

    How Warren knows how UCSF makes it's rank list, since he's not even there yet, is unknown. Programs want people who want to be there. Let's pretend I have 1 spot to fill. If I knew that person A has ranked me #12 and person B has ranked me #1, it's actually quite natural that I might actually prefer person B since they seem to really want to be here. The last thing I want is someone coming for a year, and then deciding to move elsewhere. Also, programs may have an interest in having their grads work in the local area -- especially if it's an underserved region.

    Also, you can't "waste high rank spots". Just like for applicants, highly ranking people who are unlikely to come to my program but whom I think would be excellnt can't hurt me -- I can't "lose" people lower on my list (unless I fill with people higher on my list). All it does is make me go down farther on the list.

    In the latter example, It's possible that the ED resident in seattle simply wasn't as competitive as other applicants and hence was not interviewed, but then when she mentions that her fiance works in the area, that adds to her application and gets her an interview.

    So, I guess I don't see anything wrong with considering "connection to the area" as part of the interview / ranking decision.

    This is overly dramatic. The "machine" uses the preferences of candidates and programs. Hence, the decision is really the choice of the participants. This is similar to stating that the outcome of the next election is in the "hands of the voting machine" and that somehow the voting machines actually choose who gets elected.

    The match is not "subjective", or at least no more than any other system.

    Given that no one really finds out how low down your list you go, it really isn't embarrassing to programs to go down the list. As I mentioned above, I think it's more likely that programs favor applicants with connections / interest because they actually want to take people who are interested in being there.

    There is no question that, especially in small competitive programs like ortho, this "You're my #1" thing gets crazy and out of hand. But that is independent of the match -- even without a match, PD's are going to choose people who they think want to come to that program. Remember when y'all applied to medical school, and wrote all these crazy letters to schools telling them how mcuh you really wanted to go there? No match, same insanity.

    NOTE: no match is needed in the med school application process because there's 10+ applicants for each spot, so if someone drops out at the last moment, there's plenty of willing and able people to fill the spot. Not so in residency placement.

    Just like applicants feel pressured to tell programs they are their #1 choice, programs feel the same pressure. Also, if I do go down lower on my list I don't want the "last match" to know that -- that wouldn't help anyone. So, I tend to be positive with anyone on my match list (which is not being disingenuous -- I honestly would be happy to train anyone on my list).

    This is a really stupid error. First, when you type in match numbers it immediately shows you the name of the person, so as long as you're watching what you're doing it won't be a problem. Second, anyone who doesn't recheck their list after entering it deserves what they get. Third, you can actually rank people directly in ERAS and then dump it into NRMP, avoiding typing any numbers at all.

    More importantly, this statement assumes that if you assign spots through another mechanism that less errors will occur, and that's a big assumption.

    No argument from me that the scramble sucks. If Warren was truly surprised that he didn't match, then he has a very developed sense of denial or really poor advising. He got 3 Ortho interviews, later than everyone else -- that's better than none but not good. Who cares about "constant contact with the PD"?

    Without a match, we would basically have one long scramble. But again, no argument from me that the scramble sucks, and the NRMP's decision to try to fix it is a good move

    I'm hoping they had Kim's permission to use her name, rather than just lifting it from SDN and her posts.

    The "glitch" was that they completely screwed up the match. Just to be sure we're comparing apples with apples -- if the match works (mathematically), everyone ends up in the best program they could. If it fails, it screws up everybody. If we use some sort of non-matching system, chances are that some proportion of people will have mistakes made -- applications lost, attempts to contact to offer a spot that are unanswered, etc.

    Given the overall negative bias of the article, it's somewhat surprising to see that the "protagonist" actually thinks the match is good.
     
  45. Forgottenhopes

    Forgottenhopes

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    Feb 16, 2010
    interesting article...
     
    Last edited: Mar 15, 2010
  46. WholeLottaGame7

    WholeLottaGame7 10+ Year Member

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    Jul 10, 2005
    Right here.
    I thought the story was a little sensationalized also, but then again, that's journalism. Also, I agree with everything you said, aPD, except the below.

    Having talked with various PDs, chairs, and recruitment directors on the interview trail, there seems to be a variety of opinions on the matter. One program said that they don't care how far down their list they go since they rank everyone they think would be a good resident. They ended up with a chief resident who was ranked in the 70s for a 20 person program. This seems like the way it should be.

    However, I have also heard that some programs ARE concerned about how far down the list they go, including somewhere that the hospital department's funding was tied to the program's rank list success. That department would actively bump people up the list if they sent in the "No.1" email. This seems pretty terrible.

    I think that's the problem. It's nice to envision a world where Program A dominates, but in world where there are Program B's out there, as medical students there is a huge amount of pressure to be dishonest.

    The stressful part is this: I sent a "You're No.1" email to my top-ranked school. However, it's a competitive program and there's no guarantee I'll end up there. I would also dearly love to go to my No. 2 school (or any of them, for that matter). But if my No. 2 school is Program B, they might fill up with people who "really want to be there." I'm not sure what that means, because I think ranking a program 2 out of 16 means I really want to be there, but somehow I don't think sending a "You're No.2" or "You're ranked really highly" email is going to cut it.

    Anyway, from conversations with fellow students I know this is a concern, especially for those of us who only send the one "You're No.1" email. I think the only solution is to prohibit any post-match correspondence, but I don't see that happening anytime soon.
     
  47. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    You make good points. From a match/mathematical standpoint, there is no harm to my ranking students in the order that I want them. However, if an external force ties compensation to how low down my rank list I go, or if I have a severe enough Axis II disorder (such as Narcissitic or perhaps Borderline Personality), then anything is possible.



    Banning post-interview correspondance seems draconian. Applicants can't ask questions? Neither can I? Even if you tried to do this, people would just try to do all of this at the interview itself.
     
  48. Restmycase

    Restmycase 2+ Year Member

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    Mar 2, 2010
    :love:

    I recently began to read some of the SDN postings by aProgDirector. My unabashed reaction -- aProgDirector, you're terrific! As someone who is obliged to go through the residency application process, it's been eye-opening, and even reassuring, to read your postings. Thank you so much for taking the time to post your thoughts, and for all the wisdom and candor you have shown. I wish I knew where you work -- I'd love to train in your program!

    Best of luck to everyone!
     
  49. adrenalynh

    adrenalynh

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    Mar 20, 2010
    unfortunately, i was not able to match this year in IM or pathology. I tried to scramble and after reading your posts, yes it is a nightmare. I got a 77 and 78 one my steps... no failures or anything. I'm a FMG from SGU. it didnt matter that i had 6yrs research as Mass General. it didnt matter that I had 4 published papers or did volunteer work or got honors on my thesis in graduate school, got invited to switzerland for my work. I'm forever branded with my step scores.

    so here are my question:
    what can i do in this year i have off to make these programs look at me?
    will externships help?
    will passing Step 3 help?
    will more research help?
    if i do research should i try for a university program?
    or will these programs look at my scores and toss my application aside no matter what?

    what are my chances? i'm 28 and i've accomplished a lot, but with those scores i feel like i have no shot. i've never been good with standardized tests which is why i ended up a FMG in the first place.

    any advice would be appreciated. thanks...
     
  50. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    Oct 11, 2006
    Getting low scores on your USMLE steps and being a foreign grad is a very bad combination. All of your other great work is really impressive, and you are correct that no one is likely to count it for much. With better board scores it would be a major positive, but good USMLE's are key for IMG's looking for spots.

    Maybe. The place they will help the most is where they are done. So, it's pretty vital that you try to do your externship somewhere you could imagine yourself. Also, you might want to avoid the "tip top" places. Doing an externship at MBH (Man's Best Hospital) might sound great, but they are unlikely to take you as a resident no matter how much you impress them, and other programs may be less impressed by your work there then you might think. Also, you'll be up against the "best" medical students. (This argument could work both ways -- if you get a shining LOR, it could really open doors)

    The good news is that in pathology, you might be able to do quite a bit without a medical license. This is a real problem in other fields -- graduated students find they can't get much clinical exposure once they are no longer a student and not yet a resident. Since Path often does not involve interacting with live patients, you might be able to get some good experience. I have no experience with this, so perhaps it will be more difficult than I predict.

    Not much. Perhaps if you do much, much better. But will you?
    In any case, make sure you take Step 3 within 7 years of your first step

    i
    Seems unlikely. A year of research is often recommended for not matching. reasearch might offset the fact that you are an IMG, but it will not offset your poor USMLE's. Plus, you already have a great amount of excellent research, seems unlikely that more would help.

    Probably the latter

    any advice would be appreciated. thanks...[/QUOTE]

    Impossible to tell overall. Next year you'll need to apply very broadly. You might want to apply to every path program in the nation (minus the top competitive ones). You might also need to broaden into FP if that's acceptable.
     
  51. LOVE OB

    LOVE OB

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    Mar 20, 2010
    I'm a D.O senior, took both COMLEX and USMLE With scores mid 200's. Good grades, Letters of Recommendations, and an encouraging letter from my #1 ranked program where I did audition rotation. F in didn't match anywhere. Never in a million years did I expect this! Scrambled into a preliminary Surgery spot.

    What are my chances of landing an OB Gyn catagorical program next year?

    The thought of going through this all over again next year absolutely terrifies me
    :mad:
     

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