Scramble question

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ditch doctor

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Aug 4, 2005
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So, I'm not trying to be a Henny Penny or "Oh my God, I'm not going to match!" or anything; but I have a question about scrambling and I want to be prepared. I am trying to match in a specialty that is pretty competitive, but it is really what I want to do so I'm going for it anyway.

However, I was one of those guys that really liked almost every rotation I did, so if I do have to scramble there are other specialties that I would be perfectly happy doing; I just happen to like the specialty I chose the best.

My question is this, should I go ahead make a new personal statement and get LOR's that are geared toward the other specialties? I mean would, say an Anesthesia or EM PD even consider a scramble applicant with a whole application that is 100% geared towards, say Derm or Optho? Assuming that scores and LORs are decent/competitive.

All of you PD's out there your thoughts would be most appreciated. Thanks!


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Oct 11, 2006
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As usual, I think it depends.

The big problem with your question is the fact that the number of EM and anesthesia spots in the match is very low. Last year, 98+% of programs filled in those fields, with 100% of 3 year EM spots filled. Unfilled programs might not be where you want to go -- an anesthesia program with 6 empty slots in the match was at an institution that was closed by the ACGME this year, all residents will have their training terminated at the end of the year.

Then again, UCSF appeared to fill 20 of their 21 spots, and that would certainly be a nice spot to land.

So: If you are looking at a competitive field such as EM, anesthesia, derm, rads, etc -- there will be very few slots in the match, and lots of unmatched applicants with LOR's specific to that field, so you'd be working at a distinct disadvantage. Then again, there are so few spots in the scramble in these fields, I'm not sure you would succeed with specialty specific LOR's anyway.

If you are looking at non-competitive fields -- i.e. IM, family, peds, etc, then it probably matters much less. I personally don't care if an unmatched derm candidate wants to come to my IM program whether they have IM specific letters or not - a nice dean's letter with a call from a dean's office is all I need.

The biggest question to answer (in the next 1.5 hours) is if you are applying to an advanced program (derm/opthal/anesth/3 year EM/etc) that is competitive and you don't match in that, whether you want to try to match in a prelim instead, vs go for a categorical IM program in the scramble. No easy answer there, but I'd favor getting a good prelim year and then looking for an open PGY-2 IM the next year (or try matching again), but I can easily see the benefit of having a three year IM slot "in the bag" from the scramble.


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Feb 2, 2001
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I don't think applicants generally get new LOR for the scramble... there simply isn't enough time. Programs in non-competitive specialties with empty spots in the scramble know that they will get applicants who didn't apply to their specialty originally and this is "plan B." The letters you already have in your application will be fine, since they speak to your good qualities, potential to be an excellent doctor, etc. I imagine having another well-crafted PS describing your interest in your "back up" field would be helpful, though.