signaling and dual applying

[m3ds]

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I'm applying to psychiatry residency this cycle, and should be a very competitive applicant.

I am worried that I will only get interviews to my signals, and have heard mixed advice about how to allocate them. I feel like basically no program is a reach for me with my stats, but it feels insane to only signal brand name academic programs. However, I feel like more accessible/target programs won't consider interviewing me unless I signal. This leaves me with 10 hyper-specific interviews (max), which is statistically not enough ranks to match.

Which brings me to a workaround I thought of: signal programs that offer CAP and categorical tracks, that way 1 signal can net 2 interviews/ranks. I have a genuine interest in CAP, and it has always been on the table for me, I just wasn't sold on applying to it now versus later after more experience (let's say I decide I don't need a fellowship at all). I have a solid CAP application in itself; most of my research and extracurriculars are CAP. Anyone reading my application would sense a strong CAP flavor to begin with.

I am worried that this strategy will net me 2 interviews at my dream program (let's say, hypothetically VCU), but when I actually interview, I will come off as wishy washy and insincere if I tell them (separately) how much I want to do CAP vs categorical, and I will fall down both rank lists.

How have you felt about applicants who applied to distinct tracks at the same program? Is there a way to handle this well (e.g. emphasize I want a spot at that program and would do anything to be there)?

 

[TexasPhysician]

I can’t speak to all CAP programs, but this is how it worked a few years back. Let’s say Program A has 10 PGY-1 psych spots. They advertise 8 gen psych and 2 combined psych positions to applicants. After interviews, they create 2 rank lists. They may feel that only 3 applicants clearly demonstrated their CAP desire after interviewing 20. Rank list for CAP will have 3 names. Those 3 names get automatic priority over all other PGY-1 psych applicants. The other 17 names can get ranked in the gen psych pool. If 2 of those 3 applicants match elsewhere, the program automatically matches 9 to the gen psych track.

You only reach the CAP list if you are a top applicant. If not, you will be placed in the gen psych pool wherever they want you. They don’t punish you for trying to reach the combined pool.

 

[comp1]

It's hard to figure out what exactly your situation is. Your application is just too good for average psychiatry programs to consider? This "signaling" mess came out long after I matched and it appears the above poster is talking about ranking whereas I think signaling more involves the getting an interview part? Honestly the game playing is just too much for me. Signal and then rank based on where you want to match. If your application is really just that amazing, you'll get interview offers from a wide variety of programs. I sincerely think you're overestimating how often a less competitive program thinks that someone is too good for them to offer an interview. What you definitely want to avoid is matching into a combined residency and then deciding that you really didn't actually want to give up that extra year of attending salary to do twice the work the rest of your life dealing with the dual patient child-parent setup while the making roughly the same. If you want to convince a program you want to go there, have a strong geographic tie or explain somewhere in your application why the GEOGRAPHY matters. It's easy for everyone to say they just adore the CAP faculty at some institution, harder to say that your wife's family lives in the same city as the program and ultimately your interview and rank decisions should be driven by geography since regardless of the program, you're statistically likely to keep living in that city. Residency is only four years.

 

[Merovinge]

If you are a top applicant and VCU is a (hypothetically speaking) top school from your perspective, I wouldn't hesitate to just signal 10 academic programs. You will have absolutely no problem matching as a top applicant if you get 10 interviews at mid to top tier public universities. That's a lot different than just signaling the top 10 very best psychiatry programs in the country.

 

[m3ds]

It's hard to figure out what exactly your situation is. Your application is just too good for average psychiatry programs to consider? This "signaling" mess came out long after I matched and it appears the above poster is talking about ranking whereas I think signaling more involves the getting an interview part?

Two people from my (US MD) program with high stats said they only got interviews at their signals (10 total). This included some extremely fancy brand name programs (that were signaled) and some more average programs (that were signaled). The common factor was that all were signaled. I'm sorry that this seemed to trigger you in some way, its the reality of the system now. Everyone hates it. I can't imagine a single applicant it actually helps, and it does necessitate playing games and being disingenuous.

Trust me, I would rather just apply and rank based on my actual desires. I've worked very hard and was hoping to have more than enough interviews to match well at a program I love and now I'm worried I'm going to get screened out by all but the 10 I signal. This is not an irrational worry, since I've spoken to two people who are as similar to me as anyone could be and they both got shafted.

Also, the reality is a lot of programs are going to screen me out based on my stats to begin with and this is exacerbated by signaling. This is also based on data, not my egotism. I think it's okay to describe myself as a competitive applicant when it is what I am.

What you definitely want to avoid is matching into a combined residency and then deciding that you really didn't actually want to give up that extra year of attending salary to do twice the work the rest of your life dealing with the dual patient child-parent setup while the making roughly the same.

I hear you, I was always genuinely interested in CAP anyway. One of my letters is from a pediatrician. I've done months of CAP electives. I just didn't want to lock myself into a fellowship just yet if I decide I don't need it. But I'd rather match CAP at my dream program than not match, or match regular psychiatry at my home program which is toxic.

Also I'll add that geography is my MAIN priority!! And matching CAP adds the security that I won't need to move for fellowship. I am applying to one region.

 

[Stagg737]

This leaves me with 10 hyper-specific interviews (max), which is statistically not enough ranks to match.

Not a lot to add other than this is just wildly off. Last charting the outcomes data for US MDs shows that 10 ii's puts you around a 93% chance of matching. Only ranking 6 programs had an 80% chance to match and suicide match still had a 55% match rate. Frankly, once you get the interviews performance during those interviews is likely going to be the biggest factor to determine if you match or not. I knew some absolutely outstanding applicants on paper who ranked 20+ programs and didn't match and other very mediocre or just bad applicants on paper who ranked less than 10 programs and matched in their top 3 ranks (myself included). Kill your interviews, rank everywhere you interview (unless there is a major red flag or extenuating circumstance), and you'll more than likely be happy.

CtO 2024 for US MDs, psych data starts at page 208:

https://www.nrmp.org/wp-content/uploads/2024/09/Charting_Outcomes_MD_Seniors2024.pdf

 

[m3ds]

Not a lot to add other than this is just wildly off. Last charting the outcomes data for US MDs shows that 10 ii's puts you around a 93% chance of matching.

school advisor told me you need 12

i think everything else in your post is outdated in this new paradigm where signals dictate what interviews you get

very unlikely for anyone to get 20 interviews anymore

 

[Stagg737]

school advisor told me you need 12

i think everything else in your post is outdated in this new paradigm where signals dictate what interviews you get

very unlikely for anyone to get 20 interviews anymore

The 20 interviews point is fair, but the whole point of the signals was to prevent people from hogging interviews and having rank lists 20 programs deep. Your advisor is incorrect though. 12 ii's has ~95% match rate, so only 2% higher than 10 interviews. This is data from last year published by NRMP that I linked above, trust who you want on that. I'm an attending at a mid-tier academic program (like VCU) and am involved in the process and 2 of my former colleagues are now PDs elsewhere, so I'm pretty aware of the process and the issues with it. By your logic your advisor can't be right anyway if the max interviews anyone is going to get is the 10 signaled programs. Just trying to point out that you're overstressing about the actual rank/match part of this. At this point your focus should just be getting those interviews.

I can't really speak to the CAP point but where I'm at it wouldn't matter. Our residents don't declare for the CAP track until the end of their PGY-1 year and we don't reserve positions or give significant preference to those wanting to fast-track into CAP.

 

[m3ds]

The 20 interviews point is fair, but the whole point of the signals was to prevent people from hogging interviews and having rank lists 20 programs deep. Your advisor is incorrect though. 12 ii's has ~95% match rate, so only 2% higher than 10 interviews. This is data from last year published by NRMP that I linked above, trust who you want on that. I'm an attending at a mid-tier academic program (like VCU) and am involved in the process and 2 of my former colleagues are now PDs elsewhere, so I'm pretty aware of the process and the issues with it. By your logic your advisor can't be right anyway if the max interviews anyone is going to get is the 10 signaled programs. Just trying to point out that you're overstressing about the actual rank/match part of this. At this point your focus should just be getting those interviews.

I can't really speak to the CAP point but where I'm at it wouldn't matter. Our residents don't declare for the CAP track until the end of their PGY-1 year and we don't reserve positions or give significant preference to those wanting to fast-track into CAP.

this actually made me feel a lot better, thanks. hard not to overthink when it's such a consequential life event. wish i could fast track the next like 6 months of my life.

it's very challenging to decide which target-range ("mid tier academic" as you put it) programs to signal. for example, i'm realistically equally interested in Tufts/Umass/BU but can't signal all of them. so then i am arbitrarily deciding which one will interview me by allocating my signals. the data available to me suggests that the others will NOT interview me only because i didn't signal them. so then my strategy was to signal the ones that have CAP since it's 2 slots i can later rank.

i'm doing as much research as i can but i'm driving myself a little crazy and the advisors are not all that helpful as you pointed out. they provide some advice i have been able to recognize as bad and ignore accordingly but then i still listen to their advice sometimes

 

[comp1]

Okay you are probably right that we are old fogies who do not understand this new paradigm. That said, since geography is your top priority (as it always should be) signal all the programs of all competitiveness from a given central geographic point. So for SoCal for example, that means you will signal UCLA, UCSD and USC, but also Lake Arrowhead and maybe even as far as Kern and then places like the UCLA county programs. Several of the SoCal programs have CAP too as I am sure they will also in Boston or NYC or Atlanta or wherever it is where you are thinking.

 

[TexasPhysician]

this actually made me feel a lot better, thanks. hard not to overthink when it's such a consequential life event. wish i could fast track the next like 6 months of my life.

it's very challenging to decide which target-range ("mid tier academic" as you put it) programs to signal. for example, i'm realistically equally interested in hofstra/stony brook/montefiore but can't signal all of them. so then i am arbitrarily deciding which one will interview me by allocating my signals. the data available to me suggests that the others will NOT interview me only because i didn't signal them. so then my strategy was to signal the ones that have CAP since it's 2 slots i can later rank.

i'm doing as much research as i can but i'm driving myself a little crazy and the advisors are not all that helpful as you pointed out. they provide some advice i have been able to recognize as bad and ignore accordingly but then i still listen to their advice sometimes

Dont signal the CAP options just because it is “2” slots. What I was trying to describe earlier is that it is really just 1 slot. It may show up as 2 on your list, but it adds nothing. The CAP slots are merely the top positions of the general program. It is NOT protective to match at all.

 

[m3ds]

Dont signal the CAP options just because it is “2” slots. What I was trying to describe earlier is that it is really just 1 slot. It may show up as 2 on your list, but it adds nothing. The CAP slots are merely the top positions of the general program. It is NOT protective to match at all.

yeah it seemed too good to be true. i think on the applicant side you get to rank them separately but sounds like the program only ranks you once no matter what? i wonder how it is influenced by the applicant, let's say i interview for both and then rank general higher...

it does sound like for me CAP might be protective in the sense that it's a smaller pool to compete in and i do have a good application for it and a genuine interest. let's say UVM gets 1000 applicants, 100 of them signal, and 30 of those dual apply CAP for example.

i really hope this all works out for me and i can calm down soon 😕

 

[TexasPhysician]

yeah it seemed too good to be true. i think on the applicant side you get to rank them separately but sounds like the program only ranks you once no matter what? i wonder how it is influenced by the applicant, let's say i interview for both and then rank general higher...

it does sound like for me CAP might be protective in the sense that it's a smaller pool to compete in and i do have a good application for it and a genuine interest. let's say UVM gets 1000 applicants, 100 of them signal, and 30 of those dual apply CAP for example.

i really hope this all works out for me and i can calm down soon 😕

You are either ranked once (gen psych) which means excluded for combined or you are ranked for both at an equivalent level. For instance, you are 3rd on the list (combined) and 4th on the list (gen psych). It is the same list. Either way you have equivalent odds of matching. It benefits you none from a need to match standpoint. If you don’t have an application well positioned for a combined slot, I would argue that applying to places that have combined could hurt you.

Program A has 10 positions. They take a max 2 combined applicants. If you don’t make the combined list (common), you are actually competing for 8 slots. Applying for a program without combined slots with 10 gen psych slots (assuming equal competitiveness and applicants), your odds of matching are higher as you gain access to 10 positions rather than 8.

 

[clausewitz2]

When is the NRMP just going to bite the bullet and cap total applications? This current system seems like the worst of both worlds.

 

[TexasPhysician]

When is the NRMP just going to bite the bullet and cap total applications? This current system seems like the worst of both worlds.

I think that if NRMP did that then they would open themselves up to legal risks.

Programs were unhappy that they now had to interview many more applicants than before. Online interviews made it too easy for applicants to ramp up interviews, and med schools were recommending everyone get enough interviews to more than guarantee a match. I’m old now, but even I was told to interview at 10+.

The residency programs wanted a way to reduce their burden while pulling interested applicants.

 

[clausewitz2]

I think that if NRMP did that then they would open themselves up to legal risks.

Programs were unhappy that they now had to interview many more applicants than before. Online interviews made it too easy for applicants to ramp up interviews, and med schools were recommending everyone get enough interviews to more than guarantee a match. I’m old now, but even I was told to interview at 10+.

The residency programs wanted a way to reduce their burden while pulling interested applicants.

What risks are those? There is no positive legal civil right to apply to residency. Otherwise they couldn't require you to pay for it. There is also not some free alternative, they are the only game in town. Saying 'here is the maximum number you can apply to regardless of who you are' is not prima facie discriminatory. A disparate impact case would also be hard to make based on the available data. It would disadvantage IMGs and low performing students for sure but 'got bad grades in medical school' or 'educated overseas' are not protected classes.

 

[Stagg737]

When is the NRMP just going to bite the bullet and cap total applications? This current system seems like the worst of both worlds.

I don’t particularly agree with this. I had a pretty weak app and applied to 75 programs. Got 9 ii’s, if 3 of which were very unexpected. If you limited the number of applications significantly (say 25 or less) I probably would have gotten 3-4 iis total.

I think capping interviews would probably be the much better option. No one who got 20+ interviews was interested in every program, and after a certain point performance drops off due to fatigue. I don’t think people should be stopped from applying to reach programs, but capping ii’s would certainly help on both sides.

One could even create an app/system where first round of ii’s have to be sent out by X date and interviews selected by applicants by Y date. In the data base programs can see each applicant and who has ii’s left (how many ii’s they have left if we wanted that) and then send out another round of ii’s. Would let applicants know what programs are actually interested in them and have a competitive first round and then allow weaker applicant to pick up more ii’s and less desirable programs to offer ii’s to people that would actually want to be there.

 

[comp1]

There's no legal risk (they have a specific legislative carve out for their prima facie monopoly), but they make money from each additional application. Why in the world would they cap their income flow?

 

[Merovinge]

I think that if NRMP did that then they would open themselves up to legal risks.

Programs were unhappy that they now had to interview many more applicants than before. Online interviews made it too easy for applicants to ramp up interviews, and med schools were recommending everyone get enough interviews to more than guarantee a match. I’m old now, but even I was told to interview at 10+.

The residency programs wanted a way to reduce their burden while pulling interested applicants.

Definitely would need to agree to disagree. England has had a very small cap for ages and their medical training is excellent. They blind applications without names/pictures/ethnicities etc and allow a limit of (4?) places. This keeps every application to every program as highly meaningful to both the program and the trainee. We are clearly a larger country and medical training system but just straight capping at 10 seems extremely reasonable for all involved.

 

[TexasPhysician]

What risks are those? There is no positive legal civil right to apply to residency. Otherwise they couldn't require you to pay for it. There is also not some free alternative, they are the only game in town. Saying 'here is the maximum number you can apply to regardless of who you are' is not prima facie discriminatory. A disparate impact case would also be hard to make based on the available data. It would disadvantage IMGs and low performing students for sure but 'got bad grades in medical school' or 'educated overseas' are not protected classes.

I’d be surprised if there wouldn’t be an antitrust cause of action.

Imagine if I told you that you have 10 applications allowed to find a job. If those 10 applications don’t result in being hired, you are unemployed in your field for a year. It is forced reduced competition that results in direct harm to unmatched applicants.

 

[comp1]

Again, there's no antitrust action possible because Congress protected the NRMP SPECIFICALLY from such lawsuits way back in 2004. Of course the NRMP is a trust/monopoly. Everyone recognizes that and Congress still decided it's in the public's best interest to allow and even formally protect that. Changing the number of applications allowed would not change that law.

 

[TexasPhysician]

Again, there's no antitrust action possible because Congress protected the NRMP SPECIFICALLY from such lawsuits way back in 2004. Of course the NRMP is a trust/monopoly. Everyone recognizes that and Congress still decided it's in the public's best interest to allow and even formally protect that. Changing the number of applications allowed would not change that law.

Interesting. Didn’t realize that.