Unmatched applicant advice.

[TheLoneWolf]

Hi there,

I have a student who I am mentoring who is a Caribbean IMG who went unmatched last year, only got 2 anesthesia interviews. Boards are 250s and 260s.

Did 3 anesthesiology rotations as a med student. Great letters. Will be writing step 3 soon. Working on an anesthesia case report.

Anyway, I was wondering which would you recommend of the two options would be worth doing:

A 2 month anesthesiology rotation after having graduated vs full time research assistant in a non anesthesia field at an Ivy level university. The research is relevant to a subspecialty of anesthesia.

Any thoughts would be appreciated, especially from faculty and PDs who previously interviewed applicants. Thanks.

One other point, will the coming match likely be online or in person interviews?

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[GassYous]

Research. How would a rotation help

 

[okayplayer]

Damn. Brutal

 

[IMGASMD]

Name brand may open some doors, whether as another two months of rotations won’t. (Unless those rotations have a residency associated with it, and your applicant will do “everything” to get in).

Get a good letter from Name brand PI, may still have a shot.

Need to apply super broadly, and a backup field this time around.

Not a PD.

 

[Katheudontas parateroumen]

Absolutely research. That sounds like a good deal. Hopefully get some publication out of it and also some connections. But also continue shadowing in the anesthesia department or something clinical. Reapply broadly and with back up as poster said. I believe things are still virtual for now (at least this upcoming cycle). But could change by 2023 match cycle.
I’m just a resident but we are pretty involved with the applicant process

 

[ToKingdomCome]

How crazy was anesthesia competitiveness this year or was it just because of virtual interviews ?

 

[BLADEMDA]

I would think by October interviews would be "in person" again as the all the people involved are fully vaccinated. CDC guidance and common sense dictate that if everyone in the room is fully vaccinated then the risk of infection is very low. There is no need for ZOOM this fall and those programs that recognize this pandemic is essentially over in the USA ( by the Fall) will be all the better off for it.

 

[Zekchar]

As other shave stated, research elective is the better option. While the past year was off due to COVID Zoom interviews, the lack of interviews is troubling. Are there any other red flags? Personality deficits or something else? 2-3 Interviews is very few, with those board scores. Anyways. good luck to this person.

 

[BLADEMDA]

How crazy was anesthesia competitiveness this year or was it just because of virtual interviews ?

IMHO, virtual interviews hurt a lot of otherwise qualified candidates. I agree with the others that the IMG should do the research year.

 

[IlDestriero]

Not to be horribly pessimistic but I know a Caribbean grad that did fine, graduated in 4 years, passed everything, applied broadly, and now does commercial real estate. They also did a couple research years, a couple “one last tries”, etc. And this is a person with some significant connections.
They should develop a plan B. The longer they’re out, the harder it gets. Worst case they drop plan b prep.

 

[chocomorsel]

Not to be horribly pessimistic but I know a Caribbean grad that did fine, graduated in 4 years, passed everything, applied broadly, and now does commercial real estate. They also did a couple research years, a couple “one last tries”, etc. And this is a person with some significant connections.
They should develop a plan B. The longer they’re out, the harder it gets. Worst case they drop plan b prep.

I was about to page you for assistance with your big name program abs connections.
Well, you have an answer. Hell, I need to get into real estate myself.

 

[AnonymousPD]

LoneWolf,

Without knowing a little more about this applicant, it is difficult to give good advice specific to their situation. Am happy to discuss the specifics privately if you feel it might be helpful.

There are a number of issues here that need some clarification. Your mentee went on 3 away rotations, but only got 2 interviews. So at least one program declined to even interview them after spending a month with them. Figuring out what happened there may help lead you in the right direction going forward.

There is no question that last year’s application cycle was tough on DO’s and IMG’s. Where did they apply? They had 3 interview invitations. That means one thing if they only applied to the top 20 of whatever their favorite list of top programs was. It means another thing if they applied broadly. In the most optimistic of scenarios, the solution could be to apply more broadly.

Ultimately…what this applicant needs to do going forward depends on what their goals are. Do they have an ultimate goal of being an academic faculty at an academic institution? Or do they just want to get into an anesthesiology residency, get boarded, and work in a clinical practice? I ask this only because some programs could care less about what sort of research they’ve done and others care very, very much.

One other thing to consider. The easiest path to an anesthesiology position might be through another specialty. Most of the concerns a PD might have about an applicant coming out of medical school would be addressed by completing a residency in another specialty. Many of our most successful residents have come to us after finishing (not transferring out of) other residencies. Most commonly peds and IM. As a general statement, being able to successfully completely one residency means you are likely to be able to successfully complete another.

Consider this. In an alternative universe, let’s say your mentee failed to match anesthesia but ranked a few backups and matched into IM. They could complete an IM residency and have the option of working as a boarded internist (3 years). Or apply to one of the many interesting IM fellowships. Or try and apply for an anesthesiology position. Total time of 6 years post-graduation to be a double boarded anesthesiologist (with other options along the way). In the current universe, your mentee is going to need to find something to do for this year, then hopefully match into anesthesiology next year…total time 5 years post-graduation to be an anesthesiologist. A couple of others in the thread mentioned having a plan B…and this is one example of why that’s a great idea for applicants who are at risk for not matching.

Finally, this is another example of how board scores are only one small part of what recruiting committees look at when assessing applicants. Please…those of you with low scores, don’t despair. And those who did well, don’t let up.

 

[GaseousClay]

really gonna be rough for IMG and DOs now that step 1 is pass/fail

 

[BLADEMDA]

For fall those IMG and DOs out there with questionable applications I firmly believe it is better to MATCH into any field like FP or IM than go unmatched.

Like the PD stated in another post, at least after completing a residency in ANYTHING you have options and are viewed in a better light than an unmatched applicant repeating the process. I understand that "wasting" 2 years of your life completing IM or FP may not be the game plan, but this could be what it takes to ultimately obtain a successful career in medicine.

So, my advice for the IMG in this thread is to go ahead with the research year but definitely dual apply for FP/Anesthesia or IM/Anesthesia next cycle. In fact, the focus should be on matching into FP or IM ( likely) vs Anesthesia (unlikely) for the next cycle.

With the vast increasing number of applicants, any match is a "win" in my opinion.

 

[NicMouse64]

For fall those IMG and DOs out there with questionable applications I firmly believe it is better to MATCH into any field like FP or IM than go unmatched.

Like the PD stated in another post, at least after completing a residency in ANYTHING you have options and are viewed in a better light than an unmatched applicant repeating the process. I understand that "wasting" 2 years of your life completing IM or FP may not be the game plan, but this could be what it takes to ultimately obtain a successful career in medicine.

So, my advice for the IMG in this thread is to go ahead with the research year but definitely dual apply for FP/Anesthesia or IM/Anesthesia next cycle. In fact, the focus should be on matching into FP or IM ( likely) vs Anesthesia (unlikely) for the next cycle.

With the vast increasing number of applicants, any match is a "win" in my opinion.

Even as a low-tier USMD with decent board scores, I somewhat feel the need to do this......

 

[el mero mero]

IMGs and less competitive DO candidates should apply broadly and have a backup plan. research sounds great but i don't think it helps candidates much in Anesthesia.

S/he would have been better served matching a prelim med or surgical year. Strong letters of recommendations from people that have seen an applicant clinically would open more doors than would letters from a lab

 

[DazedWanderer]

Their best bet probably would have been doing a surgery prelim (sans red flags that should be relatively easy to match, as they never fill pre-scramble), getting good letters during that year, and then applying for anesthesia again including physician reserved spots. Did this applicant apply to surgery prelims and did not even match that? Or they didn't do their homework with regards to how one must position themselves as an IMG to have a good chance of matching and didn't bother applying surg prelims and low tier programs?

 

[TheLoneWolf]

Their best bet probably would have been doing a surgery prelim (sans red flags that should be relatively easy to match, as they never fill pre-scramble), getting good letters during that year, and then applying for anesthesia again including physician reserved spots. Did this applicant apply to surgery prelims and did not even match that? Or they didn't do their homework with regards to how one must position themselves as an IMG to have a good chance of matching and didn't bother applying surg prelims and low tier programs?

Applied transitional years and prelim medicine.

Maybe needing a visa hurt their chances.

 

[secretasianman]

Such a weird paradox where things have become so absurdly difficult to achieve for physicians, but if you’re a mid level you can “specialize” in whatever you want.. plus without the debt to hold you down, this may be a less risky proposition with better ROI…. Medicine is so messed up.

 

[ace_inhibitor111]

Such a weird paradox where things have become so absurdly difficult to achieve for physicians, but if you’re a mid level you can “specialize” in whatever you want.. plus without the debt to hold you down, this may be a less risky proposition with better ROI…. Medicine is so messed up.

Worst case scenario, in oversaturated areas you can still work as a nurse making resident-level salary. Meanwhile, there are unmatched residents out there taking up secretary and minimal wage jobs.

 

[nimbus]

Worst case scenario, in oversaturated areas you can still work as a nurse making resident-level salary. Meanwhile, there are unmatched residents out there taking up secretary and minimal wage jobs.

One of the options for unmatched medical school graduates is to attend nursing school. And one can work while attending nursing school. I used to work with a nurse who was an orthopedist in the Philippines.