Nicholas Lorenzo, MD, Neurologist, AOA UNMC, Co-Founder www.emedicine.com, www.pearlsreview.com, The McGraw-Hill Pearls of Wisdom Board Review Series, and co-author of “Getting Into Medical School Today.”
Due to an increase in Caribbean schools, osteopathic schools, and international applicants, and the failure of the ACCME and U.S. Federal government to significantly increase training positions, there is a dearth of training programs. Unfortunately, some graduating medical students may go unmatched. The result is often owing not to a lack of ability but is usually attributed to poor planning. Many students fail to make a realistic assessment of their chances of getting into a specialty training program, or they optimistically only apply to only a few training programs by analyzing their chances of being accepted into a particular program or specialty.
The fact is that many programs favor students from their own schools or state. If this is the case, only a small percentage of national or international applicants have a chance. Other programs generally do not accept any foreign applicants or those from Caribbean or International medical schools. Others have published or unpublished cutoffs based on USMLE® Step 1, USMLE® Step 2 CK, COMLEX® Step 1, or COMLEX® Step 2; class rank; AOA requirement; or years from medical school graduation.
Students that don’t consider these facts may be wasting scarce funds on programs that are unlikely to offer them an interview, much less a training position. Yet, hundreds of applicants expend funds on applying to every single training program in a specialty, despite their odds of gaining acceptance being very small.
Choosing a residency training program that fits your personality is an important part of the process of achieving your ideal match. Willam Jennings Byran said, “Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be waited for, it is a thing to be achieved.”
Consider both private versus public hospitals. Private hospitals often provide a more favorable environment with insured patients and better funding, sometimes don’t offer as much opportunity for hands-on clinical experience. Public hospitals may be located in a challenging environment with socially challenged patients, yet they often provide higher patient volumes and a different experience. As a prospective resident, you need to carefully evaluate the time of training exposure that best suits your personality and tolerance to the conditions that surround you for several years of your life.
Another important consideration is location. While North Dakota or a small community hospital may not be the most pleasurable or interesting location, remember most of the next several years of your life will be spent inside with very few hours for play or recreational activities. Oftentimes you will get great training, and it may be easier to match in these locations. For example, in California or New York, there may be 10-20 applicants for every training position; in the midwest, it may be as low as 2-3 applicants for each position. While it is usually difficult to become a resident in more popular eastern and western communities, obtaining a residency in the midwest may be easier, and the training you will receive is similar.
Don’t forget family. Residency training is arduous and stressful. Having access to mom’s apple pie, dad’s sage counsel, and your family’s love and support should not be taken lightly. Most program directors will favorably consider an application that includes their desire to be close to family.
The best way to select potential residency training slots is to consider the type of applicants the training program regularly selects. You should compare your credentials to the requirements of the training program you are considering. If you can find the information, some of the criteria you should consider including the following for those selected for interviews and training:
- Percent on in- or out-of-state applicants selected
- Percent of applicants selected
- Percent of applicants that are from the Caribbean or foreign medical schools
- Average GPA or class rank
- Minimum USMLE® Step 1, USMLE® Step 2 CK, COMLEX® Step 1, or COMLEX® Step 2 scores
- Maximum number of years past graduation from medical school
- Special considerations (family ties, school affiliation, military status)
- The success of prior applicants from your school (your school advisor may have this data, etc.)
- Special qualifications (some training programs may favor older applicants, applicants with research backgrounds, additional advanced degrees, or those interested in rural practice, etc.)
- Idiosyncrasies (some training programs may look for unique applicants, such as those interested in international service)
Once you have determined a list of training programs that meet your needs and are most likely to consider you, your rank list should be checked against the recommendations of your mentor or advisor. Oftentimes residents in that the potential training area you have selected can give you further insight. Remember that your chances may go up for consideration if other students from your medical school have matched and the training program is familiar with the level of performance of prior candidates from your school. This may provide you with an edge when being considered.
Apply early! Get your application rank list in as soon as possible. Some programs have rolling selection slots, so in some cases, the early bird gets the worm.
Selecting a residency training program requires a great deal of thought. Evaluate your chances, consider all your options, and evaluate your application list carefully. A realistic and objective determination of your chances of being considered for an interview and position will increase your odds of being offered an interview and ultimately a training position.