Roads to Residency

Did you catch that? The optimistic astute observer will be intrigued by the plural in the title, whereas the pessimist may presume it to be a typo. Rest assured, this is no typo as there are many roads (traditional and non-traditional) to reaching your residency destination. First let’s talk numbers. Numbers don’t lie. Numbers are not your best friend telling you that everything will be okay. In the 2016 match, there were 42,370 total registered applicants and 30,594 positions were filled1. Both of these figures were record highs. What happened to the remaining 11,776 unmatched applicants? Some will move on to other careers, some will reapply the following year with the same application. What will set you apart is how you use this time to boost your chances for the following year.

Traditional:
First let’s briefly outline what most students already know about applying for residency. Application is online through ERAS in September of the year before the intended match. Interviews occur between October to December, rank lists are due in February, and if your tale has a storybook ending like most NCAA teams hope for during March Madness, then March = Match!

Non-traditional:
So you didn’t match? What now? Is this the end? What are you going to do with $250,000 in student loans and this MD degree? Most unmatched applicants struggle with these difficult questions. Immediately post-match the SOAP (Supplemental Offer and Acceptance Program) is active online from Monday-Thursday of match week. In 2012, SOAP replaced the process formerly known as “the scramble”. To be eligible for SOAP and have access to the unfilled list of programs, an applicant must have applied to at least one program during the regular ERAS match cycle from September to December.  

Life after SOAP:
So SOAP didn’t work out? This is time to pause and take stock of your goals. Be honest with yourself. How can you improve your application to re-apply? Perhaps an alternative career may be better suited to your particular strengths. If your goal still includes residency, then there are a number of ways to turbocharge your application.

Application enrichment often includes an obervership to gain valuable clinical experience, updated recommendation letters, and a unique opportunity to audition at a hospital where you are likely to match. Working in medical education has the benefits of being in an academic setting, staying current with today’s medicine, and networking with academic faculty. Working in research is considered a scholarly activity and gives you something interesting to speak about on your interviews. Other scholarly activities include taking Step 3 or working towards advanced degrees such as an MBA or MHA which make you more dynamic in today’s modern healthcare world.

Networking is the single most important skill to cultivate during your year off. Be honest, would you hire yourself today? Why not? After addressing your weaknesses as detailed in the above paragraph, now it’s time to network. Promote yourself at the local and national level by attending conferences and professional society meetings. If you’ve been doing research, submit your abstracts to various conferences and strive for publication. Regularly pause and take stock of your progress. Each day should be getting you closer to residency.

What to do when all positions are “filled”?
The following resources are freely available. Some examples may apply to preliminary/transitional residents looking to secure advanced standing PGY2 positions.

AMA residency vacancies:
Bookmark and follow this website for postings for open PGY-1 as well as advanced PGY-2 positions.
http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/resident-fellow-section/rfs-resources/residency-vacancies-work-environment/find-residency-fellowship.page

ACGME listings:
Focus on programs with new/initial accreditation which need to fill their class. This list is particularly useful for residents who may have completed a preliminary year in Internal Medicine, General Surgery, or a Transitional Year and can apply for advanced PGY2 standing. As of 2016, there are 431 Internal Medicine programs and 498 Family Medicine programs. Among the advanced residencies which require an intern year, there are 139 Neurology programs, 189 Radiology programs, 137 Anesthesiology programs, and 81 Physical Medicine and Rehabilitation programs.
https://apps.acgme.org/ads/public/

Keys to success:
Instead of filling this paragraph with clichés like hard work always pays off (it does) or everything happens for a reason (sometimes), or you only live once (unless you’re a zombie!), let’s focus on staying motivated and driven for the long haul. This is a long and difficult road. Keep in mind the following excerpt from President Barack Obama’s commencement address at Rutgers University this spring2. “Gear yourself for the long haul...you're going to have some setbacks…You will be frustrated…You won’t always get everything you want -- at least not as fast as you want it. So you have to stick with it. You have to be persistent. And success, however small, however incomplete, success is still success…So don’t lose hope if sometimes you hit a roadblock. Don't lose hope in the face of naysayers. And certainly don’t let resistance make you cynical. Cynicism is so easy, and cynics don’t accomplish much…Don’t let that be you. Don’t waste your time waiting.”

References:
1) NRMP Match statistics:  http://www.nrmp.org/wp-content/uploads/2016/04/2016-MRM-infographic-post-SOAP.jpg

2) “Remarks by the President at Commencement Address at Rutgers, the State University of New Jersey”. The White House, Office of the Press Secretary. https://www.whitehouse.gov/the-press-office/2016/05/15/remarks-president-commencement-address-rutgers-state-university-new

3) Accreditation Council for Graduate Medical Education

4) American Medical Assosciation

5) The staff at MasterTheWards for their continued support and guidance. http://www.masterthewards.com/

 

Dr. Raman Sharma is a Physical Medicine and Rehabilitation resident in White Plains, NY where he has taken leadership roles in the program.  He completed his internship in Internal Medicine in Brooklyn, NY. He holds a faculty appointment of Adjunct Clinical Instructor for Touro College of Medicine for a clinical training site in Brooklyn, NY. Raman is also a Captain in the United States Air Force Reserve Medical Corps.

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Raman Sharma, MD

Dr. Raman Sharma is a Physical Medicine and Rehabilitation resident in White Plains, NY where he has taken leadership roles in the program.  He completed his internship in Internal Medicine in Brooklyn, NY. He holds a faculty appointment of Adjunct Clinical Instructor for Touro College of Medicine for a clinical training site in Brooklyn, NY. Raman is also a Captain in the United States Air Force Reserve Medical Corps.