1. Establish a relationship with the program director at your institution (and additional mentors, when possible) for the specialty of your choosing to help you develop your plan for fourth year. He or she will help you determine:
- Your competitiveness for the field
- How many programs (and of what type) to apply to based on your academic and geographic needs
- Other possible goals for fourth year to round out your application, which may include particular letters of recommendation to obtain, research needs, away rotations, etc.
- The earlier you meet with the PD the better
- Take their suggestions very seriously but always seek additional viewpoints when practical
2. Talk to as many people as you can to gather as much match “experience” as you can. Match experiences are highly variable and often passed down from generation to generation. Talk to residents, classmates, recent grads, etc. throughout the process. Take all advice seriously and with a full shaker of salt.
3. Update your CV and write your personal statement early. Write multiple drafts. Sit on them. Give yourself time to get it right.
4. Complete your application in a timely manner. For the NRMP (regular) match, that means your goal should be September 15. This really does matter and can make a huge difference both in the quantity and quality of the interviews you receive, as well as when you receive them during the process (which can make your scheduling much more flexible).
5. Apply to the appropriate number of programs for your specialty and competitiveness. Like college, it’s important to have a mix of reaches, reasonables, and safeties. It is much better to over-apply and cancel unneeded interviews than it is to under-apply, as it is much more difficult to obtain interviews later in the season if you are short.
- Avg # of applications: 20-30 (up to 60ish for dermatology)
- If you are applying to an advanced specialty (which includes most but not all radiology, radiation oncology, dermatology, ophthalmology, physical medicine & rehab, and some anesthesia and neurology), do not forget to apply to preliminary and/or transitional (PGY1/internship) programs.
- Talk to as many people as you can (fellow students, residents, and faculty) to learn about programs. The internet can be helpful (sometimes) but is irritatingly insufficient. Forums, in particular, can also be a very stressful read.
6. Check your email constantly, including your spam folder, as interview invitations are almost always granted via email and often demand instantaneous responses in order to get desired dates. Do not hold onto invitations without responding. It’s an invitation, not a guarantee. If you are unsure, schedule the interview and then cancel in a timely manner (never no-show on the day of) or request to reschedule if necessary (politely).
7. Interview at the appropriate number of programs.
- Avg # of interviews: 10-12 (ranking 12 virtually guarantees a match in most specialties)
- Do not plan to enter the SOAP under any circumstances. There is no benefit to this “strategy.”
- For advanced specialties: preliminary programs vary widely in competitiveness and intensity. Make sure to have a sufficient number of preliminary programs as well. There are often some categorical and “pseudo-categorical” programs that have internships more or less included with the advanced spot. Residents who under-interview for preliminary or transitional year (TY) programs may find themselves forced to scramble into preliminary surgery years (generally undesirable). Take getting an internship seriously.
- If you receive less than 10 interviews by November then you may need a backup plan and should consult your advisor. You should go on at least 7 interviews.
8. Make your rank list. There is no gaming the system, just put your programs down in the order you actually want them. Rank every program you interview at unless you would literally rather not have a job than train there.
9. Inform programs of your intentions:
- You may tell your number one (and only your number one) program that they are your very first choice.
- Tell other programs of your interest. Do not lie. Statements like “very high on my list” are fine so long as they are true. These general statements are generally viewed as meaningless (because they generally are!).
- Do not believe programs when they tell you nice things. Rank only as your dreams dictate, not based on any verbal or informal agreements.
10. Enjoy the matching process. Try not to stress.
- You will be informed on the Monday of Match Week if you’ve matched (or not). This will include both prelim and advanced positions when applicable.
- If you do not match, you will have the chance to enter the SOAP (formerly the ‘scramble’) match of unfilled positions. There are jobs out there, but the quantity and quality are highly variable, and one should never plan to enter the SOAP.
That’s a quick recap of fourth year, ERAS, the residency interview process, and the NRMP match.
13 Comments
Hello Ben,
Been reading various of your posts and it is always a pleasure to get some insight from you. I had a couple of concerns that I was hoping someone more insight can provide some input on. I am a Canadian IMG, studied in the Caribbeans. I also had a 2.5yr gap between MS2 & MS3 due to some financial problems. Now I am wondering how much of a realistic goal it is to apply to the 2018 match. I have been feeling very demoralized after hearing stories of students going un-matched and giving up on their career goals altogether. I do have good USMLE Step 1 & 2 scores (Above the mean). But this gap year and the fact that I will be needing a Visa sponsorship is proving to be mind numbing for me at times. What are your thoughts on this subject?
Thanks!
I’d argue that financial and time cost of interviewing is relatively small compared to the psychological and opportunity cost of not carrying out your original plan and wondering what if. A gap for financial reasons is presumably easier to explain than one due to a personal or moral failing etc, so I wouldn’t consider it a dealbreaker. You’re still a native-English speaking IMG. Most of you will match assuming you a pick a reasonable specialty and apply appropriately.
Hi Ben
I’m a similar situation to John except my Step 1 and 2 scores are at the mean or average, not above it, I’m Australian and I have no visa issues (due to marriage to an American). I’m hoping for internal medicine and happy to go anywhere in USA. However my partner is from Texas as I believe I read you may be as well? She would love to return. Any thoughts about matching in IM in Texas? From a quick glance at programs such as University of Texas Houston, University of Texas Medical Branch and University of Texas Health Science Center at San Antonio, there seem to be some IMGs. But I would also be happy at a community program in case academic programs are too difficult to match for IMGs (according to what I’ve read on Student Doctor Network). My goal is to match into a subspecialty, but I’m not quite sure which (perhaps medical oncology).
Kind regards,
Michael
Thanks for the prompt reply, I hope to match into IM, and will definitely be applying broadly. Let’s hope the statistics work in my favour!
Texas has a lot of programs and spots scattered across the state with a wide spread of competitiveness. Not a bad place to want to be. Your accent will help during interviews, as will your ties to the state via your wife. Make sure that your adoptive Texan status makes it into your application (at least for the Texas programs).
Cheers, Ben, that’s very helpful. And I had been worried my Australian accent would stand out!
Hi!
I have applied to several categorical and preliminary positions at the same program. When offered an interview how do you know which spot it is for? Do residencies rank you twice for each position?
If you mean the same program, like prelim and categorical internal medicine, they would generally interview all people all at once anyway. Places don’t tend to have separate prelim and categorical interview days or anything. What you’re really doing there depends on what fields you’re really talking about. Prelim and categorical are separate spots in the match and separate rank lists.
For example, in internal medicine, prelim spots are essentially universally for people going on to advanced fields like derm, rads, etc, so it’s a very different kind of person interviewing for those spots than the categorical spots at the same program, which are actually for people going into the internal medicine.
In general surgery, however, it’s not uncommon for some candidates to interview for both and for the “best” candidates to match categorical and for others to be offered a consolation prelim year as a chance to prove themselves (but mostly to function as cheap labor).
Hi, I am relatively new here and I appreciate all the information and advice that you provide for students and residents on this journey. I am confused as to why you make entering SOAP such a negative thing?? At the end of the day, even if you SOAP into a residency spot, you have still gotten residency. For many IMGs especially non-US citizens, matching via the main Match is not always guaranteed. Hence, the back up plan to SOAP in. There are many obstacles, personal setbacks, financial, failed exams, etc. that could play a role in a person matching so maybe for that particular candidate, SOAP may be the only option. I have worked with many residents, who are brilliant and very hardworking, where this is the case and it’s discouraging to see a fellow physician be so against SOAP without taking into consideration that each candidate does not fit the mold of an “ideal candidate”. Obviously, every candidate’s goal is to match via the Main Match but making SOAP seem like a negative or bad thing is not helpful for prospective students and residents. Maybe try to be a bit more gentle and compassionate about candidates entering SOAP. Take care!
I think you’re projecting. This is advice, not judgment. The SOAP is a plan B. It’s nothing against people who need to do it, but it’s stressful and uncertain.
Years ago when this was written, there were people who argued that you didn’t need to interview at many places because you could just scramble/SOAP into a position on the backend. The commentary here is intended to suggest that using that as a primary matching strategy is risky, especially in competitive fields when there are sometimes few to no positions in your desired specialty.
No projecting going on in my end, I did not have to SOAP for Match. I am simply just giving you my opinion on your choice of words and take on SOAP. As I stated before, I have worked with many attendings and residents who were IMGs that had to SOAP in. Simply put, based on your reply, it makes sense to your advice on SOAP, however, the way you have worded it in the information above, does not portray this. That is why I was merely suggesting that you try to be more compassionate or in this case, maybe update the information so it doesn’t make you come off as someone who is against SOAP! Anyways, thats just my two cents. Take care.
Sorry I didn’t mean projecting your feelings about your personal experience, I meant projecting emotions and judgment on me as an interpretation that is not substantiated by the text.
“Do not plan to enter the SOAP under any circumstances. There is no benefit to this “strategy.””
“There are jobs out there, but the quantity and quality are highly variable, and one should never plan to enter the SOAP.”
Both of the only two statements on the SOAP merely suggest that the SOAP shouldn’t be the plan.
There’s nothing wrong with not matching and there’s nothing wrong with getting a position in the SOAP. The whole point is that it shouldn’t be the plan going in.
But you are correct that the situation is different for IMGs, who have completely different odds. IMGs planning to SOAP into unfilled medicine, family medicine, peds, etc because many programs won’t interview them during the regular season is common. This post is written from the perspective of and for an audience primarily of US grads. There are plenty of other details here that also don’t really work for IMGs, even back 12 years ago when this was published.