Blog Archives

Your Residency Application: Six Factors to Prioritize When Creating Your Rank List

Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want – first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program’s location. It’s a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

6. Realize that most programs will train you well if you work hard. Their prestige and quality may be more similar than you think. For that reason, note that your personal preferences and intuitions are paramount.

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Emergency Medicine: A Career That’s Currently Taking a Lot of Hits

Having been in the field of emergency medicine since I started my residency in 1996, I can tell you that the discipline has had its ups and downs. Currently, the specialty is facing a lot of challenges: COVID has driven some physicians out (to utilization review, administration, research) and has adversely affected others emotionally. Additionally, there’s a tremendous dearth of positions currently for emergency physicians. I’ve had friends and colleagues lose promised hours or their jobs entirely in the last 18 months. 

Here’s a short piece on the job scarcity issue. Those choosing a specialty must consider the atmosphere of the job market (while recognizing it might improve in a few years).

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The Ins and Outs of Choosing a Specialty: The Generalist vs. The Early Committer

For many third-year medical students, this is a challenging time of year: Contemplating an ERAS application can be daunting, but it’s even worse if you don’t know what specialty you want to practice. Here’s a short piece I wrote with my colleague David Presser, MD, MPH called “Choosing a Specialty: The Generalist vs. The Early Committer,” and here’s a complementary (non-medical) New York Times article called “You Don’t Want a Child Prodigy” that’s a great follow-up piece.

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An Oversupply of Emergency Physicians?

When I applied in emergency medicine (EM), I had only two other classmates submitting applications to the field. EM wasn’t a very popular specialty, although that would change as the show ER became hotter. Although enthusiasm for the field has generally increased over my career, medical students’ interest in EM has waxed and waned.

Recently an eight-organization consortium of EM groups analyzed the field’s workforce, demonstrating an oversupply of emergency physicians likely to appear over the next decade. There are a number of reasons proposed, including the proliferation of EM residencies and inappropriate use of physician extenders. Take a look at this piece in ACEP Now for detailed information, especially if you see EM in your future.

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The Rank Order List Access Opening Soon: Check Yourself Before You Wreck Yourself

On February 1 at 12 noon EST, Rank Order List (ROL) access opens, meaning applicants and programs may begin entering their rank lists at this time. Start now to think about your priorities and specifically, where you will be happiest. Waiting until the last minute and making impulsive changes to your list is not a great idea.

Please make sure to avoid simple missteps in creating your rank order list. Improving written materials and interview skills is important, but all of that work can go down the drain if applicants do not understand basic strategies for the Match. In November 2015, the NRMP published an article called, “Understanding the Interview and Ranking Behaviors of Unmatched International Medical Students and Graduates in the 2013 Main Residency Match” in the Journal of Graduate Medical Education. The data is especially important for IMGs who represented the majority of unmatched candidates.

Sadly, the authors found that some applicants made strategic errors including the below:

– Not attending all interviews, thus failing to capitalize on every opportunity to market themselves.

– Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.

– Misunderstanding the Match and ranking programs at which applicants did not interview.

– Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital. She was appointed to the Assistant Residency Director position for the Harvard Affiliated Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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