I have been getting many emails after the match results. A lot of students who visit my website are going through an extremely difficult time. Be it frustration because you have tried everything and still did not match or anger at an unfair system who prefers people with super high scores or contacts and leaving out genuinely hard working people or pure helplessness because the mistakes you made in the past with your application cannot be undone.
In this emotionally overwhelming time of your life, you open facebook or any social media and see your friends and people who you know celebrating their match success and sharing stories. And here, you are planning to go underground or disappear for an indefinite period of time.
I have been there many times. I felt something similar when I saw my low scores on my usmle results. I was able to turn it around in my favor when I eventually applied, but I have lived this painful experience through some close friends and family members who did not match. Now I stand together with students who have reached out to me before and were not able to match.
People deal with severe degrees of stress differently. Some take a downward spiral route with alcohol, drugs, persistent self-pity and inaction.
For those who know me and my principles, that is not the AlphaIMG way.
I prefer another way to deal with extreme personal or professional stress and failure. I came across this years ago in a book “Extreme Ownership” by Jocko Willink.
It is called Prioritize and Execute.
You can sit here in a puddle of misery for next 6 months and go through the same emotions at next match or you can prioritize the areas of your application that are going to create the most impact and start to execute each of those areas. Then you can celebrate and post pictures on facebook next match when you get that residency you deserve.
If you are clueless on how to prioritize and execute your application for the upcoming match, read on.
Step 1: Identify your target market
Every IMG who I coach for the match, the first thing I am looking for when I speak with them is what kind of programs I will target for them. Is she a university program (UP) candidate or a community program (CP) candidate. Applicants who have research and teaching experiences, who have rotations in specialty fields and who are aspiring to do fellowships are some markers of university program candidate. Community experiences, interest in primary care fields, strong volunteer focus display qualities for a community program resident. Identify if you are a UP candidate or a CP candidate.
Step 2: Look at your application from PD point of view.
Now that you know what category you are in, look at your application form the program director (university or community program) point of view.
Most PDs and interviewers are looking for a candidate who is going to provide the most value to their program. Not the candidate who has the highest scores or the one with most published papers. Candidate with a stellar resume may not be a good fit for a small community program focusing on serving a minority population. In this regard, every program is somewhat different.
If you are a UP candidate, is your application entirely consistent with what a university program is looking for?
If you did not match with 4 or more interviews and decent interview skills, I guess not. What is missing? Do you not have enough university clinical experience? Or are you lagging in research papers/posters? Same with if you are a CP candidate but your application is not true of a community physician. Be honest with yourself and list things that make you a wholesome UP or CP candidate.
Step 3: Prioritize. Make a list of your modifiable deficiencies.
Don’t worry about how you are going to get those research publications or clinical experiences yet, just make a list of things that make you a wholesome UP or CP candidate.
Don’t list low USMLE scores or old Year of Graduation on there. Those cannot be changed. But a lot can be. Prioritize based on what is deficient the most.
Step 4. Plan and Execute on those deficiencies.
Now that you have a list of things you need to make yourself be a perfect university or community program candidate, think about the ‘how’. How are you going to get that research papers or that rotation in a university program? If you are a CP candidate, how are you going to get strong LORs from community practitioners? Here are some articles to get you started on this process.
Step 5: Make 3-month plan.
Write down a plan for next 3 months. Not longer than that as things most likely change in 3 month period. Pick one thing on your list and target that for next 3 months. Explore every possibility you can to get that goal achieved in 3 months. Email every program that you know of. Reach out to every contact you have, even if you have not spoken to them in years. Plan on attending every conference in that field and meet as many attendings as you can.
I picked up side jobs and a loan to get the money I needed for the application. The interest rates on that loan were ridiculous. I paid it off very quickly once I got the residency. Never regretted it.
We all have a savage in us to get us what we want, it just needs to be unleashed. I know this because I saw it in myself and now I see it every year in some students.
Step 6. If you have less than 4 interviews.
It is very difficult to match for an IMG with less than 4 interviews. Your #1 goal this year is to get more than 4 interviews. Start reading this guide to make sure you get more than 4 interviews this year. All of the above still applies to you but you have to redo your entire application to get those interviews.
To summarize, start following these six steps to get over the misery of not matching as soon as possible and move on a positive spiral towards matching.
Step 1. Identify your target market- university or community programs
Step 2. Look at your application from a PD point of view- are you a UP or a CP candidate?
Step 3. Prioritize- make a list of your modifiable deficiencies in your target category.
Step 4. Execute- Start at the top of that list and make a plan to clear the first deficiency.
Step 5. Make a 3 month plan to execute on the first deficiency.
Step 6- Revamp your application if you have less than 4 interviews. Follow this guide.
There it is. 6 powerful steps to deal with the pain of not matching and ensuring that next year is a big success for you.
Do more observerships and externships, get more USCE… BUT HOW??
USCE is one of the most important pillars of your residency application. But it is becoming just as hard to get it as is residency itself. I get at least one email every day asking about how to get more USCE. A lot of IMGs have emailed many faculty members but have not received a single reply back.
If that is your problem, read this article. It will give you six ways to get observerships, externships, and research positions. I have yet to meet an IMG who was unsuccessful in getting USCE after using these 6 steps.
1. Local physician groups of your country of origin (AAPI, APPNA etc.) :
Don’t just show up at their events and ask each and every physician if they can let you shadow them in the clinic or hospital. Attend their meetings a few times. Be a friendly person in the crowd. See if you can volunteer for their events by asking the chairperson if he/she needs help. Then, when they starting knowing you a little bit since you have been going to the meetings regularly, ask them if they can let you rotate with them for a couple of weeks.
Knowing a faculty member/PD in a residency program is the highest level of contact. But most of us do not have that. Friends/neighbors in the US who know doctors, previous mates from medical college who are now residents, neighbors from back home who know someone in the US who is a doctor are contacts too. Use them. Don’t be shy now. You are going through the most decisive time of your career. Once you get into residency, you can pay them back or send them a thank you gift card.
If there is a medical conference in your city or close to where you live, try to attend that. I recently met a family medicine resident who met the program director of his residency program at once such conference, got to know him and got matched at his program. Even if you don’t meet the PD, you will meet a lot of faculty members. You don’t have to befriend everyone, but just by being present there for 2-3 days, being friendly and chatty, people will start to recognize you after a couple of days. Take contact information of those who you connect with the most and stay in touch. Registration for these conferences is not very expensive if you select a student rate.
Pro tip: Email them before you register and ask them if they will let you volunteer at the conference which provides free entry and tons of exposure to faculty members.
4. Previous rotations:
This was my go-to method to get more USCE than I can handle when I was applying. Once your current rotation comes to end, ask the attending you are working with if he has a colleague, friend or someone he knows in cardiology, GI or any other field you are interested in who you can go talk to and ask for a rotation. Repeat the process after each rotation.
5. Masters, Ph.D. programs:
I do not advocate joining one of these programs just to match but if you are in one already or have graduated, email your mentors, faculty, friends from these programs and ask them if they know someone who would let your rotate with them. This is how a lot of people get job opportunities in the US. Through their alumni circle. Again, this is no time to be shy and think “I don’t’ want to bother them, they probably don’t even remember me now”.
Pro tip: If you don’t try, you will never know. And there is nothing to lose.
6. Mass emails:
This is explained in the detail here.
These are very effective six steps that will get you into a rotation or research position. Most IMGs sent out ineffective emails for a few days and give up. That is using only one of the six methods to get USCE and that too not doing it right. No wonder they are unsuccessful. Be more aggressive in pursuing your dreams.
Decide right now what kind of doctor you want to become in the future. You can change it later.
It is also called polarization. And it works.
If you try to be liked by everyone then no one will like you.
And this social concept works for your residency application too.
With this article, I want to give you the secret sauce that will help you write a strong personal statement, CV and do well on your interviews.
It sounds too good to be true. But it is hundred percent true.
You decide exactly what kind of doctor you want to be and you make your personal statement, CV, interview answers point to that. You decide this based on your life, skills, experiences, and interests.
When I started applying, I was thinking of becoming a primary care physician (PCP) in a small town in the US. Of course, I didn’t do it (I am an assistant professor in a University now). But I made sure the story I told on my resume, personal statement and interviews matched my aspirations to become a damn good small town internist. In my personal statement, I talked about an incident in my medical college when I was working in ER and saw a patient I knew from my clinic rotation. The patient had a history of a medical condition that contraindicated the medicine infusion that the ER attending had started. Because I knew the patient well, I was able to stop that treatment before it caused harm. Experiences like these are very rewarding because I know my patients and they know me well. That makes me interested in becoming a PCP.
Yes, I still listed all the USCE, research and volunteer work I did. But, I paid more attention to the clinical experience and ability to work hard and connect with my patients (qualities of a PCP) in my personal statement and interview answers.
The program directors who trained residents mainly to go into primary care loved it. They talked about their residents who went on to start private practices and what not. They shared their stories of how good they feel when they connected with their patients and took care of them for years.
Big universities who train residents to become researchers and academicians didn’t consider me a good match. But most of them didn’t consider me at all because of my low scores.
Had I prepared my application with a little bit of research, a bit of clinical work, for both big universities and community programs, I would have appeared a weak candidate to all of them.
It is no secret that my scores were very low. In spite of that, I was able to get 11 interviews, 1 pre-match which I refused and matched at my top choice university affiliated program.
This is the secret sauce that worked for me. And it will work for you too.
Look at the big picture with your application right now. What are your strengths? All the work you have done so far. USCE you were able to get, research you worked on or got published, extra stuff you did back in medical school. Does it make you look like a person who is into primary care or a primary care/hospitalist who likes to do research or a specialist who enjoys clinical practice or a specialist who wants to research some novel treatment options and become well renowned for that? One time, I worked with an applicant who ended up matching at a University program with low scores because she focused her entire application on wanting to become a travel medicine physician (she had done some missionary work in Nicaragua). Another applicant had a successful match based on his interest in taking care of immigrant population in the US.
There are a number of different areas you can explore. The one you chose depends on your life experiences. Think about your life even before you joined medical college. Influences you had from your parents, friends, events in your life, experiences in medical college and later when you moved to the US.
Choose one specific thing you are thinking of doing in the future. Let that one thing be the flavor of your application. Let that one thing be the distinctive factor that separates you from thousand other IMGs. Talk about that in your personal statement and during your residency interviews.
Let that one thing help you get matched.
Writing personal statement is difficult, time consuming and often boring.
When your applications fits the program’s criteria for an interview, the PD looks at the personal statement and letters of recommendations to decide if you are worth the time and money to be offered an interview.
Also, once you get the interview, personal statement form the grounds for interview questions.
So, personal statement or SOP is incredibly important for your success of matching. Especially, if you have red flags in your application.
Recently, I took a class in health care quality and safety (link). This is an emerging new field in medicine focusing on improving the quality of health care in the USA and worldwide. For anyone who is interested in pursuing a masters or a graduate level course before residency, this is a great area to improve your chances of matching.
To be accepted in the course, the university required that we submit a personal statement. It has been more than three years since I wrote a personal statement for myself and I got stuck at the first line. I had three days before the application deadline.
I did what I learnt when writing my residency personal statement. I used the steps below to get it done.
With this article, I will show you how to start writing your personal statement for residency, what to do when you are stuck (writer’s block) and how to review the personal statement at the end to make sure there is no spelling of grammar error.
1. The beginning (The first words):
Set aside two to three 30-minute blocks.
Imagine a busy program director reading your application for the first time.
Make a list of things you want to tell him or her. Don’t filter or judge anything at this stage. Just start listing everything that comes to mind.
Think of your goals and achievements, life events that shaped you, failure and lessons you learnt, things you want to do in life and how residency in that field is going to help you achieve that.
Is there something that you did in your medical school, after moving to US, while raising a family that no one else around you was doing? (Real life examples: worked part time in a suicide hotline center, started a free drug sample clinic in med school, tutored high school or medical students, took long walks in the park).
Is there something your friends tell that you are good at?
List everything. Don’t stop yourself. Nothing is wrong at this stage.
My list looked for my graduate course personal statement looked like this:
- Practicing physician in a high turnover university setting for three years
- Trained at internal medicine residency program of UNC Chapel Hill. Another high workload program
- During residency, no exposure to healthcare quality except daily signal out to the next resident
- Gradually learning concepts of HQS while working as an assistant professor
- Experienced areas of healthcare in the US that did not provide the level of care compared to the money spent
- Physician burnout due to complexity electronic medical record
- Medical errors from flaws in system
- Personal story of medical errors committed because EMR was setup in a way to easily miss things
- Like to be in job where there is new to learn everyday.
- Play tennis in free time. First recreationally, now developing skills to play professional
Try to make at least 10 points. The more, the better. But don’t worry if you cannot come up with 10 points. You will find more things to say as you move on. Once you hit 30 minutes, stop, come back tomorrow and do the same for another 30 minutes.
Once again, don’t think how stupid it sounds or this is something you should not mention in a PS. Let your creativity flow. Just put down anything and everything that comes to your mind about your past life, experiences, achievements, failures, lessons learnt, skills that you have.
2. The middle (Connecting the dots):
Start writing sentences using the points above. These sentences don’t need to have the perfect grammar, spellings or flow of words. They serve only one purpose at this stage- connecting the points you listed.
So for examples, if I try to connect the points I made above for my personal statement.
I would write down something like this : “ Having completed my residency in internal medicine program at University of North Carolina, I was no stranger to the high workload and high stress medical environment. But, what I was not aware of was the extent of quality improvement projects ongoing at this institution. In residency, my experience of healthcare quality and safety was limited to an efficient and thorough checkout to the next resident coming on service.
You keep doing this until you go through most of the points on your list. Some points can be omitted if you realize they have already been covered in other sentences, not as important as you thought they were initially or you don’t want the PD to know about it.
Again, don’t judge the quality of your sentences at this time. Continue to write sentences to the best of your ability using the framework of the points you listed.
Stage 3: Just before the end (Personality formation):
By this stage, you should have about 1000 words or more in your personal statement. If you have less than 700 words, go back to stage 2.
This is a little tricky to explain.
But read over your 1000+ words you have written so far. Do you see an image of yourself being portrayed in the writing? (E.g. 1: hard working, dedicated student who always scored high in medical college but failed in USMLE step 1, learnt some lessons, came back and did very well the next time. Then started tutoring other students to avoid the mistakes she made. Now ready to move on with next step in becoming a primary care doctor that you always wanted to be. E.g. 2: high achieving and research focused doctor who is driven by researching new ways to treat heart disease, likes to be surrounded by people in off time).
It does not have to be one of these two examples. It can be anything that you feel represents you. If the sentences you have written so far don’t form a personality that matches your own, go back to step 1 and think of more points focused on your personality.
Personal statement has to be around 800-900 words to be able to fit legibly in one page. So cut down excess words now if they don’t represent you, have already been covered elsewhere and fluffy without adding meaningful content.
4. The end (Check grammar, spelling and flow of words):
Use MS Word, online grammar checker to check spelling and grammar. Make corrections suggested by these programs. Then have your computer read it out loud to you (ttsreader.com). Does the sentences flow from one line to next? Does it make sense to a first time reader? Make fine corrections based on this. Come back a week later and read your personal statement again. Do you like it? Does it need more tuning? What does your closest friend or family member think about it?
Do this every week till you are satisfied that you got a personal statement that is error free, rich in content that highlights your strengths and represents who you are perfectly.
Step 1. The beginning (The first words): Make a list of you life events, strengths, failures that you overcame, skills that you learnt, jobs that you took, projects that you started, hobbies that you are passionate about in two thirty minute blocks. Be creative. Don’t judge anything.
Step 2. The middle (Connecting the dots): Start writing sentences using the points above. Again, don’t judge the quality of sentences. Try to reach 1000+ words.
Step 3. Just before the end (Personality formation): read you personal statement and try to give it a personality that matches you perfectly. Add more points to step 1 if it lacks a personality. Remove words that don’t represent who you are. Try to cut down to 700 words.
Step 4. The end (Check grammar, spelling and flow of words): Fine tuning to ensure there are no grammatical or spelling errors, sentences flow from one to next without sounding chopping and it is an overall easy and pleasant read for the PD.
If you want me to help you get the perfect personal statement, sign up here
You have done everything you could.
USMLE steps, observerships, externships, some research and even volunteer work. You applied to a very long list of programs. And yet, you did not match.
I see this every year. Be it close friends, students that I know or people who I never knew but had exchanged emails and phone calls with through this website.
I know how it feels.
You feel all that time and money is wasted. You know you are not a fresh graduate anymore. You feel left out because some of your friends matched.
And the worse feeling is… what next?
Should I do more observerships? Maybe try to make contacts in residency program? Or should I try to get research first? Should I forget about applying and move on with other careers?
I am not going to show you a golden road to getting residency in the next match. Because there is none. Anyone who is promising you one is selling a lie. But I am going to give you the exact steps you can start taking NOW to improve you chances of matching this time.
These steps will give you a roadmap for the future if you are serious about matching. It does not guarantee success. But it statistically improves you chances of matching
1. Prepare mentally and financially to apply to a lot more programs.
I can’t stress this enough.
I have seen too many IMGs trying to save money when deciding about the number of programs to apply to. After unable to match for three of four times, they realize they should have applied to a lot more programs than they did in past three years. It’s painful to pay thousands of dollars to programs who you may never hear from again. I took student loans from a bank in India (top that with an interest rate of 13%) for my application. But, it costs much more to apply to fewer programs year after year if you add it all up. And you lose the time to start earning money. Let me tell you this, the money you spend now is going to be much less compared to your earnings as a resident and later as an attending.
There is no magic number to how many programs you should apply to. Just to get your mindset right, I had USMLE scores in low 200s, no attempts, MPH, some research and good USCE. I applied to 230 programs (IMG, FM, pediatrics). And I matched in Internal Medicine. This was back in 2010.
2. Start getting your program list ready
This is the time to start getting the list of programs ready.
You may be working hard to get more USCE and do some research, you have no time for looking at website for programs. But if you wait till August, and you will have to find the generic list off the internet to apply to. If you are going to invest thousands of dollars, make sure you research your programs well.
Get the list of all participating programs for your preferred specialty. Cross out the ones that did not invite you for interview in the past. Cross out the programs that you know are not very IMG friendly (Ivy League Medical schools). Look at 5 programs a day. Look up their website to see their requirements and current residents for IMGs. Make note of anything mentioned on their website that matches your resume pretty closely (eg. they are proud of their immigrant clinic exposure for residents and you have done an observership in an immigrant clinic).
Move on to next program. If you see a lot of IMGs on their list, but you are not sure if you meet their requirements, send an email to the program coordinator. They are more likely to respond at this time than when the match season starts.
Once you have reached the end of your preferred specialty, get the list for the next specialty you are interested in. And do the same as above.
Keep picking different specialties until you find at least 200 programs that you feel confident that are not going to screen out your application.
3. If you are going to be more attractive to community programs, stay active clinically till the very end.
There are certain candidates that university programs find very attractive. These candidates have a strong research background, high scores and academic interests. Then there are others who would be better suited for a community programs. You know what kind of candidate you are. You may have gotten more interviews from community programs over university when you applied before. It is better to recognize this early. Nothing wrong with going to community programs for residency. Some of them have fellowships or able to get you fellowships in the state, they offer great clinical education and they are easier to get into.
If you have identified yourself as a community program candidate, you need to play the part of a community physician. These programs are looking for work horses. Someone who is ready to work hard and is competent to do the same. To be that someone, you have to demonstrate a very strong clinical experience. And to do this, you need to make sure you are active in an observership or externship for a long (more than a month) period of time in a clinic or hospital when you apply. And you need to have good letters of recommendation from these rotations.
That means when you find your next rotation, make sure you schedule it in a way that your are still working there when you apply.
4. If you are going to be more attractive to university programs, stay active in research (and clinicals) till the very end.
Yes, there are many candidate who are very attractive to university programs but they did not match. If you are someone with a PhD or a long time research job, a few first author publications/abstracts and presentations, green card/ US citizen, good scores and other academic achievements, university programs are going to be more interested in you. Community programs feel that you will not rank them high because you will pick the big name universities first. So it’s time to own your talents and play the part of a smart academic physician.
Continue your research until you apply and preferably when you interview. Talk to your principal investigator, head of the research project, lab owner to let you in on another publication, have you present a poster or a research paper, critique the work of others etc.
This is in addition to focusing on USCE as well. You will have a much more advantage during match if you have more clinical rotation in universities than private clinics. This is true for all IMGs but specifically for you because universities want people trained in similar setting as their own.
5. Re-write your personal statement
I can’t tell you how many times I was impressed by someone’s ERAS CV but totally lost it when I read their personal statements. This was either because the PS lacked a career focus, personal story that is genuine or it was a generic PS copied from the internet.
Your PS might need just a little tweaking or might need a complete overhaul. But if you have used it last year and you did not match, you can’t use the same thing again.
Read your CV first. Then go over your personal statement word by word. Do you feel you are able to express if you are presenting an image of an honest, hard-working and compassionate community physician or are you presenting an image of a competitive and brilliant academic doctor who is a great teacher as well?
Your personal statement should portray an image that is true to your CV and the types of programs you are going to target. If your personal statement is unfocused or focused towards your research and you are a community program kind of applicant, then you need to fix that.
If you need more help with this part of your application, click here.
6. Re-write your CV
ERAS gives you a format to follow for CV. So you cannot be very creative with this. But within each subsection of the fomat, you can show a unique personality.
Literally every IMG writes ‘history taking’ and presenting the ‘case to the attending’ when describing duties at the observerships/externships. That makes your observership the same as every other IMG’s observership. The program director is probably not even going take this USCE into account.
Instead, write about what made this USCE different and how it made you a good doctor. There is no right answer here because we all learnt different things in different rotations.
I wrote ‘history taking’ in my CV for an externship in geriatric clinic. My attending in that clinic corrected me and told me to write this instead ‘practiced discussing end of life care and do not resuscitate orders with the families’.
The program directors at the interviews loved it !
Again, follow this link if you need more help with your CV.
7. Prepare for the interview.
You have come this far. If you follow above 6 steps, you are statistically positioned to get at least 6 interviews. Based on previous year’s match, that all it takes to match successfully.
That is true only if you don’t mess up your interviews.
Interviews are designed to get you stressed out. Pre-interview dinner, conference/rounds next day morning, multiple one on one interviews during the day, social hours with faculty or clinic staff etc. And how you perform during each of these events is taken into consideration.
Unfortunately, IMGs only prepare for the usual interview questions when getting ready for interviews. It is like preparing for just one section, say pathology only, for USMLE step 1.
To ace your interviews, you need to work on social skills, language fluency, typical interview questions, atypical interview questions and dressing/body language. And you need time to get all these aspects handled. So start preparing for interviews as soon as you get your first interview invitation. There is a lot of information on preparing for interviews, including on this website. You can read all about it here, here , here and here.
But if you need personal one on one coaching and mock interview sessions with language fluency and social skills training, go here.
That is it my friends. To make sure you don’t waste any more time or money chasing this American dream, make sure you put in the effort to get these seven steps handled well in time for the match season to start. To recap what has been said above:
- Prepare financially to apply to a lot more programs in different specialties
- Start getting your program list ready now. This is where you will outshine most other IMGs.
- Stay active clinically till the very end if you are a community program candidate
- Stay active in clinic or basic science research till the very end if you are a university program candidate.
- Re-write your personal statement with an emphasis on a common theme, be it a strong dedicated community physician or a brilliant physician who is also a passionate researcher or educator.
- Re-write your CV- make sure you don’t put ‘history taking’ in things you learnt during your rotation.
- Prepare for the interview keeping in mind that you need to prepare for many different aspects of the interview and not just the usual interview questions listed on different websites on the internet.