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.