Applying for residency is anxiogenic. That’s true for essentially anyone and everyone but perhaps even more so when applying to competitive fields, advanced specialties requiring a preliminary year, or field/location combinations you are not necessarily competitive for. The bright side is that it’s a temporary problem, and in a few extra months you’ll probably have a job and a very expensive piece of paper that says you’re qualified for it. Like other (sometimes more expensive) alternative sources, I have compiled some sage and mostly common sense advice for how to approach (and succeed in) the match.
Below are some additional thoughts to aid those who are considering pursuing a career in diagnostic radiology. Most of what follows will apply to other fields as well.
Academic “competitiveness” and your USMLE Step 1 score
There is a misconception amongst medical students that the average step score for a given field implies a necessary threshold to obtain a residency in that field. This is wrong. The average score is just that—an average. Where you want to do your residency, the prestige/quality of the program, etc. has just as much if not more to do with whatever “gold star” requirements you might need as the actual field itself. As I’ve discussed elsewhere, the key in applying to a competitive field has a lot to do with finding an appropriate mix and number of programs to apply to for your level of competitiveness. Even people who seem/are “great” may not be competitive at a given program due to idiosyncratic factors, its program director’s preferences, and geographic bias. The bottom line is that if your passion lies in a field with an average Step 1 far above your score, then you need to be willing to apply to community programs, apply to less “desirable” cities, try to woo your home institution, and generate a back-up plan. If you lost the thick skin you earned from applying to med school, it’s probably about time to get it back. No one gets all the interviews they apply for.
In 2011, the mean matched applicant Step 1 score for diagnostic radiology was 240, which is almost as high as it gets (topped only by dermatology, ENT, and integrated plastic surgery). However, the unmatched average was 211. The 30 point difference between matched and non-matched applicants tells you that there’s a lot of room in the middle for people who are below the average.
It is true however that many of the more competitive programs utilize automatic minimum cutoffs, often as high as 240. There are certainly plenty of people with 250+ and AOA applying to radiology, and some programs do have a preponderance of these folks. US allopathic applicants with scores of 250+ and concordant grades/AOA can expect to get interviews at a portion of the most competitive programs regardless of what medical school they attend. (NB: If the radiology program director at your institution feels differently or the track record at your school is different, they’re probably right and I am wrong.)
If you are a US allopathic grad and your score is ~220 or higher, there is almost certainly a job in radiology for you if you’re flexible and apply thoughtfully. The mean number of programs ranked was 13.3 for successful applicants and 3.4 for unmatched applicants. So the take-home message: go on enough interviews that you are statistically unlikely to go unmatched. 12 has been considered the magic number, but a qualified applicant with a good mix of programs (not all ‘reaches’) almost certainly doesn’t need this degree of safety. In 2011, 81% of applicants match at one of their top three choices. As a general match rule, having the “average” Step 1 score for a field or higher actually makes you pretty competitive.
There’s a lot of ego involved in discussing the various “tiers” of programs. Rest assured that outside of ego-stroking, there is plenty of good training to be had. Of note, training quality and prestige are not equivalent. Competitiveness and rankings are multi-factorial beasts that often involve things that are irrelevant to you as an applicant. Some fantastic programs are less competitive based on location. Some less stellar programs are extremely competitive based on location alone. The only reason tiers truly matter is to make sure you apply and interview at a reasonable mix. Interviewing at only nationally-recognized powerhouses and no great regional academic programs is not a fantastic idea. The fanciest programs may require some serious portfolio magic, but radiology is actually a pretty large field with a lot of spots.
…are unnecessary in radiology. The most popular time to do an away rotation is in the early fall, which is coincidentally the best time to do sub-internships, get letters of recommendation, and take Step 2—all more important tasks.
If you do one, it’s because you want to, not because you need to. If so, be on time and don’t be irritating. Many students who do audition rotations are attempting to endear themselves to specific programs or break out of regional biases. There has never been any data on if this helps. Obviously, the majority of programs are interviewing and hiring people who do not audition there. Additionally, if you sound fantastic on paper, there’s always a significant chance that the real thing fails to live up to the hype. (Or vice versa, sure sure).
There is probably no other field in medicine where a medical student is as useless and incapable of shining as in radiology.
Letters of Recommendation
I recommend one letter from radiology—probably from the PD at your institution saying how much (s)he loves you and wishes you would stay—and no more. Medical students generally do not have significant clinical performance in radiology. Clinical rotations, specifically medicine and surgery, provide more meaningful letters. As for research letters, if you can tie together radiology and research together, great. Otherwise, unless your research is superlative or you were a rock star in the lab, a random letter from a random PI isn’t as meaningful as letters from clinical faculty. Many programs specifically request clinical letters for this reason, although occasionally a research letter can be included as a fourth (optional) letter.
Since you are applying to preliminary and transitional programs, it likely betters your chances to have three meaningful non-radiology letters when applying to these programs. Some internal medicine prelims will request a chair’s letter from medicine. So, most applicants should aim to net four LOR total: send the radiology letter and two best clinical letters to all radiology programs; send non-radiology letters to preliminary years.
Your application should be submitted on day 1, end stop. Many programs, particularly on the coasts, tend to interview late, so don’t panic when you don’t have interviews instantaneously when your peers applying to pediatrics and internal medicine do. You are likely to receive a preliminary medicine interview substantially before you’ll hear back from the radiology program at the same institution if you apply to both, which can make scheduling frustrating/irritating and expensive. You can browse forums at Aunt Minnie or SDN as gunners post their successes to find out if your favorite programs have begun sending out interviews, but this will probably make you absolutely miserable.
Don’t forget about intern year
The majority of Diagnostic Radiology programs are advanced (start PGY2). While there are categorical programs (those that include your internship), be very wary about the composition of the intern year. An advanced program leaves you the opportunity to hunt out and find a delightful (by comparison) intern year, either in the same location as your categorical program or another one if you want to try out a different city for a year. There are good categorical programs with good internships, but historically many of these internships are painful. If you ask current residents about their feelings about PGY1, they will tell you to find the easiest program possible. I have a hard time imagining any internship that would not give you an idea of what’s it like to be a clinician and the clinical basis you need to place radiological findings into clinical context. There is a competing theory held by a minority of persons that those who are interested in interventional radiology should pursue a surgical internship to help them learn the management of surgical patients. Most would argue that that is an unnecessary and painful mistake and leave it at that.
Typically the most desirable internships are Transitional Year programs, though the relative desirability is highly variable. You simply have to ask around to find out which ones are “good” or “cush” or not. Be warned that the best TY programs are often more competitive than the advanced specialties themselves. The bulk of TY interns are entering dermatology, radiology, and ophthalmology, three of the most competitive fields in medicine. Don’t neglect your internship.
How important is research?
You’re probably wondering if your lack of research will preclude your success in the match. While research can “make” your application, its absence is unlikely to break it. Except at a handful specific high-powered research-centric programs, research isn’t a prerequisite for all program directors. Even some “top” programs have gone as far to say things like, “We don’t care if you do research or not. We care about you being a leader in the field,” and other statements of the sort. That said, research never hurts. And in some (rare) programs it is an absolute requirement. The stratification goes something like this:
research with publications >> “real” research with posters or nothing > a case report done the summer of fourth year when you realize you don’t have any research and panic ≥ nothing.
So not having research in radiology or an MD/PhD will not prevent you from getting an interview/job in the broad sense. If you happen to have a long-standing interest in radiology, by all means do some radiology research. Clinical diagnostic radiology research is generally flexible and approachable time-wise as a medical student. Ask the program director or medical student coordinator at your home institution if they know anyone who needs help with a project (especially a poster, which would probably net you a free trip for literally formatting together a single big Powerpoint slide). Research in other fields counts just fine, of course. Programs know that many students may not have been exposed to radiology early enough to do radiology research. Note that if you mention research in your application, you will be discussing it come interview day.
This bit of advice doesn’t translate quite as well into certain surgical fields and dermatology, by the way, which do tend to be a bit more fanatical when it comes to paying your research dues.
The bottom line
Generalizations are dangerous and opinions should not be construed as prescriptive, but reasonable advice can be difficult to find, especially from the internet. Some other resources for applying to radiology, which are a bit intimidating, include the very thorough AMSER guide and this discussion from UT Houston. Again, a relatively inclusive collection of my all-encompassing thoughts on fourth year can be found here.
Best of luck in the match.
You might also be interested in learning radiology for medical students. Then, when you get a book fund to spend, here is my recommended reading for first year radiology residents.
Guide to the (Radiology) Match
'APPS OF STEEL'
(“Match Me Yes You Can…”)
DONNA MAGID, MD, M.Ed*
The Johns Hopkins School of Medicine
DEDICATED TO ALL THE HOPKINS MATCHLORS AND MATCHLORETTES
OF '04, '05, '06, '07, '08, ’09,’10, ’11, ’12, ’13, 14, 15 and ‘16...
WHO ALL MATCHED
*Opinions are those of the author alone; caveat emptor!
WITH APOLOGIES TO D12
(THE RAP GAME, 8 MILE):
"THE MATCH GAME--HOOP-HOPPING 101...
YOU CAN'T LEARN THIS BIT IN NO MEDICAL TEXT.
THE MATCH GAME, THIS MATCH GAME
I AIN'T SELLING MY SOUL FOR THIS MATCH GAME,
I AIN'T DIGGING NO HOLE FOR THIS MATCH GAME
...THIS MATCH GAME, THIS MATCH GAME
IN THE BEGINNING…….INTRODUCTION From the first edition, 2004:
The student's voice:
Congratulations on choosing a career in radiology! You have already made one of the most difficult decisions in medical school. The coming months and the ensuing match process will be a test of your will and your ability to pay attention to details. There is a plethora of misinformation on the interview trail - the purpose of this guide is to help you successfully navigate the match process and get the placement that you want.
As Hopkins students, you have the benefit of experienced advisors and advocates to help you through this process. I would urge you to seek out these people early and establish relationships with them. Their advice and influence later in the process will become invaluable.
I started writing this guide after I had matched - my inspiration was my belief that students at our peer institutions received more guidance in approaching the match. It started off as a random collection of notes that I had made to myself while going through the match process. This guide is my attempt at giving back to the Hopkins community. It has taken many hours to compile this information, and many more hours to process the information into something that is organized and comprehensible. Some portions of this were written at insane hours of the night in attempt to cure me of my insomnia... All of this was happily done at the expense of studying for Step 2.....
Hopkins Med, Class of 2004
Hopkins Radiology Residency, Class of 2009
The Faculty voice 2004:
Ah yes, Match 2004... . George had been hammering me to `write a book' with him, which I robustly repeatedly refused. His Match envelope declared him a Hopkins resident, and since his anti-gravity and highly vocal response to this information made all major newscasts that evening, I suspect he was as thrilled as was I. Most students then vanish, spending the next few days partying, celebrating or nursing hangovers. Yet my email, less than 72 hours later, revealed that George apparently had manically `celebrated' by writing his part of what became the first version of this Guide, and he expected me to follow suit. So if any one out there gets any tiny bit of help, comfort, or information from this document... thank George.
2017: SO! You (think you) want to be a Radiology resident ... . well, welcome to an admittedly verbose, opinionated, yet hopefully helpful, document. A more traditional, compact, bulleted and highly informative guide to the Radiology Match is available from my talented colleagues in the Alliance of Medical Student Educators in Radiology (AMSER, a special interest group of the Association of University Radiologists) and no doubt you should ingest both approaches -- there is no one-size-fits-all answer. The tone and excruciating detail of this endeavor have evolved partially from responding to the slightly (and usually appropriately) OCD flavor of the applicants, and from the ever-growing examples or experiences of how Gen Y may inadvertently stumble on even the most noble and deserved of pursuits.
Non-Radiologist Matchlorettes, there are many generic nuggets in here, from dress codes to the Personal Statement to Interview oddities; hope they help.
For the past 3 years the Match-obsessed have noted that we were approaching “an interesting moment in Radiology Match history, where two parabolic curves are crossing, in your favor. That is…as the number of Radiology PGY 2 slots have been slowly creeping up, economic vicissitudes and changes in medical practice, real or impending, led apparent student interest to dip slightly over the last few years”. (Notice how carefully the obnoxious and grammatically dubious phrase ‘trending now’ was avoided). Do the math: (more slots + a few less applicants) = less hysteria and far improved odds, from your point of view. The once Program-centric Rads Match has become far more student-centric. (Sadly, the last 3 years of the Ortho Match suggest that Ortho has taken over the Program-centric, ridiculously-difficult-to-Match pinnacle)
Interestingly, 2015’s parabolic shift was far more rapid than expected, leading to what Programs considered an alarming 150 (13%) unMatched 2015 slots in Radiology residencies. This rapidly rebounded for 2016:
164 programs offered 982 slots, filled 947 slots
1360 applicants, including 805 US SOM seniors
661 of the US seniors matched; total 947 Matched
30 programs (15%) had a total of 45 openings (4%) (www.NRMP.org; A.Rozenshtein AUR 2016). Yes the math is screwy but the big picture is—far more balanced event that 2015, and showing rapid rebound (18% increase from 2015) of applicant pool, reflecting the general positive perception of Radiology’s business future.
The 2017 Match was again brilliantly summarized by Dr Rozenshtein at the 2017 May AUR meeting (op cit). Radiology happily (for programs) went from the 2016 45 slots unfilled above to a mere 22 in 2017. The drop in slots available, from 1183 to 1090 for 2017, reflected more the change to split off IR than actual program shrinkage. Applicants for the ‘Advanced” ie PGY2 positions went up to 2088 from 1873; US seniors in that category went up to 1332 from 1138. The fill rate was 98,2% (72% US seniors up from 67 in 2016), 100% of the slots opened to SOAP filled (some programs elected to take their slots off the open market).
IR: “I’m SO confused!”:
This does not mean you will not compete for coveted slots or popular cities— the average Step One scores for 2015 remained high (2016 apparently still being generated as of 6/2016), 241 for Rads and 245 for Ortho (unmatched averaging 221 and 231 respectively)—BUT it just means The Rads Game has developed far less ludicrous odds, for US SOM seniors and for the ‘Independents” (ie ‘others”-- prior US grads with gaps or other intervening activities; US students studying abroad; osteopaths; non-US citizens at non-US medical schools; Canadians). Chance will favor the prepared. There will always be a wild-card element of luck no matter how obsessively you analyze the algorithm. We will approach the finish line in stages.
Let The Games begin!! Caution--by reading this far you have just agreed to join in the organic stream of constant feedback that will let us keep this document current for those behind you. And-views expressed here are opinions (mine, primarily, influenced annually by current applicants' Match Memoirs), and neither generated by nor officially endorsed by the Department, the Dean of Student Affairs, Johns Hopkins Medical School, the Medical Institution or the American Board of Radiology. Any errors or suboptimal advice are mine, and mine alone. Caveat Emptor.
DONNA MAGID, MD, MEd
Hopkins Survivor: SOM, Radiology Residency, Fellowship, and Faculty.
Professor, Radiology, Orthopaedic Surgery, and Functional Anatomy and Evolution
Director, JHU SOM Horizontal Strand in Diagnostic Imaging
Director, Medical Student Education in Radiology
Director, JHU SOM Elective in Radiology
Co-Director Residency Selection, Asst. Program Director Rads Residency, 2005-2010
Director, JHU SOM MSK Imaging Fellowship Education 2010-2015
HOW COMPETITIVE IS THE RADIOLOGY MATCH? 2017-18 UPDATE
At the time of my Jan.2004 Editorial in Academic Radiology it was indeed uber-tight; virtually no ‘scramble’ slots and 2:1 ratio of applicants:slots. The wheel always rotates; over the next several years many programs expanded a slot or two, some new med schools opened, and tectonic plates made their subtle shifts beneath us. The 944 2012 slots swelled to 979 by 2013, with a total of 1307 applicants (865 of which were US SOM seniors). Remembering that this handbook was started just after THE most competitive year ever (2001), and at a time when ‘scramble’ (now SOAP) slots were slim to (literally) none (still as low as 6 slots 2010..yet inexplicably expanding to 86 in 2012 and 150 in 2015), take a deep breath and marvel that in 2013 there was a 99% Match rate in Radiology for US seniors. 928 of the 2013 Radiology slots filled, 724 with US seniors; with a then-astonishing 51 slots still open for the post-Black-Monday negotiations. (Statistics from NRM data, www.nrmp.org, and the excellent must-read article by JY Chen and MT Heller, How Competitive is the Match for Radiology Residency? Present Views and Historical Perspective, J Am Coll Radiol 2014; 11:501-506)
The 2015 NRMP data: 166 programs, 999 slots; when the dust settled Black Monday there were 55 programs unfilled and 150 SOAP slots on the table.US seniors supplied 680 applicants (ranking a total of 8400 positions) of whom 579 Matched; the ‘other’/Independents accounted for 1141 applicants (and 11,524 applications) of which 862 Matched. (When you go through the NRMP site numbers get slippery; total Rads numbers and per centages variably reflect or include the small number of programs providing a total of 133 PGY 1 slots on top of the 999 PGY 2 slots—hard to tease apart but main themes quite clear). 2016 NRMP data: 164 programs, 982 slots, 45 slots in the SOAP. 2017: NRMP data: 1090 slots total (PGY1 and 2), 22 unfilled, SOAP à 100% fill of remaining openings.
The unexpected new beast to battle emerged in the 2016 Rads Match and continued to be a vexing obstacle in 2017: the ACGME-approved (and mandated) PGY 1 year. In 2015 47 Matched radiology candidates could not find same—ACGME deferred one year. 2016: 26 successful Rads Matchlorettes had no internship post-SOAP (18 reclassified as ‘Categorical” ie PGY 1, no internship required). (www.NRMP. org and A.Rozenshtein AUR 2016). The inability to find internships has led many programs to consider providing a PGY! Position, especially for IMGs.
67% of Rads slots were filled by US SOM seniors in 2016 (57% in 2015); >90% of US SOM seniors Match across US, FAR higher % of JHU SOM seniors. 54% of US citizens graduating international med schools (IMG) and 45% of non-US citizen IMGs Matched. The national average score in 2016 (2017 not fully ready) was just above 240, but ‘better’ programs continued to average higher in the 240s. The 2016 Match Rate was 98%.
“Back-Up Specialty”: were we the ‘second choice’ for many? For years, US seniors dual-applying made up abput 3% of the Rads applicant pool, ie 97% truly wanted Rads as unequivocal 1st choice. In 2017 9% were apparently ‘second choicers’, which may reflect the problem with using last year’s info to ‘game’ the next year’s Match—we were already wildly rebounding from the 2015 Match.
2017: IR-DR emerges: Interestingly, while IR-DR programs finally came to the marketplace (2015 only 8 programs had been approved to offer this program; 2017 saw 61 accredited programs offering about 125 positions, 6 were unfilled. 2016 IR-DR applicants included 424 US seniors of 589 applicants. It is felt that the ‘decrease’ in NRMP Radiology slots actually reflects the transfer os positions to IR-Dr in these 61 programs—Categorical (PGY1)‘lost’ 30, Advanced (PGY2) ‘lost’ 60 slots but when IR is included, there was a 2% increase in total slots. 36% of the IR applicants positioned IR-DR as ‘backup’, implying decreased commitment—or extreme caution in a novel situation, which can be a good thing in a physician)
Why the apparent tilt? There is no obvious one reason or explanatory factor. Many terrific programs had an inexplicable empty seat or two. In the past, when programs failed to fill several slots, there tended to be lurking smoke if not fire—program on probation, major funding issues for that SOM, civic or natural catastrophes, brand new program with no track record, unwarranted rumors about residents/city/faculty… impossible, in many cases, to totally verify or assign. This year’s (decreasing) empty slots were more likely to reflect Programs misreading the tell-tales and interviewing and/or ranking inadequate numbers, still living on the assumption and luxury of high tight Matches. It is now estimated that a program will need to rakn at least 7 candidates per Advanced, 10 applicants for Categorical, slots in 2017 (Rozenshtein 2017). Our Dean of Student Affairs also now advises students in Rads and Ortho to apply to far more programs than might have been suggested just a few years earlier. Meaning, the increasing number of applicants per program does not necessary reflect increased desirability of said program, as opposed to increasingly OCD/cautious behavior on applicants’ parts. The volume makes it harder to screen applications, increasingly pressuring programs to cut the volume with arbitrary Step One or other arbitrary cut-offs; and means the Interview process costs far more, both for programs and applicants, as each side has to expand their nets to make the catch.
RADIOLOGY EMPLOYMENT PREDICTIONS: Generally, one can conjure the economy and potential huge looming cuts in Radiology reimbursements—which in turn severely tightened the job market for Rads Fellows last 3 years and discouraged many older Radiologists from leaving the employment pool. BUT Good news: the economic uptick has had these same people relaxing, many having weathered the storm or recovered; they are now implementing or contemplating the career slow-downs or retirements they hastily deferred in the wake of October 2008. This is turn has released a cascade of excellent employment opportunities and current Fellows had very happy hunting. Of course Trump is President so who knows….
Dr. Ed Bluth surveyed the employment market for the 2017 AUR. There are over 33,500 Radiologists in the US now, up from 31,000 2012. 22% are over 55, 6% over 65, most are 36-55 yrs. Old. Of the approximately 700 Radiologists retiring in 2015, 26% were part-, 74% full-time at retirement and not all were over 55 yrs. old. Another ~500 went from full- to part-time in 2015. The fastest-growing fields were night-hawks and body imagers; and IR, breast and neuro. There was a projected hiring increase of 16% (2200 job openings predicted for 2016) from 2015 ; 55% of new hires were post-training (vs 45% from earlier job). The most job openings were across the South and Midwest, the fewest New England and West Coast.
The problem with trying to predict the 2024 economy and the future job market for a 2018 Radiology Matchlorette is the time frame: you need an 8-year crystal ball. No one applying to Radiology September 2007 could have predicted the professional impact of the 2008 Recession, Obama-care, Super Storm Sandy, Fukushima, Justin Bieber, Ebola, 3D printing of bio-parts, or Caitlyn Jenner, all of which lay in the near-future and some of which impacted those who finished Fellowship June 2016, signed job contracts for July 2016 and contemplated options for 2017. (PS as of this June 2017 writing, as in 2016, all the JHU MSK Rads Fellows and many of the other JHU Rad Fellows have secured terrific jobs in their geographically preferred zip codes). And practice itself is changing: as the traditional independent private practice groups merge into larger mega-conglomerates, or are bought by huge care systems, and as the economics of medicine weaves increasingly complex webs, concepts like ‘partnership’ or ‘ownership’ are rapidly fading. Like the new licensing exam process, the new job market is not yet well-defined nor can those 4 or 5 years ahead of you give you advice guaranteed to be applicable when your time comes. The good news is that the economic improvement last few years let those who initially deferred retirement after the 2008 crisis reconsider; the bad news is the 2016 Election results--- who knows what alternate reality comes next?.
RECENT HISTORY: The ERAS-run Radiology Match is now 17 years old. Match 2010: 166 programs offered 949 Rads slots, an increase of 5 and 18 slots over Matchs ‘09 and ’08; with ‘scrambles’ of 4 slots in 2010, 7 in 2009. But suddenly in 2011 and 2012 things shifted. For multi-factorial and not-yet entirely clear reasons, there were, astonishingly, over 80 unfilled Radiology Residency slots in play in the new SOAP process following 2012’s, and 65 slots following 2013’s, Black Monday. In some cases—a program failing to fill most, or even all, of its slots—one may assume something seems off, be it a city’s economic implosion, financial or other woes at a host Institution, or issues—real, misperceived, imaginary, or just ill-timed—in a Department. But an enormous cross-country swath of excellent and desirable Radiology programs in great Institutions and in great cities, across all ‘tiers’, also had one or two unmatched slots, in many cases for absolutely no fathomable reason. 2015 magnified that trend: many superb programs used to shooing off overflow applicants found themselves, shockingly, with a hole or two on Black Monday.
The average 2008 Step Ones were 235 Rads, 240 Derm, 243 Plastics. A USMLE Forum says ‘237’ for 2010 Radiology Match; for 2011 the mean score was 240. 2012 NRMP postings said the mean Step One was 240, Step Two (increasingly requested) 245, confirming the impression of upward drift. 2015 average Step One: 241. 2017 not yet officially released, guesstimated by many to be in the low 140s. And once one focuses on the mythologic ‘top tier’, beware—actual averages here MUCH higher. Careful webwork can extract the average Step scores for some programs (for example Mallinckrodt is reported, on radiology.matchapplicants.com, to have had an average 253 Step One score in the 2011 interviewed pool.) In screening 650 applications to interview about 100 people for the 2010 Match ,Hopkins unofficially seemed to find 240s to low 250s about average, started raising eyebrows at most 230s (although unlike many programs had not been using any official cut-off point); and saw an impressively increased number of applicants sporting scores in the 270s and even, for only the second or 3rd time, a 280 or two. Meaning: ‘national average Step One 240” doesn’t offer any guarantees.(conversely-- Chen and Heller cheerfully pointed out that 92% of US seniors with Step 1 scores 211-220 Matched). International students tend to need higher scores to get attention, since potential visa and credentialing issues etc weigh against them; while on the other hand lower scores still may be countered by other positives, including popularity on home turf, grades, personality, research, community service, LORs, compelling narratives, connections. Confused? You should be!
IMMEDIATE FUTURE GUESSTIMATES: My personal read on trends up to June 2017: the Match has again ‘tightened’ and become more competitive, but has not returned to the panicky apply-to-80-programs level of Ortho currently . Particularly it favors that group I think of as the “VeryGoods”: they would make terrific residents, are rock-solid hard workers, can be tolerated for a 12 hour shift in close quarters, contribute to the team, will mature like fine wine, but do not necessarily dazzle on paper or possibly in person. Hundreds of applications and dozens of interviews into the season, the VeryGoods may be overlooked and under estimated as the occasional Rock Star distracts the interviewers. For years the VeryGoods were scarier to me, as an advisor and mentor, than some of my far weaker applicants. VGs would get the upscale interviews, would seem to be in sight of home plate…but might be ranked in the middle of the bell curve, 30 or 35 on every program’s list in an era when strong programs wouldn’t dip below 20 or 25. For at least the next year or so, wise programs need to look harder at the VGs; every one is going deeper on their Match lists as students apply to more programs each; and VGs are the people who keep the wheels spinning. Happily, Step One scores and obvious glitter may not be trusted as sufficient screen or cut-off for wise programs. The next few years— in my humble individual opinion—may see the VGs getting the attention and respect they have always deserved.
The other group likely benefitting: the IMG subset of excellent, highly motivated, high-scoring, and deeply accomplished international med grads, festooned with research accolades and intense effort. In the past they were unfairly crowded off-stage by the unduly competitive imbalanced Match; now many of these excellent future residents and faculty have a better chance of being seen in the crowd. Still a higher bar compared to a US senior—but no longer the too-often-futile pursuit of 10-15 years ago.
What is a Rock Star? They’ll still be around; you’ll know one when you encounter one on the Interview Circuit. The nauseatingly perfect 260s and 270s (and those gasp-worthy 280s?!) Step One scores, Jr. AOAs, the PhDs, the 37 publications in Nature and NEJM, the Olympic athletes, the ex-NFL players, patent-holders, the budding garage entrepreneurs from the cover of Business Week or Time; applicants who have built clinics in 3rd world nations, testified as experts before Congress or the UN, have perfect teeth, really great shoes, and dress like Dan Draper. Remember there is a huge spectrum of programs and applicants and factors at play; less academic types or those with less sparkly numbers, those who know you want to be excellent and in private practice, take heart. If I suggest you spread your nets wide and apply to at least some programs off the beaten trail (away from the Coasts, plus away from whatever is popular that year with your direct competition), it is to enhance your likelihood of interviewing and matching. Many of you are heading for the dozens and dozens of excellent residencies outside the elite academic Top Ten (a figure of speech, like ‘tiers’, without precise definition; don't ask for that list!). It may not help many superb but indifferently academic applicants to be compared to the very elite top of the food chain; getting prestigious interviews is reassuring but not sufficient. (“The perfect is the enemy of the good”—Voltaire's Dictionnaire Philosophique 1764). Be realistic, honest, and open-minded and it is (in my opinion) VERY highly likely you will Match--happily.
It remains a bit of a Numbers game: you need adequate grades and USMLE scores just to be allowed to step up to the plate. Red flags, hard or soft, must be dealt with. However, bear in mind that from the programs’ perspective there is some validity to establishing a cut-off point (which may vary widely with programs and which appears to be loosening after the past 3 years’ experiences with unfilled slots), below which most programs will not interview you. Radiology has become a high-performance and scientifically complex field, requiring not only a masterly command of medicine but of physics, electrical engineering, statistics, biochemistry, and manual dexterity. There will be for incoming residents the newly restructured arduous two-phase national Radiology boards (including the dread Physics) one must pass to complete residency and then licensing. Current applicants must be life-long learners who can qualify for recertification every 10 years. We find there is some correlation between Step Ones and the national residency In-Service exams, for example, that encourage us to cling to our Step One scores yardstick. No matter how lovable you are, if your numbers don't match up to their current Residents’, some programs will not regard your application with open enthusiasm. Your advisors may urge you to accept the fact you need to get off the high-traffic ‘first tier’ trail. Do so—and become ‘that Hopkins applicant’ instead of “that other Hopkins applicant, with the lower scores”. Sorry--but having experienced the anguish of the unmatched yet totally qualified and deserving student (not to mention that of a Resident failing mandatory exams), I'd rather you feel rebuffed or redirected now than let you set yourself up for defeat. Remember the 'average' or 'weak' potential Rads app at a place like Hopkins may look like an Alpha Animal to smaller programs, to many other sub-specialties, or to an Institution only rarely graced with a Hopkins applicant. Prestigious Institution #1 may have a totally different ‘take’ on you, or be looking for wildly different flavors, than Prestigious Institution #2. Be you faint-of-heart, lopsided, or weak-in-numbers...be prepared and strategize— but don’t be dissuaded, if this is truly your dream.
IR-DR: What does it mean? Most of this section is derived from Dr. Emily Webb’s, Dr LaBerge’s (both UCSF) and Dr. J.Bailey (UMich), excellent 2017 AUR session on same. Here is the new lingo: “Integrated” rolled out first, Matching for 2017. “ESIR” is independent and will not be reality until 2019 or 20120; ESIR programs are currently evolving/accrediting rapidly and will be very competitive. “DR” currently may or may not have IR Fellowships for current applicants (ie Fellowship 2024!); ask about this at Interviews if a real concern.
By convergence and tweaking, ‘They’ hope to have IR, DR, and the overlap in a ‘steady state” by 2023—about the time current rising 2017-18 Matchlorettes expect to be done. For now one would apply to IR-DR; those only applying to DR are quite likely to have viable later Match options, if later deciding to focus on IR, as the ESIR and Independent IR pathways emerge. At this moment in time, look for programs where IR and DR ‘cross-talk’ and cooperate, rather than compete; if seriously interested in an IR path of some sort go for a surgical internship—the far-sighted programs are already arranging carefully-tailored PGY-1 experiences. (Conversely, a mandatory PHY-1 will only make it harder for those who liked the freedom of doing a PHY-1 year elsewhere to deal with family issues, a Significant Other, etc). Interview days for now will include IR, DR, and Surgery—take your vitamins. While IR and DR officially are not supposed to ask if you are applying to both, and IR and DR file different Match lists, it becomes very apparent what you are doing by where and when you show up. Either PD can veto discordant applicants; you must be desired by both the IR and DR factions. Programs have the option to revert unfilled IR slots (6 slots went to SOAP in 2017, although 500 people applied for 120 positions) to DR rather than dip to lower-ranked IR applicants. An IR residency will provide a 6-year focus on curriculum, starting with a Surgery internship; and hopes to eventually set the national standard for patient management and care, both in- and out-patient.
If this info seems confusing—it is. Not even all IR PDs know exactly how this will all play out. Eventually there will be an IR path and uniform highly specialized IR training—not necessarily comforting to those being snared in these transition years. Those of you reluctant to be pioneers or not yet sure what Imaging sub-specialty is your future destiny—stick with IR; there will still be chances to add IR if it beckons you down the road.
Super advice from a 2017 Star Matchlorette: If you love an Institution prioritize that—apply to DR and IR-DR; Fellowships will still be around for rising Matchlorettes. He also noted some nerve-wracking texts and calls 5 hrs before the lists closed, which is not necessarily illegal but can be awkward if the call is not from a top-choice program—perhaps duck calls with ‘wrong’ area codes.
ORTHO MATCH 2017: STILL ROUGH
Brief opinions derived off the NRMP site suggests that 2017-18 applicants must bite the bullet and apply to upwards of 80 programs—absurd, expensive, exhausting, and…average, possibly even an underestimate.. This has rapidly expanded from 59 apps per student average in 2001, 64 in 2012 and now tops the apps-per-applicant of ANY sub-specialty in the Match. The number of slots offered, 692 in 2013, has risen only to 727 in 2017; This means programs and applicants must expend far more time, energy, and money chasing the goal.
NRMP statistics state that 91.9% (668) of the 2017 Ortho slots filled with US seniors (3 DOs, 13 IMGs, in case any one wondered). Don’t count on SOAP—one lonely slot there in 2017. And as always happens, tightened competition elevates average Step One scores – for 2017 hovering at 247, with a scary number of the *un* matched also seemingly safely in the low-to-mid 240s so… stay sharp, stay humble, don’t get over-confident. The 2016 Match rate was 75%.
APPROACHING THE STARTING LINE: ARE YOU A PLAYER?
Here’s a strange new resource for guesstimating your Match potential into some specialties: https://www.memorangapp.com/widget/NRMP-match/ a widget posted on a blog (memorangapp.com) crunching Match data. I make no claims to its accuracy nor validity.
Since 2005, the Hopkins Radiology VERTICAL ADVISORY system has been in effect. I want first or second year students reading this, or third years who are still uncertain, to take advantage of the Radiology Peer Counseling System BEFORE asking to see me. While with my weekly e-mails, Gross Anatomy, and TTW appearances I am probably the Radiologist a first or second year knows best, be warned I usually do not meet with Basic Science students. I will instead refer you to those more junior, but also more current and relevant, than me. My present and future residents and the clinical students are excellent sounding boards and superb advisors. You will be far more relaxed around them than around me, and able to ask those 'stupid questions' (which PS never are stupid). Talk to my Radiology Interest Group/Radiology Applicant senior students (from about January to Graduation, when they are seasoned survivors), my Pre-Clinical Interest Group people, my first year Rads residents (aka The Elite Corps), and/or ex-Hopkins students doing internships/PGY1 in town.. This system works!! Data-mine it for personal enlightenment.
Don't invite disappointment, in this or any endeavor. Do some home work and listen to your advisors. For the most competitive academic Radiology residencies, USMLE scores must soar well above 230s/mid 90s, transcripts groan under the weight of A's, Honors, and applause; accepted publications bend your mailbox from sheer volume; whole communities praise you as their savior; and your letter-writers must reflect deep faith in your future. This loosens up rapidly as one considers other less assertively academic programs or those many great programs dedicated to turning out superb future practicing radiologists without emphasizing research. Anywhere on the spectrum, accept that rigid red flags – initially failed courses or Step exams, ethical or behavioral charges or concerns, DUIs, suspensions, substance abuse, and more—remain massive speed bumps. Whether aiming academic or clinical, Coasts or fly-overs, large or small, aim for a sparkling and error-free ERAS, a compelling even if not Pulitzer-level Personal Statement, and a personal presentation showcasing yourself in person as someone people would like to hang out with for…oh, say, five years.
(Further caveat for Hopkins students: If a Rads application appeals to you primarily on life style issues; or worse, you feel insecure about the whole scary Match process or torn between two fields, and want to go with the choice that might give you more Faculty helicopter parenting, nudging, nagging, and nurturing through the Match process -- you may not be adequately committed, and I may not agree with your choice. I am a catalyst, not an alchemist, and try to avoid the impossible. I am also an ardent advocate of truth in advertising, and transparent integrity. Find another babysitter).
I send out unsolicited generic Match info and reminders to the whole class on a regular basis. Remember, the SOM, the Colleges system, and our superb Deans of Students are committed to supporting and informing you ALL; I have talked to other schools and we have unusually good fortune in having these people. And at some point before we shovel ourselves too deeply into this Game, I will ask you to be 200% honest with me or any other advisor: have you left out, glossed over, or cleverly camouflaged anything I/we should know, personal or professional, which could rear up and bite us (you as applicant, us as advisors needing great credibility, and/or your institution) down the line? Did you flunk or repeat something, ever get investigated for cheating or dubious ethics, have misdemeanors or felonies that will show up on background checks (yes, misdemeanors will, in some places), spend a year committed against your will or having intractable seizures? Carrying diagnoses or challenges which we should discuss, confront, explain, or counterbalance? On a chronic medication which will impair performance or show up oddly in a drug screen? (There are HIPAA issues here, disclosure or discussion is your choice, but some issues cannot or will not be concealed and/or will show up in ubiquitous legal pre-employment drug screens and antibody tests). Ever been suspended or asked to leave (college, med school, the country)? Are you dependent on illicit substances or 12-Stepping to recovery? Under suicide watch? On probation for shoplifting? Is your visa under review? Have you made the news lately in some unflattering manner? What will Facebook, Instagram, SnapChat, Google, Twitter, Vine, Tumblr, etc tell me/others/Program Directors about you? Does something need addressing, clarifying, finessing, spin? Is there an elephant on the couch? Sharing with me or any advisor behind closed doors does not mean these things will become public, but not sharing may be lethal if attempted concealment fails.
DO NOT conceal or misrepresent here- honesty and integrity are numbers 1, 2, 3 and 10 on everyone's list of sine qua non. We have helped students to overcome serious issues and red flags to support their efforts to Match; we have withdrawn support from students when it transpired they were gaming us, overtly deceptive, or unwilling to play by the rules. This is a Zero-Tolerance Zone. If you ask my opinion I will express it, and you may not like what I say.
SOCIAL MEDIA: CLEAN UP YOUR ACT
Being snowed into the hospital for 3 days during major snowstorms in 2010 led to boredom so intense I started running backwards through all my med student ‘friends’ Facebook accounts. By an dreary night’s end I had enough astonishing, offensive, dubious, legally unwise, and occasionally nearly-pornographic photographic and written material for a new lecture, “How to Kill Your Career on Social Media”. Review, clean and purge all such publically-accessible sites NOW—raise your privacy barriers, better yet just get off for a few months. Google yourself; you can’t always remove or modify such results but at least know what others are going to encounter (and occasionally, one must prepare to explain how there is another human with your name, who unfortunately has no taste, no sense of propriety, and no future in the professional world but is NOT you). Consider any Tweet, posting, text, or SnapChat to be potentially viewable on a highway billboard. Exercise impulse control and censor yourself at all times.Don’t agree with Mr. Trump? Proceed with caution and don’t go all Kathy Griffin. Be it Halloween in Fells Point or the Preakness Infield, assume someone is capturing you at your worst or least tasteful, indelibly. Stay sober, or you won’t even remember generating those offensive photos, situations, or quotes—but every one else will have trouble forgetting them. Cell phone cameras, Instagrams, hospital and mall security cameras—the world is watching you 24/7, so be squeaky clean and behave.
POTENTIAL RADS APPS AND THE CLINICAL YEARS
For Hopkins students, the Basic Elective is the usual entrance point, intentionally or otherwise, to exploring Radiology as a field. We cannot offer the Elective during the summer (June, July, August); those who MUST do it then may need to arrange something at Bayview or even, if you know your eventual geographic destiny, elsewhere. (At this point in time it would seem odd to some other Institutions to have a Hopkins student apply in Rads without some sign I know them; please feel free to introduce yourself and become a Matchlorette even if you take the Elective elsewhere). Although it sometimes seems that the majority of the class is inclined to Rads for at least 10 minutes somewhere along the way, we do realize most of our students actually are destined to become our referring or consulting clinicians. Our Elective emphasizes how to request exams, what each imaging modality can/cannot do, how to choose imaging exams wisely and safely, and basic survival skills for house officers and students. You spend one or two mornings a week on Tutorials, seeing how CT, fluoroscopy, EMed Rads, US, IR, etc, really work. The Elective size is rigidly limited to 10 students to protect the experience and to insure that we can get to know you. (Begging to be the 11th, or to be pushed to the front of the line because you are more annoying, is not necessarily helpful to your long-term goals). Be forewarned that there is, on my days, a heavy unofficial emphasis on perfecting professional, communication, interview, and interpersonal skills--Walking the Walk and Talking the Talk. You --hands off your face! Stop jiggling! Drop the, like you know, UpTalk? We digress often to debate and discuss relevant medical, legal, ethical, interpersonal, or educational topics.
Most people would recommend doing at least one other radiology elective to confirm your interest in the field. Popular choices among students in the past have included virtually if not literally every Division in Imaging. 2nd months include NeuroRads (Drs. Blitz, Lin, Kraut, et al), Pediatric Rads (an area wonderfully extremely pro-student); IR (Drs. Cliff Weiss, K. Hong, Yim) (The IR elective, for example, is a great rotation and a must for those interested in interventional radiology pathways, oncology, hands-on stuff, research, and adrenaline. The day typically starts at 7 am with sit-down rounds where the cases for the day are reviewed with an attending. Typically there are 4 cath labs that run throughout the day and a huge spectrum of pathology and procedures. The Catheter Cowboys really love their work.), Body CT (Drs. Atif, or L. Chu, are great first contacts), Nuclear Medicine/PET (terrific student-friendly faculty and wonderful Fellows), MR (Dr. Kamel), MSK (Drs. Demehri, Ahlawat, Fritz) and occasional other choices (Ultrasound, Mammo , molecular biology research, etc) depending on your background, interests and sophistication.
Whether you are a Hopkins student or hoping to visit from elsewhere (in or out of US), subspecialty electives must be arranged on your own, once you identify and speak with a contact attending. Use the Vertical system here-- my residents and students preceding you may have the best feedback on whom to approach.
While a 2nd month of some sort is highly suggested to those still exploring or confirming a tentative Rads interest, remember that we expect you to produce something from it--a paper, case report, poster, abstract, teaching program. No free rides!
RESEARCH: MUST I?
Research remains one of the tickets one must punch to be interviewed in a serious top-tier academic program. Academic programs wish to begat more academic radiologists. Research has become one of the primary screening tools for such programs, in addition to the traditional grades, USMLE, and letters of recommendation. The range of research experience is quite varied. Some applicants will have several publications in major journals (include Science and Nature) and presented at national meetings (like RSNA). Others will have had just a smattering of case reports. And still others will have projects in progress. It will help tremendously to have research experience, and while publications are nice, they are not mandatory. Ask around for research opportunities because they are abundant. The Dean's Office offers some summer opportunities with small stipends; talk to more senior students who have already trod your prospective path, and ask my junior residents for advice. Pick your research advisor wisely, as this is probably one of the most important factors in getting something productive out of your time. Most applicants will spend at least 2 months doing research; many spend more time than this. Some of the most competitive programs are very committed to research and to training future academic Radiologists (MIR, MGH, UCSF, Hopkins, etc.) and will not take you seriously as a dedicated future researcher if your research background is comparatively weak. Also remember that anything listed as `in progress' or `submitted' does not yet officially exist, as far as programs are concerned.
Research in other fields certainly counts—while the nature of endeavors on your CV may make it blindingly clear that another field enticed you initially (whip-tailed lizard spinal regeneration or retinal vascular studies anyone?), rigorous scientific pursuits and publishing have much in common and show dexterity and experience.
Be honest with yourself; not every one wants to stay in the ivory tower forever. If you are bright, test well, have played the game in other ways, but know you have zero intent of becoming academic, you absolutely can do well in Radiology, but you will likely need to focus on programs slightly less strongly identifying as academic powerhouses. There are so many great programs with less or no emphasis on academic production. Do your homework and take a close look at the many MANY other excellent programs that are very strong clinically but neither emphasize, expect, nor scrutinize, research as heavily. For such programs, research is a non-issue, unlike the hard-core academic fast-track.
An interesting discussion with a PD from an excellent state school 3 years ago, initiated on behalf of a strong student with sincere interests in being in a particular geographic locale, revealed that this program tended to be less excited about applications with a fair amount of research because it implied to that program that such students might be regarding them as a ‘safety’ school. The PD was reluctant to waste precious Interview slots on someone far less likely to be truly interested in or to fit in well with the program’s clinical emphasis. Other PDs from wonderful `second tier' (I detest that phrase) training programs also confirm that my high-powered research students can look less attractive to them than an equally-solid but under-published student. Some programs do not want to give research time and remain very clinically and goal-oriented. Conversely, given two Hopkins students with 99% boards, high grade-points, great letters, wonderful community service and great interpersonal skills, most `name-brand' elite programs look at the publications and research track record.
Bottom line: Figure out who you are and channel yourself appropriately. Assess your background and goals and apply intelligently; you should be able to identify programs delighted to make your acquaintance. If your numbers qualify but your Research section is anemic, be prepared to hear me directing you away from wherever the bulk of your more-academic Hopkins competition is looking. Doesn't mean you couldn't do the work at a superstar program, just that it is less likely for you to land one. I want you to be able to get the attention and respect you deserve wherever you interview; if you are always traveling with and being compared to The Academic Rock Stars, that won't happen. It’s a bit like speed-dating; everyone wants the supermodels but pragmatically put yourself where you are a good fit.
If you have never done research and still intend to compete at the academic programs, be realistic. Arrange some research months as early as possible; most attendings can only work with one student per month, not every month; and are popular. Have a game plan. Pre-assess your interests, skills, inclinations, short-comings. Check the Dean’s collection of opportunities for students. Approach a potential research mentor with a CV or summary of your experiences and special skills, if any; knowing you have claims to an electrical engineering , biochemistry, or computer or website background may lead to different suggestions than those elicited by the "I'm new to all this but gee whiz I'd like to try" ex-Fine Arts or Psych major. Do not expect us to have huge menus of instantly-available projects ready to pluck; remember that you may need to exercise some ingenuity and initiative getting someone to show you how to search a database, the literature, or Pathology. Do not expect to bite off and chew the whole carcass at once; even a simple case report may seem like the Rosetta Stone for neophytes. Nor can someone who woke up one August morning early fourth year and said "Wow-it just came to me-RADS!!!" realistically catch up research-wise with someone who has been punching in goal-directed research tickets all along.
"TIERS" ARE IN THE EYE OF THE BEHOLDER
If you decided quite late, have no research background, yet want to go to a top-tier academic program, you may need to consider spending an extra year or two developing your research credentials and CV. If you decided quite late, do not have strong academic career goals, but have still racked up the grades and Step One scores, you can target the less-academic 'first' and 'second' tier and smaller programs, who would be thrilled to have a bright talented Hopkins student and are not as preoccupied with future researchers. This is where you have the Hopkins advantage: I will help these programs understand and believe that you *do* want to be taken seriously (again, they may automatically assume you consider them a 'safety' while you pursue a huge brand name, and so snub you pre-emptively in favor of more likely candidates) and would be delighted to be interviewed. And remember this: there are dozens of super programs just below the elite academic handful, which will provide excellent training, superb mentoring, and spring-board stupendous careers.
The so-called 'third tier" (and these titles are informal; there is no secret rank list somewhere), and indeed many "2nd tier" places, are excellent choices for those absolutely not heading for academics, and would be the only viable choices for an applicant with marginal grades or Step Ones, embedded red flags, or other suboptimal attributes. Students who meet these latter criteria: do not expect me to lavish reassurances or to hide truly important negative info; I can and will be blunt.
CAVEAT EMPTOR: In the past I have occasionally agreed to help a student who, against my strongest instincts and direct advice, insisted on trying Rads. Certainly it is your life and your choice--but in such cases, my now-well-known letters (and I do not guarantee I will write anyone a letter in such cases, no matter how much I adore you personally), to programs who have read epistles from me previously, are CLEARLY more vague, less enthusiastic, and less specific. You WILL NOT stack up well against your Hopkins brethren. Success may mean a strategic retreat to the smaller or more geographically far-flung programs not often/ever seeing a Hopkins applicant, and if you want my (written) support in January (“Hey my student Katniss is absolutely ranking you Number One!”) YOU MUST choose a realistic #1-choice target.
TO GO OR NOT TO GO: AWAY ROTATIONS
I'm not sure I have a valid opinion here. As Director of an Elective which is locked against outside visitors (with a one-year Hopkins waiting list, we just can't do it) I don't have much experience with how visitors subsequently do at any one visited school. By all means, if your ideal future includes institutional or geographic specificity, target them early on. Becoming an 'inside outsider' helps, especially if you dream of fantastically competitive and geographically coveted (read: California) programs. DO NOT repeat the Basic Elective; it reads poorly on your transcript ("Hey, look, another out-of-town try-out brown-noser" is a direct quote from a Left Coast PD) and we are not impressed. Try to identify both your area of interest/ability and an area which will expose you to the residents, Program Director, or other people vital to the selection process. Surprisingly (to most students), in most places the Chairman often has far less to do with daily functions, research, or Residency Selection than one might expect; do your homework. Talk to students or residents with ties to that program, jump online, and do your ground work, to identify appropriate entrance points.
CAVEAT: we have had super, talented, and likeable students spend months at Cali schools and still not even get an interview invite to same. Others did a month there, interviewed, and Matched. No guarantees. If you do go: sparkle, sparkle, sparkle. Be first in, last out, dress well, spend your evenings looking things up, preparing, studying, playing the game--if you're thinking it's a mini-vacation with great sunsets and rollerblades you are wasting your time.
OPINION: The Prelim Year As of 2016 and again in 2017, this is a Hot Spot and has caused unusual problems. 2015 Match data shows something both interesting and concerning: there were 47 Matched students in Radiology who did NOT have an internship as SOAP dust settled, would not be starting internship July 1, 2015, and therefore COULD NOT take their July 2016 Radiology slot. ACGME and NRMP made some short-term exceptions/accomodations which let most but NOT ALL of the 2015 and 2015 Rads Matched students to keep on track. I had not heard of such a squeeze before, but after 15 years of ‘Don’t worry, if you are qualified for Radiology residency any internship would be happy to grab you”, I will be encouraging far more energy and effort on the PGY 1 applications, both from you and from me. (Ironically one 2015 JHU Rads applicant, considered one of the top 10 applicants in the US, opened their Match envelope to find they had dropped down a few slots to secure an internship while scoring their Number One ranked residency—my first warning that once again the celestial spheres were shifting. Expanding the PGY 1 search will be sad, expensive, annoying—and necessary. We may see more Residencies offering to help with that PGY-1 position but that is unclear.
I do not happen to think an Osler sub-I is necessary for a Rads app. Do it if you wish, but not because you think you ‘have to’. Again—my opinion and mine only! Internship is something you must do and hope to do well, but think about what you want from that year as you consider options.
We use email so constantly and casually that we forget to think about the impression it makes. It may well be the first impression of you received by a future employer or letter-writer. Like that interview suit, err in favor of the formal and conservative. In ‘business’ email communications of any sort during this process, remember to adhere to professional format and phrasing. HEADERS in particularly are important. No header may lead to deletion by the viral-cautious. One hopes the inappropriateness of “Hey”, “Hi’, ‘Yo’ as headers need no further commentary. I find the most professional and efficient way to draw positive attention, approbation, and even a response is to make the header a succinct summary of what the recipient will find within and from whom: eg “Query: Possible LOR/Chuck Sheen MSIII”; “Request for Advisory Meeting/K.Everdeen MSII”, “Request for Vertical Advisor Referral/B.Obama MSI’. If you met the addressee briefly but they are not necessarily going to remember (you were one of 16 people who stayed after the lecture to ask a question; you introduced yourself in a crowded elevator 9 months ago; they coached your kindergarten T Ball) briefly allude to that point and re-introduce yourself in first line. ”Hello it’s Katniss, I sat next to you at the Pan-Asian Orientation lunch last Sept…”
Open with “Dear Dr. XXX….” And spell the person’s name correctly. Re-introduce or define who you are. (“I am a Hopkins MS III currently applying for your Radiology residency…”).Keep sentences and paragraphs short, tight and to the point. NEVER use text abbreviations (LOL, OMG, IMHO, YOLO…) . NO emoticons, XOXOs or emojis of any sort. If you have a photo on your email make it a professional-style head shot, not in a one-shouldered gown, bow tie, or T shirt. Ditch the pithy quote, sports team emblem, or other personal touch under your signature. Use a formal sign-off such as ‘Sincerely”; possibly “Best Wishes” if a relationship exists. Do not assume Spellcheck will catch everything (there/their; its/it’s)
Any doubts? Sit on it 15 minutes or an hour. Have someone else read it. Re-read. Edit. Repeat.
ON-LINE RESOURCES: GOOD, BAD, MOSTLY UGLY
Certainly one starts at the official NRMP Match website, which someday someone may translate into English. Sooner or later every frantic Radiology applicant succumbs to auntminnie.com. There are some useful sources of info and statistics here, a lot of great quiz cases and career updates, but remember that, like Wikipedia, students and applicants can post whatever random and occasionally irrational thought skitters across their convoluted minds and make it sound like fact. I made my first foray into the anonymous Aunt Minnie Residency Applicant chat room in January 2004. Wow. The rumors, the spin, the unduly-vivid imaginations, the sour grapes, the gratuitous sniping--wear Kevlar and take 3 grains of salt. There was some accurate and positive stuff there, but just as much dead-wrong or harmful info. Be skeptical, and triple-check anything alarming or worrisome with a Hopkins resident, Match survivor, or mentor before getting too excited. The JHU Radiology Vertical Advisory has a platinum track record and involves non-anonymous, knowable, sources—use it, not the Web. We are developing an unhealthy respect for and belief in anything on the Web; lose it. BACK AWAY FROM THAT SEARCH ENGINE!
Remember it is not unheard-of for residents or faculty to skim auntminnie.com, so if you are moved to ventilate/confabulate Gen Y blog-style, declare yourself suicidal, or trash-talk someone or something, think twice--like that picture of you passed out dead drunk on the bathroom floor posted on FaceBook, it may come back to haunt you. Better yet--STAY OUT OF THIS CHAT ROOM!!!
Which reminds me- this is the era of social networking. It has spread like flu. You are all unduly plugged in, and communicate words and images freely—too, too freely. Indiscreet verbal or visual postings of any sort, anywhere, may come back to bite you on the rump. Do you really think no one over 25 is looking? Those adorable self-expressive misadventures and digital dirt gain immortality once on-line. Sex, drugs, alcohol abuse, violence, profanity, dishonesty, antisocial behavior, any act or comment of dubious taste or integrity: purge your sites and search your souls NOW. Mind your Tweets. Go to FaceBook, Pinterest, SnapChap, InstaGram,Twitter, BeBo, your blog, or its equivalent right now and take any photo or message or quote off there that could reflect badly on you now or at any point during the next 90 years. Do not have faith in the mythology that certain sites actually succeed in erasing transient comments or photos (screen shot or photo, anyone?). Passed out running the urinals at Preakness? Bared some anatomy in a regrettable drunken moment 8 years ago? Delete, delete, delete; and pray. If Rolling Stone caught you naked at Bonnaro or Burning Man do NOT give your real name. Better yet—keep your cloths on and stay cyber-squeaky clean. I now have a lovely 5x7 print-out of one of 2008’s star JHU candidates, obtained in public domain, where he and a dozen of his BFFs are jubilantly celebrating their approaching completion of 1st year college—stark naked except for strategically placed hats. You have no idea how eternal these ill-advised images can be. And surprise --committees know how to Google you. We do it routinely at Hopkins before interviews, and a recent survey of recruiters indicted as many as 83% of recruiters (!) may now do the same.
And don’t use Facebook, Twitter, or text messaging to communicate with advisors. Even if we are on it, play the professional game and use the business email approach. DO NOT ask ‘Cn U C me 2dA’!
LETTERS OF RECOMMENDATION: Whom should I ask?
Your letters are a key to distinguishing you from the (talented, accomplished, likable) pack. I suggest at least 2 Rads people, with the other one or two chosen from whomever you feel/hope will write the best letters. (See my comments above--my letters are nationally popular, but I will be honest, titrate my opinions and clarify your place on the Hopkins and national food chains, for better or worse). Your writers need to be a) enthusiastic, b) knowledgeable, c) credible, d) literary, and e), ALL of the above. They need to know more about you than the factoids or accomplishments on your resume or ERAS; the committee's collective eyes glaze over the third time this CV info is recycled. A Nobel-prize winning scientist or world-renowned Department Chairman who doesn't know you, reiterates your CV and mumbles generic praise is less effective than a less well-known person who can make you leap from the page, elaborating and specifying your many glowing personal and professional attributes. (Of course, if you can land one who is both a recognized Rads Nobel-level world figure and can warble your praises in 3-part harmony, mazel tov). And there are some real cheerleaders out there who can't get the message into effective words. Some people are just so habitually understated, or perhaps translate poorly to paper for one reason or another. No way to really check this factor out; just word-of-mouth and crossed fingers.
There persists a rumor the Rad Chair has to write a letter— this is NOT TRUE. NOT. And some LOR writers can tweak the epistle to fit both PGY1 and residency applications.
As to what they need know about you--go back to page one and re-read my comments about honesty. If you misrepresent ANYTHING in your information packet, you are in essence encouraging an attending to (inadvertently) misrepresent you--and drill irreparable great gaping holes in his/her own credibility. Sins of omission count as heavily as those of commission. I have been burned a couple times by both carefully orchestrated omissions and blatant misrepresentations (neglecting to mention flunking Step One; claiming AOA status; carefully not mentioning that silly little ‘F’ or DUI...). By then writing super-supportive but inadvertently erroneous letters, I have had my credibility scorched. Unless you have strong back-up plans, such as running your brother-in-law's dog walking business, come clean. This is another Zero Tolerance Zone.
Once you identify a potential LOR author--preferably by late third year--make sure they KNOW you. Let's say the only reason Dr. Who seems like a potential LOR author is the glowing comments she made grading your IM rotation. Do you email her interesting follow-ups, web sites relating to a case recently under mutual discussion, updates on your joint research projects or notification that your mutual patient from Dr. W's service, Mrs. Baratheon from Westeros, turned up while you were in the EMed? Do you ever drop by her office or lab (be sensitive to cues that this is either a bad time, or in general a bad idea; not every one likes surprises), attend conferences or lectures in her area, make an appointment or dash off an email (professionally headed) every few months to touch base?
Once you have identified your potential LOR cheerleader (and probably 4 people should be in hand by late July, folks; don't forget you also need LORs for that Prelim year), meet with them to discuss/request same. Approach by email to be clear about reason for meeting, potential times, and your hopes for their enthusiastic support. Remember to leave them wiggle-room to refuse ("I'm hoping I could ask you for a letter, if you feel you could write me a strong one", or, "...if you feel you are the right person to speak up for me"). Come prepared with a NEAT, ORDERLY, and BRIEF resume (see numerous guide books and below; there is a Hopkins faculty format online which will not entirely suit a student but gives some generic sense to the format). Your procrastination or deadlines are not their problem. Many attendings disappear in August or early September (vacations, meetings, kids to be delivered to schools). Meet with and land their support by June if possible (remember the medical world goes head-over-heels and circles the wagons each July), mid July at the latest, and (tactfully, respectfully) double-check if they have plans to leave the known Universe late August/September. Get your whole package--final draft resume, transcripts, ERAS number and instructions, etc.-to these people no later than early August (ask if they prefer email or hard copy; if the latter, neatly and orderly assembled in clearly-labeled plain interdepartmental manila envelope is fine; please don't go buy expensive glossy folders to lovingly cradle your fragile babies), telling them you will check back before Labor Day to follow-up. Then DO JUST THAT-tactfully and respectfully (email works well-"Just a reminder, my advisor insists my package be complete by September 10; please feel free to contact me if you have any questions or need more information' ; or, "Dr. Magid is really neurotic about getting these letters in by Labor Day, if you put them on your letterhead* in a sealed signed envelope I'd be happy to hand-deliver them to the Dean") ). Whatever the current system of tracking, MAKE SURE these all get there. I will be nagging you relentlessly to have your entire package INCLUDING letters ready to hit 'send' in early September.
He/she who slides info under attendings' doors Sept 25 runs risk of getting a) no letter--faculty just left for 10 days at the Skeletal Society in Istanbul--or b) a hastily-produced letter by an annoyed and harassed doc who has several other deadlines pending the same week. Leaving it to the last second also makes one question your organizational skills, attention to detail, ability to follow through, and functional effectiveness. Especially when all your comrades beat you there by 3 weeks.
*Not enough to worry about? The DOSA office tells me that even now they get some LORs with typos, or not even on letterhead. Faxed or even scanned LORs tend to acquire lines or artifacts or blur they cannot correct. Be subtle but precise in requesting the letters, and in asking that you be able to hand deliver them in a sealed envelope which the LOR author has signed across the back. If they prefer to mail them, provide stamped addressed envelopes; JHH InterDepartmental Mail is awful. (No need to hand-deliver mine- -I promise you I personally hand-deliver them to DOSA).
INFORMAL AUTOBIOGRAPHY PLEASE!
If you want a letter from me, please produce an informal Autobiography by mid-July at the latest. This is a casual, free-form memoir/confessional/stream of consciousness plunge into your psyche. Use taste and common sense; there are things the NO ONE needs to share. I want family history (your choice how many generations back), info on parents, sibs, important relatives, where you got your core identity; earliest memories, school days, siblings, circumstances, oddness, hobbies, quirks, passions, pitfalls, peeves, triumphs, mildly embarrassing moments, those stories every one breaks out over the holiday table, your décor style, things you feel are central to your identity, and more. Baby and family pictures are a wonderful charming conversation-starter when you bring me this opus (as one of my delightful and beloved ’08 candidates 1st demonstrated. I’m considering making it required!). Do you wear lucky green socks to all exams, or carry a carved sea otter for luck? Ever been exorcised, abducted by aliens, lost or found your faith, collected bottle caps or roller blotters, hand-crafted a chess set, run a business, been homeless, lost sleep because the bees are dying or the polar bears are losing weight, been shipwrecked or in a plane crash, had some key pivotal experience? Careful sterile recitations will be resoundingly rejected for a re-do. No points off for grammar, spelling, sentence structure—just let it flow. IMPORTANT SIDE EFFECT: I have been told endless times that in trying to perform this exercise, students found some inspiration or direction un-jamming them for that dread obstacle ahead: The Personal Statement.
THAT CV... .
You will be preparing a personal and professional resume for the Deans and for your advisors/letter writers. This must be a flawless opus, logically arranged, readable, oozing precision and integrity. This is not Freshman Creative Lit class, nor Hyperbole 101. Any errors, exaggerations, typos, or misstatements here will be lethal. Find a traditional format--compare notes with friends, or check the various guidebooks, and look at the Hopkins faculty CV format on-line (in the Silver or Gold books). Keep away from fussy fonts or quirky layouts.