Applying, interviewing and matching into a top residency program is a medical student’s dream. It is the culmination of four years of commitment and dedication to becoming a physician. Everything accomplished in medical school leads up to match day, when medical students across the country learn where they will attend residency. And while matching at their #1 ranked program can be celebrated without compare, there are many who have a challenging application and interview process, do not match into their top choice, or go unmatched to any residency positions at all.
Performance in medical school is critical to success, but having a thorough understanding of the intricacies of the process can ultimately play a significant role in the final outcome. Thus, it is important for all medical students to learn the ins and outs of the journey, starting with application to the Electronic Residency Application Service (ERAS), continuing with the interview season, and ending with the National Resident Matching Program (NRMP), the Supplemental Offer Acceptance Program (SOAP), and the scramble, all concluding in Match Day and beyond!
Hear it from the experts
Team Thalamus is here to guide you along the way. As the most-preferred GME interview management solution, we have insider knowledge to master this process. While we prefer to remain modest, we are the experts in all things related to the residency application and interview process.
Our entire team is composed of current or prior applicants, program coordinators, program directors, and GME administration. We understand the process because we have lived it firsthand. We have also managed the process in hundreds of programs at hundreds of hospitals throughout the country. We’ve also scheduled hundreds of thousands of interviews for over 100,000 residency and fellowship applicants, and have analyzed the resulting large collection of data.
We understand the nuances and intricacies of the process, we’ve experienced the emotions both celebratory and otherwise, and we’ve interacted with program coordinators and directors at nearly every top academic medical center in the country. This process isn’t only our business, it is also our passion. We are academics at heart, love nerding out on the data, and have committed our careers to streamlining and optimizing this process for all involved. Most importantly, we are always here to help!
What follows is our best advice on Match Day: our definitive guide for med students. It contains all of the highlights, tips, tricks, and specific knowledge that we wish we knew when we went through this process, as well as other key items we picked up along the way through our business practices and data analysis, including:
- Match Day: How it works and how it feels
- Preparing for your GME program: What to do after Match Day
- Post-match day blues: What to do if you don’t get into the right program
- What to do if you don’t match at all
- IMGs applying to residency: What happens if you don’t match?
- How Thalamus helps match a resident to the right program
We hope that you enjoy the information presented and that it prepares you to optimize your individual rank list. Happy reading and best of luck on your journey to Match Day!
Match Day: How it works, and how it feels
Formally, Match Day at the end of Match Week is the pinnacle moment in a medical student’s educational journey. It is that day when the residency interview and application matching process reaches its conclusion. It is when students learn the location where they will be training as a resident.
For each doctor in training (and this includes Thalamus CEO and Founder, Jason Reminick, MD, MBA, MS, whose story we told in our blog post on the subject) it begins six months prior, with the submission of an ERAS application. Then comes traveling throughout the country, interviewing like it’s a candidate’s only job. This is followed by the creation and certification of a rank order list, its submission in mid-February, and then the grueling wait until Match Week arrives. What a process! And that’s just getting to the day in question.
The events of Match Day amount to opening an envelope or email to discover your residency program. However, for fourth-year medical students around the country, the day is so much more. Here Jason provides insider knowledge including key takeaways from the process, and what students can expect on Match Day.
What Match Day is all about
Match Day is celebrated on the 3rd Friday of March, which this year (2019) fell on March 15th. At noon EST on each Match Day, graduating medical students around the country open an envelope from the National Resident Matching Program (NRMP)—or read an email, or log in to the NRMP R3 site—to learn at which institution they will complete their training.
The structure of the Match Day ceremony itself is dependent on each medical school. Some schools will lay the envelopes out in a communal area, which generally results in a mad (but fun) dash to grab envelopes at noon. Others will have students open the envelope at the front of an auditorium and read their match into the microphone. The traditions vary, but all of them are full of nervous excitement!
The organized events that precede or follow the envelope opening ceremony may also vary greatly between med schools. Traditionally, there will be events the morning of Match Day, then a ceremonial meal following the match (this takes the form of lunch on the east coast, and breakfast on the west coast). Other festivities such as slide shows, class bonding activities and celebratory dinners with families are also common. Whatever happens on your Match Day, it is certain to be memorable.
When personal sacrifices pay off!
Match Day is the culmination of so much hard work and dedication. It is every late night spent in the anatomy lab, every early morning trudge through snow to gather vitals on all the patients on the surgical service before the residents arrive. Match Day is the skipped lunches during fourth year—in fact, during every year. It is the personal sacrifices: missed weddings, family gatherings and holidays.
That single Friday brings to a head the excitement and hardship of a medical education spent learning about the wonders of the human body. Match Day is the crushing defeat of getting a less than stellar review, and crying with a patient and their family. It is USMLE Step 1, Step 2 CK and Step 2 CS. Match Day is every other test you take in medical school. It is every standardized and actual patient encounter. Match Day is that time in pathology where you realized you had absolutely no idea what was being shown on the slide. It is the first time you tried to intubate a patient and succeeded or failed.
Match Day is the smile and pride you see on your parents’ faces. It is the hug you receive from your brother/sister/significant other. Match Day is the handshake you get from the attending you’ve always respected most, knowing that you will soon join them as a colleague. It is the realization that you will soon be Dr. so-and-so. And it is the excitement and sheer terror that comes with it.
Preparing for your GME program: what to do after Match Day
Life can be quite sweet after Match Day. Med school may be filled with awkwardness and anxiety, but after opening a Match Day envelope (or email), things change! There’s a bit of certainty and a major reality check—we know where we are going to spend the next three to eight years of our lives. This post helps describe what applicants should do in between matching and getting started in residency—or internship, or fellowship program, whatever form your graduate medical education program may take.
- First step is to email the Program Director. Taking the time to reach out and introduce yourself will show that you are professional. This is a way for you to start off on the right foot. It doesn’t have to be too verbose, just communicate that you are happy that you matched there and looking forward to learning from them.
- Next, download Docusign. A practical and essential tip. You’ll receive some very important documents that you’ll have to sign in a time-sensitive manner. Docusign is a way to electronically sign them right on your phone with ease.
- Be sure to give back at your specialty interest group or to lower classmen/women at your medical school. Help out the MS1s and MS2s. Offer to speak on a panel. Give out your cell phone number to those who want to learn more. You know the application process and your specialty very well. You possess insider knowledge. Share it! Sharing knowledge is valuable at all stages of medicine. Sharing knowledge is valuable at all stages of the medical journey. If you’ve just matched and are nervous about what’s coming next, speak with a mentor, attending, or current resident to get the inside scoop.
- Thank your supporters. There were many people who contributed to your success in medical school and your success on Match Day. You’ll likely also continue to lean on them for support during residency. So be sure to contact your mentors using whatever means necessary, update them with the next step in your life and explicitly thank them for the support.
- Consider your finances. Financial literacy is rarely taught in medical school, but is an essential skill in residency. Having control of your finances will ensure you can take better care of your patients. As reported by the AAMC, 76% of medical students graduate with debt, with the mean hovering at $192,000. If you were able to become a physician, you should certainly be able to understand core financial topics, which can be found on sites such as The White Coat Investor: A Doctor’s Guide to Personal Finances.
- Do not study. You’ve spent four years amassing medical knowledge, and that will be worry #7 on your list come intern year. You’ll know the academic details as a resident and your concerns will be more systems or patient-care based rather than knowledge-based. And these can only be learned through experience, not beforehand. Besides, being prepared is different than studying. Review and have good resources available such as: “On Call Principles and Protocols” and “Pocket Medicine”. Don’t worry about USMLE Step 3 either. The hardest part is figuring out the layout of the software. If you use UWorld and do a few practice scenarios, you will pass. If you want a quick brush-up, read Master the Boards USMLE Step 3.
- Find a place to live! The best way to go about finding one is by emailing the program coordinator—he or she could connect you with graduating residents. They can often set you up with a sweet deal for the living situation they are leaving behind, one which is already resident-approved!
- Most importantly, enjoy yourself. You’ll learn what you need to know in residency, so enjoy the free time before residency starts. Get out and about, do a bit of traveling if you can. Aim to forget about health care and learning for a short period. If you want to do the popular Europe or South East Asia trips, go for it! But don’t forget there are a lot of amazing places to explore in the U.S, too. As well as all the things we mentioned above, try to arrive to the first day of intern year well rested, with some recent nice memories. That will ensure your residency gets off to a good start!
Post-Match Day Blues: What to Do When You Don’t Get into the Right Medical Program
Sometimes Match Day isn’t perfect. That is just the reality. And that means at times you don’t end up at your number one option. In this blog post, Thalamus provides insight into how it is likely to be OK in the long run. Research has shown we are pretty bad at predicting what will make us happy.
But let’s be real, that isn’t the case for everyone. In fact, about half of U.S. allopathic medical school applicants do not get into their top choice residency medical program. It is a day loaded with expectations and at the core of it is this: you are very vulnerable. Some students take up an additional $20,000 in loans just for interviews, and they don’t really have control over the entire process—especially where they match. It stings. But what you do have, post-match, is control over things going forward. Read on to discover what you can do if you don’t get into your top program on Match Day.
No one can predict the future
Let’s stop for a second and ask a simple question: what was your favorite band ten years ago? Now, are they still your favorite band? Probably not. There is ample research out there that says we are incredibly bad at predicting what will make us happy in the future.
You might even find that the program you did match to gives you what you are looking for. Let a few months pass after Match Day. By that time, the shock and surprise will have worn off, and you’ll get a clearer view of the situation. Should you still really crave what your first-choice program offered, then find alternative ways to get it. If it was in a certain location (perhaps close to significant other or home), then take some vacations there. If it was a specific fellowship, then follow the journals, attend conferences, and work within your institution to stay up-to-date and competitive. Search out a mentor. Introduce yourself to key people. Put in extra hours doing a small scale study. Join committees.
Basically, find the silver lining. Missing out on your first-choice program on Match Day doesn’t mean that you can’t still achieve what you want. Sure, certain programs make it easier than others. You might have to work a bit harder, but ultimately if you want it to happen you can still take control of the situation. Remember: residency is the beginning and not the last step.
Take the entire picture into view. There is not a single program that offers every single thing we could want. Sometimes the ones that focus on clinical exposure lack adequate research opportunities or dedicated teaching sessions. Those that are research powerhouses at times may not be located in an area with a favorable cost of living. You get the idea.
Wherever you end up, there are sure to be positive things. They may not be readily apparent or recognizable to everyone, but they are there.
Overall, it’s all about perspective. This is the key. Wherever you train, you can still become a good doctor and have a fulfilling life and career. It just requires effort and a positive attitude. So don’t despair about missing out on your first choice in The Match—focus on how to get what you need from the program you’re in. You will become a fantastic medical professional, wherever residency takes you.
What to do if you don’t match into a residency program at all
Not matching is jarring. While the first step is to dust yourself off and let the shock fade away, an unmatched med student can certainly feel adrift. This post is a step-by-step guide for US graduates who don’t have a residency program lined up after Match Week, the supplemental offer and acceptance program (SOAP) and Match Day have come to a close. Similarly, if you are an IMG, read this post specifically targeted to International Medical Graduates.
As a US Grad, remember that the odds are in your favor. More than 99 percent of US medical school graduates do end up practicing medicine within six years of graduation, according to a study published in JAMA.
First, if you didn’t match take a moment to consider and find out, “why?” Diagnose why you did not match. Sometimes having another set of eyes on your application can be valuable—so turn to an advisor, mentor, or trusted med school friend and ask them for their thoughts. Take a close look at your personal statement. Remember, your medical school really wants you to have a successful Match Day. They are a tremendous asset in this. Make appointments to speak with relevant people there.
In terms of the data from a survey by the AAMC, top reasons for not matching included:
- 1) A poor USMLE score,
- 2) poor or uncompetitive academic standing, and
- 3) poor interviewing or interpersonal skills.
The next step includes signing up and taking USMLE Step 3. Passing Step 3 may be beneficial for multiple reasons, including assuring program directors of your test-taking abilities, overshadowing previous poor test scores, allowing you to fill a vacant position of another trainee unable to pass Step 3, and enabling application for H1b and J1 visas.
Finally, take a year to stay clinically competent and seek out research opportunities. This may include working in a lab, being a scribe, or being an EMR trainer. Complete a poster presentation. Offer to volunteer or teach to demonstrate your commitment.
Dr. Margarita Loeza, MD, who is a family medicine physician and chief medical information officer at Venice Family Clinic, has a handful of strategies for how to best spend your time post-Match Day if you aren’t in residency. If you know the field you’d like to end up in, then reach out to the people who run the labs or conduct the research.
If you wish to practice without doing residency, realize that in some states this is possible. However, this program is in its infancy. Missouri, Kansas, and Arkansas permit unmatched medical school graduates to work in medically underserved areas without a residency.
Further, you can look into the data and considering applying to another specialty. The NRMP has some incredibly useful information regarding the numbers of students that match into their preferred specialty. It has the average Step 1 score, Step 2 CK, number of publications, and more, all relating to the statistics around matching. For those who like to deal with numbers, this is as close as you’re likely to get to predicting chances of a successful Match Day based on scores and other metrics.
Most importantly, stay positive!
Not matching is not the end of the world, and nor is it the end of the road for your medical career. There are options for you, from research fellowships to volunteering to dedicating yourself to studying for USMLE Step 3. Keep your eyes and mind open to any and all opportunities, and prepare yourself to try again at the next Match Day, if it comes to that.
IMGs Applying to Residency: What Happens When You Don’t Match?
This post is all about perspective. In the short term, the odds do not favor international medical graduates (IMGs) matching—94% of AMGs match, compared to 60% of IMGs. In the long term, though? One in four physicians who practice in the United States are IMGs, according to the Association of American Medical Colleges. If you’re an IMG who hasn’t matched or is worried about what to do if you don’t, this blog post offers a step-by-step guide to lead you through the next steps following Match Day.
First, stay positive and take action. Look at this as an opportunity to reinvent yourself!
Next, as is often the case with any good clinician, diagnosing the program is helpful. If the reason that you didn’t match doesn’t jump out right away, ask a trusted friend from your school who has matched. Ask for honest feedback. Touch base with your mentor or sponsor. Sometimes it is something out of your control, but many times it is something that, when reconfigured, will ultimately result in your success.
If you applied to a field in which you are not competitive enough, consider the odds. According to recent data from the National Resident Matching Program (NRMP), the specialties in which IMGs are most likely to match include pathology, internal medicine, neurology, family medicine, and general surgery. Aim for those.
If it is a poor letter of recommendation that hurt your chances on Match Day, then apply for externship opportunities in the field you will be applying to next cycle. That way, the letters will be more specific. If one is applying to radiology and a program director in family medicine reads a radiology letter, then he or she might discover that family medicine is a backup plan. Plan ahead for a relevant letter of recommendation next time around.
Is it lackluster interactions with patients and an inability to present information concisely? If that is the case, then take an externship and really hone in on those areas. Find a way to come early, stay late, and watch how people present. Be proactive—early on, ask what you can do better in terms of presenting. Watch more experienced residents present. Mirror their tactics.
Other areas to hone in on are: clinical experience, publications, lack of networking contacts, interview skills, and your personal statement.
Tips for improvement
During the year to follow, you should also maintain your clinical skills. Email mentors and ask if they need assistance doing research. Offer to be an MA or scribe. Apply for an externship or subinternship. This will keep your medical knowledge sharp, allow you to become more than the average applicant on paper, and demonstrate a commitment to your (possibly new) field. You could even get a publication or poster presentation.
This will all set you up in the next cycle to apply smarter. It isn’t the number of programs you apply to, it is the likelihood they will take you on Match Day. That means you should figure out which states, programs, and specialties people from your school have been accepted.
Take advantage of the resources out there as you decide how to approach the next year or so, whether to change your specialty and what to change it to. You probably already know about MatchAResident which has an abundance of data and understanding for this purpose.
IF YOU REQUIRE A VISA, MAKE SURE YOU ONLY APPLY TO PROGRAMS THAT ARE ABLE TO AND DO SPONSOR THE PROPER TYPE OF VISA NEEDED! Taking a focused approach to target programs most likely to take you on Match Day may yield an advantage, and a positive residency interview.
You might even consider being able to achieve your goals without a residency program. Some states allow one to practice without residency experience. Take Missouri for example, which now allows physicians to practice without residency as Assistant Physicians in health care shortage areas.
And while it may not seem true, there are benefits to the re-application process. In recognition of the number of repeat applicants each year, most of the official residency services have made adjustments to improve the process for those who are not applying for the first time.
The residency application service ERAS implemented a new “Import” feature in 2017, allowing applicants to import their answers to the previous season’s MyERAS Common Applications. You will be able to import all of your answers, but make sure you go through each answer and edit them as needed! ECFMG is allowing more documents than ever to be preserved and reused for the following year.
Most importantly, knowledge really is power. As a repeat applicant, you will have a much better idea of how the application season works. This includes what deadlines to follow, and what to do and not do during interview season and on Match Day. The experience you gained from your previous residency application cycle will put you ahead of the newer applicants who don’t know the process like you do.
Things to consider when applying again
Before you re-apply (if you plan to), you’ll want to be very familiar with the requirements. Have everything squared away before the next match. Research residency requirements before applying, and direct the submission of your application appropriately. You may want to know if you can get a license in a specific state during residency. Some states, such as California, have a list of recognized international medical schools that are eligible for licensure in the state. In addition, some states have restrictions on the number of USMLE attempts allowed or the timeframe in which they must be taken.
Because offers made and accepted during Match Week and Match Day will be binding under the Match Participation Agreement, only applicants eligible to begin training on July first in the year of the Match will be allowed to participate. The NRMP will exchange data with the ECFMG to recertify the status of IMGs.
Also, make sure you get your status sorted. To participate in US graduate medical education programs, IMGs who are not citizens or lawful permanent residents must obtain the appropriate visa. If you’re re-applying, your visa may need extending. Questions about obtaining a visa should be directed to your residency program staff, the US embassy or consulate in your country of residence, or the US Citizenship and Immigration Services.
Finally, and perhaps most importantly, don’t give up! You’ve worked really hard up to this point. Now, with a bit of focused change, reinvention and working smarter, you can increase your chances of achieving your goals on Match Day.
How Thalamus Helps Match Residents to the Right Program
Thalamus is the premier GME interview management solution. Now having completed our fifth residency recruitment season and NRMP Match, Thalamus has taken the lead as the most-preferred interview scheduling platform for applicants, program coordinators, program directors, and GME leadership. How did we get to this position? What exactly does Thalamus do? And most importantly, how does it help both applicants and programs streamline the recruitment process?
Learn from the CEO and founder of Thalamus (and a former applicant and resident), Jason Reminick, MD, MBA, MS, as he provides an in-depth look as to how Thalamus became what it is today (full blog post here). Most importantly, you’ll learn how Thalamus assists applicants in streamlining their residency interview process in order to optimize their match and have a successful Match Day!
As a result of Superstorm Sandy, Jason was trapped in New York City with the majority of his interviews canceled. His co-founder and residency program director, Suzanne Karan, MD was equally affected by applicant cancellations due to the inclement weather and candidates unable to travel to Rochester, NY. Together, the two brainstormed a better way for candidates, GME programs, and all others involved to innovate and disrupt the residency application, interview, and match process. Thus, ThalamusGME was born.
How Thalamus is changing the Match Process
Thalamus is a two-sided interview management platform specifically designed for application to Graduate Medical Education (GME) training programs. It has features for both applicants and programs, online and mobile. It was created—and iterated on—through a grassroots collaboration of applicants, program coordinators, program directors, and GME leadership.
Thalamus integrates with the Electronic Residency Application Service (ERAS), allowing residency and fellowship program coordinators to upload their candidates. Programs set up their calendars to include a scheduling algorithm allowing specific positions to be reserved for specific tracks (e.g. categorical, advanced, research, primary care, etc…), customize their emails, and build survey questions. Programs then invite their candidates either in waves or as an entire cohort.
Thalamus sends out invites via email directly to the candidates, which includes links for candidates to build a profile in Thalamus (which takes less than 20 seconds). This links directly to each candidates’ unique Thalamus calendar. Similarly to Open Table, candidates can sign up for interview dates in real time—including scheduling, canceling and rescheduling until the program “locks” the interview date. If a date is full, Thalamus has the most flexible waitlist management, allowing candidates to simultaneously hold an interview spot at a program, while adding themselves to one or more waitlists dates to provide the freedom to create the most optimized schedule. Candidates can then book travel and have their itineraries stored in Thalamus automatically and free of charge. Thalamus has mobile apps for both iPhone and Android.
It’s not only for students
Back on the program side, Thalamus manages all of the interview season data—including face sheets, waitlist management, report creation, itinerary management, faculty scheduling, and scoring, evaluating and ranking candidates. Rank lists may be exported directly to the NRMP for a true end-to-end experience leading to Match Day.
Using the above processes, Thalamus is innovating the way applicants and programs manage their interview seasons, increasing ease of scheduling and decreasing overall frustration. Applicants can align their interviews regionally to decrease travel costs. Similarly, residency programs are saving 30-50% of their workload. This allows them to focus on the more critical and personalized components of recruitment.
However, the future of Thalamus is even more exciting. Given significant increases in residency application costs, now spiraling over $80 million/year (with a 5 times increase over the last 20 years), US graduates are applying to 60+ programs and International Medical Graduates applying to 150+ programs on average, across all specialties.
To help alleviate these costs, Thalamus is developing data and ranking products to provide candidates greater insight into the recruitment process and assess their individual competitiveness. Enterprise dashboards are also being built for programs to provide enhanced strategies for GME recruitment. Our goal is to use data and technology to humanize the recruitment process and battle application inflation and anxiety. The current model is creating too much strain on all involved in the process. This leads to early forms of burnout before candidates even reach Match Day and then start their training on July 1st.
We are thrilled about the future of Thalamus and we are always here to assist! So please reach out to us anytime.
Match Day marks the penultimate moment in a medical student’s education prior to graduating and becoming a REAL doctor. As we have discussed, understanding the process is key—because it will ultimately affect not only how, where and into what specialty you match, but ultimately determine and define the beginning of the next phase in your professional journey.
Match Day may come with emotions, both good and not so good. Once matched, you must immediately start thinking about getting ready to start your residency. Perhaps you didn’t get into your top choice and now need to both understand, cope, and succeed with Plan B (or C or D). While the odds are in your favor, there is always the chance that you may not match, which has different implications for both US graduates and International Medical Graduates (IMGs).
Yet, regardless of who you are, where you’re from, or what you did, Thalamus is here for you (as long as you love us, even if we throw out terrible puns). 90s boy band lyrics aside, we are here to help you match into the right residency program. We will be there on your journey assisting you in the scheduling of interviews along the way. We hope you have enjoyed our guide, learned a lot, and take away these nuggets to optimize your match process. It isn’t only advertising, but our true privilege to provide you support throughout this process. If you’d like to learn more about Thalamus, please write to us at firstname.lastname@example.org. We look forward to hearing from you.