Graduate medical education recruitment can be an arduous, long and grueling process. Ask anyone who has been in GME, and they’ll tell you that the residency recruitment process, which lasts from September through March (or the winter or summer for fellowship), can be the most challenging role for a program coordinator.
For those new to the coordinator role, it can be overwhelming.
Learning new acronyms like ERAS and NRMP, applications, interviews, coordinating faculty, composing ranks lists, Match Day and onboarding residents—all of that could very well be a job in itself. Add on the other responsibilities of managing the current residents in your program, and it is no wonder that program coordinators are often the unsung heroes that make GME work.
Team Thalamus works closely with residency program coordinators, as they are the primary users of our software. Over the last half-decade, we’ve worked intimately with these hardworking individuals on the front lines of recruitment. We pride ourselves on working with brand new programs and leadership.
It’s safe to say we are familiar with the process. So, here is our guide for new medical residency program coordinators.
How the medical residency recruitment process works: the one-sentence version
Residency programs recruit medical students through a process operated by the Electronic Residency Service (ERAS) and the National Resident Matching Program (NRMP) from September to March each academic year.
How the residency recruitment process works: The longer version
Let’s break it down.
Pre-application season: preparing for the upcoming year.
The academic year at most hospitals or academic medical centers runs from July 1st to June 30th. This signifies the start of training for new interns as well as the promotion of residents to the next level of their training, which is measured in Post-Graduate Years (i.e. PGY-1 = Post Graduate Year 1). While new medical residency program coordinators may start their work year at any time dependent on when they are hired, we use this as our starting point because most programs will be busy with the tasks of onboarding new interns and turning over the academic year until after this milestone.
Thus, most planning for recruitment season begins around mid-July. At this time, those on your recruitment team will prepare the strategy to recruit your next batch of residents.
Planning will likely include:
- Determining which dates your program will hold interviews,
- Targeting the number of interview invitations that will be sent and the number of candidates that will be interviewed each day.
- Deciding which faculty members and other program leadership including chief and current residents will be involved in the process.
- Outlining the order of events, budget, and activities that will comprise an interview day.
- Preparing scoring practices and rubrics upon which candidates will be evaluated. and
- Identifying the processes and systems that will be used to rank candidates who will eventually match and be onboarded to your program.
While this may seem straightforward, the process is quite nuanced.
In addition to developing strategies and goals to be accomplished, you’ll need to ensure that your program is equipped with the tools to actively manage the process. Thalamus is one of these tools, falling into the category of interview scheduling and management software.
Thalamus helps streamline the process of interview management by allowing applicants to self-schedule, cutting out hundreds to thousands of emails and phone calls. The software then manages all of your data, creates face sheets, allows for scoring and ranking of candidates. It is an end-to-end solution designed to match your workflow. While we aren’t the only solution on the market, we are the most-preferred by program coordinators (and program directors, GME administrators and applicants too!). This is because we’ve had input from hundreds of coordinators over the years. In fact, several members of our team are current and prior program coordinators. Take a look at our How It Works page to learn more.
Further, if you are needing some leverage to convince your program director to use such a helpful and time-saving tool, take a look at our tips for selling your program director on interview scheduling software.
The Residency Application Process
The residency application process starts each year on September 15th. Medical students submit their applications via the Electronic Residency Application Service (ERAS). This is the software through which your program will receive and review candidate applications to your program and is available for setup starting June 20th, 2019.
While applicants will begin working on their application starting June 6th and then start applying to programs on September 5th (for the 2019-2020 application cycle, around these dates in other years), residency programs will only start receiving them on September 15th.
At this time, some combination of your program director/leadership, faculty, and program administration (which will likely include YOU!) will start reviewing applications through the ERAS system, which is accessed through the Program Director’s Work Station (PDWS), an online cloud-based software. This requires having a username and password to access the software.
Have questions about ERAS? They provide an extensive setup guide with registration instructions, webinars, policy and software updates.
Once the ERAS application season is in full swing on September 15th, review of applicant files will commence. A completed applicant file will include:
- A completed ERAS Application
- Their personal statement
- Letters of recommendation
- Medical Student Performance Evaluation (MSPE or “Dean’s Letter”)
- Medical School Transcript
- A photograph
- USMLE/COMLEX-USA (licensing exam) transcript
International Medical Graduates (IMGs) who completed medical school outside of the United States must also include:
- Their ECFMG Status Report
- A Postgraduate Training Authorization Letter (PTAL or “California Letter”) if seeking to train in California—although this requirement is planned to be removed for the 2019-2020 application season
It is important to note that applying for residency training is expensive for candidates. For instance, during the 2018-2019 application cycle, candidates collectively spent greater than $80 million on application fees alone. When factoring in the cost of travel, also paid for by candidates, total costs increase collectively to $1 billion, the majority of which is put on credit cards and additional student loans—up to $25,000 per applicant.
For convenience and a greater understanding of the ERAS fees structure, we have included their fee schedule here.
Programs per specialty:
- Ten or fewer: $99
- 11-20: $14 each
- 21-30 $18 each
- 31 or more: $26 each
It’s a little complicated, so here’s an example of the payment structure:
If a student were to apply to 22 Family Medicine programs and 15 Internal Medicine programs, they would pay $99 for both the first ten FM and first ten IM programs ($198), then $14 each for the next ten FM ($140), $18 each for the final 2 FM ($36), and $14 each for the next five IM ($70). Their total fee would be $444.
With all of this in mind, your program’s review of applications will begin. Filters in ERAS allow programs to easily sort candidates. Historically, candidates have primarily been filtered by their performance on their United State Medical Licensing Exam (USMLE) Step 1 score, but this topic is being hotly debated throughout graduate medical education given the poor correlation of academic report and clinical knowledge. Currently, the National Board of Medical Examiners (NBME) is considering proposals to make the test pass/fail. However, this brings up additional challenges in determining objective, distinctive, and continuous variables upon which to evaluate candidates.
An entire blog post (and more) could be written on this topic alone. We recommend this article from the Journal of the American Medical Association (JAMA).
At Thalamus, we support holistic review of applications and recommend this to our program users. This means taking the entirety of an applicants file into consideration when assessing their candidacy to your residency program. Different programs are looking for different things, but we encourage you to speak with your program director/leadership regarding your application review strategies.
From the batch of candidates applications, you’ll then begin selecting those candidates you want to consider further to interview at your program. And thus, the interview season begins!
But not all programs user ERAS! An aside…
While the majority of programs use ERAS for applications, there are exceptions to this rule. For a complete list of residency programs using ERAS, please check their list of participating programs. Fellowship program coordinators may also check this list for participating programs, which also provides insight into when your fellowship program receives invites (December or July).
For Ophthalmology and Independent Plastic Surgery residency programs, applications are submitted and managed through the San Francisco (SF) Match. Additionally, many fellowship programs are managed through the SF Match including anesthesiology and orthopedic subspecialties. For a complete list, please see SF Match’s page on participating specialties, which links to a timeline for each specialty.
Similarly, Urology follows a varying application process and timeline run by the American Urological Association dubbed the Urology and Specialty Matches. A handy overview of this can be downloaded on the linked page. While urology programs use ERAS for application season, Match Day for Urology programs is January 18th for the 2019-2020 application cycle through the AUA.
Finally, there are some fellowship programs using independent application systems and/or 3rd party services. If your program falls into this category, you will likely receive information from your institution regarding materials, policies, and timelines.
The interview season part 1: Things new program coordinators should remember when inviting and scheduling
Prior to sending out invites
As applications are reviewed by your program director, faculty, administrative staff and yourself, your residency program will begin selecting qualified and competitive candidates to interview at your program.
The interview season extends from early October to mid-February. Applicants travel to hospitals nationwide to attend interviews, where they meet with program leadership and faculty, and tour hospital facilities. They are also evaluated by faculty on how well they will fit in your particular residency program.
This is the most critical and time-consuming part of the application season. Before sending out invites, it is important to have your interview strategy all mapped out to answer questions such as:
- How many interview days will we complete?
- Which days will those be?
- How many applicants will we see per day?
- How many applicants will we invite to interview?
- Will we provide hotel accommodations?
- How many pre-interview dinners or socials will we host? When?
- What information do we need to communicate to our applicants and when will we do so?
- What will happen on interview days in terms of events?
- Which faculty, staff, and residents will partake in interviews?
- How will we score our candidates when they interview?
- How will my program director and other leadership eventually determine which candidates to rank highly?
- What is our ranking strategy in general?
- How are we going to manage our interview season? Will we be using interview scheduling software? How will we manage our data, scoring, and ranking?
It is essential that your program determines its particular interviewing strategy and has answers to these questions. Some programs will invite as many as 10 to 20 applicants to interview to fill each residency spot that is available!
It is important to recognize that the average candidate is now applying to 60+ programs if they graduated from a medical school within the United States and 150+ programs if they are an international medical graduate (IMG). As such, candidates and programs have many difficult and important choices to make throughout the interview season. Having the proper strategy in place for your program will ensure you’re set up for success.
Additionally, while you are recruiting as part of one or more residency programs, several programs are recruiting for one or more sub-tracks. For instance, a pediatrics program may have categorical, primary care and research tracks, while an anesthesiology program may have both categorical and advanced tracks. Knowing which positions you’re recruiting for and why will ultimately dictate your final interview strategy.
For more tips regarding interview invitation strategy, take a look at our blog post laying out five of the most important questions we suggest you answer prior to sending out interview invitations.
Inviting your candidates
To organize and schedule interviews en masse, programs use Thalamus or another interview scheduling software—or rely on manual emails and phone calls.
We recommend you discuss with your program leadership which option will be used. That said, we’re always here to provide support, answer any questions or happy to provide a demo at any time.
Whatever option you choose, your program will mark competitive candidates as “selected to interview” in ERAS, then allowing invites to be sent. This will occur either in bulk or in waves throughout the interview season, as invitations are communicated via email and/or interview scheduling software.
While various interview strategies may be employed, we recommend that you:
1) Do not rush sending out invites. With the mass adoption of interview scheduling software, candidates can and will schedule very quickly.
2) Invite in waves to allow your top candidates adequate time to schedule. This will give your top candidates the most flexibility and make them feel valued.
3) Wait until after MSPE letters are released on October 1st to send invites. Inviting candidates before this is a giveaway to candidates that you didn’t review their application in full. Additionally, inviting too early may lead to cancellations as candidates cancel early invites to schedule with more desirable programs. Invites do not happen in a vacuum and your individual program’s performance is heavily dependent on when competitive programs (both regionally and nationally) also send out invitations and on what days they are interviewing.
4) DO NOT INVITE MORE CANDIDATES THAN YOU HAVE AVAILABLE INTERVIEW POSITIONS (at least initially)! This will only frustrate candidates and result in higher cancellation rates.
5) Clearly communicate with the applicants that they are being invited for waitlist positions in their interview invitation or other messaging, if you are inviting candidates to a full or nearly full calendar.
Optimal and humane interview scheduling strategies are now highly discussed topics which have gotten significant recent attention in academic publications, such as this recent article in the Journal of Graduate Medical Education (JGME).
Once candidates are invited to interview, responses by email/phone call or through interview scheduling software will occur very quickly (usually within minutes… or sooner!). Expect that throughout your season, candidates will continue to cancel or reschedule often, as each interview invitation received from another program will affect their overall scheduling and travel plans. Just because a candidate changes their interview date with your program, does not mean they are no longer seriously considering your program. However, multiple changes by a single candidate may be a red flag that they are prioritizing your program lower.
As interview dates approach, most scheduling software provides a “lockout” or “freeze” date, which prevents candidates from self-scheduling. While this interval is customizable by programs in Thalamus, we recommend setting this interval to allow for easy planning of specific interview days, while remaining flexible enough to allow candidates to reschedule. Candidates are met with having to pay and travel to many interviews, so the more flexibility your program allows in that regard, the greater the possibility of the candidate interviewing at your program.
Similarly, 95%+ of candidates will behave in the expected professional manner and with the best of intentions. That said, do not be surprised if a candidate no-shows, relays untrue information, communicates poorly or tries to take advantage of the scheduling process. Recognize that such signals are easy ways to eliminate such candidates from considering, colloquially known as “red flags.”
As candidates schedule and your season begins to fill, figure out when and what messaging will be sent. Many of the interview scheduling softwares, including Thalamus, include automated confirmation messaging. Additionally, surveys asking questions about candidate research/specialty interests, need for hotels, attendance at interview dinners and dietary restrictions are used (all of which is part of the survey feature in Thalamus). Such tools allow you to maximize data and information collection to ensure your candidates have the best possible interview day.
As each interview day approaches, your itinerary and candidate list will be set! However, given much of the interview season occurs over the winter, flight cancellations, travel delays and other unplanned disruptions to travel (family deaths, illness, etc.) will also occur. It is up to your program to manage these per your own policies, but please anticipate that it will happen. For instance, one of the founders of Thalamus had all of their interviews in New York City canceled by Hurricane Sandy in 2012. Life happens, so be ready to plan and manage accordingly.
Now, on to interviewing your candidates!
The interview season part 2: conducting interviews
Interview days tend to follow the same general agenda. While some residency programs will modify this agenda to include multiple interview sessions per day (e.g. morning + afternoon sessions, etc.) or to interview candidates over multiple days, interview days are meant to provide applicants with insight into the highlights of your program. Further, it also provides your faculty and other leadership the opportunity to evaluate and assess applicants in a formal interview setting.
Whatever itinerary and interview strategy your program chooses, be sure to standardize everything as much as possible to allow for comparison amongst the varying interview days. Make sure your faculty evaluation and scoring methods are determined prior to the first interview day. And be sure to include your residents so candidates have a first-hand look into what it is like training at your program!
Building your program’s candidate rank list
After each interview day and/or after all of your interview days are completed, your program leadership will begin composing its Rank Order List (ROL) for the National Residency Matching Program (NRMP). This is a list that ranks most or all of the candidates that you interviewed in order of preference for which you desire the candidates to attend your program.
The candidate ranked #1 is most strongly preferred and the candidate ranked at the bottom is the least desirable candidate you wish to match at your program. Candidates will build similar lists that rank all or most of the programs at which they interviewed. This information is then inserted into the NRMP R3 system, and an algorithm is run which favors the applicant choice (i.e. is “applicant-proposing”) to determine final residency placements as part of Match Day/Week.
The NRMP Match checklist for programs contains essential information for those participating programs.
Key dates for the 2019-2020 application cycle include:
September 15th, 2019: Match Registration Opens.
*New coordinators and/or programs should create their accounts in the Registration, Ranking and Results (R3) system using the token link sent by email when the Match opens.
January 15th, 2020: Rank Order List Entry Begins in NRMP R3 System.
January 31st, 2020: Quota Change/Withdrawal Deadline, SOAP Participation Status Deadline.
February 26th, 2020: Rank Order List Certification Deadline.
For those programs that use the SF Match, information for that specific process may be found here.
Similarly, information regarding the Urology match may be found here.
During the period of rank order list creation, some candidates may send “love letters” about how strongly they desire to attend and/or rank your program. Please be aware that such communication between applicants and programs, and programs and applicants may border on match violations. Ensure that all key members of your program leadership review the Match Participation Agreement including the important rules and regulations by which to abide.
It is incredibly important that your program enter this information in a timely manner, in the correct format, and by the deadline. Otherwise, you will not match residents at your program.
Luckily Thalamus has tools to assist with this as well!
How exactly does the Residency Match Process algorithm Work?
The algorithm starts by attempting to match each applicant to their first-choice program. If there is a match with a residency program, the candidate is “tentatively” matched. This means that the candidate will match at that institution, as long as applicants ranked higher than that candidate at that particular institution do not occupy the available positions.
If an applicant’s first choice is already occupied by higher-ranked candidates or a “tentatively” matched candidate is subsequently displaced, the algorithm will attempt to match the displaced candidate to their second choice. And then to their third choice. And so on.
Once a candidate has matched into their most-preferred available choice, with no higher-ranked candidates securing remaining available positions, a “tentative” match becomes a “confirmed” match. This is the program where the candidate will complete their residency training.
Once rank choices for all candidates have been run through the algorithm, the match is considered final. This leads to Match Week, the last stage of the residency match process.
Match Week and SOAP: The final hurdle
“Match Week” is the third week of March, a very important time for medical students and residency programs. It ends with “Match Day,” the third Friday of March. Here’s the basic schedule for the week:
On Monday of match week at 11 am EST, applicants are informed of whether they successfully matched into residency positions by email and through the NRMP R3 system—but not where they matched. At this time, program directors are also notified if their programs filled via the same process.
Applicants who have not matched and programs that have not filled become eligible for the Supplemental Offer and Acceptance Program (SOAP), which is an additional, accelerated supplemental matching process that takes place between Monday 3 pm EST and Thursday 11 am EST.
There is still opportunity for applicants to match to a program and for programs to fill. Unfilled residency program positions are offered to unmatched applicants via the following process:
1. Candidates will have one hour after discovering that they are unmatched to research the programs with spaces available. At 12 pm EST, ERAS will open and they may submit a maximum of 45 applications to unfilled positions.
2. Programs receive the list of SOAP applicants at 3 pm EST, and from these interviews build preference lists. Applicants are forbidden to contact programs until the program initiates contact. Programs will spend the Tuesday of match week reaching out to applicants and conducting phone interviews.
3. There are three rounds in which programs offer places and applicants decide whether to accept or reject them. Each is two hours long. They take place on Wednesday at 12 pm-2 pm and 3 pm-5 pm EST, then on Thursday at 9 am-11 am EST.
4. Applicant offers are extended through the R3 system simultaneously at the end of each round.
5. Applicants may accept, reject or allow offers to expire. If accepted to multiple programs, accepting one offer rejects the others. An accepted SOAP offer is binding.
6. The majority of positions fill in round one. The unfilled program list updates after each round.
7. SOAP ends on Thursday at 11 am EST. Unmatched candidates and unfilled programs may then contact each other freely at 12 pm EST to fill any remaining positions.
The six-month-long residency match process culminates in Match Day, on the third Friday of March at the end of Match Week. This is a significant milestone in a physician’s career that is celebrated at medical schools nationwide with faculty, mentors, family, and friends.
It is a monumental and emotional day—all applicants open an envelope at 12pm EST to reveal their residency program matches. Every medical school celebrates differently. Some lay out the envelopes on a table, leading to a mad dash, while others have candidates open their envelopes on an auditorium stage to read aloud into a microphone. Regardless, it is an exciting day for physicians as they begin the next step in their career by training at your program and others!
After Match Day, your next residency class is set!
To celebrate Match Day, many residency programs celebrate their new recruits by sending a photo roster/composite to their current residents and faculty. It assists all in the program to know the members that will represent the future of the program and will arrive that summer.
Over the coming months, your program will work with your GME office to conduct its onboarding process for incoming trainees including completing resident contracts, health screens, background checks, and other onboarding/HR documents.
That summer and leading up to the July 1st start date, many programs will host orientations and boot camps for their new interns to get them acquainted to the hospital setting, policies and procedures before they begin training. While the exact programs vary by academic medical center, they are integral to preparing your new workforce for optimal patient care.
And with that, congratulations! You made it through your first application and recruitment season! Time to now prepare for the following year! Welcome to the never-ending cycle of Graduate Medical Education.
Making matching simpler
Laid out in its entirety, it’s obvious that the residency application and match process is a lengthy and involved one for any new medical residency program coordinator (or even the most experienced coordinator). The work doesn’t stop there, either. Once onboarding occurs and your candidates begin their training, there are site visits to prepare for and all of the other responsibilities to which a coordinator must attend.
Thalamus aims to make the whole process a little bit easier for applicants and programs alike. We manage interview scheduling and use automation to do it in a way that’s streamlined and cost-effective. Here’s how it works—take a look to see whether Thalamus could be right for you as a residency (or fellowship) program!