The Nuts and Bolts

While nothing needs to be carved in stone, by the end of third year you should have a pretty good idea of what kind of residency you want to do. This is because matching is a long process that will occupy you in one way or another for most of fourth year. The process starts with scheduling your fourth year electives. While most people elect to take it easy during the last few months of fourth year (because nothing that you do after Christmas will have an impact on where you match) it is important to schedule rotations in your area of interest early to get good letters of recommendation submitted early enough to help you get interviews.

For most of the residency programs, applications are submitted through the Electronic Residency Application Service (or ERAS). ERAS is an on-line service which greatly simplifies the application process by providing a common application form which is used by every program. It also serves as a clearing house for all of your letters of recommendations, transcripts, USMLE or COMLEX scores, and other important documents which can be accessed by the programs t0 which you apply.

You can also enter any number of personal statements which you can customize and target to specific programs or specialties if you are doing a multi-specialty match. All of these things are confidential, by the way, and can only be looked at by programs to which you apply. Programs cannot “browse” through ERAS looking for likely candidates. Personal statements and letters in particular have to be explicitelty designated for each program so there is no way for a program to know to which other programs or specialties you have applied.

It shouldn’t matter but a Surgery program might not think you were serious about surgery if you are also applying to Emergency Medicine.

It is not my intent to describe how to fill out the application. Your school will give you an orientation on this early in fourth year and you should definitely go. I have done the match twice so I have a pretty good handle on the mechanics.

I will say that you need to stary early and shoot to have your application completed with at least a few letters of recommendation designated by the opening of the application period in early September. You really only need the CAF completed to apply and it is possible to get early interview offers with nothing but this. Still, you might as well get an early start especially if you are competing for a competitive specialty (and you are competing). You can always designate letters as they come in and the programs will download them as they become available.

The letters actually go to your registrars office or student affairs office where they are scanned in and downloaded to something called the ERAS post office. Except for designating them you can not access your letters through ERAS.

Your personal statement should also be finished by the time you apply.

I regret to inform you that the personal statement is a very important part of the application and just like for the AMCAS, you will be forced to write what is usually a cringe-inducing essay about you and your career goals. I read my AMCAS personal statement the other day and literally winced in shame that I could have produced such drivel.

ERAS will also afford you the opportunity of releasing your USMLE or COMLEX scores. You don’t actually have to but not releasing them is probably a big red flag to program directors. Some Emergency Medicine programs, as an example, receive close to a thousand applications from which only 75 or so will be selected for interviews. At this stage it is pretty easy for the program director to put you in the reject pile for any reason at all.

Most programs don’t actually start offering interviews until After November 1st when your Dean’s letter is released to the post-office. The Dean’s letter is a synopsis of your medical school career and is always positive and flattering. It is so positive and flattering that a whole code language of praise has been developed to help differentiate the good, the bad, and the ugly. It is here that a weak student may be damned with faint praise. It is also here that your class rank will be either explicitly given or hinted at in code phrases understood by every program director.

So there you are. Career path selected, application taking shape, and ready to apply to some programs. ERAS makes it easy to do this. Pretty much point and click from pull down menus. A click here, a click there, designate a few letters and your personal statement and you’re in business. Hell, it’s so easy you might as will apply to every General Surgery program just to see if you get any bites.

Right?

Not necessarily. ERAS is not free and you pay for each program to which you apply. The minimum fee is sixty bucks and this pays for up to ten programs. After this there is a sliding scale for fees. For up to 30 programs the application fee is pretty reasonable. After 30 it costs 25 dollars per program. I suppose the sliding scale was implemented to prevent the kind of spam-like application saturation that ERAS makes all too easy.

On the other hand you need to apply to enough programs to get the interviews you will need to position yourself for the match. How many? Well, like everything else it depends. If you want nothing better than to match into Family Medicine in a small unknown program in Cousincouple, Arkansas you probably only need to apply to that one program as Family Medicine is hugely noncompetitive with many more residency positions than applicants.

Conversely, some specialties are more competitive and require a different approach. I applied to 54 Emergency Medicine programs which cost me close to a thousand bucks and only got nine interviews. I matched number six on my rank list so you see that it was a near-run thing. Let your conscience be your guide. If you are a strong applicant you can probably apply to fewer programs. The weaker your application the more program to which you should apply because some programs may like your CV despite a bad grade here of there or a low class rank.

I won’t say too much about interviewing. Your CV, letters, and grades got you in the door and now you need to sell yourself. Wear a suit. Be polite. Don’t try to bullshit anybody and don’t be a tool. Not much more than that. Interviewing can be fun if you don’t let yourself get intimidated.

During the application process you will need to register with the NRMP. ERAS handles the application. The NRMP handles the match. The two are separate and while your school will send you reminders, there is always somebody who almost misses the NRMP registration deadline. If you don’t register you can’t match. Period.

Towards the end of the interview season which runs from around the end of October to the first week of February the NRMP will become available to submit your Rank Order List. Nothing magic here. You go on-line, select the programs where you interviewed and rank them in your order of preference. After you certify the list you are officially entered in the match. You can change your list, either adding or removing or changing the rank of programs, pretty much at will until the deadline for submitting your final ROL which is at the end of February. Once this deadline passes if you have not certified at least one list you are out of the match and will have to scramble.

Now you wait. And wait. And wait some more as the results aren’t released until the third week of March. On Monday of this week you will get an email from the NRMP telling you whether you matched. If you fail to match then you had better have a plan because the very next day at noon EST the list of unfilled programs is released on the NRMP website to all unmatched applicants and the scramble begins.

If you match then you have to wait until Thursday at One O’Clock EST to find out where you matched. Most medical schools have a Match Day Ceremony where you open an envelope in front of your whole class. I was an independent applicant so I just waited biting my fingernails for the email.

Programs mail out contracts on Friday and fourth year now becomes a competition to see who can do the least amount of work between match day and graduation.

Next: How Not to Match