2015 USMLE RESIDENCY MATCH

Few tips from Dr. Schaeffer (as posted in 2014 Forum), PD , SUNY , Buffalo

Tips from Dr. Schaeffer (P.D. SUNY BUFFALO)

Question of the Day: "Is it true that programs do not download any more applications once they receive the first 1000 applications that meet score criteria? And if so won't that happen much earlier than end of October?". I can't speak for other programs universally, but I will say that many programs download throughout the first half of the season because we realize that some very good candidates aren't 100% complete with their application on September 15th, and if you only downloaded the first 1000 (which you could do on September 15th), you will miss some good candidates. Are there some programs that take that shortcut and stop at 1000 applications, even if that means that they're done on September 15th? Sure, I suppose there are. But they are a minority of programs. Just like there are some programs that are all-out, and fill entirely by prematch. You will not have a shot at programs that are all pre-match and rely heavily on word-of-mouth reference. Those programs may already be done recruiting for 2014! For any program going through the work of ERAS and the Match, however, they should have learned by now that good candidates continue to appear in their queue through the early fall. After mid-October, more and more programs stop downloading and any applications in mid-November or December better be done with a good reason.

Most important qualities in IMGs.. .#1. English skills and some understanding of American idiom. #2. Medical knowledge with clinical application. Scores alone are nice, but not enough. #3. Ability to work on teams - our medicine is all done on teams. #4. Work ethic. #5. No strike outs (failures of courses, extreme time away, failures of CK).

Clinical experience is a plus, that is true. I know some companies have taken advantage of this. I think that this is one of the most difficult issues facing IMGs

Research experience is good as long as you can talk about the project knowledgably. The most important part of the project is NOT publication (although that is nice), it is gaining an understanding of how research proceeds and what basic knowledge is required. Most research people do NOT want to have to explain basic concepts. They want you to be able to join in.

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Tips from Dr. Schaeffer (P.D. SUNY BUFFALO)

Complete Application LATE or Incomplete Application EARLY Both options are less than optimal, but as long as the delay is just 2 weeks, it is better to have a complete application. Programs will download new applications all through the process and will usually only stop downloading around late October. If your scores will be much later than 2 weeks, I would submit an incomplete application. A complete application on S eptember 15th is the best.

Answer of the day: ECFMG certification. The most selective programs may indeed only offer interviews to IMGs who are already certified. They will also be the ones looking at very high Step 1s etc. Many programs will certainly interview without certification. Many IMGs are a year or two out from medical school and are certified, and many are just graduating in the spring of that year and will not have certification. I would encourage you to apply without certification, realizing that some programs will screen you out.

Question of the Day: "Is it true that programs do not download any more applications once they receive the first 1000 applications that meet score criteria? And if so won't that happen much earlier than end of October?". I can't speak for other programs universally, but I will say that many programs download throughout the first half of the season because we realize that some very good candidates aren't 100% complete with their application on September 15th, and if you only downloaded the first 1000 (which you could do on September 15th), you will miss some good candidates. Are there some programs that take that shortcut and stop at 1000 applications, even if that means that they're done on September 15th? Sure, I suppose there are. But they are a minority of programs. Just like there are some programs that are all-out, and fill entirely by prematch. You will not have a shot at programs that are all pre-match and rely heavily on word-of-mouth reference. Those programs may already be done recruiting for 2014! For any program going through the work of ERAS and the Match, however, they should have learned by now that good candidates continue to appear in their queue through the early fall. After mid-October, more and more programs stop downloading and any applications in mid-November or December better be done with a good reason.

Bonus question for Driday: "What I would like to ask is what exactly do program directors look for in our personal statements ? Also can u advice us on how best can we represent ourselves in our personal statements ?". Personal statements are the most difficult piece of the application puzzle. I am aware of the paid services and I am aware that people often take a "just write x, y and z" approach. The statements that I dislike (and this is a very personal opinion) are those that rely on extremely lofty or impersonal expressions like "I've always dreamed of being the best cardiologist in the world" or "I hope to discover the cure for cancer". These extreme statements make you sound unr ealistic, not ambitious. To be clear: We LIKE ambition, we DISLIKE completely unrealistic ideas.

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Tips from Dr. Schaeffer (P.D. SUNY BUFFALO)

We LIKE examples (i.e. if you are compassionate, tell me a story of a time that you *showed* compassion, not just felt it). We DISLIKE lists ("I have mastered the skills of x y z w a b c"). We LIKE humor, we DISLIKE overly personal or inappropriate language. We LIKE stories about what motivated you, we have read, literally, >1000 stories about grandmothers and grandfathers with cancer/heart disease/diabetes. It gets boring. I tend to skip ahead over any sentence that begins "My grandmother blah blah blah" We LIKE to hear about your future plans (see ambition), we want more DETAILS about those plans if you really have them. (Not "I want to be a rheumatologist", but "I want to especially focus my work on the diagnosis and care of patients with autoimmune disease because these patients make me think about a wide variety of diseases and they can be very challenging") We LIKE to hear about your own life and how it's twists and turns led you to medicine. We DISLIKE when you skip over any failures or setbacks. If you have *anything* on your CV that looks like (or is) a failure, it needs to be addressed in your personal statement. This is a MUST DO.

Next question: " I have a question about couple's match for Internal Medicine residency for IMGs." Good question. This varies widely for each program. In general, to find two good applicants is a plus, and when we rank couples we have a general (not universal) policy of ranking them together. Why? Because we have found that couples who split up for residency have more problems and travel issues. This often translates into scheduling problems and occasionally, requests for transfer. If we saw a couple who were very different in terms of rank-ability, then yes, the better candidate is going to suffer in the rank list. If we saw a great candidate and a so-so partner, would be upgrade the so-so candidate? Occasionally yes. If you can't live without your partner or have a newborn should you consider splitting upn anyway? This is one of the most painful and difficult decisions couples have to make. I can't offer universal advice on this. Some people can make it work being in very different places, some cannot. You may not know for yourself until you try it out. If you decide to split up to maximize chances, have an honest convers ation about what would make things change. If you decide to couples match, be realistic about each application and apply accordingly.

Answer of the day: "Could you please share your opinion as to how foreign medical graduates with YOG more than 4-5 yrs are looked upon? maybe 5 yrs since graduation ". Challenging situation! Obviously, prolonged absences are not favorable. Each year counts against you for the following reasons: People who are out for a long time lose knowledge, no matter how much reading you do, you lose the practical knowledge that you gain from doing something day in, day out. As a PD I get 4-6 calls every year from students as far out of graduation as 10 years. They often have good reasons for this delay in their training. Families, money, health issues are the most common. However, they are a huge risk to train because our experience has shown us that they are much more likely to quit training and much more likely to not tolerate longer hours. These are two things that I can't risk.

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Tips from Dr. Schaeffer (P.D. SUNY BUFFALO)

So...in order to compensate for your time away, there are two possible tracks. One is to aim specifically for a program where you have done some observerships and have a personal relationship with someone who can testify to your work ethic and commitment. The second is to address the deficiency directly in your personal statement. You *must* find ways to show the PD that your time away was for reasonable reasons and not because you are ambivalent about training. You *must* find ways to demonstrate your persistence, work ethic and "toughness". So, there are some wrinkles in time away from graduation being entirely negative. So much depends on the specifics. Previous training is (usually) fine, a year or two to take Steps and get experience is expected. 2-3 years with no clinical work or beyond what is needed for Steps, USCE is the situation that will be a problem.

Question of the day: "I am an old img having completed a 4 year residency IM in my home country. I would be interested and very grateful If Dr Christopher Schaeffer would kindly share his views regarding such residency applicants." Folks who have completed training have a special kind of application for residency. On the one hand, you possess a huge asset - your training. So much of what we do will be familiar to you, even if the systems are different. On the other hand, we worry as PDs that you won't be able to return to being the junior member of a team, taking directions from someone who will likely be younger than you. So, your job is to explain in your Personal Statement why you want to move to the US for another round of training and that you will be *thrilled* to be the junior member of a team again and how wil l you deal with getting directions from people that may, at times, know less than you. We have had a number of very successful folks who retrained with us, some even previously fellowship trained. We have also had at least one total disaster. So, it is important to acknowledge that IMGs with completed previous training have a special path.

Questions of the Day: "Will 2015 be the end for IMGs matching" and "Ideal length of a personal statement/CV". #1. This is the big elephant in the room of GME. Let's review some numbers. In 2013, there were 1.5 spots for every AMG. Or, 3 spots for every 2 AMGs. Who will fill that other spot? US Citizens training offshore and Non-Citizens training offshore or otherwise internationally. Even if US AMGs increase by 30% (the "target" number), it will be several more years before we see those students applying for residency (you can't just create medical schools out of thin air, or expand them too rapidly). Also, it is even unclear that US schools will be able to reach that target. The truth is that Caribbean and DO schools are also expanding. Who will be in the toughest position when all these new positions come online (3 years? 5 years? 10 years?) IMGs for sure. Does this mean no IMGs will match by 2015? Far from it. In Internal Medicine, we have 6000 US positions for training and only 3000 AMG applicants.

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Tips from Dr. Schaeffer (P.D. SUNY BUFFALO)

We have long experience training IMGs and know that IMGs are often better qualified and make better residents than some AMGs. Well qualified IMGs will continue to match for the foreseeable future in the fields of IM, Peds, FM and Psych. The final wrinkle that makes predicting all of this difficult is money, of course. If US GME positions are cut (seems possible) will that affect things? What if the cut only happens in specialty training? What if they actually expand IM/Peds/Psych spots? There are a lot of variables. The numbers will tell us if there is any trend this year. The number I will watch most closely is the number of AMGs matching into IM. Once that number starts to rise (and it would have to rise A LOT), that will spell bigger changes for IMGs. #2. One page for your personal statement. CVs should not be more than 3-4.

I'm starting my rotation time on the general wards, and then ERAS opens, so I'm signing off. Thanks for your kind words and interest. I apologize in advance for not responding to PMs, it's just not possible. If you are a well-qualified IMG, consider applying to my program at the University at Buffalo!

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