Give Me Your Tired, Your Poor, Your Huddled Masses

Last week, I discussed trying to find resources to guide your search for the “best” residency program. When it comes to finding the right fit, one of the other more specific questions that I get is “If I am a student with some bumps on my record, how do I know what programs are more likely to consider me?” Unfortunately, there is no one resource for that either. However, I do have some tips and tricks to consider when it comes to considering your application strategy if you don’t exactly fit the bill as an ideal candidate.

First and foremost, this is why it is always important to have a backup plan. No matter how perfect or imperfect your record is, you need a backup plan. As I wrote in that post, everyone’s backup plan is different and unique, but everyone needs to have some idea of a backup plan. Specifically, for students with some bumps on their record, there are a number of programs out there that are going to be willing to look for students that are not perfect, diamonds in the rough if you will. However, unlike the Statue of Liberty, programs do not advertise they they are looking for imperfect students, otherwise that is the only type of students that would apply.

So, what should a student be looking for and doing?

1. This is why it is important to apply to a larger number of programs than the “average student”. You know there are programs out there that will be interested, you just don’t know which ones specifically. If you cast a wide net, you increase your chances of getting your application in front of the “right” residency programs.
2. For the most part, there are three main tiers of residency programs:
   • High level, elite academic centers – These are the cream of the crop, the best of the best, the places with multiple billions in endowments. If you are an imperfect applicant, you have a low likelihood of getting an interview, let alone matching at a ultra-competitive program like this. It doesn’t mean you shouldn’t apply to some dream programs like these, but depending upon the degree of your imperfections, they should certainly be in the minority on your list.
   • Solid academic centers – These are very good centers, hosting very good residency programs. There is high-level research being done there and many top-notch faculty. They are just overall a step below that first tier of programs, either in actuality or just in public impression. You will get an excellent experience here and excellent training. You are also much more likely to get interviews and possibly match here than in the first group if you an imperfect applicant, again depending upon your degree of bumps. There are no guarantees for you here either, but if you are interested in an academic career and in training at an academic center, it is a good idea to load up on these types of programs on your application list.
   • Community programs – These are programs that are not associated with a university. These are much more common in lower competitiveness specialties (Pediatrics, Family Medicine, Internal Medicine and so forth, although there are a number of General Surgery community programs) than high competitive specialties (There are not going to be any community Dermatology, ENT or Neurosurgery programs). Thanks to the ACGME, you are still going to get a solid training here, it is just that the program will probably be smaller and there may not be as many bells and whistles as at the bigger places. The bumpier your record, the more of these types of programs you should have on your list.
   • Within each of these tiers, there are sub-tiers but this isn’t the place to get so granular…
3. Consider places that are not exactly “sexy” geographically. All things considered, many students are looking for a great program that also happens to be near by the ocean or mountains or a big city or a certain coast or…. you get the picture. While all 50 states are great and unique and fabulous in their own way, we all know that some tend to be more attractive than others for various reasons. If you are a student with a few bumps, you may have to consider programs in locations that are not all NYC, Boston, Chicago or California.
4. Include programs that previously did not fill in the match. Just like you do not want to be unmatched, programs do not want to be unfilled. While some programs don’t fill because they have have some deep seated issues with their program, often times there is some other reason that they didn’t fill: they got unlucky, they limited their interviews or rank list too much  or ranked too many people above their own competitiveness as a program. So, they will be motivated the next year to do a better job of looking for diamonds in the rough and taking a chance on a solid student with some past mistakes.

The Match is stressful and competitive, but if you are smart about your application strategy, you can improve your chances of matching considerably. Even if you are a student with some bumps on your record. Own your issues, work on making yourself better for the future and cast a wide net.