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<p>The other day, I was talking with a student about  and they said to me &#8220;You keep talking about an Application Strategy for applying to residency&#8230;. what do you mean by that?&#8221; It is true, this is a phrase I use often when talking about applying for residency. So&#8230;. what do I really mean when [&hellip;]</p>

X’s and O’s

The other day, I was talking with a student about  and they said to me “You keep talking about an Application Strategy for applying to residency…. what do you mean by that?” It is true, this is a phrase I use often when talking about applying for residency. So…. what do I really mean when I say Application Strategy? With the start of college football this weekend and the NFL soon after, not to mention the fact that ERAS and CAS open for applications in less than 2 weeks, now is the perfect time to consider the X’s and O’s of applying for residency to successfully match in the specialty of your choice. If you came here for a discussion of the Elle King’s hot new song of a similar name, thank you for thinking I am so musically connected, but you’ve stopped at the wrong blog.


The ultimate lesson to learn here is that you need to have a back-up plan. You. I’m talking to you. YES YOU! Everyone one of you reading this right now needs to have a back-up plan when it comes to applying for residency. It doesn’t matter if you are the #1 student in the class with all Honors and a 290 on Step 1 or if you are a student with a few bumps on the transcript. Everyone needs a back-up plan. Now, for each student your back-up plan is a different. That essentially perfect student’s back-up plan might be that they are going to apply to 10 programs instead of just the one she really wants to go to because 10 is the same price as 1 in ERAS. For everyone else, your back-up plan will at least need some thought put into it. Let’s consider a few situations and go over a few topics to consider when building your Application Strategy. Just a brief reminder that this is general advice based on general information. If you have specific issues, questions or concerns, you should talk to your mentor, your advisor or to me individually.

Are you applying to a competitive specialty?

As a reminder, the Careers in Medicine site rates each specialty on an overall scale of competitiveness: Low, Medium and High. So to get a sense of exactly where your desired specialty ranks, I would check out that site. But in general, you can think of the competitive specialties as General Surgery and all of the surgical sub-specialties (Neurosurgery, ENT, Plastic Surgery, Orthopaedics….) as well as Dermatology, Radiation Oncology. Also, if your chosen specialty has an early match (I’m looking at you Ophthalmology and Urology), you might be in a competitive specialty. If you are applying to a competitive specialty, the next thing to consider is “How competitive am I?” for this specialty. Again, Careers in Medicine has a great deal of information about things like numbers of publications, average Step scores and number of programs applied to in order to match. You should also talk with a Career Mentor here at the school in that specialty to help you assess your competitiveness.

If you are a strong candidate in a competitive specialty, maybe your back-up plan ends up being that you apply to a few more places than you normally would have, just in case. Just like when you applied to college (or maybe even medical school), you have your list of dream schools, solid schools and back-up schools. Or maybe you put a few preliminary or transitional programs at the very bottom of your primary rank list, just in case.

If you are not as strong of a candidate in a competitive specialty, then your back-up plan should probably include applying to a back-up specialty and/or applying to most of the available residency programs. Most of the time, students try to be thoughtful about what their back-up specialty is. For example, let’s say that you really want to be a cardio-thoracic surgeon, but you are not sure if you are competitive enough for the integrated programs. You might consider applying to both cardio-thoracic surgery and general surgery, knowing you can try to get into the cardio-thoracic surgery fellowship after residency. Or maybe you just really love the heart and you apply to CT surgery but also internal medicine with a back-up plan of doing a cardiology fellowship and specializing in interventional cardiology. Think about what you really love about your specialty and consider other ways that you might be able to get there or at least close, if you are not the most competitive candidate.

Do you have some bumps on your record?

If you had a rough patch in medical school, maybe ended up on Academic Probation at some point or even had to repeat an entire year, your prospects for matching are not sunk. You will have some work to do and you need to be thoughtful about what you are applying to and what your goals are. Even if you think you might be a great Ophthalmologist, you may need to reconsider that as a possibility. You may need to focus on specialties in the lower competitiveness category. These include Internal Medicine, Pediatrics, Family Medicine, Psychiatry, Physical Medicine and Rehabilitation and Pathology. These specialties are not easier or less prestigious, but they either have a large number of available spots across the country or they are a specialty that needs some more specialized skills and interests.

Even in these specialties, if you have significant bumps on your record, you will need to be thoughtful about how you apply. Just because internal medicine as an overall specialty is low competitiveness, it does not mean that there are not difficult to get into programs. You may still need to apply to a significant number of programs or to residencies based at community hospitals as opposed to academic centers or to places that have not traditionally filled or are in geographically less popular areas.

The best advice I can give any student who has a number of bumps on the record is to take an honest assessment of you competitiveness and then apply with that in mind.

Are you limited in some other way?

While you would never consider your significant other a “limitation“, the fact is trying to couples match is an extra complication that you need to consider when devising your Application Strategy. If you are couples matching, you will most likely need to expand your pool of programs applied to in order to maximize your chances of a successful match. I would also highly recommend watching these tutorials from the National Residency Matching Program.

Are you limited geographically? If you need to stay in a certain city or region of the country, you should then maximize the number of applications in that area. So if you need to stay in Indianapolis, apply to every program in your specialty in the city and you should strongly consider applying to multiple specialties if it is that important since there is not a large variety of programs here in Indianapolis. Or if you are looking to go to stay in the Midwest, consider expanding what your definition of the Midwest is. Would you accept Colorado? Tennessee? Texas? Most people would not consider these in the Midwest, but you might, depending on your needs.

No matter what your record as a student, it is always important to be thoughtful about your future and to have a well-thought out Application Strategy. But remember, don’t go it alone. You have advisors and mentors and assistant deans (oh my!) to help you along the way.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Michael McKenna

Dr. McKenna is a graduate of IU School of Medicine, where he also completed a pediatric residency. He served as chief resident and was an Assistant Professor in the Department of Pediatrics and the Associate Program Director for the pediatric residency p...