More to Match: Should I choose a back-up specialty?

After going through an academically rigorous and financially draining four years of medical school, no applicant wants to be left without any residency matches. One of the key factors to consider as you prepare residency applications is the number of programs you should apply to in order to maximize your chances of getting matched. Ranking in multiple specialties may also better ensure you find a match.

There are several reasons why medical students apply to more than one specialty during the Match. A few reasons include uncertainty about a career path, specialty competitiveness or assurance of a residency position.

In reviewing data from the 2018 Main Residency Match, senior students from U.S. osteopathic medical schools who matched ranked in an average of 1.2 specialties and those who didn’t match ranked in 1.5. Based on these numbers, the primary driver for medical students ranking in more than one specialty may be a desire to match.

Related to this is how competitive the specialty is in which one hopes to match. According to the American Medical Association (AMA) data from the 2021 Match, the most sought after residency spots by fill-rate were plastic surgery, ENT, neurosurgery, thoracic surgery, vascular surgery, orthopedic surgery, dermatology and interventional radiology. The least competitive residencies were internal medicine, pediatrics (primary), pathology, family medicine and preliminary surgery.

Align your long-term goals with where you apply

I personally tell students to shoot for no more than 30-35 programs, but other students may find that applying to more programs aligns better with their goals. Discuss the number of programs you plan to apply for with your student advisor.

Your chances of getting matched to a specific specialty are extremely low if you don’t have prior exposure. That’s why it’s important to start planning your medical school electives early, so you can devote enough time to research, find the best choices that align with your long-term career goals and apply early to secure your spot in prestigious rotations.

The timing of your electives is crucial. Electives are typically completed in the last year of medical school, so you’ll need to plan carefully to ensure you complete the ones you want to reference in your application earlier (before the application deadlines). Try and include a variety of electives so you can strategically plan your applications when the time comes.

Play it safe, but don’t be afraid to reach high too

While the starting point of your research should always be based on your interest and skills, also consider which programs are most likely to accept you. Your list of residency programs should include a balanced mix of “safe” programs where you exceed their average acceptance statistics, “competitive” programs where you match the average acceptance statistics, and “high-reach” programs where you are slightly below the average of accepted statistics, but could potentially be accepted based on other application elements like your extracurriculars or ERAS letters of recommendation.

Please remember that a residency match is legally binding, so don’t pursue any programs that you’re not fully committed to attending.

For many students, logistical issues can be a critical factor in their choice of residency programs. For instance, the length of the residency, family obligations or other personal circumstances may require you to stay in a specific geographic location.

A good resource of information for residency programs can be found at FREIDA™, a comprehensive residency and fellowship database. You can also use the AAMC residency explorer tool to learn the different residency program requirements and statistics in the U.S. and identify the best choices for you.  Your chances as a DO applicant can also be calculated using the AAMC Residency Match Calculator. 

Preparing your materials

Below are some other general guidelines to optimize your chance of matching on the big day.

You should prepare an academic portfolio. This refers to gathering “academic” requirements such as your history of coursework, GPA, standardized exam scores and written components. Residency programs will consider your qualitative elements like your personal statement, so make sure you spend at least six weeks working towards writing an eloquent, coherent personal statement that succinctly explains your journey to becoming a doctor and your personal motivation for the specialty you’re applying to.

A word about your curriculum vitae (CV). Your residency application CV is different from any of your previous resumes. Make sure you don’t just recycle your old resumes, but instead, create a new, detailed CV that matches the requirements for ERAS. Try to tailor your list to align with the priorities of the residency programs you’re applying to.

Your letters of recommendation are a crucial aspect of your residency application. They provide supportive proof from an external source about your suitability for the program. You should aim to have at least two letters of recommendations from attending physicians or professors in your top-choice specialty.

Don’t restrict yourself only to faculty members – use your clinical rotations and electives to form useful connections, explore your university’s alumni network to find mentors, and take up extracurriculars that will give you a chance to work with potential referees.

The residency interview is your chance to show why you, personally, would be a great addition to the team. They’ve already seen your application with all its impressive facts and figures; now, they want to see who you are as a person, including your communication skills and how well your qualities translate from the page to in-person. To make the best impression, spend some time practicing the commonly expected interview questions in each specialty. 

Finally, it would be wise to apply to several programs in different specialties in order to increase your chances of matching. Unless you disclose the information, programs cannot see whether you are applying to more than one specialty through the residency application process. Plan ahead and research various residency programs to increase your chances of matching. Good luck!