Tag Archives: Match

Internship/Residency Rankings Done Right

After you’ve chosen the programs in which you are interested, sent in your application materials, and done an interview (if applicable), you are now ready to rank the programs.  The rank order list is due in early January. What does it mean and how do you do it?

The mechanics of the match are described in detail elsewhere.  Put simply, you rank the institutions and the institutions rank the applicants.  Then an algorithm runs and matches the applicants with the institutions.

Some people try to over-complicate the match process.  They think, “Well, I doubt I will get into place X, so I won’t ‘waste’ a high level spot for it.”  Don’t assign value to the actual rank spot. Instead, you should rank purely on one criteria: Where do you want to go?  Rank in order from YOUR highest picks to your lowest, without regard for your likelihood of them wanting you. The system is designed to be treated this way; you’ll mess up your chances if you try to second-guess the algorithm.

How many institutions should you rank?  It depends primarily on how happy you can be in a given circumstance.  For example, have you decided that literally the only way you can have professional fulfillment is to be a surgeon?  First, I’m sorry for you. But if so, then you have to rank every single program. On the other hand, if you’ve decided that you would very much like to do surgery, but not at the expense of your physical or mental health, then you should only rank the programs where you would be happy.  That’s difficult to know a priori, but it is possible if you do your research and talk to current or former interns/residents

The second consideration for number of institutions to rank is financial cost.  There is a substantial step up from 10 to 11 institutions ranked ($90 to $250 in 2019).  However, this is your future, the next step in the rest of your life. Even the highest step ($350 in 2019) is not particularly expensive, matched against your entire education to date and your professional future. My advice therefore is to rank more.

The next consideration is how good of an applicant you are.  If you know you will be a top choice at a few schools, you only need to rank a few.  If you are a good candidate but not sure where you stack up, you will want to hedge your bets and rank many more institutions.

The final and most important consideration is how to decide how to order your rankings.  Being an analytical sort, I made a table. It looked something like this:

Program# InternsSalaryElective TimeSpecialists% ER TimeResearch Notes

Your table may have other variables, such as: geographic location, # cases, equipment, license requirements, rounds, or % primary care time.  Some of this information you can get from the position description, some will come from your research on the position. At the end, organize the programs according to the most important variables for you.

My general advice is to rank every institution where you think you could be happy.  The cost is not very significant, it minimizes the risk of not matching and having to do The Scramble, and is fairly efficient.  Rank them in order of where you want to go. That’s it! Tell me what you think and how it goes!

Avoid the Biggest Mistakes Made during The Match

Making your professional life successful is as much about what NOT TO do as it is about what TO do.  The Match is probably the highest-stakes professional selection in academic veterinary medicine- even more so than getting into vet school in the first place.  As a result of this pressure, people make a lot of mistakes which adversely affect their professional future. This is not an exhaustive list, just the most prominent ones I have encountered.

1) Trying to game the matching algorithm.  Please don’t do this.  I know it’s tempting. I did it because I was foolish, didn’t talk to anyone wiser, and the internet was barely a thing.  Rank the place you most want to go #1 and then move on to the next.

2) Not reviewing your application materials.  How is it possible there is a misspelled word in your letter of intent?  You have spell-check on your writing program, don’t you? Run basic diagnostics and read and re-read your materials.  Simple errors like this suggest to me that the applicant isn’t really all that interested in the position. If they were, they would have spent more time on their application.

3) Not sending out your application materials.  You must get others to read your letter of intent and CV.  Preferably veterinary academics who have looked at many such applications.  However, even your friends and family can be helpful. Tell everyone to be brutally honest.  Your goal is to get the best application possible, not to assuage your ego. You don’t have to take everyone’s suggestions.  In fact, if you send it out enough, you will start to get conflicting suggestions. But you must have others review them. You would not believe the poorly written letters I have helped people improve.

4) Not getting your ducks in a row in time.  Hopefully, you strategized your time to maximize your match success.  And you did give those writing letters of recommendation plenty of notice, didn’t you?  And you have gotten all your materials in well before the deadline, right?

5) Not preparing for interviews.  If you apply to institutions which hold interviews, you must do your research and study up on how to do a successful interview.  Failing to plan is planning to fail.

6) Delaying the decision.  I know some students and interns who waffle on whether to apply to the match and then make a decision at the last second.  That is unacceptable. If you THINK you may want to apply, set up everything as if you will. You don’t have to submit your rank list until January.  If you put in applications but don’t rank any institutions, you won’t match anywhere.

It’s not a long list, but you would be surprised at the number of people who continue to make these mistakes- hence this post.  Try to avoid being one of them and let me know if you need help!

Should You Commit to Working for a Company in Exchange for Getting a Residency?

The Devil’s Advocate summarizes my feelings on this issue.

In my opinion: no.  If you want a more detailed, analysis, read on.

The first time I encountered this concept, UGA had taken a radiology resident from VCA.  We later took a surgery resident from the military. We also took a surgery resident from another university.  The essential premise is the same: the sponsoring organization (university, company, military, etc.) pays for the resident’s salary (including benefits) and then the resident contractually owes that organization a certain number of years of service after they finish the residency.  Why would anyone do this?

The training institution benefits because they get an ‘extra’ resident.  Resources to find residency positions are limited, but services need to meet their caseload demands.  Residents are an effective way to enhance service delivery. Universities see residents like this as “free” residents- they get the labor of a resident without having to pay for it themselves.  So it’s a good deal for the training institution.

The sponsoring institution benefits because they get a committed specialist for a certain period of time.  Institutions that have a hard time attracting specialists may choose this route so they have a guaranteed specialist at the end of the program.  One problem is that it takes 3 years to train a resident, so if they need someone NOW, this won’t help much. Another problem is that the specialist may not stay once their contract is up, which puts the institution right back in the same position they were before.  So it may be a good deal for certain sponsoring institutions, but may not be a long-term benefit for others.

The individual doing the residency benefits because they get a residency position which they may not have otherwise gotten.  For example, if someone does not get a position through the Matching Program, and they desperately want to do a residency, they could find a sponsoring organization and then get to do a residency.  These positions exist OUTSIDE The Match and are spots in addition to the existing spots offered by training institutions. They then HAVE to work for the sponsoring organization, usually for about 3 years, after finishing the residency.  So it may be a good deal if the individual would have wanted to work for that organization anyway, or if they are basically fine working for them until the contract is up.

Naturally, my idealism clashes dramatically with this free market approach.  I don’t believe anyone should have to sell their time as a specialist in order to get a residency.  It just strikes me as unfair. In an ideal world, these organizations would have to change so that people would WANT to work for them, rather than forcing desperate residency-seekers into a deal with the devil.  In an ideal world, those most deserving of residencies would get them, and those who don’t would be happy with a different life path.

I understand it isn’t an ideal world, and the free market allows for these kinds of contracts.  As long as there are applicants desperate to get a residency, who will do almost anything to get one, these kinds of contracts will persist.  I wish people wouldn’t make these deals, because then organizations would have to improve and actually ATTRACT specialists. But I’m not in charge of the world, and you’re an adult, so you can make your own choices. Just make sure you’ve taken all the benefits and drawbacks into serious consideration before making that choice.

How to Choose Your Internship

The Vetducator- screen shot of the VIRMP matching program website.

Where you got to vet school does not substantively affect your internship prospects, but the institution where you do your internship may affect your future residency prospects.  Selecting the most appropriate internship position is particularly important for those bound for residencies. For those bound for private practice, the primary goal is to avoid a bad internship.  Internship programs change in quality over time, so there is not a reliable database of bad internships. These are some variables you should keep in mind as you consider your future.

First, I am very evidence-motivated and fact-oriented, so I made a table.  This table had each program as a row, and column headings for important variables, some of which are listed below.

Specialties.  If you want to do an ophtho residency, of course you have to go somewhere which has ophthalmologists.  Otherwise, you want to have surgery and internal medicine at a bare minimum.

Number of interns.  If you are one of two interns, you may not have as many opportunities for collaboration and support in the program.  If you are part of a 28-intern mob, you may become just another faceless, poorly-paid doctor. Decide where you want to fall in this spectrum.

Amount of emergency work.  Every intern’s salary is justified by the ER work they do.  Some programs provide good backup for their interns on ER so that they learn quite a lot.  Some leave them to sink or swim. The more time you spend on ER seeing cases, the less time you may have with specialists who are focused on teaching you.  Be cautious of anything over 25% ER time.

Cost of living/Salary.  Most interns get paid poorly, but being paid poorly in Athens, GA is different than being paid poorly in Philadelphia, PA.  In Athens, you can get a decent duplex in a safe part of town. In Philadelphia, you’ll probably be longing for those self-defense courses you took in undergrad.

Reputation.  This is only relevant if you are interested in a residency.  In general, academic internships have a better reputation, mostly because their faculty are ‘plugged in’ to the post-grad system and know people at other institutions.  The reputation is not necessarily related to the actual quality of the program. If you get an internship in a small private practice with one surgeon and one internist, it may be harder to get a residency than if you get an internship at, say, the University of Tennessee.

Geography.  Most people I know ignore geography, and it’s understandable as to why.  It’s only a year- you can dig yourself out of snow every day for that short amount of time.  For a rare few, this is an important variable. For most people, though, geography is (and should be) irrelevant.

Identifying an actively bad program is a different decision tree, and requires personal contacts at a large array of institutions.  Assuming most programs aren’t bad, the characteristics listed here are the ones I think are most useful in deciding where to go. What are other variables you think are important in internship program selection?

Six Steps to Win the Scramble

You applied through the match for an internship or residency- great job!  Now, 8am on match day has come… and gone, and you are without a matched position.  You still want to do an internship or residency, and there are programs which did not fill all their positions.  What do you do now? Now you Scramble.

The Scramble is the informal term for the process following 8am on match day.  All unmatched applicants scramble to find good positions while programs with unmatched positions scramble to find good applicants.  It is an absolute mess and a travesty of a system. Pharmacy has a two-step matching process to avoid the chaos of a scramble, but veterinary medicine, as always, lags behind.  

It can be an emotional blow to not get matched, but realize that not matching does not mean you are a bad applicant.  The vagaries of the match mean that good programs and good candidates go unmatched every year. Scrambling to pick up an open position is a normal part of the process.  Heck, I scrambled after I didn’t match for a surgery residency and ended up having a terrific career. If you decide to scramble, you can maximize your success with six steps.

Step One: Be Prepared.  I’m sure your application packet is superb because you have followed the advice on this blog.  Nonetheless, the match is capricious, and even the best candidates may find themselves unmatched if they didn’t find a good fit or were too restrictive in their selections.  Be ready for not successfully matching by answering these questions:

  1. Do you still want to do an internship/residency?  If you are disheartened by not matching where you wanted to go, are you still excited at the prospect of going SOMEWHERE?  Decide this beforehand- don’t be wishy-washy in the middle of the Scramble.
  2. Are your materials ready and updated?  Is your CV and letter fully up-to-date?  Can you send them off today with a high degree of confidence they reflect your current state of mind, ideas, and experiences?  If not, get them ready.
  3. Have you looked at all the programs to which you didn’t apply but would consider?  If there’s a position unfilled somewhere, do you have to do research to find out about that position or are you poised and ready to go?
  4. How do you feel about going into a program that is not quite what you wanted?  If you wanted to do a surgery residency, would you ever consider something else for a year which may position you better to apply next year?

If you are prepared mentally and practically, then you may be successful with the Scramble.

Step Two: Don’t wait.  Email programs with open positions at 8:10am on match day.  You can get this list from your institution’s VIRMP administrator.  If you wait a day or, god forbid, a week, most open positions will be filled.

Step Three: Be decisive.  Contact programs with open positions and attach your letter and CV in that initial email.  Tell them why you are reaching out to them. Not just because they have an open position, what you would be excited about if you got to work there?  If you get an offer, you need to be prepared to accept or decline it on the spot. Programs won’t wait for you to decide, because their second choice may be gone by the time you decide to decline.

Step Four: Cast a broad net.  Don’t just send your materials to the top 2-3 places you want to go.  They may fill up with someone else, and by the time you look around, your top 4-6 places may be already filled, too.  Send a message to every open position where you would be happy immediately after the match results come out. Realize that, at this point in the process, there is no more official ‘ranking’.  Just as with the match, though, you need to be prepared to accept any program which gives you an offer. If you get an offer from a place you’re willing to go, but not excited to go, go back to planning in #1.

Step Five: Be attentive.  Don’t send an email and fail to follow up.  If you don’t hear back, a polite follow-up the next day is appropriate.  Most positions get filled in the first few days after the match results come out.  If they reply with, “Thank you, we will be in touch in the next 2 days”, send a follow-up on the second day.  You need to be present without being pushy.

Step Six: Be at peace.  The Scramble is frustrating, intense, and emotional.  Be prepared for the possibility of not finding anything.  Be prepared to commit to a program and have them back out at the last second.  Have contingency plans laid out so you are ready whatever the outcome.

It’s always frustrating to fail to match.  I failed to match for a surgery residency and scrambled.  I even applied for transfusion medicine fellowships and similar programs.  Ultimately I thought, “I can go do anesthesia for a couple of years (residencies were 2 years then) and then go into surgery!”  Here I am 20 years later, perfectly content in anesthesia. As always, the key is to be honest with yourself.