The Match: Revisited

I have now been through the match twice. It has worked out well for me both times, so I cannot complain too much. But I must say that I still feel that it is a bizarre and rather draining ritual. I am not really sure if there would be a better way to apply for residencies. A colleague told me that a similar match system was used at her undergraduate university for people rushing sororities and fraternities. She said it worked out well for most people and that even if they felt disappointed on rush night, they usually realized in retrospect that they ended up in the best fit sorority for them. From what I have heard from medical school classmates, most people now seem pretty happy with their matches 2 years later. So I guess it does produce good results for many people, even if the process can be rather painful.

Here are a few thoughts on the match after the second time around. Hopefully, they will be helpful to someone out there.

1. Don't panic if the interview invites come late. Both times I received interview invitations from great programs after the dean's letter came out. Some programs send invitations later than others. Also, do not panic if other people have gotten invitations and you have not. It takes some time for programs to get through reviewing all of the applications.

2. The interview matters. Speaking from both sides of this process, as a resident and an applicant, I can say that the interview matters in this process. It really shapes both the program's and the applicant's viewpoints of each other. Having the best package on paper does not matter much if the residents from the interview lunch remember you as being combative, arrogant, or a total douchebag (all terms I have heard used to describe resident impressions of applicants who did not behave well at their interview lunch). And from an applicant's perspective having an uncomfortable interview or a bad experience with some aspect of the interview day can really color one's opinion of a program for the worse.

3. Do not believe everything the program tells you. Luckily, I felt like most of the programs that I visited both times on the interview trail were decent programs with program directors who sincerely cared about resident learning and development. That said, remember that the program is selling itself to you. No program will ever be perfect and without flaws. Residency training is an experience that is going to be painful at times, no matter how good a fit a program is for you. Knowing this, especially the second time through the process, made it easier for me to evaluate the programs more critically. Try to have realistic expectations of what they can offer you, so that you are not disappointed in the end.

4. Make sure the program matches your goals. This sounds obvious, but too often we are encouraged, especially in academic medicine, to solely focus on factors like prestige, fellowship placement, and research prowess when selecting a residency program. Think about your career goals and how the program will get you there. If you want to do a competitive fellowship then some of the above mentioned factors may be really important. If you want to work at a community hospital in primary care then things like job placement in the community and outpatient experiences during residency may be more important.

5. Look beyond intern year. On a related note, probe deeper into what the program will offer you in the long run. Ask residents if the program is supportive when they are applying to fellowships and looking for jobs. A lot of interview days focus on things like the intern year call schedule and how to transition to the city the program is located in. It is similar to the focus that many medical school applicants have on the preclinical curriculum when interviewing for medical school. The later years likely will be more influential on the direction of your career.

6. Talk to residents. Try to meet as many residents as you can and talk to all of them. See if you could really see yourself working with them. Determine if they seem happy, overworked, stressed, relaxed, etc. You may need to talk to residents outside of the program-sponsored lunch or meet-and-greet at the interview day to get the full story. Social events the night before can be a good place to get a decent sense of this.

7. Do second looks for yourself. There is a lot of debate about whether one should revisit top choice programs before making the rank list. I have been on both sides of this one now, as an applicant and as a resident lunching with re-visit candidates, and I really have no idea if it really helps an applicant move up on the rank list. There are some programs that emphasize re-visits at the interview day, so maybe at certain places it is more important to go and show interest. I am not really sure. Anyway, do re-visits if you feel they will help you make your list. I did two at programs I was having a hard time deciding between and it dd help me get a better sense of both programs. I got to meet more residents and to see the true work environment in real time. In the end, I thought they were helpful and luckily I did not have to travel too far to do them.

8. Assess the administration of the program. I have been lucky to be in a program with great administrative support for the past two years. Our program coordinators are awesome and I remember feeling that my interview day flowed really well. If the interview day seems disorganized, ask the residents how they feel about the program support. Things like getting a medical license and setting up computer access at various sites can be time-consuming, so having good administrative support behind you can be a lifesaver.

9. Trust your gut. Listen to that inner voice that tells you one place would be a great fit and that another would make you unhappy. First impressions are really important. I really think that we can pick up on subconscious cues while visiting places that influence our decisions. The vibe you get at the program is important.

How To Switch: Know Yourself

Going through the switching process you will do a lot of self analysis. First you have to make your decision, which can involve a lot of thinking and second-guessing yourself. Once you are set to go it is important to sit down and figure out a way to articulate why you are switching fields in a clear, concise manner. If you go through the match again, you will have to write a personal statement, and the new programs that are reviewing your application are going to want to know why you are switching. Even if you pursue a spot outside of the match, programs are going to want a personal statement or a cover letter that explains why you are leaving another field for the one you are applying to. And you will need to be able to explain why you are switching at interviews. I was asked about it at every interview, as I expected, except one where the interviewer said he never understood why anyone would want to be a pathologist in the first place, so there was no need to tell him why I needed to leave. That was quite an interview...

Basically, you need to be able to convince a new program that you have legitimate reasons for switching, that you know why the current field was a bad fit for you, and how you know that the new one will be better. Think about past experiences you can use to make your case. For me looking back to medical school and even before was helpful. Be able to articulate clearly why your current specialty is not working for you and how you came to that conclusion. Have a vision of what your future in the new specialty will look like 5-10 years down the road.

How To Switch: Get Support

I must say on some days throughout this process I felt like I was crazy. This feeling seems to be pretty universal among specialty switchers with whom I have interacted. So it may sound obvious, but make sure you reach out to people you trust and get some support while going though this. People outside of medicine are great to give you different perspectives. But you will need to find some support from within medicine too. You will need help in figuring out how to proceed and having someone supportive while going through the process will help save your sanity. And from a purely practical and strategic standpoint, you will need to gather letters of recommendation for making your switch. Here are a few places where I turned for support from people within medicine.

Medical School. Initially, especially as I was struggling with whether to stay or go, I did not want my program to know that I was considering leaving. I also wanted to get a sense of what my options were, so turned to my medical school for help. My former dean's letter writer, the registrar's office, and the GME office were all very helpful in giving me big picture advice about how one goes about switching. Faculty in the fields I was considering switching into gave me good information about what programs would be looking for in a specialty-switching applicant. An adviser who had helped me decide to go into pathology gave me some advice about things I could consider within pathology that might be a better fit for my interests.

When I had made the final decision to leave, I turned to my medical school to help me go through the match again. My dean's letter was updated and I had to get some new letters of recommendation. Luckily, the pediatrics department at my medical school and some of my past letter writers were very supportive and helpful with the needed letters. In the end, I could not have switched without having my medical school behind me. I am very grateful that I attended a school that is so supportive of its students and graduates.

My program. Although the idea of telling my program that I was thinking about leaving felt daunting and scary at first, I knew that things would go much more smoothly for all parties involved if I was up front and honest with them. In the early stages, when I was unsure of whether I really wanted to switch, I needed some advice about how to find my niche in pathology. I identified a faculty member with whom I had a good relationship. This faculty member was someone who worked with a lot of residents and was familiar with the training program. I felt I could trust this person to give me good advice and to keep my dilemma confidential. I was right. We had several meetings over the course of my decision making and the faculty member was supportive, gave me things to think about, and also helped me change my schedule a bit to explore areas that might be a good fit for me within pathology. When my decision was final, the faculty member helped me determine the best timeline for notifying my program director.

I spoke to my program director in the early fall. This was the time when I was starting to put together my application for the match and when the program was getting ready to start screening applications. It really well--my program director was very supportive, offered to write me a strong letter for my application, and gave me the date by which I had to tell them my final decision so that they would determine how many positions to take in the next match.

At that time I also spoke with another faculty member, with whom I had worked fairly extensively, about obtaining another letter of recommendation. Ultimately, I ended up with two good letters from my current program to supplement the letters from my medical school. Even though I had re-entered the match, I was till not 100% sure I was leaving until December. I wanted to get some more surgical pathology months in before I made my final decision. Once I realized I was definitely leaving, I told a few of my fellow residents and gave my program director my final decision. I was set to switch.

How To Switch

Once the decision is made to switch fields, how do you go about doing it? As I quickly discovered there is no one-size-fits all answer to this question. There is no formal system in place for residents who want to change fields. In a way this makes sense because people decide to switch at different stages of training and, depending on the switch that is being made, may have very different needs when looking for a new training program.

For me leaving pathology would mean starting over. Since we do not do a typical intern year, I would not get credit for the work I had been doing that would be applicable to the new clinical field. Having to start over made things simpler in one sense. I would be looking for an intern position, so going through the match again would give me the most options. Otherwise, I would have to find an open intern year position somehow.

There are several websites that offer to help residents find new residencies like FindAResident, and Resident Swap. Once I realized I would most likely need to go through the match again, it seemed like they would not be that helpful for me.

Much of what I learned about switching fields came from advisers, blogs, reading stuff on Student Doctor Network, and talking to people who had switched. In the next few posts I will go into detail about some of the key things I learned about switching.