It was a warm and sunny St Patrick’s Day in 2004, also Match Day for residency programs in America. Due to financial reasons, I had only applied to 30 Internal Medicine programs and accepted 8 interviews. These days, with how competitive things are, most people recommend applying to 50 programs and up.
I sat in front of the computer and anxiously waited for the National Resident Matching Program (NRMP) screen to load..Ta Da! “Congratulations, you have matched!” lit up the screen, I am headed to New York for the next step in my career.
However, I did have a contingency plan if I did not match: back then, all unmatched applications will be searching online for contacts from programs that went unmatched. Be prepared with my CV and access to a fax machine and phone to call the unmatched program to scramble for a spot.
With the introduction of the Post-Match Supplemental Offer and Acceptance Program (SOAP), things have changed. Get to know how this program works before Match Day! This is especially important for Foreign Born MD (who need visa sponsorship) and Foreign Medical Graduates (both citizens and non citizens). Every year since 2015, the number of American medical graduates as well as foreign medical graduates have increased. Residency spots have not. As a result, it has gotten tremendously more competitive to secure a residency training position – the first step to practicing in America.
Get to know programs that will sponsor visas for physicians way before it is time to apply for your residency spot. Besides the usual paper qualifications thresholds that needs to be met – medical school, USMLEs, etc, there are things you can do to make your application stand-out.
With the competitive nature of residency programs, the best way to get into such programs is to apply for an observership/externship when you are still in medical school. Most medical schools accredited under the World Federation of Medical Schools allow their students to participate in electives in the United States. Most also will have limited liability coverage. It would be best to participate and to get to know the Program Directors in a field and hospital you wish to get a residency spot. Arrangements typically need to be made months ahead, so plan well.
Here is a list of places that provide observership/electives (some for a fee):
Participating in research projects, particularly publishable research, will definitely make your application stand out. I even know of a candidate who manage to partake in a research at a renown university in the United States and presented a poster presentation while still in medical school. This will greatly increase your chances of matching into a top residency program.
Get good letters:
While many candidates aim to work with established doctors in a university setting, what is even more important are good letters. Once you have passed the initial screening stage/vetting (board scores, no repeat USMLE steps, etc), letters of references, especially from United States based doctors, are very important. Do remember to work with your references/their assistants to ensure your letters are uploaded on the ERAS site in a timely fashion.
Study hard and do well in your USMLE – this is still the first thing programs look at first glance.
If I have one regret, it is the lack of understanding of what the USMLE exams entail and studying harder for my Step 1. While I did not fail the exam, my scores are lower than I had expected, simply because I did not know what to focus on. I did change my strategy for my Step 2, CS and Step 3 and scored better in those exams.
Good luck and plan and budget well!
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