Victor Kondray, Amit Suneja, and Roshun Sangani contributed to this post.
Each year, as the residency interview season comes to an end, many medical students focus their attention toward … “The Match.”
Like the Sorting Hat from Harry Potter, this nebulous computer swallows up the rank lists that we fire off into the void of cyberspace, somehow reads the cosmos, and spits out our fate for the next three to seven years of training.
Being the scientists we are in medicine, we don’t tend to trust the enigmatic magic of such a process. Without any button, knob, or switch of control, this process can cause significant anxiety for many medical students who have preconceived career dreams and goals.
As a resident who is years removed from “The Match,” and who has developed a few gray hairs of wisdom (actually not there yet thank God, but figuratively speaking), there are some things I wish I had known before applying to residency.
The top 11 things we wish we knew before applying to residency:
1. Life still happens during residency. If you decide to change specialties, that’s okay.
Perhaps one of the biggest weights on my chest during fourth year was the idea that I was picking a career for “the rest of my life.”
For those who are unsure or have expectations of going into competitive fields or specific locations in the country, The Match is not the end-all-be-all of your life.
First of all, I implore you to do your due diligence in career research and preparation prior to applying to save yourself the headache later.
With that in mind, however, residency is not as permanent of a stop as many people make it out to be (whether you’re thinking of short-term or long-term goals).
I have countless friends who have started out in the field that they matched in, only to switch one or two years into starting residency all over again.
Many friends found out that they still loved the field they originally applied for and found opportunities elsewhere. Others found out that the field that they matched into was not for them anymore, and some just wanted some better scenery!
Life still happens in residency, and by definition change is a part of life. If you don’t like the Sorting Hat’s decision for you, do not be convinced that you cannot take life by the horns and change it.
2. Fully understand your field of choice.
It’s very important when choosing a specialty and applying to residency that you have a full grasp of what the field/your training entails.
As a student, it’s very easy to visualize what it would be like to be an attending in your field. However, I also think it’s important to understand the necessary steps to reach that point and ask important questions:
How long does it take to reach this point?
Are there different paths to practice the type of medicine I’m interested in?
What is the training like?
Ultimately, most of the time, if someone is interested in a field, their choice won’t waver, but at the very least by asking these questions and being aware of the answers, you’ll be all the more prepared for residency.
3. Ask others for advice.
Another wonderful thing about medicine is that there are so many people who are more than happy to offer help. It may not be as a formal mentor, but people are always willing to offer you their perspective if you are genuine and curious.
It really doesn’t hurt to reach out to residents in a field or at a program you’re interested in and get their insights. I’ve had many people reach out to me whom I’ve never met before or have only met once or twice, and I like to think my conversations with them were helpful and insightful in some way.
Similarly, I recall asking a few people in my field for advice, but only felt comfortable asking people I personally knew. Looking back, I realize it definitely wouldn’t have hurt to get some additional perspectives.
4. Understand the importance of your learning environment.
Think about what type of training environment you will do best in. Are you someone who really learns through hands-on experience and would benefit from a high-volume training center?
Or are you someone who likes learning as much as they possibly can from each patient and consequently learn by studying and reviewing concepts?
Everyone has different learning styles, much like there are many different types of residencies in terms of clinic/ward/OR structure and volume so try to keep that in mind when you’re making your rank list.
5. Consider where you’d be happy living.
It’s very easy to focus on concrete, tangible measures such as program rankings. While those rankings can definitely be extremely helpful, it’s important not to fixate on them.
Ultimately, your training will be a minimum of three years, and therefore you want to make sure you’re happy in the environment that you live in.
While you will definitely be extremely busy during training, you will invariably have free time as well.
Personally, I think being close to friends and family was my main priority followed by living close to an urban environment.
Everybody has their own preferences but these factors are important to take into account in addition to a program’s ranking/prestige.
6. Consider who your colleagues will be.
It’s important to get an idea of what type of residents a program generally selects. While this bit of advice applies a bit more to smaller fields, it’s still applicable to almost every residency. Thus far, I have really enjoyed the people whom I have met in residency (prelim and main residency) and it has made my training experience all the more enjoyable.
Since many long hours will be spent in the hospital, I can honestly say that the experience is definitely better if you are surrounded with people whose company you enjoy.
I personally think I got lucky since it wasn’t something that was on my mind when ranking, but I think the “feel” you get from the residents you meet during your interview process can definitely be a great tiebreaker.
7. It’s OK to switch your specialty—even if it’s late!
I applied into emergency medicine after doing 2 away rotation and an MPH where my research focused on emergency medicine public health topics. By the time the application cycle came around, though, I had more doubts than when I had started the process. I felt, however, that I had already done too much to justify changing my mind late.
Do not fall into this trap. This is a decision that will impact you for the rest of your life and is going to guide how you spend most of your waking hours outside of sleep.
If you end up changing your mind, listen to yourself. Of course, if you were going to apply in Pediatrics and now you want to do Orthopedics, the path is more difficult than if you wanted to switch from Emergency Medicine to Internal Medicine.
That being said, there is probably a way to make it work. It will require courage on your part, as well as proactivity in seeking out the advice of your Deans, mentors, and others to figure out how to get a competitive application in to a different specialty.
And yes, it will also cause stress and uncertainty—maybe you won’t end up at your dream program because you have to make some compromises and your application isn’t as robust as it would have been if you had known from the beginning. But that’s better than the stressor of doing the wrong residency and being committed to a career in a clinical field that you don’t like for the rest of your life.
8. Residency programs really do care about what you do outside of rotations and school, and soon they will care even more.
Don’t let medical school take over your life. You should put your nose to the grindstone during clinical year and key electives when you are getting letters of recommendation, of course—but at most this takes up 15-18 months of your 48-month medical education.
We are at a critical juncture in medicine and public health where the impacts of structural racism and white supremacy are being increasingly recognized as undeniable.
Your extracurricular activities don’t have to be entirely focused on these issues, but it is worth considering that many programs may increasingly be interested in how medical students engage in broader issues of justice and equity in medicine.
9. Determine a way to keep track of your feelings after interviews.
By the end of interview season, many programs will blend together. They are, after all, all certified to meet certain minimum requirements by the ACGME.
Some folks utilize spreadsheets to rank different elements of a program, but that isn’t for everyone. For many of us, it is stressful to be “on” during the entire interview day. By the end of the day, we may just want to sit back and unwind.
Figure out a way to keep track of how you feel after you interview! Whether that is journaling, talking to someone you trust after you interview at each program, or making a short video of yourself after each interview, being able to return to these recounts will be extremely helpful come the rank list deadline.
Sometimes it is hard to remember the one aspect of a program that really made you think you’d be unhappy there, especially if when you revisit the program online to refresh yourself, it looks really appealing.
A video of yourself spending 2 minutes talking about that sticking point, or a partner who tells you that you were really troubled by that issue with the program will help you keep perspective.
It is much easier to stick to a way to remembering your interview days if you commit to it ahead of time, so I encourage you to really think about the way you want to do it, and then focus on carrying it through during the entirety of interview season.
10. Benefits, unionization, the cafeteria, and call hours matter. Talk to residents!
It can sometimes be hard to completely wrap your head around what it would be like to doing q4 24-hour calls. That being said, the residents at the program are your best guide.
Don’t feel bad about about talking to them in depth about these finer issues of a program. Some medical students who have never had a full time job with benefits before may not realize that all residencies are not created equal in this regard.
Housing stipends, expansive and affordable health coverage, a union that renegotiates cost of living increases in salary every few years, and the quality of the cafeteria are things that will substantially impact your day to day life in a program.
Residency is already difficult enough, so you don’t want to be worried about paying your bills. A good benefits package and a union can be a sign that the program and its institution value residents and want to make sure that their lives outside of work are manageable and enjoyable.
Now, the cafeteria. While you may have hopes of cooking all your meals, that won’t always happen. We know that food can substantially impact the quality of sleep and mood: two things that you definitely want to optimize during residency (and life in general!). If the only food at your cafeteria is anemic vegetables, questionable meat, and packaged or processed foods, this is going to matter to you at the end of a 16-hour day when you have to come back the next day for a 24-hour shift.
Finally, call hours. These are part of residency, and while the superiority of 24-hour calls over shift work for residents is questionable, this aspect of training is unlikely to go anywhere soon.
These shifts are tiring and difficult. They are a somewhat unavoidable part of intern year and the earlier years of residency depending on your specialty.
However, many programs lessen this burden as you progress, and that can be an important addition to your quality of life. Talk to residents about what their call schedule is like, and about how it is when they are in the thick of it.
Talk to the second years doing q4 call. Talk to the interns getting off 1 month of night float. Ask them how they feel and if the program has been supportive of them and checked in during these tough periods.
If they feel like they’ve had to weather these difficult times by themselves, this can be telling. It doesn’t necessarily mean the program doesn’t care about residents, but it is something to consider as some program are better about supporting residents during certain difficult specific months or years of residency.
And reducing call in later years can be a double-edged sword. Often this means that call is heavier in earlier years to compensate for senior residents not having very much (or sometimes any!) call. You’ll have to decide what works best for you, but you should definitely consider this.
Again, talk to residents about all of these aspects of a program. In addition, interrogate websites, and email program coordinators for more information before you agree to interview!
If you know you are going to need certain health benefits, or you know you aren’t ok with doing q3 call at any point in your training, it is better to know that before you interview so you can decide if you want to interview in the first place. Every interview at a program you wish you hadn’t interviewed at because it has a deal breaker that you didn’t realize is an interview you may not have taken at a different institution that matched your priorities better.
11. You are enough.
Applying to residency is hard. It can make us reflect on our career as medical students, our grades and evaluations, and compare ourselves unendingly to our peers.
Sometimes, we have to face difficult realities that a certain “caliber” of program may not be within our reach. We may even have to reconcile the fact that we started residency wanting to go into a certain field, and it just didn’t work out.
These can be tough things to sit with during the application process, and they can cause considerable stress. That being said, you are about to graduate from medical school and be a doctor. That is a tremendous achievement, and it will be a privilege to take care of patients no matter where you do it and no matter in what specialty. And you (basically!) have made it by the time you are applying.
You are enough. You put your blood, sweat, and tears into this experience, and depending on your prior life experiences and background, you may have overcome and dealt with various forms of structural and institutional racism as well as pervasive macro and micro-aggressions within your medical school on your way to doing it.
Don’t let anyone take that away from you, never lose sight of it, and be proud of where you are at. Surround yourself with people you love and care about, seek out mental health support if you need it, and be kind to yourself. You are enough, and we’re proud of you.