Two Hundred New Residency Slots Open

For a long time there has existed a bottleneck in the physician training system with more medical students graduating than residency spots available. This phenomenon has been one of the contributors to the physician shortage in the United States. 

In an effort to begin to relieve the problem, in 2021 Congress passed the Consolidated Appropriations Act Section 126 to expand the number of Medicare-supported residency slots. 

Last month the Centers for Medicare and Medicaid Services announced a list of hospitals that were awarded 200 new residency positions under the Act. About seven in 10 of the positions are going to primary care and psychiatry training programs. 

You can read an American Association of Medical Colleges (AAMC) news article about the new slots here. 

Introducing NRMP's Rank Order List Lock Pilot

In October I wrote a blog entry about the benefits of virtual interviews. One issue that has come up is the concern that those who choose to do in-person interviews may have an advantage compared to candidates who interview virtually. The NRMP has noted this worry and is, consequently, instituting a voluntary Program Rank Order List Lock pilot for internal medicine, pediatrics, and vascular surgery for the 2026 Main Residency Match cycle.

The idea is that programs can choose to finalize their certified Rank Order Lists and then provide time for interviewed applicants to come in-person, thus reassuring candidates that visiting or not visiting will not affect their candidacies.

Here is a statement from NRMP regarding the voluntary pilot. It's an interesting idea, and I'm curious to see how it will play out.

Sleep As a Vital Sign

“Without enough sleep, we all become tall two-year-olds.” — JoJo Jensen, Dirt Farmer Wisdom

As a resident, I spent one horrible week on my surgical rotation clocking 138 hours in the hospital...and I slept only 6 1/2 of those. By the end of the week, I had decided to quit residency. Fortunately, a good night's sleep helped me turn that decision around.

I recently heard an interesting AMA Journal of Ethics podcast called "Sleep as a Vital Sign" with Dr. Lauren Hale from Stony Brook University. In her interview, she clarifies the distinction between sleep medicine and the study of sleep as a public health issue, the latter of which is her academic interest. She offers policy recommendations to decrease morbidity and mortality from sleep deprivation, like eliminating daylight savings time and making school start times later. She also touches on how the lack of sleep adversely affects medical professionals. 

The podcast episode is brief and interesting. Plus, you can get CME credit for listening :-).

Mistake or Needed Break: Should You Take a Gap Year?

Recently, I've advised several premeds who are trying to make decisions about the utility of a "gap year" – an elective, non-curricular period between college and medical school. There are important professional, financial, and personal consequences to consider before making the decision. Here's a piece I wrote for Wolters Kluwer that offers guidance. 

Love Letters and Janet Jackson

Letters of interest (LOI) - or what some applicants jokingly call "love letters" - can be used in several types of situations:

1. Residency and medical school applicants who want to make an impression post-interview before decisions are made about their candidacies.
2. Medical school and residency applicants who have not yet been invited to interview. (Please do your research because a few schools forbid post-AMCAS/pre-interview contact.)
3. Medical school applicants who have been waitlisted.

When writing your letters of interest, you should have the following goals:

1. Restating your strong enthusiasm for the institution.
2. Positioning yourself as a distinctive candidate who can contribute fully to the institution.

Errors to avoid in LOIs are:

1. Don't include generic content about a specific institution's advantages. There is no reason to spend a paragraph or more telling a PD or medical school admissions member what makes his/her institution special. ("Your faculty is strong and your trainees are collegial" or "You are a world-renowned institution.") Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant. Having said that, it is very reasonable to link a particular interest of yours with a specific opportunity at an institution. For example if you have done cancer research, make sure to mention how you will contribute to the renowned oncology program the institution is associated with.
2. Don't write about how the program or school will help you. ("I know your residency will make me into a great doctor.") The focus should, instead, be on how you will be a contributor to their institution. For example, you can detail how a specific leadership experience of yours has given you the skills to make you a future leader at this institution. (It's the "What have you done for me lately?" Janet Jackson principle.)

Finally, let me say that I find the term "letter of interest" to be better than "letter of intent" because, generally, I don't recommend you let institutions know what your intent is (since it might change). Note that with a letter of interest you can create one general letter that you modify and send to different institutions with different goals (i.e. requesting an interview or demonstrating your interest post-interview). You can also modify the letter and send it to your top choices because, if you are not making commitments, then you can honestly use it for multiple institutions. 

For those of you interested in LOI assistance for medical school or residency applicants, please contact me.

A Great Opportunity for College Students Interested in Medicine

Applications for the Summer Healthcare Professionals Education Program (SHPEP), a Robert Wood Johnson funded opportunity for college students interested in healthcare professions, are open. SHPEP specifically targets students from economically or educationally disadvantaged backgrounds and those with demonstrated interest in issues affecting underserved populations. The goal is to help college freshmen, sophomores, and juniors apply and matriculate successfully to health professions schools. SHPEP is housed at 11 universities across the country with different start dates – but all over the summer. Housing, meals, stipend, and travel expenses are all paid.

Take a look at the program in more detail here. The application deadline is February 5.

Wondering How to Evaluate a Medical School or Residency Program? Consider Your Happiness and Trust Your Intuition.

Medical school and residency applicants routinely ask me how to evaluate institutions, especially since most interviews are virtual. This is a huge topic, but here are some thoughts:

• To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
• Cost is sometimes a deal breaker when it comes to medical school. There can be significant differences – especially state versus private institutions – and scholarships can make a huge impact in your debt profile going forward.
• Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many programs of similar caliber have equivalent curricula and offerings. You likely could be happy at many different institutions. With regard to residency specifically, it's important both to ensure you're getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
• Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is critical (understanding that he or she could leave at any time :-( ).
• With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.

One of your best bets is to talk to current medical students or residents. Oftentimes they will be very honest about the pros and cons of their institution.

Once you've assessed all of the above - narrowing down your list by geography and quality - I would analyze the vibe you have. If this sounds too touchy-feely, remember that intuition is not a magical assessment; it's based on major and minor facts that you consciously and subconsciously analyze.

Remember: If you're a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is extremely challenging; it's a great problem if you have to struggle to decide among multiple schools!

Virtual Interviews Aren't Perfect but the Benefits Unquestionably Outweigh the Downsides

The AAMC recently published a piece about the post-pandemic persistence of residency virtual interviews. While some programs still encourage in-person interviews, most now standardly conduct online ones. The AAMC article points out important benefits including financial and environmental.

Something the AAMC article doesn't specifically touch on is that virtual interviews have likely softened the sting of systemic sexism in the application process. The potential (albeit remote) for a candidate to record an interview or even have another person listening in diminishes the risk of sexist questions. 

What happens in the room between an applicant and faculty member may no longer necessarily stay there. 

Check out the Doximity piece I wrote, "How Virtual Interviews Might Mitigate Systemic Sexism in Medicine." (Unfortunately, the story I tell at the beginning of the article is only one of several inappropriate questions I got from faculty interviewers when I was a student.) 

A Valuable Tool: AAMC Webinars

The AAMC offers a variety of recorded premed webinars on their website here, including current topics like "2025 MCAT Testing Year Update for Examinees," "Preparing for the MCAT Exam," and "Learn about the 2024 AAMC Fee Assistance Program." 

They also have comprehensive information about the Fee Assistance Program (FAP) here. Please remember that the AAMC recommends applying for an FAP waiver prior to taking the MCAT.

With regard to my services at Insider Medical Admissions, premed applicants demonstrating financial hardship through a current AAMC FAP grant may be considered for reduced rates. Please contact me for more information.

Taking the Fifth

The goal of every medical school, residency, and fellowship interview is to distinguish yourself from everyone else to demonstrate you're worthy of a competitive spot. So what happens when you get this (ugly) question:  

If there were one reason not to accept you, what would it be?

When a (salty) faculty member asks you this interview question, her motivation might be to determine whether there's a weakness in your application she's missing. Or she may be assessing how you manage stressful situations by posing a question that is unpleasant.

While you need to be honest throughout the entire application process, you do not need to volunteer information that might harm you. So, for a charged question like this one that conflicts with your goal, you might answer, “While no candidacy is perfect, I have a strong application, and I don't see a reason not to accept me." Then you can leverage the question as an opportunity to mention the strengths of your candidacy. Remember: You have a duty to further your application, not damage it.

Contact me for mock interview help. I still have some October slots open, as of this writing.