NRMP® Data Indicates Matched Residency Applicants had Longer Rank Order Lists than Unmatched Ones

Over the years, the NRMP has published data regarding the impact of length of rank order list (ROL) on success in the Match. I first noticed information on this topic in a document called the Impact of Length of Rank Order List on Main Residency Match Outcomes: 2002-2016. There, the NRMP reported that matched applicants consistently had longer ROLs than unmatched applicants. More recently, this information has been validated in the NRMP's Impact of Length of Rank Order List on Match Results: 2004-2023 Main Residency Match. 

Since the latter document assesses two decades of Matches, we can take it seriously. Those approaching the application process should consider a reasonably wide net in choosing residency programs at which to apply and then should include all programs on their ROLs that they would consider "acceptable," meaning an applicant would rather train there than not Match. Of course, there is a financial cost to applying broadly, and that expense needs to be balanced. However, according to this data, matched applicants and filled programs consistently have longer ROLs than unmatched applicants and unfilled programs. The NRMP reminds candidates that a longer ROL does not adversely affect the chances of matching to choices higher on the ROL. Here's a video that reinforces that fact. 

NRMP's Charting Outcomes™ in the Match 2024 is Out

The NRMP just published their Charting Outcomes information for 2024, data I keep bookmarked and which I would recommend medical students review. There are separate reports for US MDs, DOs, and IMGs, and results are further broken down into specialties. Charting Outcomes includes extremely helpful information, including what the mean board scores, number of contiguous ranks, and number of research experiences were for those who successfully matched - and those who did not.

It's important to make sure you are in the range for your intended field. Also, make sure to compare the competitiveness of different specialties if you are seeking to apply in two fields.

Here is the link.

Get y'ERAS in Gear

On September 4 (two plus weeks from today) at 9 am EST residency applicants may begin submitting MyERAS® applications to programs. Residency candidates often ask me about the timing of ERAS submissions. These are my thoughts:

1. Yes, getting your ERAS in early helps. As one of my program director friends wrote to me, since the residency application is arguably one of the biggest steps in one's medical career, getting the application in as early as possible should be a given.

2. On the other hand, if your application is not in its best shape, waiting a few days is preferable to submitting a suboptimal ERAS that will be tossed into the "do not invite" pile. Having said that, you still have 16 days to get your written materials in tip top shape, so there's no need to plan for a late submission :).

Contact me ASAP for help with your residency application.

The Number One Strategy for Crushing Medical School Interviews

Google had a problem. As a 2012 New York Times article described it, Google executives were growing increasingly aware that they were not hiring enough women. Worse still, they were attracting negative attention about it. So, Google did what Google does best: They amassed data and mined it.

In their analysis, among other findings, Google concluded that the company was overlooking women who tended to be more modest than comparable male applicants during interviews. The interviewers inappropriately perceived the women applicants to be less accomplished, and the candidates were not offered jobs. (Once they understood the problem, Google reported that they altered their internal hiring policies, accordingly.) 

This story is instructive in understanding the importance of how to approach your medical school interview: I call it, Let Your Story Show Your Glory.

Let’s start with this overarching strategy, one that can be gleaned from the Google story: The interview process is a persuasive one. Your role is to convince medical schools you deserve a slot at their institutions. The best way to persuade is with facts, just like a lawyer does when s/he is trying a case in front of a judge. Saying you are compassionate or hardworking is not convincing, and it doesn’t distinguish you from the scores of other candidates the interviewer is meeting. You need to prove your worth by highlighting your academic, clinical, research, community service, leadership, international, and teaching achievements.

When mentoring applicants, I hear them ask: Michelle, if I showcase my accomplishments in my interview, doesn’t that mean I’m being redundant? My answer: Absolutely! Think of the medical admissions process like building a house. Your AMCAS® and letters serve as one layer of that house – like scaffolding. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness (plumbing, pipes, electrical). Finally, the interview is your chance to add on the thickest peel (exterior, roof).

Discussing your accomplishments in detail can seal the interviewer’s positive impression of you. 
If you still feel shy about drawing attention to your achievements, I can assure you that occasionally, interviewers do not leave adequate time to review materials for the candidates they will ultimately judge, or they are asked to interview such a large number of applicants that they might understandably get candidates confused. If you treat every interview as though it were a “blind” one, you address these obstacles. Determine in advance how you want your interviewers to remember you when they represent you to the committee, and tailor your interview to leave that impression. At the end of the week, when your interviewer asks what others thought of the "young woman who volunteered with Mother Teresa while doing malaria research and competitive hammer-throwing," all the other admissions officers will know immediately she is referring to you.
Remember: You can say you are smart or caring or that you want to heal the world, but to admissions committees (who don’t know you like your grandmother does), who you are is what you’ve done...and what traits and skills you’ve gained accordingly.

[A version of this blog was previously published on the Varsity Tutors website, where I was part of their Admissions Expert Series.]

Medical Student and Resident Mistreatment is Pervasive

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't something we were truly being targeted for: He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days.

It's not personal, he said.

When I got to my clerkships, I was dismayed to find that I had underestimated how often I would experience the mistreatment the well-meaning third-year had warned us about. As a medical student, I was berated on numerous occasions for absolutely no logical reason. Residency was worse. The sexism and cruelty was hard to manage, and yet, I had little recourse. 

In a recent piece, AAMC staff writer Stacy Weiner highlighted that, in 2023, at least 38% of US medical students reported having suffered mistreatment and that residents described similar rates. According to the piece, 75% of students and residents don't report their mistreatment, at least in part because of concerns about retribution. 

The good news is that there are some institutions that are implementing systems to decrease mistreatment, including the University of Colorado School of Medicine and Penn State College of Medicine in Hershey. To its credit, Icahn School of Medicine at Mount Sinai created an online form to report mistreatment with access from every hospital computer.

Here is the AAMC article with more details about this ubiquitous, critical issue.

If You're an IMG, Make Sure to Review this Page

If you're an international medical graduate (IMG) applying for residency this year, I'd recommend you take a look at the Educational Commission for Foreign Medical Graduates® (ECFMG) ERAS Support for Residency main page. There, you can find eligibility requirements, an overview of the IMG application process, a timeline, and details regarding which documents ECFMG ERAS Support Services will upload for candidates and what your obligation is regarding those documents.

There's also technical guidance for your letter of recommendation writers, so you can direct them to online instructions through the Support for Residency main page.

Check out the NRMP Program Directory for Main Residency Match Applicants

The NRMP® recently launched a directory of residency programs that showcases over 6000 Match-participating PGY-1 and PGY-2 programs. It's a searchable database that includes locations, program type, and NRMP program codes.

I fiddled with the directory a bit, and I found it most helpful in 1) narrowing down programs by specialty and geography and 2) providing residency director names and program website links.

The NRMP says it will continue to update the database so it remains current.

"Optional" Secondary Essays: Are They Really?

I've recently received several questions about optional secondary essays. How to approach these depends on two things – the prompt itself and your candidacy.

The beauty of a generic "additional comments" section is that it is intentionally vague. It's your chance to provide details, context, or qualifications that the structure of the application didn't allow you to present. 

For that reason, if you have a candidacy without any red flags, I lean toward using the "additional comments" space to both highlight who you are and any exceptional aspects of your candidacy that you'd want a reader to know before making an interview decision. One good option in this circumstance is to pick something completely nonmedical that distinguishes you and is nowhere else to be found in your application. Since an interview isn't guaranteed, don't save your best material for an in-person meeting. (On the other hand, if you have a large weakness in your candidacy, you usually want to use an optional, generic prompt or a more focused one to gingerly address the issue. See the next paragraph for guidance.)

Sometimes an optional essay is more pointed. An applicant recently forwarded me this prompt: Please describe any extenuating circumstances that may have affected your medical or non-medical service experiences, including any circumstances that impacted your engagement in activities, academics, and MCAT that would have helped to prepare you for medical school. If you have no major deficiencies in your candidacy, there's no need to write this essay. On the other hand, you should draft a response to this prompt if there's a big elephant in the room. While, in general, I tell applicants to avoid highlighting standard weaknesses, sometimes someone has a big problem that's important to address head on. It's better that you write your own story than let someone else do it.

Bottom line: Optional essays are frequently worth completing because this process is so competitive. And, if you have a big weakness, you should leverage an optional prompt to explain extenuating circumstances. 

Secondary Essays: The Diversity Prompt

In considering your strategy and content for the medical school secondary diversity prompt, I’d recommend you ask yourself the following question:

What ethnic, religious, racial, gender, language, socioeconomic, or sexual orientation aspects of me, my family, or my experience make me distinctive?

Please note that experience is part of the question I have posed. An applicant I mentored a few years back wrote to me concerned that she did not fit into a minority category and thus, could not answer the prompt effectively. I suggested she consider an experience that targeted the prompt’s theme, and she wrote a strong essay about her successful efforts to increase diversity during sorority rush, which she spearheaded. When I applied to medical school, I crafted one of my secondary essays on my experience hearing Spike Lee speak on my college campus. Don’t be afraid to think outside the box.

If you haven't already, check out my Doximity piece on shortcomings of the medical school admissions process, especially the secondary applications (a moneymaker for institutions).

15 ERAS Tips to Boost your Residency Candidacy

Over the years, I've cultivated many tips for crafting the best ERAS Experience Section. I've included 15 important ones below:

1. Include relevant pre-professional accomplishments from college. If you conducted research, for example, list and describe it. Do not include high school achievements unless they were truly unique (worked at the White House, sang on Broadway, published in Nature ;)).

2. As of last year, you have only 10 slots, so avoid minor activities (like an afternoon health fair). 

3. Write in a streamlined fashion. Avoid verbiage. Of note, as of last year, you can choose three most meaningful activities, but you only have 300 characters for each. So while you want to explain why the activity was impactful, you'll need to keep your writing here especially tight.

4. Use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

5. Avoid most abbreviations. Ones you think are common might not be familiar to the reader.

6. Avoid contractions; they are too informal for an ERAS. 

7. Make sure you spell out your accomplishments clearly. If your reader doesn’t understand an activity, you won't get “full credit” for what you’ve done. Make no assumptions - not even that the reader has reviewed the experience's introductory information (position title, location). 

8. Write about yourself and your role – not an organization. For example, don’t use the space to discuss Physicians without Borders. Use it to discuss the specifics of your role at Physicians without Borders.

9. Use numbers to be persuasive. Saying that the conference you organized had 500 participants says a lot.

10. Unless your PI won the Nobel, avoid using supervisors' and/or doctors' names in your descriptors as they will be meaningless to the majority of your readers.

11. Do your best not to leave the "Medical School Awards" section blank. Even if you have to simply include clerkships in which you obtained honors (or high honors), fill that section out.

12. If you have not already, consider joining your specialty's national organization and listing it under the "Membership in Honorary/Professional Societies" section. If you are applying in two fields, take this advice, though. 

13. Try to end your entries with a sentence about how the experience you just described will help you as a future specialist. Making that connection for the reader furthers your candidacy. 

14. As with all good writing, avoid redundant language. Having the word "research" three times in two lines is distracting and demonstrates a lack of originality. 

15. Get help. Don't submit your residency application without having it reviewed by someone with a lot of experience. (I started Insider Medical Admissions in 2007.) You do not want to put forward suboptimal materials for a process that is this important and competitive.

(Please note that there are a few changes to this year's ERAS. For more information, see this AAMC page.)

Getting Started with the "Why Our School" Secondary Essay Prompt

Secondary essay prompts vary, but there are a few that are standard fare like "Why do you want to attend our school?" Here, medical school admissions officers want to be assured you know their institution, are seriously considering it, and will fit in well. In approaching the "why-our-school" question, do your research on the institution and link something specific about you with the school's philosophy, curriculum, patient population, and/or extracurricular programs.

For example, if you were a physics teaching assistant in college, you might link your use of the Socratic method with a school's tutorial-based learning. In that way, you demonstrate knowledge of the school, show you connect well with it, and showcase your distinctive accomplishment.  

The paradox here is that - although you are focusing your essay on one school - because so many institutions have overlapping philosophies, curricula, programs, and objectives - you can oftentimes use the same framework for many different institutions. That's one strategic way to cut down the overwhelming workload that secondary applications present.  As you craft your essay, it's key, however, to know and leverage the names of institution-specific programs like student-run clinics, summer travel scholarships, and/or primary care tracks, for example.

Great Things About Being a Physician

Years ago my physician dad told me that it was important to select a specialty whose bread-and-butter you could still enjoy. For orthopedists, it's back pain. Interestingly, it's probably back pain for us emergency physicians as well!

Along those lines, I devote a reasonable fraction of my blog entries to the downsides of being a physician because I want to ensure that those who are considering a career in medicine understand and can tolerate the more mundane – even negative – aspects of their planned profession before they can't turn back.

I'm very happy, then, in contrast, to use today's blog entry to showcase Medscape's Best Things About Being a Doctor piece. It's interesting how many of the physicians interviewed mention having a "tangible" effect on their patients' lives.

White Coat Investor Scholarship 2024 Applications are Open

Each year the White Coat Investor (WCI) offers a scholarship opportunity to students enrolled in full-time US professional schools for the 2024-5 year. Students must be in good academic standing in eligible professional schools, including medical, dental, law, podiatry, pharmacy, physician assistant, nurse practitioner, and veterinarian, among others. The stated goal of the scholarship is to reduce winning students' indebtedness and to promote financial literacy in professional schools.

The lion's share of the application is an 800 to 1200 word essay in one of two topics: Inspiring Stories or Financial. The deadline is August 31.

For more information please check out this web page.

After You Get In

The AAMC recently published a piece called "Congratulations, you got into medical school! Now what?" in which staff writer Bridget Balch lists seven tips for rising first-year medical students. You can see the article here.

The author makes several suggestions, including leveraging the orientation and embracing the academic challenge, but I would highlight her recommendations to find mentors and prioritize your health.

Identifying strong mentors not only affords you the potential for good letters of recommendation and little-known opportunities, but also doing so can support you when medical school is a terrible grind. Mentors can be especially important role models for women and those in traditionally underrepresented groups. The key is to assert yourself and overcome feelings of insignificance. Many faculty are eager to meet and guide students.

With regard to physical and emotional health, I've written recently and many times in the past about clinician burnout and depression. Medical school can be a time of significant contraction in your life. Make sure to care for yourself physically and seek mental help when needed.

In the meantime, before school starts, take a well-deserved break!

Aim for All Stuff and No Fluff

The goal of your written materials (and your interview) is to distinguish yourself from everyone else to demonstrate that you are worthy of a competitive medical school or residency slot.

Therefore, it's critical that you avoid flowery or trite language, as using it does the opposite of making you distinctive. Recently, I read a piece by Lisa Miller called, "When Did Everything Become a 'Journey'" about the overuse of the word. Miller cites Northern Arizona University linguistics professor Jesse Egbert who notes that "journey," as a noun, has almost doubled in American English since 1990. 

In her piece, Miller also includes a wry quote from a Los Angeles clinical psychologist who describes the word "journey" as "eye-rollingly cheapened." In editing personal statements, I see the word used frequently – maybe once in every four essays I revise.

Good writing takes a lot of time - brainstorming, outlining, and many drafts. Make sure your written materials are the best they can be by being diligent about your process (and by getting professional help).

Avoid These Ten Common AMCAS Mistakes

Here's a brief list of AMCAS Work and Activities section errors to avoid at all costs:

1. Don't write to write. While you want to include many strong achievements, you do not want your AMCAS to be so wordy that your reader is tempted to skim.

2. While you need to be brief, don't write in phrases; use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

3. Don't assume your reader will carefully study the "header" section (including the title of the activity, hours, etc.). Make sure your descriptor could stand alone: Instead of "As an assistant, I conducted experiments..." use "As a research assistant at a Stanford Medical School neuroscience lab, I conducted experiments..."

4. Don't be vague, dramatic, or trite. Make sure you spell out your accomplishments clearly and substantively. If your reader doesn’t understand an activity, you will not get “full credit” for what you’ve done. Make no assumptions.

5. Avoid abbreviations. Again, you want to be formal; plus, abbreviations you think are common might not be familiar to the reader.

6. Write about yourself and your role – not an organization. For example, don’t use the space to discuss Doctors without Borders. Use it to discuss the specifics of your role at Doctors without Borders.

7. Avoid generalities and consider using numbers to be persuasive. Saying that the conference you organized had 300 participants says it all.

8. Don't merge the descriptors with the most meaningful paragraphs because they are separate sections: You can complete descriptors for up to 15 activities with up to 700 characters each plus up to three most meaningful paragraphs of up to 1325 characters each.

9. Unless your PI won the Nobel, avoid using supervisors' and/or doctors' names in your descriptors as they will be meaningless to the majority of your readers.

10. Choose the right category for each activity, so you get "full credit."

Bonus: Get help. Do not submit your medical school application without having it reviewed by someone with experience. You do not want to showcase suboptimal materials for a process that is this important and competitive.

How to Avoid AMCAS Verification Delays

The AAMC recently posted a piece with tips on how to avoid delays in the AMCAS verification process. The link to the article is below, but I've created an outline of their recommendations here:

1) Submit all of your official transcripts – including college courses taken during high school. The AAMC notes that transcript issues are the most common cause of verification delays.

2) When completing your application, include alternate names that appear on your official transcripts so AMCAS verifiers can readily match your transcripts with your application.

3) While this is not a requirement, the AAMC recommends you use the Transcript Request Form (TRF) to match paper transcripts to your application. The TRF can be found in the application's Schools Attended section.

4) When requesting e-transcripts, ensure you provide your accurate AAMC ID and Transcript IDs to avoid problems matching your transcripts with your application.

5) Make sure to fill out your coursework exactly as it is printed on your official transcripts (including abbreviations, grades, and symbols) and in chronological order. Include all courses - even ones you took more than once, you withdrew from, and/or you did not excel in. The AAMC recommends you order a personal copy of your official transcript early so you can complete the coursework section accurately.

6) If you are reapplying, resubmit all of your transcripts and your letters of evaluation, even if nothing has changed since your last application.

7) Proofread your AMCAS(!), as there are limited changes you can make once your application is submitted.

Here is the AAMC article.

How to Adeptly Complete the AMCAS Other Impactful Experiences Section

Last year the Association of American Medical Colleges (AAMC) gutted the AMCAS Disadvantaged Status section, replacing it with the Other Impactful Experiences, which allows for a broader approach to challenges that can adversely affect an applicant's life and candidacy. 

In other words, when you're considering the Other Impactful Experiences essay, consider financial barriers, but also issues like learning disabilities, immigration experiences, caregiving roles, etc. Here is some guidance from the AAMC.

Emotional PPE

Back in February, I showcased the sobering results of the Medscape Physician Depression and Burnout Report 2024: Of those doctors surveyed, 53% reported burnout and 23% depression. And those disturbingly high statistics had increased from the previous year. 

I recently listened to a Stanford Medcast Episode interview of Ariel Brown PhD called "Physician Distress Miniseries – Emotional Health Support for Health Care Workers." (You can get CME credit for listening to the podcast and completing the quiz afterward.) According to the session, each year in the United States, one in 10 physicians think about or attempt suicide and around 400 die by suicide. 

At the start of the pandemic, Dr. Brown started a nonprofit with Massachusetts General Hospital Anesthesia Program Director Dr. Daniel Saddawi-Koefka, called The Emotional PPE Project. The organization provides free and confidential psychological counseling for healthcare workers. Here is the website.

Applying to Residency this Cycle? Don't Forget the New AAMC Fee Assistance Program for Residency Applicants

Here's a quick reminder that the Association of American Medical Colleges (AAMC) is expanding its Fee Assistance Program (FAP) to residency applicants this year.

The good news is that if you were previously approved for the AAMC FAP, you will automatically get a 60% discount on your residency application for this ERAS season.

The bad news is that current medical students are not eligible to apply for the FAP even if they now have financial challenges that they did not have prior to medical school or if they qualified before medical school but declined to apply for the FAP benefits.

The AAMC says they are going to survey "the student affairs community" to understand "if and how" they can further expand the FAP for residency applicants.

Here is more information with some frequently asked questions.

Try a Residency Bootcamp

I was recently speaking to a medical student with excellent foresight, who was asking me what he could do to prepare himself for residency. I suggested reviewing the basics – perhaps by perusing a favorite clinic handbook – of how to work up common chief complaints like chest pain, shortness of breath, abdominal pain, back pain, among others. It was timely, then, that I read an article about Transition to Residency classes offered at the majority of medical schools. These intensive courses help medical students refresh their knowledge about clinical approaches, so they can hit the ground running when internship starts. 

If a Transition to Residency class is robust and offered at your institution, I would recommend taking it.

Also, when thinking about preparing for residency, I advised the student to consider ways to make life as smooth as possible: When I was in training, I splurged to pay for a laundry service. I never missed the money; instead of spending my downtime at a laundromat or an apartment complex laundry room, I was able to sleep a little more. 

Of course, I had to be frugal during residency, as many others do, but doing one or two things that can make your life better can pay dividends.

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational medical school fair this Wednesday, April 10 through Friday, April 12. There will be sessions on financial issues like loans, budgeting, and scholarships and some advice from current medical students and admissions officers. Registering also affords you 15% off a one- or two-year subscription to the Medical School Admissions Requirements (MSAR®) website.

You can register here. I offer individually-tailored, one-on-one assistance, but there's no downside to hearing more general tips from the AAMC itself.

Major Changes are Needed to Head Off a Worsening Physician Shortage

 The AAMC recently published a report estimating that the United States will face a physician shortage of up to 86,000 doctors by 2036.  

A variety of issues are contributing to the problem, including the lack of adequate residency slots. A bipartisan bill called the Resident Physician Shortage Reduction Act of 2023 (H.R. 2389/S. 1302) has promise but has yet to progress through Congress. The legislation would gradually increase the number of Medicare-supported residency slots by 14,000 over the course of seven years.

Other issues are at play, including an aging American population, one that requires more healthcare. Additionally, doctors who are 65 and older make up 20% of the physician workforce, and those between age 55 and 64 constitute 22%, meaning that many doctors are reaching retirement age. 

A cohort also left clinical medicine during and after the pandemic, and, in a related issue, burnout is very high for those who stayed. A whopping 49% of doctors surveyed through the annual Medscape questionnaire reported being burned out.

The opaque medical school admissions process and the very high cost of medical school are also barriers.

Anecdotally, I hear of many family members who wait weeks or even months to see a physician. Most of those people live in urban areas; the problem is significantly worse in rural locations. Becoming a physician is a noble endeavor, but without structural support, many talented students will pursue other fields. We can't blame them.

My Five Year Anniversary with the White Coat Investor Podcast

Looking for a podcast episode for today's drive to work? Check out my take on entrepreneurship, creating autonomy and flexibility, and balancing clinical practice with raising a family on the White Coat Investor (WCI) podcast. The interview initially ran in March 2019, but the content is still highly relevant for those considering alternatives or enhancements to clinical careers.

For those of you who aren't familiar with WCI, it's a website/blog/podcast founded by James Dahle MD, an emergency physician whose interest in personal finance and the FIRE (financial independence - retire early) movement sparked a slew of devotees. Check out my podcast episode here (where you can also read the full transcript) or listen on your favorite podcast app. 

Leverage the MSAR for Your Benefit

The Medical School Admission Requirements database (MSAR) is an online resource that allows users to search, sort and compare information about U.S. and Canadian medical schools. (I hate to date myself, but when I was applying, the MSAR was a hard copy book.) The annual MSAR usually comes out this month or next; if you're applying to medical school, I'd recommend purchasing the 2024 version when it's here because it provides so much information about institutions and their admissions statistics. The MSAR allows you to compare schools by median MCAT scores, AMCAS GPAs, and other criteria. (Of course, how institutions utilize the MCAT score is variable, which contributes to the shameful opaqueness of the medical school admissions process.)

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of "reach" schools (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers. The advantage of the MSAR is that you can make evidence-based decisions. I've found some applicants have eye-opening experiences when they thoroughly review schools' statistics and either realize that their numbers are low and that they should apply accordingly or, happily, that they have numbers that match with top schools. Either way, reviewing the data is critical to good decision making.

 

The Medical School Admissions Process is Totally Broken - From Start to End

The medical school admissions process is cruel. I recently told that to a strong applicant who was "ghosted" by five institutions this cycle. Poor or absent communication is only one of the problems. The lack of clarity about selection criteria causes confusion, and expensive supplementary applications that generate money for schools are sometimes exploitative.

Check out my Doximity op-ed piece "The Medical School Admissions Process is Falling Short," and feel free to leave a comment on the site about your experiences and opinions.

One Billion Dollars

I was super impressed with the news that Albert Einstein College of Medicine Professor Ruth Gottesman is donating $1 billion to her institution to make tuition free for all medical students going forward.

In 2019 NYU made medical school tuition free. Subsequently, the demand to go to their institution skyrocketed, as did their matriculants' median MCAT and AMCAS GPAs. According to the most recently published MSAR, NYU's median total and BCPM GPAs were both 3.96, and their median MCAT was 522. A similar phenomenon will occur with Albert Einstein School of Medicine.

The tremendously generous donation by Professor Gottesman allows earnest individuals interested in caring for our communities to become physicians without excessive debt. Of note, Albert Einstein offered to rename their school to include "Gottesman," but the professor declined, a choice which adds to her stature in my mind.

No One Wants to be your Second Choice for the High School Prom

Imagine you're back in high school, planning to ask out a fellow classmate to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're my second choice."

Not very compelling...The same is true for letters of interest or, really, any outreach to medical schools or residency programs: Over the years, I've edited many letters in which applicants mention that an institution is "one of my top" picks.

Avoid that type of language. Instead you can say something like "I would be thrilled to be at your institution," or "I am confident I can make a positive contribution." In other words, you can stay honest while not shooting yourself in the foot.

Let me know if you need assistance with a letter of interest.

This Has Been a Weird Cycle

I founded Insider Medical Admissions in early 2007, and, looking back, I'm struck by the fact that this is one of the longest medical school admissions cycles I remember. What I mean by that is I have applicants who were admitted to medical school in early fall, and, simultaneously, there are some who are still being invited for interviews at top schools, scheduled for this month and early March.

I've seen late invitations in the past, but they were few and far between. This year, it seems almost routine to be interviewing into the late winter.

If you're facing an interview this month or next, check out a couple of articles I wrote for Student Doctor Network years ago that have survived the test of time: One is about how to skillfully manage difficult interview questions and the other will teach you how to transform your candidacy's liabilities into assets. 

I'm still offering mock interviews this cycle, so contact me for help.

  

How Sesame Street Can Help You Write a Good Medical School Personal Statement

I learned an interesting fact years ago: When small children don't understand something, they will simply tune it out and start to engage in another activity. That's why great shows like Sesame Street use professionals to make sure their content is precisely age-appropriate. Children - and adults - don't like being confused, and you can’t blame them.

In their personal statements, some medical school candidates make the mistake of referring to an accomplishment without explaining it. This is understandable since we are all intimately familiar with what we've done. The problem is that the vast majority of application readers are way too busy to do independent research or go back and forth checking an applicant’s supporting documents if she writes something that isn’t crystal clear.

I remember a talented candidate I advised who showcased an award she had won. She listed the name, but didn’t explain what it was. When I asked her, she told me the award was an academic honor given to only the top 1% of students out of several thousand. I was impressed! And, I asked her to rewrite the section so that her admissions readers would give her the credit she deserved for that extraordinary accomplishment. Because the medical school admissions process is so competitive, what you fail to adequately explain counts against you.

On a related topic, don’t expect a reader to understand something in your essay because it’s explained in your AMCAS activities. Different faculty members will approach the application in different ways, so – to get “full credit” for your accomplishments - you need to assume that your reader is seeing your essay first, independent of your AMCAS activities. Ensure your personal statement can stand alone and doesn't rely on your AMCAS Activities section for clarification.

Contact me for help with your written materials. I have read thousands of essays, and I personally review every document sent to me.

The Medscape Physician Depression and Burnout Survey 2024 is out and the News Isn't Good

For the last several years I've made sure to blog on the annual Medscape Physician Survey that chronicles physician satisfaction. Unfortunately, it's pretty much always bad news.

If you're an optimist, you'll be happy to hear that burnout rates were lower than last year. You may remember that the numbers skyrocketed during the pandemic. Last year 53% of physicians surveyed reported burnout and 23% reported depression. This year the numbers are 49% and 20%, respectively. If you're a pessimist, you'll notice that those numbers are still very high, with approximately half of the doctors surveyed reporting burnout. That's a very big number.

Of note, emergency physicians are the most burned out at 63%, and the runner-up is obstetrics and gynecology at 53%. Plastic surgeons are the least burned out at 37%.

See more stratification and data by taking a look at the survey results here.

Which Specialties Have the Biggest Gender Gaps During Residency? You Will and Won't be Surprised.

The AMA recently published a short piece based on 2022-23 data culled from their National Graduate Medical Education Census: They evaluated which medical specialties were most popular among male and female candidates who were entering residency. They then extrapolated as to which specialties are going to be increasingly female- versus male-dominated.

Female-dominated specialties included obstetrics and gynecology, pediatrics/psychiatry/child and adolescent psychiatry (combined), pediatrics, allergy and immunology, public health and general preventive medicine, and dermatology.

I wasn't surprised that pediatrics or obstetrics and gynecology were female-dominated, but I found it interesting that dermatology - which is so well remunerated - has more women residents than male residents. Historically, women were relegated to lower paying fields.

Male-dominated specialties included orthopedic surgery, interventional radiology, neurological surgery, diagnostic radiology, and urology.

The AMA reports that specialties that offered a near equal balance of men and women in residency included neurology, general surgery, and psychiatry. Again, as someone who trained in the late 1990s, it's a joy to hear that general surgery is now a well-balanced field in terms of gender. On the whole, when the AMA included specialties, subspecialties, and combined specialties, they report that women account for 48.2% of trainees.

For more details, you can check out the AMA piece here.

There's a New and Improved ERAS Fee Structure on its Way

The AAMC recently announced an updated fee structure for the next ERAS cycle with the goal of lowering total application costs and simplifying the current cost framework, which has been criticized for its complexity. In theory, the change should be an improvement for this year's applicants.

Essentially, residency candidates will pay $11 per application for up to 30 and $30 per application for 31+. Of note, the structure restarts for any new specialty. So if you plan to apply to two, your costs will be higher.

The AAMC estimates most applicants will see discounts of up to 36%.

The old system was triple tiered. You can see it here. Of note, as I previously blogged about, this year the AAMC will also expand their Fee Assistance Program to include some residency applicants, a first.

You can see the new ERAS fee structure in graphic form here.

Make Sure to Read the Fine Print

Many years ago a medical school applicant told me the following story:

The student sent follow up notes to all schools where he had interviewed, usually a strategic move. However, he was very upset to receive a brusque note from one of the institutions telling him that a) he should have read their policies; they do not allow post-interview contact and b) he was rejected from the school.

I found the school's note extremely severe – almost cruel – and I strongly suspect the post-interview contact was not related to his rejection. (As an aside, he successfully and happily matriculated at another school.) But this story is a reminder that it's important to read institutions' policies about post-interview and post-waitlist contact. Most places welcome written updates, but make sure to confirm before you reach out.

Consider Ten Ways to Improve your Medical School Application

New Year's resolutions are notoriously hard to realize. But there are smart tips for executing them, including making sure goals are specific and truly achievable within a reasonable time frame. That's why starting early on your medical school candidacy is important. The beginning of the year is a great time for pre-meds to redouble their efforts toward their academic and professional goals. 

As always, I recommend a very focused approach that allows you to do more of what you want and less of what you don't. Think research will help your candidacy but don't like being in the lab? Consider public health or clinical investigations. Think volunteerism will bolster your application but don't like being one of a crowd in a group project? Select a setting that allows you to work independently: Several of my clients have chosen to volunteer on a crisis line – from home.

There are definitely necessary elements to any robust medical school candidacy (clinical experience, strong grades, a reasonable MCAT score), but being a pre-med can also be fun, mind-broadening, and career-affirming.

Here's a piece I wrote for Student Doctor Network showcasing ten ways to improve your medical school application. The idea is to give you direction but also leeway to be a happy applicant - not just a strong one.

Diversity in Medical School?

The AAMC recently published a piece about racial, socioeconomic, and gender diversity in 2023-4 medical school classes. The good news is that there's some more representation of those from Latino and Native American backgrounds. 

African-American student enrollment remained mostly stable.

Women matriculants rose slightly to 56.6%. Economic diversity was still a problem. See the article here for details.

Interestingly, those who entered medical school in 2023-4 had a median undergraduate GPA of 3.84, which was even higher than in previous years.

A Bad Prognosis for Emergency Medicine

I read a fascinating piece by Dr. Thomas Cook in the December edition of Emergency Medicine News. In it, he cites work done by Cameron Gettel, MD who devised an interesting way to assess the attrition rate of emergency physicians (EPs): Gettel and his colleagues used data from the Centers for Medicare and Medicaid Services (CMS), noting which healthcare providers stopped billing CMS for emergency medical services. Gettel used this information to calculate the attrition rate for EPs. What he and his colleagues found is that the EP attrition rate was approximately 5% prior to the pandemic while it shot up to approximately 8% in urban spots and more than 11% in rural areas during the first year of the pandemic.

Using information from the American Board of Emergency Medicine, Gettel found - shockingly - that the median age of attrition for male EPs was 53.5 years and for female EPs was 43.7 years in 2019. This means that the median EP career was around 23 years long for men and fewer than 14 years long for women. Wow!

It's absolutely critical that medical students who are considering a career in emergency medicine think about what their professional trajectory might be, considering the short median lifespan of the typical EP.

For more information on this interesting topic and how attrition might affect the job market, the need for physician personal finance training, and who applies to emergency medicine, see Dr. Cook's piece here.