Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

As you look toward the NRMP Match rank order list open date on February 3, you'll want to avoid simple missteps. Improving written materials and interview skills are critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back in November 2015, the NRMP published an article called, "Understanding the interview and ranking behaviors of unmatched international medical students and graduates in the 2013 Main Residency Match" in the Journal of Graduate Medical Education. The data is still relevant today.

Sadly, the authors found that some applicants made strategic errors including the below:

1. Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
2. Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
3. Misunderstanding the Match and, thus, ranking programs at which applicants did not interview.
4. Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

More Medical Students, Fewer Applicants, and a 3.86 (!) GPA Mean

The AAMC published information recently demonstrating several trends about last year's cycle:

1) The number of medical students has expanded because of new medical schools. First-year matriculants increased 0.8% from the previous academic year to 23,048.

2) On the other hand, the number of applicants decreased for the third year in a row. There was a 1.2% decline versus 4.7% the previous year and 11.6% two years ago. Remember, though, that there had been a huge increase in numbers during the height of the COVID pandemic.

3) Underrepresented minority group matriculant numbers generally declined.

4) What impressed me was that the current incoming class had a mean GPA of 3.86. Wow!

You can see all of the numbers and the AAMC's conclusions here.

Great Podcast Episode for the New Year

I've blogged before about Four Thousand Weeks: Time Management for Mortals by Oliver Burkeman. This wonderful nonfiction book is targeted at those of you who – like me – are productivity geeks. However, unlike other time management authors, Burkeman recommends you surrender to the fact that you cannot get everything done and that traditional time management strategies, which are supposed to help you multitask, will fail and cause anxiety. He recommends recognizing that our lives are finite and that we make choices about our time accordingly.

Burkeman was recently interviewed by Ezra Klein, and I strongly recommend listening to their conversation, especially now, at the beginning of the new year. I found it extremely affecting.

With regard to the book's title, four thousand weeks is how much time the average human has on this earth.

Letters of Interest: No One Wants to be your Second Choice for the Prom

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

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.

p.s. I'm a huge Flight of the Conchords fan. See this song for reinforcement.

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

Is Making Medical School Tuition-Free Doing What it's Supposed to?

Six years ago, when Kenneth and Elaine Langone generously donated $100 million so that students could attend NYU Medical School tuition-free, the philanthropists' main goal was to encourage more graduating doctors to enter primary care fields. 

Fast forward: In 2024, the number of NYU graduating medical students who went into primary care was about the same as it was in 2017. Furthermore, in the interim, the number of African-American students has declined – although the number of Latinos grew slightly. Additionally, at least in the first two years of the experiment, the percentage of incoming matriculants categorized as "financially disadvantaged" fell from 12% to 3%. 

One thing that has improved is NYU's rankings and reputation.

All of this begs the question: Is making medical school tuition-free the most effective way to increase the number of primary care practitioners and improve equity?

See this clearly-written Atlantic article by Rose Horowitch for a deeper dive into the query. She was also recently interviewed by Kai Ryssdal on NPR's Marketplace. 

Some Medical Institutions are Offering their Trainees Coaching

I was just reading an interesting piece by the AAMC's Stacy Weiner on coaching for medical students and residents. The idea is that – beyond advising – students can benefit from the attention of skilled listeners to help them develop individualized plans to achieve short- and long-term goals. 

In the article, Dr. Dana Dunne, the director of coaching at Yale School of Medicine explains, “A coach mostly asks you questions. ‘How do you know when you’re doing well?’ ‘What does success look like for you?’ ‘What has helped you make decisions in the past?’" The AAMC article also highlights Colorado University's Better Together program. The Better Together website addresses assistance with issues like imposter syndrome, time management, perfectionism, and burnout.

What a great opportunity! All things being equal, choosing an institution that has accessible coaching makes sense when you're considering which medical school or residency to attend.

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.

Suicide Rates are Significantly Higher for Female Physicians

The British Medical Journal published a meta-analysis last month by lead author Claudia Zimmermann looking at studies published between 1960 and March 2024 that found physicians were more likely to die by suicide than the general population and that female doctors suffered from a rate that was higher than their male counterparts. While male doctors had a suicide rate ratio of 1.05 across all studies, female physicians faced a rate ratio of 1.76. The findings suggest that female physicians have unique challenges and need targeted interventions.

A few months back I read about a nonprofit organization that offers free and confidential counseling for physicians and medical students, using volunteer psychiatrists. The organization is called Physician Support Line and their number is 1-888-409-0141.

Highly Recommended Paid Summer Opportunity

I was an American Association for the Advancement of Science (AAAS) Mass Media Science Fellow in 1995 (during medical school). The program was truly fantastic and life-altering.

Applications for this year's AAAS Mass Media Science and Engineering Fellowship will open on October 1 and will remain available through January 1, 2025. The scholarship is a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - outlets like NPR, the Los Angeles Times, and WIRED. I worked at the Oregonian in Portland and had a tremendous time, learning how to write effectively and edit. I also gained an appreciation for the immense public health influence journalists can have. It's really an amazing program.

Here are the anticipated dates for this cycle:
Application window: October 1, 2024 - January 1, 2025
Fellowship: June 4, 2025 - August 19, 2025
Orientation in DC: June 4 - 6, 2025
Dates onsite: June 9 - August 15, 2025
Wrap-up in DC: August 18 - 19, 2025

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational fair Wednesday, October 16 and Thursday, October 17. There will be sessions with staff from medical schools, postbac programs, and the AAMC. 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 for pre-meds and candidates applying to postbaccalaureate programs, but there's no downside to hearing more general tips from the AAMC itself.

What Do Program Directors Really Want?

Imagine you're a program director (PD) reading hundreds of ERASes and conducting scores of interviews. What questions would you ask yourself as you assess each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person "play well with others" and not create complaints from patients, faculty, and/or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you finish crafting your ERAS and approach your interviews, consider how to demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extracurricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your winning personality. For the latter, highlight sub-internships, research projects in the specialty, and knowledge about the program and city it's in.

Making sure the PD knows you aren't going to cause him/her trouble is at least half the battle.