#7: Matching into a Competitive Specialty

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In this episode I will talk about steps you can take during the first two years of med school to help you achieve your ultimate career goals.  I have to give a disclaimer, which is that these tips are what I’ve learned from matching into dermatology.  The suggestions for other competitive specialties, like orthopedics or plastics, may be different.

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Q: —Should I be doing research?

A: Yes, to match into a competitive specialty, you’ll need to show that you’ve done some research in that field.  In some specialties this is more important than others, and you should start talking to people early to find out if your chosen field is one of these specialties.  There is time in third year to squeeze in some research if you haven’t done any the first two years, so don’t feel like you missed your chance or get overly worried if you did research in a different field and then changed your mind.  And if you hate research, don’t try to force it; just accept that you won’t be applying to certain programs that emphasize research.  

Now, if you don’t have much research, you need to figure out a way to weave that into your overall story.  Were you not doing research because you were doing mission work overseas?  Did you do a ton of research in undergrad and realize that clinical practice is more your speed, and if so how does the rest of your CV support that? What I’m getting at is that it’s okay to have a weak area of your application, whether that’s research or anything else, but you need to have an overall story that you are telling.  If you are painting yourself as the “public health” applicant, research isn’t as important as community action.  If you are the “underserved populations” applicant, research isn’t as important as volunteer work.

Q: —Is it too early to be thinking about _____?

A: —No – but possibly too early to be aggressive about it.  For example, it would be great to find a mentor in your chosen field during your first year.  But if it doesn’t happen naturally and you are contacting several different people, or if you find a mentor and inadvertently ask them for too much guidance early on, it could hurt you.  Now I know nobody ever thinks they are going to be the one to make such a silly mistake, but trust me it’s not just socially awkward people who make these missteps, and it’s surprisingly easy to fumble.

Another example is shadowing.  It’s never too early to shadow but really ask yourself what your goal is.  If you are doing it to network with the department, I would wait until you have a little more medical experience.  If you are doing it to seriously find out if you’ve chosen the right specialty, I would try to shadow with someone who is completely unaffiliated with your institution.  Find a good community practitioner, maybe an alumni of your school, and start there.  

People often ask this question about volunteering.  It’s never too early to volunteer, and it’s always a good idea because it’s good for the community and for the soul.  But I always say, keep your eye on the prize.  Grades come first, so while it’s good to be thinking about it, yes, it’s too early to take action until you know you can keep all your balls in the air.

And finally, people ask if it is too early to have a CV, or if they need one early.  It’s good that you’re thinking about it, and you can start keeping a casual list of accomplishments so that when it’s time to apply to residency programs, you won’t miss anything that could help tell your story. But you really don’t need it until later in 3rd year.

Q: —How much do grades matter?

A: A lot, but they aren’t a complete deal breaker.  Again, it’s about your overall story.  If grades are a weakness in your application, you need to have a compelling story that makes up for it, or an alternative area where you clearly excelled above the other applicants.  But if your grades are good, you are making life easier for yourself.  Programs will kind of fast-track you to an interview if your grades and board scores are high enough, and then it’s up to you to wow them with your personality and “fit.”  Good grades also means studying for step 1 will be easier.  So let me say a few words about grades in med school.  

In your first year, it’s best to focus on getting a successful study strategy down.  If the first year is pass/fail at your school, this is a great time to experiment with study strategies, because what worked in undergrad may not work with the new volume of material.  For me, it was discovering the memory palace technique, and also finding an excellent study group.  The fact that you are listening to this podcast is a good sign.  You can also google “Charting Outcomes in the Match” and find out the Step 1 average for your chosen field.  This will give you a goal to shoot for, and an idea of how hard you’ll need to study.

Another thing to look at in Charting Outcomes is what percentage of people in a given field are AOA, which is the medical honor society. To qualify, you need to be in the top 25% of your class, and of those only 2/3 can be inducted.  Again, this isn’t a deal breaker but if your specialty is one, like derm, where about half of matched applicants are AOA, you’ll know very early on whether you’re on track.  If you are consistently scoring in the bottom half of your class on exams, you need to step it up because you’ll continue on this trajectory through Step 1, and ultimately you’ll have a much harder time matching well.

Q: Should I be trying to network right now?

A: I have never been a schmoozer, so I’m probably the wrong person to ask.  I can say that I found it helpful to have friends at each level of the process, so be sure to go to interest group meetings and meet some of the M4s who just submitted their ERAS applications in your field, M3s who are learning how horribly subjective the wards can be, M2s who might have some insights about research advisors and next year’s classes.

As far as networking with physicians in your field, I would let it happen organically, and as a result of your doing things that you actually love.  Like, if there’s a visiting lecturer and the topic actually sounds interesting to you, go to the event and see what happens.  No reason to force anything; remember, at the end of the day you should be enjoying medical school and the process of becoming a physician.

The last thing I want to say is that every time you are with a physician in a school-related capacity, think of it as part of your interview.  This may sound extreme, but you’ll hear stories of people who made a misstep at an event unrelated to their chosen field.  I’ll give you a reverse example, from my own experience.  At my med school we have a class called PDS, or Patient, Doctor, and Society.  It’s our doctoring class, where you learn to talk to patients, do a knee exam, practice on standardized patients, all that stuff.  My M1 spring, I had two preceptors; one was a colorectal surgeon and one was a plastic surgeon.  At the time I wasn’t sure what I wanted to go into, but I had pretty much ruled out surgery.  I had no reason to really try to impress these two surgeons, but I couldn’t help myself (I’m a bit of a gunner I suppose) and I developed a great relationship with the plastic surgeon.  Later I found out he was the chairman of the plastics department, and he was my attending during my 3rd year surgery rotation, and again during a 4th year elective.  He ended up writing a letter of recommendation for me, because he had known me for so long and seen me in several different clinical contexts.  Luckily for me, plastics and derm have some overlap so it made sense, but the point is that you never really know where your path will lead and who will end up being a key player.  You don’t know what attending in a different department is friends with the chair of your department.  So you have to be in constant interview mode whenever there is faculty or staff around.

Do you have more questions?  If you do, please send them to me at info@sholamd.com and I will do another installment of FAQs.  Thank you for reading.  I hope this post answered some questions you may be starting to ask about matching into your dream specialty.

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