Thursday, September 26, 2013

Assessing Competitiveness - Part 2

In Part 1 we introduced how to assess your own competitiveness.

An even more difficult task is determining competitiveness of the programs you are considering spending your application dollars on.

The most important thing to remember about assessing programs is that "perceived competitiveness" has little to do with how good your training experience is going to be at that program.  "Perceived competitiveness" determines how hard it is to get an interview at the program.  Your experience training at the program is going to be determined by the educators, the clinical environment, your class mates, etc, etc. (as addressed in "Where to Apply").

What follows are some characteristics that may help you predict which programs have a high degree of "perceived competitiveness" = "harder to get an interview."

In descending order:

1.  Is the program in a region that is highly desirable and where there are not many other programs?  For example: many people in their 20's prefer big cities to small ones.  Another example: there are many more programs on the East Coast than on the West Coast, so West is even more sought after. (Last note both the Northeast and West Coast want letters and rotations from their own coast, if you did not rotate in their region this will be a hale mary for you.)

2.  Does the program have "EM-famous" faculty?  Prominent figures in the world of EM, particularly those who would be visible to students (i.e. #FOAMed > past-presidents of ACEP).
Is there a popular blog or, podcast out of this program. Were you dying to hear a lecture by an attending? Is one of the attendings an author of a book you keep handy?

3.  Academic affiliation with a University that sounds impressive?  If your mom would be impressed with the affiliation, that counts.

4.  Age of program?  Older, very well established programs are often more competitive than their newer neighbors, especially if they played prominent roles in the history of EM.

5.  A multitude of fellowships, especially the ACGME approved ones (Toxicology, Pedi EM, EMS, Sports Medicine, Hyperbaric)? More fellows can be a surrogate for more academic stuff going on.

The mistake often made by applicants is to only apply to programs with high degrees of "perceived competitiveness".  If you are an average or below average applicant, you should be applying to programs across the spectrum.  This will ensure that you get enough interviews to not be a sweaty mess on Match Day.

You need to do the math:

The number of interviews you will get is a product of your competitiveness times the perceived competitiveness of the programs you apply to:

Above average candidate X Uber only = some interviews :|

Average candidate X Full Spectrum = Uber interviews :)

Average candidate X Uber only = few interviews :(

Below Average candidate X Uber only = no interviews :((

Lastly remember this is advise so you can maximize your application and interviews. There is nothing wrong with applying to a program you have always dreamed of joining, even if you are not an above average candidate, just realize the interview may not come.

Assessing Competitiveness - Part 1

Step 1 is to figure out how competitive a candidate your are.  Your advisor's should be able to help you sort yourself into one of three "buckets":  the average candidate, the above average candidate, and the below average candidate.

Above average candidates have:

  • Honors in everything clinical
  • Board scores that are above average (>240)

Above average candidates have little to worry about and should not be reading blog entry's on how to get a residency. Make a list of spots you like and would like to train (15-20).

An average candidate is going to match in EM if they make a reasonable list of programs to apply to.

The average applicant has:
  • Board scores that are in the neighborhood of average (~220  >220).
  • EM grades and letters that sum up as: going to do well in EM (Honors or High Pass with a supportive letter, & hopefully followed by Honors on the second rotation).
  • No red flags.
Goal is a diverse list in different regions of the country (25-40).

If you fall short on any of those criteria you should consider yourself to be a below average candidate and plan appropriately.  This means applying to lots of programs (40-50), not wasting money on the most competitive programs, and having a back-up plan for not matching in EM.

This is additionally complicated if you are an Osteopathic or Foreign Medical Graduate looking to join an Allopathic EM program.  Only some programs (68%) will even consider your application.  The programs open to you have their pick of candidates and they are looking for the cream of the crop.  If your not at least an average candidate AND you are from an Osteopathic or non-U.S. school, your chances are slim and you need a back-up residency plan like IM or Family Medicine.

Fortunately, the receptive programs are easy to find by going to their website.  Look at their "residents" pages and see where their residents came from.  If you see residents who are D.O.'s or are from your country/med school, they will probably give your application a fair review.

Now that you have a sense how competitive you are, you can try to figure out the programs...