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Sunday, August 29, 2010

When to Apply for Residency

(The article is taken from "Another Road to Residency" compiled by class of 2003 and 2004 of Agha Khan University, Karachi Pakistan.)

Applications for residency positions are sent via Electronic Residency Application Service (ERAS(r)). ERAS office starts transmitting your applications to the programs on September 2nd every year. Therefore, the earliest you can apply to any program is September 2nd.

The timeline of important events can be found at relevant web sites. However, here is the pointer that I want to give you.

- If you apply in September, you are applying early and you will get the advantage of early bird.

- If you apply in the first two weeks of October, your application is "in time". You are OK.

- If you apply in late October or worse yet, in November, your application will suffer. You will end up with less interview calls.

Why is that? The programs analyze applications in order of the date of application. If you are a regular candidate but you have applied early, programs will look at your application first and decide there and then whether to give you an interview call. They are more likely to end up calling you because it’s early season and a regular candidate is acceptable.

Now consider the same regular candidate applying in late October. Most of the programs have already called a lot of applicants. There are very few slots left so the programs tend to become more selective. A regular candidate may or may not be acceptable depending upon other options available to the program.

Now the question arises "I will only have my Step 1 score in September… Should I still apply? Will I suffer if I do not have my Step 2 score?” The answer to both the questions is yes.

Let’s go through it step by step.

- Ideally, you should have both Step 1 and Step 2 scores and passed the CS by the time you send in an application. That will give you the maximum advantage. However, that means studying hard and fast, going to US just for the sake of CS and getting it all done and over with before September. Thank God, we do not live in an ideal world so we can get away with less.

- The minimum you need to apply for residency programs is a Step 1 score. That's the bare minimum and most international applicants do that. It is acceptable. In fact, if a program likes your application but requires your Step 2 scores before they grant you an interview, they will wait for you and put your application on hold till than. They will make their final decision whether to call you for an interview or not only after they have received your Step 2 scores.

- The best approach which is both economical and fruitful at the same time is to have Step 1 and 2 scores before application (i.e. September). You take your CS when you go to US for residency interviews. Thus there is only one trip to US and you get the advantage of Step 2 scores as well.

Conclusion: The advantage of early application outweighs the disadvantage of applying without Step 2 scores. Therefore apply early!!!!!!!!

WHERE TO APPLY                                      Class of 2003

If you know nothing about the various hospitals in the USA – don’t worry. Neither did I, until a month or two before I sent my application. Many people gather this information during medical school. If you did, Great! If not, join the club.

How to find out? Ask your seniors! The reason for this is simple. They have already done their homework! Else, find out where your seniors have gotten into. This is very important. You see, the fact of the matter is, if a program has a history of taking students from your university, they will probably continue to do so, so long as their experience has been worthwhile. Hence, there is a gradual development of so called ‘hubs.’ Some programs are AKU hubs. They love AKU students. Others are DMC hubs, etc. The university that you have studied at has a major impact on how much importance they give your application. I will illustrate this with a simple example. At one of the programs where I interviewed, an authoritative member of faculty informed us of the following: When that particular program interviews candidates, it gives them points for their various qualities. One of the things which gets points is the medical school. If a graduate from the home institution, they get 20 points. If from another US institution, they get 10 points. IMGs get 5 points. However, AKU students are the exception to the rule, and they get 10 points… Think about it… So, you see, if they are familiar with your school, your chances increase. Of course, even the fact that students are called for interviews is a positive sign, even if no one has matched there yet. After all, a program will only spend its resources on you if you have some chance (however remote) of matching there. So, keep in touch with your seniors.

Of course, you do not always have to stick to the beaten path. Someone has to take the initiative in applying to previously uncharted territory. If you have done electives in a great university and you feel that you have been able to ensure that you have been well noticed, by all means, apply! If you have been looking at websites and have found a program which suits your interests, apply! After all, if you succeed in securing a spot, you’ll be pushing boundaries for your own juniors. However, keep in mind, applying is an expensive process. Furthermore, the more places you apply to, the more expensive it gets. The first ten places that you apply to will cost you $60. Programs 11-20 will cost $8 each, 21-30 will cost $15 each, and 31 onwards will cost $25 each! To put that in perspective, 10 programs cost $60, 20 programs cost $140 and 30 cost $290… It keeps doubling… Keeping this in mind, decide upon the number of places which you should apply. The main factors that should determine this number are the strength of your application and the program specialty for which you are applying (and your bank balance, of course). If you have a decent application and are applying to a non-competitive specialty like internal medicine or pediatrics, 30 programs are more than enough, as long as the list of programs is primarily made up of the places which are AKU friendly. You could even get away with less, but, I don’t think it is worth the risk. Of course, if you feel your application is weak, apply to more. If you are applying for something more competitive (like surgery, ophthalmology, radiology, etc.), apply to more. If you are couple matching, apply to more. I couple matched internal medicine with pediatrics, and we consequently sent out our application to fifty programs. Your aim should be to get yourself about ten interviews. If you achieve that, your chances of matching are quite good. Statistically speaking, applicants with at least six interview calls have almost always matched.

Another tip would be to mark all the cities that you are considering on a map of the USA. Make sure you understand the distances which the map represents. I minimally understood USA geography prior to this exercise. Trust me, it made a huge difference – both to my knowledge base and to my choice of application. The reason for this is… THE USA IS ENORMOUS. And most of us travel by greyhound. I applied to places in Florida, but, I later realized that it was completely out of the way. I was even going to apply to Maine and Seattle… but then I saw where they were on the map. Eventually, I restricted my program sites to central and eastern time zones. Even that was quite a ride… The map will also be useful when you are planning your interview calls. See where you will be at a given date and where you have to go. This way you will be able to plan better. You don't want to spend time going back and forth, because it will exhaust you. Remember, although the residency trail is not that much of an intellectual challenge, it is physically exhausting as it requires a lot of traveling. Save your energy as mush as possible.

Being a senior myself, my further two bits. Attached within this zip file is an excel file with all the information which I could muster. I also scanned the map which I made for myself. Help yourself!

Do check out program websites. They will give you a feel of the program. Look at their requirements. They usually stick to what they state, however, they some programs overlook some of their requirements at times. Be wary of the language used (e.g. “6 months of US experience required” is different from “6 months of US experience recommended” etc.) If you feel that you need to know more, write to the program to ask them your questions. Ask them things like whether they take IMGs, visas offered, specific requirements like US experience, application deadlines, etc. Another thing to keep in mind is that some programs may suddenly become non-operational! So, make sure you check out the list of programs which are participating with ERAS. The website is

To repeat an above mentioned statement, make sure you apply to as many AKU friendly places as you can. Also, apply to an appropriate mix of programs. As in, some great places, some back ups, and lots of in betweens. Keep in mind though, at the end of the day, there is another thing that you will be told time and time again. “Never rank a program which you would hate to go to… It is better to go unmatched and go for the scramble than to be stuck in a place where you will be miserable.” Since that is the case, why bother applying to a place where you have no intention of going?

Another place where you can find out information about residency programs is FREIDA (Fellowship and Residency programs Electronic Interactive Database). ( ). This enables you to search for residency and fellowship programs in terms of specialty and location. Hence, a very useful tool. It will give you a good idea of what kind of program it is (university, community, etc.), size of the program, and, probably most importantly, the contact information for the program director and the program secretary. This is where you get the keys which open the door the ancient ritual of bugging the program administrative staff. There is a ton of information here. Keep in mind, the contents of this site have been written by the administration of the programs themselves. None of the information has actually been authenticated by anyone, and thus does not have to be all true. I came across program which claimed that the average amount of time that a resident works is 65 hours. If you come across something similar, make a mental note to hear the residents there laugh. During your interview trail, you will often notice that there is an interesting gap between how many hours the residents work and how many hours the program director thinks the residents work. So, don’t believe everything you read. The only drawback of FRIEDA is that it does not have the information specific for IMGs. For example, it has no information on willingness to accept IMGs, IMG requirements for application, visa sponsorship availability and type, etc.  All such information on FREIDA is pertinent only for US Medical Graduates (USMGs). Therefore, do not get excited if you find a certain program on FREIDA which states that applicants have to take USMLE Step 2 CS exam anytime before starting residency. That's only valid for USMGs, not IMGs.

US News rankings are alright too. It’ll give you a general idea of how great the place is. Most of the details are in the Premium bit. Admittedly, I bought it, but I don’t think it taught me anything worthwhile. So, I don’t advise it. I did some extensive work on US News. I read the rankings in many different ways. Looked at medical school rankings. Looked at rankings of internal medicine, pediatrics and family medicine programs:
Looked at the rankings of the best hospitals for everything:
In doing so, one can get a pretty good feel for how good the hospitals are. Keep in mind. Just because a hospital is good for something, it is not necessary that the corresponding residency program will be good. Sometimes you may wind up in a fellow run slump. So, look out! Another point to keep in mind is that US News Rankings are dependent on many factors, many of which do not concern the average resident. On the flip side, US News does not consider many factors which are of significant importance to the average resident. So, do not treat them like scriptures. Programs which are not ranked can be much better than those which are ranked. Better faculty contacts may lead to better fellowship placement. Board pass rates may be higher. Environments may be far more friendly (big shot programs are usually quite arrogant). The hospital may be excellent in the area which you want to sub-specialize in. Remember, your priorities will determine the ultimate list of program rankings.

Another website is . Here, you’ll find a bunch of program reviews. Admittedly, I didn’t use it, however, I mention it as it was recommended by Umbereen S. Nehal in “Road to Residency.”

I have also added an extract from Road to Residency below:

“The things I was looking for in a Residency

-Good program

-Takes foreign medical grads (had at least one in their residents!!) although I did apply to a few programs which had really good names and no FMGs (did not get calls from those guys)

-If there was an AKU grad there

-Places that people in AKU apply to in general

-Places which were not badly talked about or which did not get bad ratings from the previous classes. Because you spend a lot of money traveling to these places and time and effort, if you know in advance that a reasonable person really did not like it, then it is a waste of time and effort to go there I thought...unless, you are in the area and can interview there at the same time as your interview in another place nearby...... (Like I was in Houston so interviewing at UT as well as Baylor was something easy and convenient for me)

-Places in clusters...if you are applying to one program in a city and serious about going there for an interview if you get a call then apply to a program close to that...if you get a call and want to interview there you can schedule the 2 together...even so don’t apply to programs you will certainly not want to end up in and might not even interview at cause it is a lot of waste of money which happens every year to almost all of us cause we worry about not getting enough calls.

Things to think about when going to an interview

-What are your priorities in a place? Mine were location (I had family in Texas), the kind of program, residents, the sort of faculty, did I fit into that place, was it psychotherapeutic or pharm-oriented, was research necessary, did everyone seem happy or were really stressed out or even worse, bored...etc

- Can you see yourself spending 4 or 5 years at this place and if you are thinking of a fellowship can you get one after this place? Or if you are thinking of an H1 or private practice, then what are the chances?

-Do people moonlight and if so how does the program feel about it and do you want to.”

Shaheen Mithani

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