Norcalguy's Residency Application Process

Pre-Med & Medical School Pre-Med Topics
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<p>As the old saying goes, when one residency application year ends, another one begins...</p>

<p>As with past threads, I will try to update this post as I progress. I'm seeing a lot more questions in this forum on the residency application process. Hopefully, this post can eventually help answer some of those. </p>

<p>A little background on me:</p>

<p>Planning on applying for residency in radiology</p>

<p>Medical school: US News Top 20</p>

<p>Grades:
Pass for the first two years (my school only does P/F in the first two years)
Average high pass in the third year (1 rotation to go)</p>

<p>USMLE Step 1: 240's</p>

<p>Recs: Should have 1-2 solid non-radiology clinical recs; planning on getting 1-2 radiology recs when I do my radiology electives in the fourth year</p>

<p>Research: 1 summer of full-time neuroimaging research; no pubs</p>

<p>Publications/posters: 1 poster presented at national conference as undergrad, 1 review article published in peer-reviewed journal; currently working on case report</p>

<p>EC's:
1 semi-prestigious national award for a mentoring organization I co-founded as a M1
President of Radiology Interest Group
Board member of AMSA at my school
2 mentoring gigs working with local HS students</p>

<p>I would've liked a few more "honors" grades this year but quite honestly, I'm probably getting the grades I deserve. My graduating class is pretty exceptional (average USMLE score of 240; highest in school history). The top 20-25% per rotation gets honors while the next 20-25% get high pass. I'm solidly in the second 20-25% in all facets. </p>

<p>Currently, I'm working on getting the case report published and setting my schedule for next year. Planning to take my radiology electives early on to get LOR's. Will take Step 2 later this year. I've been scoring 85-90 on Shelf Exams so expecting somewhere in the 245-255 range on Step 2. My CV is almost done and my personal statement is almost started.</p>

<p>I still need to sit down with a radiology advisor to formally assess the competitiveness of my application. Right now, I'm thinking my target programs are probably low-end academic radiology programs.</p>

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<p>^^^^ Whats the lifestyle like for Radiologists? What kind of job outlook do radiologists have after obamacare? My parents told me that their friends who are radiologists can work from home if they wanted to because a large part of what radiologists do is examine various diagnostic scan results (which they can do from anywhere as long as they are near a computer). Is there any truth to this statement?</p>

<p>Sorry that my questions don’t pertain to the residency application process, but I am curious about this specialty (even though its too early for me to even think about what kind of doctor I would want to be).</p>

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<p>Thank you. Thank you. Thank you. This will help a lot. Maybe at some point it won’t seem like jabber-wocky to me.</p>

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<p>The lifestyle is pretty good for radiologists. Reasonable working hours with excellent pay. I expect the reimbursement to continue to decline for radiologists, as it will for most specialists. And I think that’s fair. Radiologists are probably over reimbursed right now.</p>

<p>As for teleradiology, you see it more in private practice. Not as much in academic centers where residents do most of the off-hour readings. At my institution, we don’t use teleradiology at all. Clinicians like in-house radiologists who they know and can trust rather than some anonymous radiologist a few states away. If we have a question about a reading, we can go right into the radiology reading room and talk to the radiologist in person. In fact, at my institution, we often request images from outside hospitals so our radiologists can read them rather than trust the readings from the radiologists at the outside hospital.</p>

<p>This is also probably the reason why you won’t see radiology exported to India. From a malpractice standpoint, it’s almost impossible to go after some anonymous Indian doctor for mis-reading something. I don’t think you will ever see Indian radiologists do final reads. From a liability standpoint, it’s just impractical to try to hold a doctor half a world away accountable for something. And the other reason for keeping radiology in the US is what I said above. It’s a luxury for clinicians to be able to call down to radiology and speak to the radiologist directly. Those of us who have ever talked to customer service from India know it’s a nightmare to get even simple things done.</p>

<p>I plan on being an academic radiologist myself so I probably won’t do much teleradiology. The hours in academic radiology are especially good although the pay is obviously decreased from private practice (but still excellent). Eventually, my goal is either interventional radiology or neuroradiology.</p>

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<p>What specifically drew you to radiology?</p>

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<p>I like the sheer variety of what you can do as an interventional radiologist. The field is rapidly evolving in terms of new techniques and interventions that you can do without subjecting the patient to a lot of harm.</p>

<p>For example, paracentesis, lumbar punctures, and pleurocentesis are all done by other specialties on the floors. But, when they can’t do it, they call down to IR. The sheer range of what an interventional radiologist can done is staggering. Including stenting someone’s arteries open, embolizing someone’s arteries closed (such as if you’re trying to shrink a uterine fibroid), putting in an IVC filter in someone with clots in their legs, doing tough, hard to reach biopsies, TIPS for someone with liver disease, injecting tPA directly into a stroke patient’s cerebral arteries, radiofrequency ablating of tumors, draining abscesses, etc. Whether you’re talking about heart disease, liver disease, cancer, stroke, infection, gyn, etc. there’s really no field that doesn’t use interventional radiology. As an IR doc told me, “There’s a lot of fighting b/w other fields and IR because our techniques work. If they didn’t work, there wouldn’t be so many doctors trying to do them.”</p>

<p>I’ll have to think of a better answer for interviews as I’m sure program directors are tired of hearing about IR. They want diagnostic radiologists. To be fair, the radiology board itself is practically pushing every new radiologist graduate to pursue fellowships. In a few years, you won’t see anyone stop after a 5 year radiology residency. EVERYONE will be doing a fellowship, whether it’s in breast imaging, IR, neuroradiology, whatever.</p>

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<p>According to a recent meeting I attended, Dermatology, Cardiology, Radiology, and Pulmonary are being hit by significant reimbursement drops. Also significant changes in the radiology ecosystem with radiologists becoming employees of hospitals, telemedicine etc causing a lot of anguish in the radiologists I know. Might affect applications for residency but I suspect not as most medical students have little information about life after training.</p>

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<p>For the record, as a pediatrician, I have never failed on an LP that IR was subsequently able to get…lot of help they are. ;)</p>

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<p>You don’t have to do many LP’s on obese 300 lbers lol IR handles the LP’s when someone comes in with plates in their back or have some sort of deformity or are obese, etc. These complications will be more common in adults. I was on call the other day for neurology and we failed on both patients despite trying for 5 hours. IR gets annoyed when you send someone without trying first.</p>

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<p>This is why it’s not a good idea to choose a specialty based on lifestyle factors which could change at any time. The future of radiology with teleradiology, anesthesiology with CRNA’s, internal med with mid-level providers, etc. are not clear. Everyone wants a piece of the doctor pie. I don’t expect radiology to get less competitive in the near future although I would love it if it did.</p>

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<p>Thanks for this thread, NCG. I look forward to understanding all the steps involved in applications, timelines, and the process in general from you.</p>

<p>We will cheer you on as you progress through this process as well.</p>

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<p>Best wishes for you as you proceed! </p>

<p>Please keep us updated! :)</p>

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<p>Schedules came out today. Got just about every course I asked for at the times I asked for. Almost perfect. Third year ends in June. I’ll (like everyone else) will be taking electives in the field I’m applying to in July and August in order to get LOR’s. One thing that shouldn’t be underestimated is getting LOR’s from attendings you meet on your third year clerkships. It’s often difficult since attendings are only on service for 2 weeks at a time but if you can get 1-2 good letters from third year then you only have to scape together another 1-2 letters from your fourth year. Right now, LOR’s are my biggest worry as I was not aggressive enough in asking for letters this year.</p>

<p>Otherwise, I scheduled around 6 weeks of vacation time in November and December to do interviews for residency and to complete my Step 2 CS.</p>

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<p>Any away rotations? Any thing cool or fun after interviews are done - international or otherwise?</p>

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<p>in your 3rd year, do u ask the attendings for LOR right at the end of the clerkships or do you ask when you actually start applying?</p>

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<p>I originally wanted to do an away rotation but, in the end, decided the hassle of applying wasn’t worth it. I didn’t have a clear #1 choice that I could audition at so I didn’t want to waste my time taking the same basic radiology course at two different schools. Instead, I elected to take the basic radiology course at my school along with electives in neuroradiology and interventional radiology.</p>

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<p>It’s best to tell them that you would like a LOR from them at the end of the rotation rather than waiting. That way they will try to remember you. It’s funny. Attendings have AMAZING memories. They’ve seen thousands of patients and they will remember the stories of most of them. Yet, with med students, they can forget you only a month later lol So, even though you don’t necessary have your personal statement or CV done and they can’t write a LOR for you at that moment, it’s best to just tell the attending, you’ll need a LOR later. </p>

<p>Next week, I’m asking an attending I worked with back in November for a LOR. Let’s see if he remembers me lol In hindsight, I should’ve asked right then. I really worked hard during those two weeks on consults. The team had shrunk from 1 fellow, 2 residents, and 3 med students to just 1 fellow, 1 resident, and me. I switched off with the resident in taking consults and saw 3-4 consults a day by myself (consults = problems too complicated for the main medical team to manage). I carried around 8 patients myself and prerounded on them every day myself. The team always gave me the chance to read chest CT’s even though I made a fool out of myself. I stayed till around 8 every night writing 3-4 brand new H&P’s myself and the fellow copied a lot of my notes. At the end of the rotation, the attending basically said that I functioned at the level of an intern on the rotation and had no negative feedback whatsoever even when I pressed him on it. </p>

<p>Yep, shoulda asked right then.</p>

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<p>My goodness. I sure hope my kid has upper-classmen who like her and understand this stuff. </p>

<p>Again. Thank you, ncg.</p>

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<p>I’ve been on a couple of consult teams since then. Typically, med students carry around 3 patients. There’s usually enough residents that each patient is seen by the med student AND a resident. That way, if you miss anything in your presentation, the resident can fill in the necessary details. But, back on that consult team in November, we only had 1 resident and the fellow was 30+ weeks pregnant and we got 4-9 consults a day so essentially I was the only person to see the patient and form a differential before the team saw them on rounds. It’s really a rare opportunity at my school to do consults by yourself. Med students in general are not expected to be high functioning on consult teams since consult questions are questions that are too complicated for the generalists to answer. You aren’t necessarily expected to answer questions and solve problems that the hospitalists, residents, and med students on the primary teams couldn’t answer.</p>

<p>Other than those two weeks, I’ve been consistent and “good” but nothing that meets my own expectations of being LOR-worthy.</p>

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<p>NCG, It would be great if you could write up a list of the essential ‘things to do’ and their recommended timelines wrt residency applications. Even if you put this down by the time you finish your applications, that would be fine. Many thanks for your efforts to educate the rest of us on this process and good luck to you.</p>

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<p>An extremely good book on the topic is “The Successful Match” by Rajani Katta and Samir Desai. They take an evidenced based approach to looking at what really matters in residency application. Evidenced-based meaning they look at data and residency director surveys. These aren’t cohort studies or anything like that but they at least tried to cite the evidence behind what they’re saying. Caution though: this book is not for the faint of heart. It’s very matter of fact in what it tells you to do and not very diplomatic. You will feel like a complete failure after reading this book and realizing you haven’t done half of what it says. But, I feel like it offers very good advice in assembling a strong residency application, especially if you’re aiming for some of the more competitive specialties. </p>

<p>There is surprisingly little you can do in your first two years to beef up your application. Obviously, you should try to learn as much as possible in your basic science classes but grades from the first two years are consistently ranked as low importance on residency applications (unless you’re applying to pathology). Many top med schools don’t even have grades. You should try to look for a project where you can get a pub in the summer after your 1st year of med school but it’s difficult to achieve in only 1 summer. If you can get even a poster or an abstract, that would be an accomplishment. My internal medicine clerkship director called the research med students do “play research” and it’s pretty much true lol It really isn’t possible to do much that’s substantial in a summer. It’s also extremely unlikely you’ll ask one of your professors from the first two years to write a LOR.</p>

<p>The most important thing to come out of the first two years is your USMLE Step 1 score. It’s one of the top 3 most important factors for residency applications so it’s obviously important to do well on that. Most people don’t sign up for a prep course (in contrast to studying for the MCAT). Generally, you need First Aid and maybe 1-2 supplementary books along with a few practice tests (the NBME sells these directly for $40 or so each). </p>

<p>Third year grades are consistently ranked as the most important factor in your application for virtually any specialty so it’s important to try to get high pass and honors in your rotations. This is easier said than done as grading is so subjective depending on what attending or residents you get. If you are the cream of the crop type student or the bottom of the barrel student, it probably won’t matter. For students like me, it really feels like my grade is out of my control. I’ve slacked off on some rotations and gotten better evaluations than I expected and there were other rotations where I tried my heart out with disappointing results (the pinnacle of that was getting a 84.8 in internal medicine; honors was a 85). </p>

<p>The other important thing which I have mentioned is getting LOR’s. All of your LOR’s for residency apps will come from your 3rd and 4th year attendings. I personally hate getting LOR’s. I understand that attendings expect to write them. But, it’s difficult to ask someone you’ve worked with for literally only 13 days to write you a rec letter. But, it’s something that must be done as rec letters are one of the most important components of your app along with your USMLE Step 1 score and your clinical grades.</p>

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<p>Is there not program close by that you might do at least 1 away at or maybe look for a program that doesn’t require a VSAS app? So you wouldn’t have to worry about housing expense. Both 4h years who matched into radiology did aways at their respective programs and were able to get LOR’s from at least one known name in the field which helped them in on the interview trail. They ended up matching at those programs, which for what its worth, are on this list.</p>

<p>[Top</a> 10 Radiology Residency Programs - radRounds Radiology Network](<a href=“http://www.radrounds.com/profiles/blogs/top-10-radiology-residency]Top”>http://www.radrounds.com/profiles/blogs/top-10-radiology-residency)</p>

<p>Currently, radiology is in my top 3, but I still have time. </p>

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<p>Those are my interest too and what my research consist of.</p>