Blog Archive

Tuesday, February 20, 2018

The Difficulty of Re-Applying to a Residency

As a fairly optimistic person, I would usually err on the side of optimism by encouraging a doctor who did not match into a residency the first time, to re-apply again next year.  However, with all that I have deduced over the last 2 years of research about the residency shortage, I would worry about setting up an unmatched doctor for failure.  Not matching the first time is devastating.  I actually fear the outcomes for these doctors with subsequent failures to match.  I have heard from several doctors who have failed to match after 3 or 4 re-applications.  One doctor actually sounded suicidal…This is what caused me to try to figure out what was happening and why.

I mentioned in my BIO that I have been on the sidelines of Medical Education for 50 years.  Based on my exposure to at least 7 different residency programs, there appears to be one Program Manager or Administrative Assistant assigned to the task of managing residency applications at each program.  With the current situation of the residency shortage, the fear of not matching has caused graduate doctors to apply to an average of 47 applications each.  The application process has been deluged with almost 2 million applications per year (42,000 applicants X 47 applications = 1.974 million applications).  Depending upon the specialty, that amounts to hundreds and thousands of applications to each residency program, and in turn, to 1 solitary program manager!  That is a lot of applications to read!  The applications are lengthy as well.  They include a personal statement and often 3 letters of recommendation, a dean’s letter, and other credentials.  As I have mentioned in a prior blog, several residencies in my area have received:
  • 1,000 applications for 15 positions
  • 900                           20   
  • 1400                         12    "
Based upon these numbers, I came to the conclusion that a computer-generated screening device had to be used to “whittle-down” the number of applications that actually had to be read.  I then realized that due to the “quantitative” screening (e.g. a STEP II score) performed by a computer, the same applicants would be repeatedly passed over, even though the applicants may have had additional years of training, research, etc. This is why my normally optimistic outlook was fearful of offering false hope to the doctors who had not matched the first time. 

Part of me worried that readers would say, “How do YOU know that is really happening?  You don’t work there…”  Another part of me realized no one would readily admit that this process was occurring.  They would want to say, “We read all applications we receive, and give fair consideration to each.”

So I contacted a residency Program Manager I know personally, and interviewed her about their application procedures as well as her other job responsibilities, knowing the full scope of her job would help to generalize the process somewhat to the other residencies across the US. She told me her program receives 500-600 applications, and that she reads each personal statement.  This is her first level of screening.  She admitted that if their numbers of applications were greater, she would resort to a screening of some kind.  She indicated that although there is an email network of program managers and that they communicate with one another, that probably no one would admit to using a computer screening to reduce the applications read for their programs.

The crush of applicants has deluged the programs with phone messages, emails, and cold- call visits.  It is useless to try to make contact with a residency to “state your case” or get a foot in the door.  The program manager said she answers as many emails and phone calls as she can, and lets the others go unanswered.  Any impromptu visits by applicants are not given an appointment.  So your hands are tied.  Your only chance is if your application made the “cut” in the computer screening of programs with huge numbers of applications.  This is why my normally optimistic self has become a realist…

 There are at least 13 other roles the program manager fulfills.  I will name just a few, which in themselves are quite detailed:
  • keep track of 27 milestones accomplished for each resident (16 of them), twice/yr.
  • organize a week-long orientation program for new residents
  • maintain independent contractor contracts for each faculty member
  • keep the “on call” schedules (365 days/year)
  • process physician payments based on clinic, surgery, on-call, supervision, etc.
  • maintain ACGME requirements and credentials
  • reimburse and make travel arrangements for faculty
  • set up online recommendations system for each monthly rotation for each resident
  • read apps, set interviews, arrange visits, answer emails and phone messages
  • etc., etc.
At this point you are probably thinking this is too much information.  I thought that providing this amount of detail would lend credibility to the plight of the unmatched doctor and their chances of successfully matching with successive re-applications.  I have tried to expose the “dirty little secrets” of what is going on during the residency shortage.  There are 42,000 applicants for 32,000 positions each year.  This has to be corrected!  It is complete insanity to discard fully educated and qualified doctors, especially in view of the projected doctor shortage!