Congratulations on reaching fourth year!!
You are nearly at the finish line, at the foot of your MD degree, and your hard work is about to pay off. So don’t give up and don’t fret; the worst is almost over. You have just one more bridge to cross… and I promise that you can do it! You can and you will match.
I have been in your shoes, and I’ve struggled through similar anxieties that you may be facing. From debating which specialty to apply to, to worrying about not matching, to figuring out how to do the damn application, the list can go on! The ultimate reason I wanted to put this Q & A together is so you can avoid some of the pitfalls that I encountered, and can enjoy the ride (and many flights) that are coming your way.
Some background on my match stats (i.e. why you should and can read my advice): I matched into my number 1 transitional year program through the regular match, and into one of my top 5 ophthalmology programs through the early match. I’ve done not one, but two applications: the snail mail method of SF Match, and the electronic application of ERAS. (And I’ve been equally stumped by both at times.) I am also currently an intern and loving it. Honestly, I couldn’t have found a better place. But it took a tremendous struggle and work to get to where I am, and I don’t want you to face the same hurdles I did. Without further ado, let’s talk!
1. How do I pick a specialty?
I am going to be very honest and practical with you. Don’t do something because you should do it, do it because you love and will enjoy it. Figure out what you value (is it money? having a life? becoming the top of your field?) and draw the line with what you’re willing to sacrifice to get there. Because the thing about medicine is it is a long and lifelong journey, and while you can switch between specialties, it is hard to do so later on. And yes, it is difficult to know these things as a medical student, so you have to make sure you are making the most educated decision you can.
Don’t be afraid to ask people about their lifestyles, about the bread and butter they see, and what they like and dislike most about their specialty! There will be no perfect specialty, just one you are willing to make yours. One of the reasons I picked ophthalmology was because the residents were the happiest I knew and seemed to regret it the least. (Though looking back, it may have just been partially the Wills Eye effect, haha.)
To help with selecting a specialty, you first have to figure out if you want to play an active role or supportive role for your patients. The supportive roles are specialties like radiology, pathology, anesthesiology. While you affect the care and diagnosis of the patient – you will not be the primary caretaker, so if developing patient relationships is very important to you, these specialties may not be for you.
The active roles can be further divided into medicine and surgery or both. This depends on whether you prefer to work in primary care, or in the acute setting (hospital/ER/surgery), or with your hands. It is also said that internal medicine is for those who can never decide – you can continue to sub-specialize until you find an area you like.
2. What if I’m stuck between two specialties? How do I pick where to apply to?
The two most important factors that will play into your decision making are these: location and lifestyle. When I started medical school, I fully believed that I could live and breathe medicine, that I could spend my entire life in the hospital and it would be all I needed. However, it was only when third year rolled around, that I realized – there is much more to life than just work. There are friendships and relationships and family and hobbies that are just as important.
So depending on your personality, you have to think about what you want in a future career. Will it be in research and academia? Or outpatient, or both? Usually the specialties that offer the better lifestyles and flexibility, are the ROAD(E) specialties or in primary care. (Of course, after you are an attending, you will be able to dictate your schedule. However, the years of training should also be accounted for.)
On the flip side, location is also very important. Do you have a significant other, family, or friends you want to stay close to? Or prefer to live in the city or the country? If you decide to pursue a competitive specialty and are an average applicant for that specialty, be aware that you may have or may not have to sacrifice location.
- if you have a specialty you would regret not pursuing – go for that specialty. If you feel that your stats are perhaps not high enough, discuss with your adviser about ways to maximize your chances, such as taking a year off and building your resume. If you really fall far, you may want to consider applying to a backup field at the same time, depending on how you feel about not matching.
- If you like two specialties equally, but one provides a better work-life balance - go for the one with the better lifestyle. Of course, this is my personal opinion, but from my experience, being able to maintain a good work-life balance is crucial to overall happiness.
3. Okay, I’ve decided want to sub-specialize. How do I pick between a transitional year or preliminary year program? What is the difference?
First, the difference between preliminary and transitional years is this: a prelim year tends to contain more medicine months (i.e. in the ICU, CCU, inpatient floors) whereas a transitional year tends to be more similar to fourth year (i.e. few inpatient months with more elective time.) But just because a program is a prelim program does not mean it may be harder than a TY program! Some prelims programs are structured to be easier than some TY programs – so make sure to do your research (SDN is a great resource, and PA has some great programs to apply to!)
All I will say on the topic of deciding between the two is this: you will spend the rest of your life learning and working in your sub-specialty. In this intern year – do you want to work as hard as a medicine intern even if you are not going into medicine or would you rather learn at your own pace, and have the freedom to delve into specialties you may never be able to in the future? There is no right or wrong answer – just one that fits you.
This leads to my next point: I wish I had spent more time on selecting prelim/transitional year programs on my ERAS application. I selected programs based off of location, without much research, and applied to WAY too many. For example, half my list were California programs (hey, one can dream); however, the majority of my interviews came from regional hospitals close to my location. Had I known, I would have applied to fewer locations further away. I also applied to way too many preliminary programs as back up, and ended up canceling all but one, after realizing they didn’t offer what I was looking for.
Tip: These programs offer frequent interview dates. I recommend scheduling them (if you can) after your advanced specialty interviews; this way, you can have an idea of where you many end up, and cancel interviews accordingly.
Tip: You do not need to go to every interview! If you can match into your advanced specialty, you will absolutely match into a prelim or TY program. I ended up going to 8 transitional/prelim interviews, and found it was more than enough.
Tip: Contact programs you are going to be in the area for! For example, if you are interviewing in Boston for an advanced specialty, contact the program director of the prelim/TY program and see if you can squeeze in an interview before or after! They may have spots available and it is always worth a shot.
Tip: Follow up with the program you are most interested in. Program directors like it when the people they like want to come. Instant points.