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The Match: An AmeriClerkships Internal Chapter

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ompetitive programs in certain specialties and locations in several states to include
California, Illinois, Pennsylvania, and Texas had very stringent requirements that
required state-specific registration and verification of one’s credentials- just to apply.

Many of the residency spots listed in private online accounts promoted primary care,
and offered the single greatest opportunity for the greatest number of programs to view our client
applications. Certain factors dictated the interview extension and application submission process to
include: USMLE scores (Step 2 > Step 1) and Attempts, dates of graduation, and amount of insured US clinical experience
(not as a Medical Assistant, a lab technician, a researcher or an observer). This chapter contains important information
about the Match Week events for applicants, and applies to all those who have submitted a certified rank order list. You
must first log on to the Match Site with your AAMC ID and password and click on My Reports from the left menu bar.

Detailed Analysis
Every year more than 16,500 American Medical Graduates and 20,000 IMG compete for
approximately 25,000 1st and 2nd year residency positions. This is what typically happens:
 THIRD MONDAY OF MARCH - NOON Eastern Standard Time (EST)
1. Applicants found out "Did I Match?" - Posted to the web and a message sent via e-mail to this
address. The message displayed automatically when one logged on. It was worded so the applicant
knows whether they need to scramble and, if so, for which type of position.
2. Regional Match Statistics by Specialty - posted to the web
 THIRD TUESDAY OF EACH MARCH - NOON EST
1. List of Unfilled Programs - Posted on the private account of all NRMP registrants on www.nrmp.org. Since 2006, this list
has become dynamic and available online only; therefore a .pdf will not be available, so don’t wait for that!
2. Unmatched applicants began to contact unfilled programs.
 THIRD THURSDAY OF EACH MARCH - NOON EST
US medical school Match Day ceremonies begin.
 THIRD THURSDAY OF EACH MARCH - 1:00 PM EST
Applicants found out "Where Did I Match?" - posted to the web; the program code, specialty and institution name were
automatically displayed when logged on.
 THIRD FRIDAY OF EACH MARCH - 6:00 AM EST
Match Outcome for All Programs by State - posted to the web

The 2001 “Black Tuesday”: Where It All Began


For more than 20 years, primary care showed a growing strength amongst all residency programs. In
2001 – March 20, “Black Tuesday” – was different from any Scramble Day in recent memory. There were
more than 700 family practice residency positions available after the National Residency Matching
Program (THE “Match”). And, with perhaps one or two unmatched US graduates per medical school,
there were up to 200 US medical school graduates in the scramble. We were not sure that anyone knows
the exact number of scrambling” graduates, but 2001’s Scramble Day was certainly a favorable market
for students.

At medical schools across the U.S., there were a low number of unmatched students, mostly for the usual reasons—applying
to the most popular programs and not going on enough interviews. The usual routine for American Medical School’s Dean’s
office is to assign one student to one faculty member. This faculty member and the student then begin calling residency
programs, based on the list (which all unmatched students are given) of all the programs with available positions, along with
the programs’ telephone and fax numbers. For each student, schools used four or five phones, including cell phones, to
avoid missing the incoming offer of a position. What was different in 2001 was that after speaking to residency faculty and
coordinators who had always filled until this year, we found that they did not know how the scramble process worked. Over
and over, unmatched students dents were told, “Leave a message after the tone,” or “Fax us your material (if the program
did not already have a file on the student),” or “We will meet this afternoon and let you know what we decide.” Deans of
medical schools with unmatched students wanted to shout to the person at the residency program, “Today is different! You
do not understand what is happening. You are going to lose this student!” But, we had to bite our tongues and did not try to
tell the already-stressed residency faculty what to do.

Residency Programs Requiring “Pre-residency” Hands-on Clinical Experience of the International Medical Graduates
In the 1990's, residency program directors were concerned that thousands of International Medical Graduates (IMG's)
entered residency with little or no US clinical experience which led to time being lost at the beginning of the PGY1 year
bringing them up to speed with the art of US clinical medicine. The major contributing factors to this included
communication difficulties, cultural differences, lack of familiarity with US diagnostics and procedures, poor history taking
and physical exams, and an inability to write orders.

Below, you will find listed pre-residency clinical clerkship requirements for a few medical residency programs throughout the
United States (the actual number of programs with similar requirements is greater than 60% of total residency programs
across the U.S.):
 University of Missouri Kansas City, Department of Psychiatry requires one year of clinical experience;
 University of California San Francisco, Department of Pediatrics requires prior U.S. clinical experience and letters of
recommendation;
 Morehouse School of Medicine, Department of Family Medicine requires 6 months (24 weeks) of HANDS-ON clinical
experience for each IMG applicant, and not observerships;
 University of West Virginia, Department of Pediatrics requires IMG's to have direct U.S. or Canadian patient care
prior to applying;
 University of Massachusetts, Dept of Obstetrics and Gynecology requires one year of clinical experience in a U.S.
medical system
 New York University, Department of Pediatrics strongly encourages prior U.S., Canadian or U.K. clinical experience
 Richard Lugar Family Practice Residency in Indiana requires at least 6 months of clinical experience in U.S., Canada,
U.K. or Australia
 University of Pittsburgh, Shadyside Family Medicine Residency If graduation date is more than two years ago, then
look for excellent U.S. clinical experience.
 Aurora St. Luke's Family Medicine Residency, Milwaukee, WI. We do require 3 months of objectively-evaluated
clinic experience in the US to be considered for residency. Observerships and Externships do not count.
 New York Medical College (Brooklyn-Queens) Program at Caritas Health Care Clinical experience in the US, although
not required, is desirable.
 DGM, Brigham & Woman's Hospital in Boston, MA Clinical experience inside the US is a requirement. There is no set
duration. Experience must be clinical, not observership/externship/research)
 Mc Laren Regional Medical Centers We have no minimum requirements but some U.S. clinical experience may be
required depending on your graduation date.
 Franklin Square Hospital Family Medicine Department in Maryland requires a minimum of 4 months of clinical
experience in U.S., Canada, U.K., Australia or South Africa

The majority of the 536 programs contacted by AmeriClerkships in 2007 lost the well qualified students to
a program that was ready to scramble effectively. At the same time, those clients who were best
prepared, had hands-on U.S. clinical experience, and educated on Scramble were able to secure
themselves residency positions within the first 20 hours of Scramble.
Disaster Plan: Understanding the Scramble Chapter
s Match Day draws closer and anxiety grows, it is important to think about your
contingency plans. One of the most alarming events for fourth-year medical students or
International Medical Graduates is finding out that they have not matched. Basically, if a
Match participant has anything less than 5 interviews before the Scramble, he/she
should prepare to Scramble! Additionally, the most prepared Scrambler will win his/her residency
position over the phone! This brief tutorial will give you the important things to know about the
Scramble and most importantly push you to start thinking now about "what if...."

Every year, on the Monday preceding Match Day, the NRMP notifies all Match participants in the residency application
process whether they have matched or not. Participants will be able to check their status on the NRMP R3 Website at Noon
on 3rd Monday of March. While a scary moment for each candidate, it is crucial to check your status as soon as possible after
it is released so that you can stay ahead of the curve.

In the United States, students are encouraged to come to their Dean's office immediately if they find out they have not
matched for counseling and strategy planning. For thousands of IMG’s, this option is not available, and it is important to find
out NOW what you should do if the unthinkable occurs.

Monday afternoon is a time to think about your options and decide on a plan of action for You should
the coming days. In short, your options are:
prepare several
1. Try to scramble into any open spots Personal
2. Consider changing specialties to one less competitive with open slots Statements just in
3. Make sure that you can answer all of their questions, better known as the Factor of 8
4. Consider taking a year off for research and/or travel, and reapplying next year
case you decide to
change specialties
In recent years, specialties have gotten increasingly competitive and consistently have only the last minute
single digit number of spots open for the Scramble. According to NRMP data, 995 of 1001
spots in Emergency Medicine were filled in 2007 through the match, with 966/971 in 2006. It
is important to think about the above three choices before Match Week so that you are not pressured to make a potentially
life-altering decision on the spur of the moment.
You have 3
choices: As Monday afternoon progresses, administrators and AmeriClerkships’ staff will receive a regional
Scramble for listing of open slots in each specialty (e.g. 12 General S spots in the Northeast U.S.). This will help us
understand the likelihood of scrambling our clients into another open spot in highly desired
your specialty, geographical area.
be prepared to
answer all By now, you should have collected and have the following materials ready to submit for the
“Critical 48 Hour” Scramble:
questions,
change 1. CL - Cover Letter
specialties or Hand written by you and VERY non-specialty oriented in nature. For example: “Attached, please
find the documents you requested from me. Once again, I appreciate the opportunity to be
wait for next considered for your open residency position. Sincerely, XX, MD and signature”. We should be able
year’s Match! to use this CL for any and all specialties.
2. CV - Curriculum Vitae
Again, universal in nature; the first line should state nothing about a particular specialty as our Goal is to match you
to “A RESIDENCY PROGRAM”, unless you are absolutely dead set on one specialty (a huge mistake during the
Scramble).
3. PS - Personal Statement
Need PS to be universal as well. No mention of specialty… THIS IS VITAL FOR YOUR SUCCESS AND GENUINE
INTEREST IN A PROGRAM!
4. LOR - Letters of Recommendation
Minimum of 3, preferably 4, form physician located in the U.S. We are mindful of the fact that there is very little
that can be done about LOR and whom they are addressed to. You should use the utmost care to have these
documents reviewed before submitting these documents to us. Just remember that its unprofessional to have a
Surgery LOR be sent to a Family Practice residency program!
5. TRAN – Transcript
It is NOT a
Your most recent transcript shall be sufficient.
reflection of 6. CAF - Common Application Form
you when you The complete version; you can have this attached to an email and sent to us.
7. UT - USMLE Transcript
don’t match! Many programs will ask for both Step 1 and 2 score reports, therefore you must have passed both.
The score or number of attempts is of little importance during the Scramble, as it will be 48 hours
of “absolute chaos!”
8. Step 2 CS or CSA transcript
Since this exam will no longer be administered, we don’t want you to be caught in the grey time line zone of
transition into the Step 2 CS. Therefore, all applicants must have passed this exam.
The following are recommended, but not required:
9. DL - Deans Letter
Many have graduated several years ago, and can’t get their hands on this document. If you can provide this, then
its another plus on your application.
10. EC - ECFMG Certification
If available, this document will server you greatly during the Scramble as residency programs love this certification.
We encourage you to have this document, if possible, by March 1.

Residency programs with open slots will frequently ask for the above-mentioned materials, needing them faxed
immediately. It is important that you and/or your school have quick access to a fax machine. Often times, programs that
historically do not fill will send brochures to American medical schools prior to Match Week to aid students in their decision
about which programs to pursue, however once again, this option is not available to the IMG.

The Tuesday of Match Week is the official Scramble Day or Un-match Day. At U.S. schools, students will likely be advised to
visit with their school's academic coordinators from the field in which they are trying to match. In the U.S., there is no such
centralized Dean’s Office for the Scramble. As for all other applicants, unfortunately, there is no time to be picky; special
request on specialty, state or particular program will not be honored. It is up to you, to choose to contact those programs
that interest you, introduce yourself and secure yourself a contract for a residency position.

Spots can go very quickly, with many available positions filled by 2PM on Tuesday. Offers will be made over the telephone. If
given an offer for a scramble position that is not your first choice, you should always ask how long you have to accept. Keep
in mind that a bird in the hand is worth a couple in the bush. Often times, there are positions available at very prominent
residency programs. It is not uncommon for these residency directors to be more methodical in filling their open positions.

Match Day is an important time for every future physician. Fortunately, many students will get one of their top choices and
move onto residency with great anticipation. However, there are others who must endure the Scramble to secure their
intern spot. It is not a reflection of you when you don't match, but more commonly ill-advised program selection or bad luck.
Many students emerge from the Scramble with highly sought after positions with still others who purposely waited for Un-
match Day to find a transitional year program. With your rank list turned in, the most important thing you can do is think
about your contingency plans for the future. Good luck in the Match, and we hope that you take advantage of clinicals
offered through AmeriClerkships during this vital time of your medical career!
Suggestions for the International Medical Chapter
Graduates – To Scramble or Not?
Anticipate Not Matching and Have a Backup Plan
 One person is not enough to handle the calls. Also, the applicant must be
on-site and ready to talk to residency programs. This is why signing up for
Scramble Assistance is such an efficient “insurance” for all of those who
anticipated not matching.

Be Ready to Scramble
 Success during the Scramble is partly based on chance and sheer number of programs contacted by you (or on your
behalf). Your direct participation in the Scramble process will only increase your chances of finding that ONE program
who is willing to accept your candidacy as one of their newest Attending Physicians.

Keep Your Phone Line(s) Open during the Scramble


 You will need at least 2 phone lines and another fax line. We encountered many busy signals and automated messages.
All the students are calling the line listed in the book they are given. Therefore, if you plan a 30-minute telephone
interview with a residency program, use another phone line and leave your main phone line open for incoming calls.

Know the Factor of 8 - Be prepared to provide answers to the following questions immediately on the phone; your:
1. USMLE scores and number of attempts (average score is in the low 80’s, with an average of 1.4 attempts per
USMLE; Step 2CK seems to be more important than Step 1; Step 2CS is typically overlooked during the Scramble)

2. Insured pre-residency “hands-on” clinical experience and Acculturation


in the U.S. (residencies typically require up to one academic year (36 Looking for Navigation and
weeks) of clinicals; observerships (hands-off) or research DO NOT
Medical Career Planning?
COUNT!)
3. Activities since medical school Graduation – (formerly known as “When
Contact your AmeriClerkships
did you graduate from medical school?”; you can bridge this gap with U.S. Residency Strategist by calling
clinical experience from AmeriClerkships! You should continue your 877.MD.Clerkships (632.5375),
clinicals during the months of March, April, May and June, so that you or careers@americlerkships.org.
don’t have any gaps in your clinical experience before residency starts.)
4. 3 to 5 Recent Letters of Recommendation from licensed U.S. physicians (< 12 months old), documenting your
clinical experience in the U.S.
5. U.S. Immigration Status (be very honest with residency programs about your need for a visa sponsorship, as many
will not entertain your visa requests if it’s done any time after Scramble, and you could lose your spot!)
6. ECFMG Certification (this is important, but not essential. You may need to educate the residency programs about
what constitutes an ECFMG Certification, especially if you have all of its components, but haven’t yet received the
certification.)
7. Passing score on USMLE Step 3, if taken (a passing score on Step 3 shows the residency programs that they won’t
have to worry about you failing Step 3 during residency, which could lead to your suspension and possible dismissal
from the program.)
8. And finally, your Interview skills and English Competency during the interview process (during the Scramble, this is
done on the phone. Try to avoid going to personal interviews as you will lose vital time in scrambling for contracts
that may be offered over the phone.)
Rest assured that AmeriClerkships can help with all of the above 8 factors. Contact your AmeriClerkships Residency
Strategist for navigation and medical career planning by calling 877.MD.Clerkships (632.5375).

Ask for Help


 Your family and friends are your best immediate and least expensive resource at this point. You can have others call the
unmatched list with you, to take messages, fax documents and maintain a record of all the occurrences during the
Scramble.
Use Caution When Scheduling In-person Interviews
You should have  We DO NOT recommend you attend in-person interviews during Match week. Airline
at least three tickets are too expensive with a short term notice, and you will not have another chance
for the Scramble for another year. It is a tempting offer to refuse, especially if you have
communication several factors working against you: board attempts, year of graduation, low scores, no
lines: 2 phone U.S. clinical experience, etc… but you will soon realize that a good applicant is identified
quickly by the residency programs, and your personal “phone” interview shall suffice you
and 1 fax during receiving a contract over the phone.
the Scramble! Be Ready to Use ERAS During the Scramble
 Be ready to use the Electronic Residency Application System on Tuesday, Wednesday and
Thursday. On Tuesday morning, one student sat at my computer and sent his ERAS application to 15 programs that did
not have a file for him. Only one program we called was able to access and use these items; the
others told us to fax his application materials. It is worth
Don’t Solely Depend on Emailing Documents investing $60
 Residency email account quickly gets saturated with large attachments from over anxious
Scrambling applicants. Do not be surprised if you receive several email bounce-backs. to apply to one
Keep Your Fax Lines Open program via
 We had one assistant trying, over and over, to send application materials by fax, but almost all ERAS so that
residency program faxes were busy, busy, busy. The residency directors were wondering why
they were not receiving our faxes, but the problem was on their end. My suggestion is Breaks in your
a Word document appear as “labeled,” dotted double-lines. documents
Follow-up with Each Faxed Documents
 It is quite difficult to successfully fax documents to programs, therefore don’t loose this
may be sent to
opportunity to hold a conversation with the residency program by asking if they received your those who only
documents. Don’t depend on them to call you; there are literally thousands of application accept ERAS-
pages floating around in their offices.
Be Prepared to Make Prompt Decisions transmitted
 Our clients are counseled that the best available positions are being taken minute by minute documents
and that they should not try to play one program against another. In practice, students might
only call places they would like to go, and they take the first position offered. Too many sites
during the
tried to accumulate all applications and then hold an emergency faculty meeting later in the day Scramble.
to make a decision . When the student hears this, we go on the next call.
Offers will be Made Over the Telephone
 If given an offer for a scramble position that is not your first choice, you should always ask how long you have to accept.

For any further questions about clinical rotations, or policies that pertain to International Medical Graduates, feel free to
speak with a AmeriClerkships IMG Certified Residency Strategist, or send an email to Enrollment@AmeriClerkships.org. We
look forward to seeing you in your next AmeriClerkships clinical experience!