Hi guys! Long time no blog. As I was writing my biggest blog post about matching, I realized that I never provided background information about the match process. Many of you guys are premed or in the early years of medical school and I remember being completely oblivious to the residency process. To be completely honest, it was a learning process even up until Match day! This post serves as a guide to the process of medical school up until the beginning of residency. *Note: all of my posts will be from a DO medical student point of view. My MD student counterparts experience similar circumstances.

Below, I include the timeline of my osteopathic medical school career. There is some variation among different schools but the red boxes show the core three board exams that students must pass in order to graduate from a US medical school. Allopathic (MD) students must pass their equivalent three board exams (USMLE). Osteopathic students can opt to take USMLE 1 and 2 (to broaden where they can apply for residency) but must take COMLEX Level 1 and 2 to graduate with a DO degree.


Setting Up Audition Rotations: After you determine the specialty of your choice during third year (or earlier), most students schedule anywhere from one to six away/audition rotations. Here is an article I wrote to explain a little bit more about that. Scheduling for osteopathic students typically begins January of the same year you will be doing the away rotations. I.e. I planned my rotations January 2017 and went on these rotations in the fall of 2017.

Apply for residency: Applications are eerily similar to the medical school application process. Everything occurs on the ERAS (some acronym for something nobody quite knows) system. It's a good idea to update your CV often so when it gets to this point, it's just a matter of entering your CV into this system. For osteopathic students applying to the AOA (DO) match, applications open around mid-July. For the NRMP (MD) match, applications open early September. At first, I thought it was unfair to apply so early for the DO match because I had so much on my plate but it was really great to be finished before starting away rotations. In ERAS, you can apply to as many programs as you'd like.

The application involves writing another personal statement. I think the best and only advice I was given was to start early for this. Did I do it? No (lol). During the end of my third year, I still had rotations, shelf exams, OSCEs, and Level 2 studying. But, magically it will get done and you'll happily submit everything (hopefully) by the time application opens!

The difference between the AOA (DO) and NRMP (MD) match:
First, the terminology for these matches are confusing because they are called many things:
  • DO match: AOA, NMS (National Matching System)
  • MD match: NRMP (National Resident Matching Process)
By 2020, both matches will merge into one giant residency match. There are so many posts out there that describe this better than I will ever be able to so if you are interested in this, I would definitely Google it! Here are some factoids:
  • DOs can apply to either matches. MDs can only apply to the MD match. This may seem like an advantage to DOs but the number of programs is significantly less in the DO match than the MD. For example: there were only 46 general surgery programs (118 spots) in the DO match this year vs. 270+ programs (~1300 spots) in the MD match. And, depending on the specialty, it may be harder to match into mid-tier to higher-tier MD programs for DOs. 
  • By 2020, programs should accept COMLEX and USMLE. Currently, the DO match only considers COMLEX scores. The MD match can consider either depending on the specialty and program
  • DO programs must be ACGME accredited by 2020 in order to stay open and participate in the Match. Because of these new standards, DO programs may be closing. 
  • If you are interested in applying to general surgery as a DO, I highly recommend taking USMLE as it will make you a more competitive applicant. 

Audition rotations: I'll talk a little bit more about this in other blogs so stay tuned for how I navigated my way through this. For most students, these take place anywhere from July to January of fourth-year. My biggest advice is to schedule your #1 program last so you have an idea of what the heck you're doing by the time you're there! And also to schedule in the peak months of September through November (when interviews are sent out).

Residency interviews: Every program has different requirements so the basis of how they pick their interviewees is hard to summarize in one defining sentence. I think the general consensus is that programs have a minimum board score cutoff. It is unfortunate that your board scores determine so much but I think it's good to be realistic what specialties you can apply to with your board score. Once you meet that minimum score, there are other factors used to determine whether you get an interview.

These invites are usually emailed to you through the same ERAS system I described above. You can either accept within the website or contact the programs directly. After this point, you are contacted by the residency coordinator with dates for interviews, itinerary, etc. Then you go on these interviews! It can get very expensive. See how I saved money on away rotations and interviews here.

Letter of intent and rank list: After you complete your last interview, it's time to rank your programs to be entered into the Match. It's one of those mysterious computer systems where you enter a list and the programs enter a list and somehow out of it pops a result. Below is a video of how this works:

Ideally, you should rank the program you want to be at the most, not necessarily where you think you have the best chance. Then, a computer algorithm computes a decision in favor of the applicant. I wish I could explain this process better but it is very confusing! Some people opt to send a letter of intent or "love letter" to their top/number 1 programs to let them know you will be ranking them highly. This can be done via email or handwritten letter. It is debatable on whether this makes a difference but I opted to write them because I felt there was no harm and only benefit.

Match Day: DO vs MD: Match day for the DO match happens a month earlier than the MD match and applicants will find out where and what they match into on the same day. The MD match occurs in March and applicants will find out what they match into on a Monday and on the subsequent Friday, find out where they match. Many schools have "Match Day" celebrations where applicants get to find out where they match, together! How cool is that?

If you are an osteopathic student, can you participate in both matches?: Yes and no. Since the DO match occurs earlier, if you don't match into a program, you can subsequently participate in the MD match. This year, I know of applicants who liked one great program in the DO match and only ranked that program but if they didn't match there, they would continue onto the MD match. If you match in the DO match, you are bounded by a contract to that residency and cannot participate in the MD match. Others may opt to only go through the MD match for various reasons.

"Scrambling" vs. "SOAP-ing": If you don't match in the DO match, you have the opportunity to "scramble" into remaining programs that are released at noon the same day. This procedure requires you to contact programs and submit applications for a spot. If you don't match in the MD match initially, you can "SOAP" into remaining spots.

So, that was a quick and dirty summary of what occurs during your residency application process. I hope this is helpful for those of you that will be participating in this next year or the year after. This process is ever-changing because of the AOA-ACGME merger. If you have any specific questions, feel free to email me at coffeeandscrubsblog@gmail.com!

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