PANIC! At the ERAS

The inspiration for this blog, originally, was family – in particular, the Bringers of Life and their respective bringers of life. No, this is not an ode to a special love of family; I was really, really tired of explaining the medical school application process to everyone with my last name over and over again.

So I started writing down my explanations online – postbac program to knock out requirements, MCAT, complicated multi-stage application, interviews, second looks – and sending out links to spare myself. It’s been more than five years since my first post.

Sometime late this week, I will submit my application for residency. In case you haven’t figured it out yet, I’ll be applying to “match” in emergency medicine. The process is long, confusing, tortuous (in multiple definitions of the word), and culminates in Match Day. For those of you already in medicine, this post might be kind of boring. I will thus use far more GIFs than normal to keep you interested.

For everyone else, welcome to the madness that is the residency application.

soitbegins

The first thing to know about this process is that it is entirely centralized and entirely controlled by the AAMC, the Association of American Medical Colleges. Their system, the Electronic Residency Application System (ERAS), is a website that serves as a clearinghouse for all of the documents. Here’s how it works.

Summer before 4th year: For me, this stage is concluding now. The ERAS application “opens” and aspiring doctors can go in to the system and fill out some basic information, add a personal statement, input their CV, and request letters of recommendation. I’ve written before about the personal statement (Eat Food, Not Too Much, Mostly Plants).

The curriculum vitae – essentially a long resume – is the irritating part. Because ERAS uses a standardized system, you have to rewrite your entire CV, line by line, into the system. It takes forever, unless you are an applicant with zero publication history and no notable achievements outside of membership on some committees, such as myself.

Letters are a whole different story. To obtain a letter of recommendation, the student must:

  • Ask the luminous, prestigious, gloriously altruistic letter writer to write them a letter
  • Grovel if needed
  • Enter the ERAS system and create a “Letter Request Form”
  • Email the PDF of the form to the aforementioned illustrious being
  • Wait
  • Wait
  • Wait some more

In September it becomes acceptable, according to Medical School Etiquette (which is a hilarious concept, seeing this is a population that happily dissects human beings), to engage in “mild pestering” of the letter writer if they have yet to upload your letter to the system. Most letter writers are themselves physicians and know that the deadline for submitting the application comes around in mid-September, so they usually get it done.

Of course, you waive your right to view these letters, so that your letter writers can write Honest Things like “Nate is a borderline student for whom I am writing this letter because he came to my office with Toll House chocolate chip cookies and a really sad look on his face” without feeling guilty.

love me.gif

The other major component of the summer period is creating your list. When the ERAS application “opens” for submission in mid-September, your application is really a common app – you can apply to as many or as few residency programs as you want. Part of the summer is spent researching and adding programs to a list that is, of course, stored on ERAS (and in a not-yet-colorful-enough spreadsheet on my computer).

This is where the process gets interesting. There’s an entire cottage industry of advice around how many programs you should apply to, and how many you should interview at, based on how competitive of an applicant you are in order to guarantee a residency spot. The advice is very interesting: if you ask five people In The Know for these numbers and ratios, you will get at least seven different answers. So it’s a crapshoot anyway

A short aside: the key to getting good residency advice is never to ask a med student for it, especially one who claims to Know Things. This is the fastest path to getting bad advice that exists outside of WebMD. Medical students are hardworking (usually), conscientious (mostly), well-meaning (sometimes) colleagues who have absolutely no idea what they are doing. Pretending otherwise is insane and the height of self-deception. As a famous emergency medicine article says, “Trust no one; believe nothing.” The article was obviously in reference to medical students (just kidding).

5390389be535cb7ff5068078cb4ef6730fd0f3e240c03892c162fe035ee6b5d3

(In case you can’t tell, I love this picture.)

The advice also varies by specialty. For emergency medicine, the best consensus recommendation I’ve heard is that the “Average Applicant” – whatever the hell that is – should apply to about 25-30 programs and expect to interview at about 12-15. There is published data that shows if you interview at a certain number of programs, presumably a number below the recommended twelve, your odds of matching exceed 99%.

So that’s good to hear. It’s worth noting that I have practically no idea if I am a Below Average, Average, or Above Average candidate except for my middling TTTSNBN score (which places me decidedly in the Average category).

Of course, if you’re matching into a Competitive Specialty – like otolaryngology, or neurosurgery, or cardiothoracic anoderm surgery, you should apply to far more programs, and then pray.

Yep snuck anoderm in there again, just to see if you were paying attention.

Anyway. So you have to “research” the hundreds of residency programs to figure out which ones you should actually include on your application. I put research in quotes because that makes the process of “googling things and asking random faculty members for their opinion” seem far more scientific than it really is.

So finally, after hours of “research” and probably a lot of coffee dates with People Who Know Things (i.e. not other medical students, as described above), your intrepid medical student has a completed application: the personal statement filled out, the CV copied over, the lists completed, and the letters (hopefully) uploaded. There’s also the Dean’s Letter, which is a summative explanation of your performance in medical school written by school administration, but you have practically no control over this so I don’t want to deal with it.

Finally, we are up to the present day.

Submitting the Application: It used to be that on September 15th, the highest-stress group of human beings in the Western Hemisphere simultaneously logged on to one website and furiously hit refresh in order to submit their job applications en masse. Predictably, the website would crash every year, sending the aforementioned highest-stress-imaginable people into paroxysms of panic attacks, explosive diarrhea, and acute onset carpal tunnel syndrome.

popcorn

This looks bad when the medical student is trying to simultaneously manage these symptoms while also rounding in the hospital, so ERAS has decided to open the application earlier this year (September 6) and timestamp all early applicants “September 15.”

This has alleviated some of the diarrhea, if not the stress, a great deal.

(There are stories, seriously, of people fainting on rounds when ERAS crashes. I am not exaggerating when I say you cannot find a higher-stress group of people. I challenge you to do so. We are all thoroughly insane.)

After your application goes in, you wait until sometime in October, when:

Interview Offers: Residency programs will begin contacting applicants for interviews in mid-October, stretching through the winter. Most residency programs use a calendar-based program where they will send you a link that contains all of the interview dates and allows you to sign up for the one you want. Of course, this means it’s first-come first-serve, which realistically means that medical students with heart rates of 200 are continually dashing away from their teams to furtively whip out their phones in the staff bathroom in order to snag a particularly desirable date before everyone else.

panicking

October and November are not particularly productive medical student months.

The Interview: I’ll write more about the interviews once I’ve actually, you know, interviewed, but typically it includes a cocktail hour or dinner the night before, a full interview “day” with presentations and tours, and a shit ton of air travel. I am legitimately scarred from my return trip from Guyana and am dreading the idea of flying.

I am serious. I need therapy.

After the interview, stuff gets really weird:

The Match.

The Match process was implemented in 1952 in order to reduce the amount of cronyism and nepotism inherent to what was a seriously old-boy network in medicine. In short, a computer takes into account the applicant’s preferences and the program’s preferences, puts it all into an algorithm, and spits out a binding “best match” that determines where someone will spend the next 2-10 years of their life.

After interview season is over, the applicant goes into yet another website and “ranks” all of the programs where they interviewed, from #1 to whatever. There is no requirement to rank ALL of the programs where you interviewed, but the recommendation is to do so.

On the other side, the program directors do the exact same thing for every applicant they interviewed that winter: they rank them from #1 to however many interview spots they had. If they interviewed 160, they rank them all from #1-160.

This is, obviously, a tremendous undertaking.

Once lists are completed in February, all this information goes into a computer algorithm – a proprietary computer algorithm that no one understands – which spits out a Best Match for every applicant and every program in the country.

Match4

Match Day: This information is held until a special day in March, called Match Day. This year, it’s March 17. At the same time on the same day all across the country, med students find out where they will go for their residency program. Different schools do various things: some schools have everyone open their paper envelopes at the same time in private ceremonies; others go one by one, broadcasting the spectacle to the whole world.

It’s a big deal. It’s a big enough deal that many students opt to skip the much later graduation (in May) in favor of traveling or savoring their last few days of freedom before intern year.

Most U.S. senior medical students will match (north of 90%). A small number will not, and will participate in a horrible rat race after the Match colloquially called the Scramble; we’ll cover this much later on.

Told you this would be boring. But now I don’t have to explain it 50 times.

ERAS opens in two days. Not that I’m counting.

PS if you google “Match Day GIF” this comes up:

matchday

I have no idea why.

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