Tips to match a competitive specialty part one: timeline

Hey guys! By far, the most common topic I'm asked about is matching dermatology. The honest answer is - I don't know. It's such a random process and my success is the result of a thousand small things that came together for me (and a thousand other things that fell apart to create a gaping hole of opportunity). I know of people who, in my opinion, were much more qualified than me who went unmatched my year. For that reason, I am incredibly hesitant to give advice on this topic, but you keep asking! haha.

In my opinion, it is pretty impossible to match a competitive program without the support of your home program, so make sure you reach out to your home program and get advice on what has worked for previous students from your institution. Ask previous graduates who have matched also! I wholeheartedly attribute all of my success to my tribe of amazing mentors - Emory faculty, previous and current Emory residents, and previous Emory graduates who successfully matched before me - who held my hand throughout this process starting M1 year.

I'll be sharing in this post the general things you should be doing each year and in the next post I'll go into the components of a competitive application in more detail but disclaimer disclaimer disclaimer - every applicant/school/specialty/program is different. I am a lowly PGY-1 in this big system. Take my advice with a grain of salt.


I also recommend our resident career profiles for more advice.

Tips to match a competitive specialty - part 1 - a timeline

what are the competitive specialties?

Plastic surgery integrative, dermatology, ophthalmology, otolaryngology/ENT, orthopedic surgery, neurosurgery, vascular surgery, radiation oncology, thoracic surgery integrative, med-peds, med-psych, and urology are probably the most competitive. Followed by ob/gyn, emergency medicine, radiology, anesthesiology, and probably general surgery. So, pretty much everything. The number of available PGY-1/PGY-2 residency positions is increasing, but not enough to keep up with the growing size of medical schools (npr reference). Each year, the squeeze continues to get tighter.

The NRMP Charting Outcomes in the Match gives you a good idea of how competitive a specialty is. There should be an updated report out sometime this year.

Also, even if a specialty isn't incredibly competitive, there are still very competitive programs within each specialty. My application was a strong dermatology application, but I don't know how well I would have done in the match if I'd applied to internal medicine.



when should I start pursuing these fields?

High school: Your focus should be on learning for the sake of learning, deciding what college you want to go to, volunteering, and hanging out with friends and family. It is way too early (in my opinion) to actively pursue any specialty. Shadowing is fun at this stage, but do it because it's enjoyable - not because you feel you have to (because you don't. Nothing you do in high school will go on your med school application). One of the reasons people find themselves unhappy in medicine is that they hopped on the premedical tract too early, powered through many things they hated, only to find out they hate medicine.


undergrad: Your focus should be on following your passions, learning your study style, figuring out if medicine is really want you want to do and building a strong medical school application if so. Definitely shadow physicians in fields you're interested in and talk to physicians about their daily life. Also, look at allied health careers. If you think you're interested in a certain field, it doesn't hurt to join a related research project, but it is definitely not necessary to have plastic surgery research on your resume coming into medical school. I did a lot of research in undergrad, but nothing dermatology related. I did shadow my dermatologist though, and I had an idea that I wanted to go into dermatology entering medical school - which very much was a strength for me. When I decided on medical schools, I asked around about how well dermatology applicants do. I checked matched lists. Despite all of this, I didn't decide officially on dermatology until 4th year. All of the medical fields are fun and I took time to explore all of them (see my posts on choosing a medical school and choosing a medical specialty for more).


gap year: it's okay to take time off between undergrad and medical school - some schools actually prefer older, more mature applicants. If you think medicine is right for you, but you're not ready to commit (it's a lifelong commitment) or your application isn't quite ready, do something meaningful with your time (read how Natalie spent her time here). When I say meaningful, I mean meaningful to you. Work on Wallstreet, work at a local Boys and Girls Club, have a successful architect career, get a public health degree (these are all examples of what some of my classmates did).


m1: Just learn. That's all you need to do. Continue to explore your study style (it can change!). Make lifelong friends. Spend lots of time in the library learning the foundations of medicine. Do well on your exams. Don't start preparing for step 1 (yes, I said do not start preparing for step 1). I also encourage you to shadow! The greatest thing about first year is you have the access of a medical student, but no one expects you to know anything! If you think you might be interested in a field, email either someone in private practice or at your institution (or both) and ask to spend a half day or two with them. Consider fields that you won't have much access to during 3rd year. I spent time with an anesthesiologist and a mohs surgeon my first year of medical school. Seek out and become an active member/leader of one or two organizations that really interest you - organizations that interest you enough to go to a meeting or volunteer event the week of an exam - but don't take on too much. Academics are the core of medical school and they will be the most important aspect of your residency application. Being president of multiple clubs with mediocre grades is not to your benefit - even if your school doesn't publish grades in the preclinical years. This is your time to learn the foundations of medicine, and if you're aiming for a competitive field (or don't know what field you're aiming for), you should be scoring in the top percentiles of your class. Study. study. study!


m1 summer: We only had 3 weeks of summer vacation at Emory, so I don't have a strong thought on what you should do with your m1 summer. If you school doesn't have dedicated research time, this is a great time for you to get involved with specialty specific research. My advice - don't be lazy. If you're going to sacrifice your summer, produce something!


m2: Basically the same as MS1 year, but study hard for step - it's important. If you don't blow it out of the water, it's not the end of the world but it makes life a lot easier if you do really well. I know - your next question is - how do I do well on step 1? My answer is - I don't know. There's no one answer for how to do well on step 1. I think it's important to ask upper levels at your institution because every school has different strengths and weaknesses in their curriculum. How Emory students study may be very different from how students with the traditional curriculum studied. Our upper levels who did well were nice enough to share their exact schedules and study resources. It's helpful to get schedules from a few people because different people have different study strategies and one will gel with your studying style a little better (and you'll know what your studying style is because you spent 1st year figuring it out instead of worrying about step). You can always adapt the study schedules, but be careful about trying to do too many things. A few resources will take you a long way. Doing well on standardized exams is part knowledge and part test taking skills, so also try to hone your test taking skills during 2nd year. Depending on how on top of your academics you are, it would not be unreasonable to be involved in research during 2nd year. I joined my research lab at the end of first year, but I took a sabbatical for step 1. I know other people who continued to pump out research while studying (we had a pretty large amount of dedicated time off, so it wasn't unreasonable. I was just too anxious and tunnel visioned). Again, academics come first.


m3: By this time, you should be aggressively focused on finding out what you want to do with your life. You should go into every rotation thinking, "is this the one?" See what sticks and what doesn't stick. When you find your calling, start building connections with faculty to secure good advice and personal letters of recommendation. Become friendly with the residents and the M4s going into that field because they will give you the best advice and encouragement (hopefully. If they're nice). Ideally, this will happen towards the front half of the year, but not necessarily. We had absolutely no say in our 3rd year schedules, so I prayed I wouldn't fall in love with my last rotation - surgery. If you do have some say, front load the things you think you might be interested in. You should aim for As in all of your clerkships, but definitely the specialty you want to go into (or general surgery if you want to go into a surgical specialty).


gap year: to take a year off or not is probably the biggest question of any applicant applying to a competitive specialty. A gap year can definitely increase your competitiveness by buffing up your CV and hopefully creating a close relationship with someone who will write you a great letter of recommendation. If you already have a substantial amount of research, taking a year to do more research probably isn't necessary. Also, it's questionable if a gap year can make up for a low step 1 score - I would discuss this with your mentor explicitly if that's your case. I'm not sure how MPH and MBA degrees affect competitiveness. I would also be careful about taking a gap year at another institution - I've seen this work out and backfire on people depending on how much facetime they ultimately obtained with their home program and the program they visited.

I was told to take an extra year if there was something I really wanted to do before residency started - be that live in a certain city, work with a particular attending, etc. I considered a masters in clinical research or spending a year with another institution who does a lot of global dermatology. I entered medical school right after undergrad, so by 3rd year I was exhausted and drowning in debt. I couldn't afford to live off loans another year. Some people take a gap year because they're burned out and need a slower paced schedule, but for me that wasn't an option. If I took a year off, I would work just as hard as if I was in residency. Our curriculum has 5 months of research built into it, so I extended mine to 6 months and worked my butt off 7 days a week on 3 projects. I was able to present multiple posters at the national dermatology meeting, got 2 first author publications (1 was a publication I'd finished 3rd year), and a couple of 2nd author publications in the works. With those results, I think it looked better than I didn't take any time off.


m4: It's not too late to decide on a competitive field if you've been working hard from the beginning (read Joyce's story on changing from optho to dermatology 4th year here). At this point, your application is pretty much set and it's time to apply for away rotations and ERAS! Talk to your high-level mentor about away rotations. I was advised not to do any, so I didn't. I know other programs that recommend the opposite. You should ideally have been having honest conversations with your mentors throughout this process, but definitely talk to them about your application before you start the application process. Your options will be to apply to only one specialty and risk not matching or dual apply to a more and less competitive specialty to decrease the risk of not matching. If you don't match, it's a big deal, but it's not the end of the world (more on that coming later).


Good luck to all of you on this journey! It's stressful, but really fun if you enjoy working hard and learning.

Check out the resident career profiles for more information on how awesome people matched great specialties and programs.

I'm happy to answer any questions either in the comments section or the email section of the blog!


elyse love, md