Thursday, February 14, 2013
Love letters and the Match
For any students wondering what to do if they write or receive love letters from residency programs, here is an oldie-but-goodie blog post to help.
While Valentine's Day is coming soon, a different sort of "love letter" may be sent or received by senior medical students. As recruitment season draws to a close, residency programs and applicants may be busy exchanging notes of interest, affectionately dubbed "love letters" by scores of medical students and on StudentDoctor.net.
What do these love letters mean? Some students have asked us whether it is a Match Violation to get or send a love letter. Others have worried they did not send enough or what type of language they should use. Well, here are some quick tips on how to approach this somewhat awkward situation.
Is it a Match Violation? It is not a Match Violation for a program or a student to express interest in the other. However, these statements of interest cannot be binding (i.e. we will only rank you highly if you rank us #1). If there is any part of it that is binding, then it would escalate to the level of a Match Violation. Read more about what constitutes a violation here.
"Rank highly" vs. "Rank #1"? It is poor form to send more than 1 program a "I will rank you #1" note. There are two strategies that most students will use- The first is to select the #1 program to send a "rank #1" letter to and then to send "rank highly" to the next 2-3 programs on the list. Since some believe that "rank highly" has become the code for "I love you but not enough," the alternative is to be coy and not let any program you will rank them #1, but use language like "I could see myself there" or "I would be honored to train there."
"Rank to match" statements from the program. It is possible that programs could call or e-mail to alert you that they are "ranking you to match." While you may feel elated, this does NOT mean that you should pack up your belongings and move. This also does NOT mean that you should cut programs from your list since are secured a spot. What this DOES mean is that they are interested in you and have likely placed you in a position on their rank list where they THINK on an average year you could match there.
Because the Match is very tricky and the competitiveness for an individual program can change year to year, "ranked to match" in one year may mean "out of luck" in another year. So our advice is to not put a lot of stock into these statements and still preserve the breadth and depth on your list that you will need to secure a position. Remember the length of your Rank List is one of the best predictors of whether you will match or not.
What about programs that I don't send letters to? Will they think I hate them? Absolutely not. The letters can serve as a signal in the game that you are interested but just because you don't send a letter does not mean that you can't end up at that program. Programs are maximizing their ability to get the best candidates regardless of this communication. It would be extremely unusual for a program to strike someone from their list if they don't receive a letter. Likewise, if you are not very competitive for a program, your letter is not going to be the deal-breaker to move you in to the rankable range. Remember, the letter is really a statement of interest that may help a little, but not a lot.
E-mail vs. paper. During the recruitment season, paper thank you cards can be a nice touch if sent in a timely fashion. However, the post-recruitment love letter should probably be an e-mail given the occasional snafu in snail-mail especially in large hospitals. The nice thing about the e-mail is that it can be immediately forwarded to the members of the recruitment committee or others. In terms of who to send the love letter to, it is usually sent to the program director unless someone else was clearly the lead recruitment person for the day (an associate program director or a faculty member). As always, try to personalize the letter to highlight the things you enjoyed about the program that day.
There is no right answer . As with our other career advising posts regarding the Match, there is no right answer here. Since everyone's case is different, the best thing may be to consult with a faculty member from your field who has been advising you on the process.
Alas, in spite of all the love you may get or feel, the irony is that the key to a successful residency match is not to fall in love. Remember, you are not in a relationship with any program yet. Since anything is possible, you need to keep an open mind. Try to group your list in tiers. Consider that you would be happy at any of the programs in your "top tier" to avoid being dead set on one place. Visit last year's archived post if you need more help creating a rank list or checking it twice. Lastly, don't forget to certify your list.
[Author's Note: Since this post, we conducted a seven-school study in 2010 of graduates that showed that almost one-fifth reported feeling assured by a program they would match there but did not despite ranking that program first. Nearly one-fourth said they changed their rank order list based on communications with programs. The conclusion "Students should be advised to interpret any comments made by programs cautiously." And of course be mindful that the 2013 Rank order list certification deadline is Feb. 20 at 8 p.m. Central Time. Good luck!
Vineet Arora, MD, is a Fellow of the American College of Physicians. She is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist, supervising internal medicine residents and students caring for general medicine patients, and serves as a career advisor and mentor for several medical students and residents, and directs the NIH-sponsored Training Early Achievers for Careers in Health (TEACH) Research program, which prepares and inspires talented diverse Chicago high school students to enter medical research careers. This post originally appeared on her blog, FutureDocs.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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