OHLIs Unplugged: The Match

I believe we have started. Welcome, everyone, who has joined the meeting right at the dot. Thank you so much for joining one of our very, I think, quite important episodes. I am very excited to talk with Dr. Mike as well. Yes, here. I think we could give a few minutes while we wait for everyone to join. How about you just write in the chat where you are joining from, like which country, and maybe where you are at in your medical training? Come on, everyone, welcome! Welcome! We have some viewers from Egypt, Canada, second-year med students. Woohoo, Canada! I am also Canadian. Oh wait, what? Canada is a big place. Whereabouts in Canada? Alberta. I am from Ontario. Let's see where. Nice. Wow, there is a lot of geographic diversity. Hello, Poland! Awesome, welcome. Nice diverse crowd. That's six-year med school. Oh, we got a physiotherapy second-year student from Dubai as well. That is pretty interesting. Cool, awesome. You will get to learn some things about the match. I do not know how it works in physiotherapy, but hope some things you can pick up from here. Maybe you can get started. Yes. I would like to just welcome everyone again to All the Unplugged, the Osmosis Health Leadership Initiative program. I am Parsa, an intern student in my final year of medical school based in Istanbul. With me today, I have Yasir Taki. We are excited to bring you our second episode of 2025. Welcome, everyone. Just for those who are new to these episodes, the OHLI stands for the Osmosis Health Leadership Initiative. It is a fantastic program within Osmosis from Elsevier. Through these episodes, we unplug from our busy medicine and student lives and meet amazing people from the world to discuss aspects of healthcare and beyond. Today, I am really excited about our topic because it is something I am going through: the match. The match is just around the corner, starting next week. There is a lot for us to learn and discuss. Yeah, I believe the match timeline starts kind of next week in terms of finding out. It is quite a stressful period of time, I would say, for many of us as well this year actually. Yes, this year's life is coming up. Definitely one of the most nerve-wracking and, I believe, rewarding moments for any medical student who finishes through their four years of undergraduate, later four years of med school in the US, or six years or seven in Europe or other countries. I believe today will be a discussion packed with lots of insights that you would not want to miss. We highly encourage our lovely audience to engage. Please do share your experiences or ask any questions. We like to have this session be as interactive as possible. Do not hesitate to put anything that you would like to first extend to Dr. Mike. This is meant for anyone from all over the world, whether you are starting med school, thinking of med school, or even approaching med school or beyond. Just drop those questions. Without further ado, I would like to welcome our special guest today, Dr. Michael Fug. He is a third-year psychiatry resident at Brody School of Medicine at East Carolina University. He completed his med school at Rowan University in New Jersey and went to college also in New Orleans. He has been through quite a bit all over the States. Outside of mentoring medical students and conducting research in psychiatry and neurology, he spends his free time playing guitar, trying coffees from around the world, and also working at lifting weights. I would love to give you a warm welcome and thank you for joining us. Maybe you can start off by telling us a bit about yourself and what drew you to psychiatry, and then we can go from there into the match. I had a pretty, I considered it for a long time an abnormal decision into psychiatry, but over time, I have realized it is more and more common these days. I originally went to Tulane to pursue basically biological psychology. I kind of landed into neuro from there. I was interested initially in neuropharmacology, and then I realized I much preferred working with people one-on-one than I did the bench research. Not to knock bench research in any means; I think it is awesome. It is just I felt more inclined towards the extroverted aspects of medicine. Of course, as a medical doctor, you can always go back and do research later. That was part of the motivation too. From there, I had to decide if I liked the spinal cord, if I liked how the brain works. How the brain works is really where I landed. I had an interesting take on med school because I went to do a specific specialty instead of going open-minded. I do not regret it. I think that is abnormal, but it worked for me. If any of you in the audience have that kind of inclination, like I want to do this specialty, you can. More than you can do that is going to give you a lot of drive, and that probably helps, if anything. But I guess that is the brass tacks of how I got to how I am doing this today. Well, I mean, going in with that drive is very... I mean, for me, I went in pretty open-minded, so getting that different perspective through med school is also great to see, and where you end up is great to hear, especially with your interest in psychiatry and the brain and all that. It is amazing to see where you end up, and I am looking forward to what more will come out with your research and your work. I think it is important to comment on what you just said too when you said drive. I think you can be open-minded and have drive at the same time. The drive comes from someplace else. For someone like you who went in open-minded, it is the drive to be open to those experiences and to try things that might make you uncomfortable. That is important no matter what you choose to do in medicine because that is how you stay a lifelong learner in general. Well, I am sure we will get into that part of applying. So, let us talk about applying first. This episode is called The Match, so especially for people who are not here from the States and maybe are not familiar with that term, maybe we can start off with: What is The Match? The Match is a Nobel Prize-winning program made in the US. The best way I can compare it is if you have ever seen a movie with Greek life where they are rushing the fraternity; it is sort of like that. You apply to a wide net of programs, interview at the programs, and then at the end of the process, you rank the program you like the most. The programs rank the students they like the most, or, more accurately, the students they feel are the best candidates for their kind of program or training. Then you wind up matching or getting a job basically at the highest mutual rank. For example, if you had some places number one and they had you as number one, you are probably going there. It is an interesting system because it provides some geographical uncertainty with how big the US is. For example, someone in New Jersey might match somewhere in California and then have a few months until July to figure out that move. But it basically serves as a way to match into the paid portion of training because after The Match, you match into residency, which I always describe to people not in medicine as basically being a doctor apprentice. You work underneath another doctor for a certain number of years before you can become a full-fledged independent doctor. So basically, it serves as a vehicle for matching you into the next part of training. Quite a journey. I am personally not from the States. We have a different system here, which is quite more computerized, I would say. But there seems to be quite an importance on trying to find the right sort of communication or being on the same wavelength with the program and the networkers. I do wonder, in this case, how do applicants go about this? How many programs should they apply to, would you think, to hopefully find the appropriate spot for them? That is a fair question. I will start off by plugging probably one of my favorite resources around the ACGME every year, which is the US Graduate Medical Education Board. They do something called a Program Director Survey. It is by specialty and shows the qualifications that program directors, say in urology, really care about. You can even see roughly the number of interviews they gave that year versus how many people applied. There are other services through the ACGME as well like FREIDA, which is basically a database that not every program is connected to, but it gives rough statistics. For example, some programs can get anywhere from like 9,000 applicants for a few dozen spots. It also tells you certain information like, say, you are applying psychiatry. When I applied, as long as someone had 10 places on their rank list, they basically had a 99% chance of matching. So, the number of programs to apply for really depends on the specialty. The more competitive the specialty, the higher that number goes. Geography can play a huge role. For example, if you want to work in New York as a psychiatrist, the most programs are in New York and California. If you really do not care about where you match, more than likely it could be New York or California. That has good things and bad things. If someone has a family, like a good mentee of mine wanted to stay in North Carolina because this is where his kids are at. He basically had like nine programs that were his best shot some hours away. It is really hard to give a specific number without knowing those circumstances. The general rule of thumb is: The more specific and competitive a specialty is, the more programs you will likely apply to. Adding to that, the logical progression from this is: It seems part of your question was also how do people figure out what programs to apply to, right? Okay, I think this is where the advice I give is different than a lot of places. Specifically, because I worked in?I had a career before medicine?I think this applies to physiotherapy too and any grad school that has a residency-type vibe including dentistry. Learning about what people look for when they are finding their first job out of college is hugely important. A lot of residency programs leverage the fact that med students have not really applied for a real job before. It becomes basically the students trying to impress the program, whereas for the match process it should be vice versa. When I work with someone directly, I always coach them on: You are interviewing them just as much as they are interviewing you. With that mindset, you can really identify what matters to you. If you go into it like, "I need to impress these programs to have a job next year," you might miss out on some red flags. It is really easy to miss possibly negative things subjectively when you are only focused on showing your best self. I observed this even when I would ask questions during interviews. I would ask, "How often do you guys actually work your average workweek? Is it usually more? How often do you find yourself able to get seven hours of sleep?" These are basic questions you would ask any job. When I was still working as a writer, those are things I would ask all the time. They did not come up very much. I think taking some time for this is important. Medicine in the US and Europe is going in a direction where the balance is changing. The EU has never really had a problem with having a good mix of people going from high school into medicine versus people doing a late-stage career change. This balance is much different in the US, where most people go from college to med school. As time goes on, more and more people have another job and then go back to do med school later, like a post-bac program or something like that. I almost wonder if people in that second category have an advantage because they probably worked a job before and know what they care about in a job. Once you have those ideas and things you care about, you will be able to pick up on things you might not like about certain programs pretty quickly. At the end of the day, and I think this is really important, I will probably say it more than once during this: Every program is a base level of good or they would not exist. That is one of the things about the ACGME that is really good and gets missed all the time. They do a lot of things wrong, do not get me wrong, but every program for specialties is a base level of good. If you match somewhere at the end of your training, you will be an attending. It is figuring out all the little nuances of each program and which one has the quirks you can deal with or like. I definitely went through that experience. Towards the end of the interview cycle, that really stuck out to me where I did not know enough about the programs to really decide where I was going to place them on my rank list. In the beginning, it was more like, "I am just trying to impress them with all my accomplishments." I was not really trying to ask questions like, "How many hours of sleep do you get? How far are your commutes? Do you get to hang out?" I did not ask those questions until towards the end of the interview cycle when I had enough programs to feel like, "Okay, now I should be asking these questions." When it came time to rank, I was looking at all the programs I interviewed with and wondering how to compare them if I do not really know much. I wish I met you before because you ran into something I really tried to prepare people for. Think of it this way: By the time you were more confident going into interviews, that's when you started to have a better concept of what you cared about. I think it is hugely important. In third year med school or any sort of clinical rotations, pay attention and talk to residents about non-medicine things because residents will love that. We enjoy when med students are not asking about complicated cases in the middle of something. If med students ask me what I like to do for fun, that is great. It is a great distraction and will help you identify what you might value in a program. You are on the money. The second you are more confident, that is when things become more apparent. The task and trick is how do you get there early enough to compare all the programs. That would be an interesting direction for this to go because I have my own system for coaching people on that, unless you have another direction in mind. I would like to at least cover the match. That is definitely something I want to explore?how do you compare and prepare yourself for these? Maybe we can do a quick overview of the whole process, especially for first- or second-year med students. Sure. For those who may not know, it starts out through most of the programs. Several other specialties have their own application cycles. I am not sure about OBGYN or EM switching. Are you familiar with those? I know a little about the OPT match, which I believe is the same. It is the place in California's match; their timelines are a little different but very similar. Even folks from other countries, the ERAS is similar to a common app for grad school or college. It is basically a web portal that programs connect to through an accreditation body, and your application can get sent to more than one place. It serves as a vehicle to get your application to different places. The OPT match and the OBGYN match are very similar but broke off from the ACGME a bit. Texas has its own program, which is beyond the confines of this episode. If anyone has questions about it, they can email me. The state of Texas has their own program, even for applying to Texas med schools and residencies. The OPT match is the San Francisco match but quite similar to the ACGME, so what we discuss will largely apply to them even if they have a separate common app. It starts with preparing your application. You have your common things: letters of recommendation, personal statements. There are enough resources on Osmosis and blogs that can help with that. Maybe you want to give a few pointers on what to expect? In medicine and any academic field, people feel pressure for their letters of recommendation to come from someone well-known in the field, even if they barely worked with them. Most students will try to ask those well-known people. But from program directors I have talked to and applicants I have read about, the best letters come from someone who may not be well-known academically but really knows you well as a person. If you work with an attending or even a resident later in training who will be an attending by the time you graduate and they know you inside and out, that should be your letter writer. When I applied, one of my letters came from an attending four months into being an attending. Every single interview talked about what they said because they worked with me from when they were chief resident into attending, even more than letters from directors of CHOP in Philadelphia. A question that is underrated: You can literally ask attendings, "If I ask you for a letter of recommendation, do you think it would be a good letter?" They will tell you. If someone does not know you well enough, they may recommend you to someone else. Those are my immediate thoughts on the letters of recommendation process. In med school, keep your hobbies up because there are sections for hobbies, and they will ask you about them in interviews. That surprised me. I heard stories where the whole interview was just talking about hobbies. I had one interview like that. I put video games as a hobby, and we talked about Call of Duty, the games he played when younger, and the kids playing now. That was the whole interview. It felt like a conversation, which gave me a good vibe for what to expect. Yes, that is a good point. When you get to the interview, there is astronomical pressure to rehearse your application to the interviewer. Try to avoid that temptation if it is not what they ask. To no fault of their own, sometimes interviewers have not read your application. If they ask you to summarize why psychiatry or why this specialty, that is not a knock against you. They may not have had time. When a conversation comes up naturally, like Yir described, do not forget doctors are people too. They will remember a good feel-good conversation about something you did when younger. One of my interviews, I talked about Pokémon for 45 minutes. I am not kidding. It was a really academic place. Afterwards, he emailed me saying he appreciated that conversation. For psychiatry, we are good at piecing together who is a good fit for the program. You can be the perfect applicant on paper, but if residents do not think you fit the social culture, you might not match there. Every program has its own social culture. ECU tends to have older folk; many co-residents are married and on the older side. These little details matter. What residents say about people is weighted heavily. If you interview and do not get a good vibe, or if you connect well, pay attention to that. It is an underrated aspect of who matches where. I wish we had that system. Here, it is computerized, literally based on one exam and no interviews. Based on your score, you match. I believe there are Step 1, Step 2, and Step 3 exams, possibly done during residency, with no CV sent. How does it work with geographical locations? You said you are in Turkey, right? Yes, the exam called TUS is a specialty exam, a combination of Step 1 and Step 2 in one day. Once you take that exam, you get a ranking among all applicants. The higher you are, the more freedom you have to choose where you want to go. For example, dermatology at Istanbul University or Ankara University, internal medicine, etc. No interviews. There is stress of not knowing if you will like the program, so students usually visit beforehand to make sure it is the right place. There is a lot of emphasis on extracurriculars and seeing the medical student?s development from year one to year four. Do you have anything particular you think people should emphasize more? Someone who did a lot academically, what helped you? Honestly, a lot of academic stuff did not help me much. I helped out with labs and bench research, but what gave me a leg up was never losing who I was outside of medicine. I was resistant to dropping things I valued, like guitar playing and enjoying coffee. Those things helped with my wellness. By the time you are applying, you have come of age. Most people are in their mid to late 20s. Programs assume you meet basic requirements on paper. The remaining pieces are who you are behind all that. The system in Turkey does not have interviews, but there are probably groups online where medical students share program info. The same advice applies. For those applying, the tried and true advice is good. You do not need to overdo it. Try research if you like it. Volunteer and shadow doctors you find interesting. Do not do something just because you think you have to. Do what you want to do because you will put in more effort and have a better experience to talk about. Medicine is a talking specialty. Outside of radiology and pathology, you talk to other doctors a lot. When you talk about experiences, it is better to say, "I did this because I loved it," rather than doing something just to check a box. Everyone has passions; finding and fostering them makes you a well-rounded person and a great applicant. In the US, applications are holistic. Beyond grades, they look at research, volunteering, and the interview plays a huge role. Yale?s internal medicine residency published how they rank applicants. The interview had a big role in their formula. I recommend the Program Director Survey early on. Many students do not know it exists. It is people who make the match list anonymously telling you what they care about. Step 2 scores are often low on the list; integrity, communication, and friendliness are highly valued. Even for competitive specialties like interventional radiology, they focus more on ranking the person than accomplishments. We got two questions. Do you want to hold questions for the end or answer as we go? We can answer as we go. First question: How do you communicate your interests and strengths to program directors and residents during interviews? There are two ways. First, if the interviewer reads your application well, they will ask open-ended questions. Use those to comment naturally. Do not force it. Practice at networking events talking to attendings outside medicine to learn how to communicate better. Second, if the interviewer has not read your application and asks, "Why this specialty? Why here?" give a brief, good elevator pitch. Be able to say in under a minute why you chose the specialty. Then, they will ask open-ended questions to continue the conversation. Next question about SOAP (Supplemental Offer and Acceptance Program). For applicants who do not match their programs, SOAP occurs the same week as match week. It is a flurry to get a spot in programs with unfilled spots. SOAP runs Monday through Thursday. It can get chaotic, with programs posting on Twitter for applicants to email resumes. SOAP helps unmatched applicants get spots and programs fill late spots. It is fast with little downtime. If you get the SOAP email, take a nap, collect yourself, and accept that this is the process. It is more common in surgical specialties. SOAP is a catch net. Getting through SOAP is possible. A friend got his spot the day before residency started outside SOAP. One of my friends went through SOAP, got internal medicine, and is grateful and happy. If you do not match your specialty but get another, you can be creative and integrate your passion later. We have a question about the chance of matching from SOAP depending on where you applied. I cannot give a good answer, sorry. If you match through SOAP and it is a transitional intern year, you can reapply for your specialty. Some specialties like dermatology and neurology require a transitional year. For example, family medicine can lead to sports medicine fellowship. You can still get to your goal with creative problem solving. Another question about rank order list: What if I have a change in career goals after submitting it? Can you clarify if you mean changing specialty? You can apply to more than one specialty, but changing after submitting is tough. Having doubts after submission is common. It may be anxiety and lack of control. If it is more serious, review why you changed. Sometimes last-minute changes are regretted. Take time to relax after submission. I changed my rank list many times before the deadline. It is fear of losing control. NRMP says most last-minute changes are not well thought out and often regretted. Best advice is to finalize soon and enjoy life. My advice on rank lists: Pick your number one and your least favorite program first. Then rank the programs that remind you of your favorite or least favorite. Sleep on your list and review it the next day. Getting your programs on the list is the hardest part. Last-minute decisions tend to be regrettable unless there is a stark reason like a couples match. We have a question: How can I handle discrepancies between my application and interview performance? Applicants overthink poor or average interview performance. Programs are aware of this. They look at your full application. The interview has direct control, but others on the rank list committee see your application. Most people think they did badly, but that is common. Let your application speak for you. If a program does not like you, maybe it is not a great fit. How can I work on my application and interview to have a better chance at competitive programs? Mock interviews help remove first-exposure anxiety. First interviews are often the best because of nervousness. Scheduling interviews early is advised. Mock interviews are like a dry run. Find interests you are passionate about and talk about them genuinely. For interview scheduling, put the programs you want in the middle of your cycle to avoid exhaustion. For IMGs, different programs have different requirements and visa issues. Check program websites and FREIDA for visa info. Contact program coordinators by phone; they will answer. Schools usually have a match list of where their students end up. Use your school's network. Regarding MBBS or NBS students, they can apply if they take Step 1 and Step 2. IMGs apply through ECFMG. Thank you. We are approaching the end of the episode. Dr. Michael, any final words or encouragement about the match or misconceptions about psychiatry? Psychiatry is going through an exciting time. Everything is changing. If you like the brain and want to improve psychiatry, it is the best time ever to join. Words of encouragement: If you are watching, you are already great applicants. You survived many tribulations to get here. An interview is something you can handle. If you can handle working 60-hour weeks, hospital rotations, or learning a second language for exams, you can tackle an interview. Take a moment and think of all you have done. You got this. Last question: On match day, what should someone do? Assuming you match, plan things to distract yourself from Tuesday to Thursday. Plan fun things outside medicine. Reach out to friends and family. Take your parents out; they miss you. Use your time well; rotations may have shorter days. Thank you. Great advice. Please do not try to prepare for residency after you match. Rest and recuperate. That is how you prepare. Thank you. On that note, thanks everyone for joining. For those matching next week, good luck. Thank you again, Dr. Michael, for joining us to talk about the match. Thank you for reminding us to be human. We tend to forget that during stressful times like this. Thank you for your encouragement and advice. To the audience, thank you for joining. If you found this episode helpful, please subscribe to the Ali Unplugged podcast. We hope to catch you in the next episode or the program if you apply. Thank you all for joining. Thank you, Dr. Michael, and thank you, Yasir. Helping current and future clinicians focus, learn, retain, and thrive. Learn more.