Tag: application

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How Critical Are Connections To Getting Into Radiology Residency?

connections

Let’s face it. In any job, position, or institution, connections can make all the difference between getting an opportunity or falling short. Even in medicine and radiology, nepotism is alive and well. Sometimes, a lesser qualified applicant can get an interview because the father is a large donor to the institution. Maybe, a cousin of the applicant is a physician on staff and asks the coordinator to give her nephew an interview.

So if you ask the question, does influence sometimes trump qualifications on an application? The answer is still yes. Unless egregious, it is easy to disguise. Why? Because the evaluation of applicants for an interview is so subjective.

All this said, I believe most programs and program directors strive to take the best applicants possible to make sure that the most qualified applicants get the position. And I think that the radiology field is more equanimous than most!

So, How Critical Are Connections In Radiology Residency?

Well, all this discussion leads us to the theme. For the average applicant to radiology residency, how critical are these connections? And, my brief answer to that is not so much. Of course, this statement comes from someone who has vested interests not to expose the radiology program to undue scrutiny. However, in all sincerity, we strive to be as fair as is humanly possible. And, I believe for most program directors, the answer is the same.

It is exceedingly rare that a connection will have more influence than allowing a candidate to receive an interview that otherwise wouldn’t. But even if the candidate with a relationship gets an interview, most program directors and chairmen are unwilling to take candidates that cannot get through the rigorous requirements of a radiology residency no matter how “powerful” the connection. A resident who can’t make it through a four-year residency is far more damaging to the program’s reputation than the opportunity cost of an “upset connection.” The amount of time and effort wasted to support an unqualified candidate is enormous. And, the pain and suffering of having to terminate an incompetent resident is worse. Even more so, when the resident who we admitted is a relationship to a “connection.”

Should You Use A Connection If You Have One?

Given all this questionable power of the “connection” and how it affects the application process, you may ask, is it even worth it to use one. Well, as always, the answer is it depends. If you are a borderline candidate who may not score an interview, a kind word from a known connection can push your application into the interview pile. On the other hand, if you have excellent qualifications that speak for themselves, too much name dropping can irk the interviewers. Yet, a well-placed phone call from a trusted source can confirm the quality of the candidate.

So, you can see using a connection appropriately can be a bit tricky. You need to thread the needle, so to say. And make sure to do it diplomatically.

Using Connections To Get Into Radiology Residency- A Mixed Bag

So, there you have it. Connections can help, to some extent. But, more importantly, you need the appropriate qualifications to get the spot. No matter how good the link, make sure that the program is the right fit for you. And use the relationship discreetly so as not to overpower the admissions committee. A connection should confirm the candidate’s quality, particularly when the admissions committee may otherwise skip over the application before the interview ever happens. If used as a battering ram to push an unqualified candidate into an open residency slot, it doesn’t work. (At least at our program!)

 

 

 

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What Is The Difference Between Categorical And Advanced Radiology Positions?

categorical and advanced radiology positions

Question About Categorical And Advanced Radiology Positions:

Dear Dr. Julius,

I wasn’t sure of the difference between categorical and advanced radiology positions. What should I tell the applicants this year? Could you let me know the differences?

A Confused Program Coordinator

 

Answer:

For some reason, I have been receiving this question about categorical and advanced radiology positions a lot this year. Perhaps, it has something to do with how ERAS lists our residency program on its website. In any case, I had to look it up to make sure to give you the correct answer!

Definitions

First of all, some of you know that an Advanced residency, according to ERAS, is any residency that begins after the postgraduate one year. On the other hand, a categorical residency is any residency that begins at PGY-1 year. This categorical spot must continue for subsequent years until the end of the training. 

In this situation, how is it possible for some radiology programs to have a categorical spot when radiology training begins during the PGY-2 year? Well, some radiology programs have an affiliated prelim year at the same institution. And, usually, there is some form of agreement between the two programs. This combined prelim year could be any of the approved PGY-1 slots for radiology, including Prelim surgery, Prelim medicine, transitional year, etc. Therefore, if you are not applying to the prelim spot at the same institution, you should not apply for a categorical slot in radiology.

If Interested In A Prelim Spot At The Same Place As Radiology Residency, Ask!

Also, if you are interested in completing the PGY-1 year at the same institution as the radiology residency, make sure to ask the radiology program director if they have a categorical connection with the same institution’s prelim year. Some do, and others don’t. If they do, sometimes the radiology residency can make a phone call to the prelim program. In this case, this connection can give you a better shot of getting the prelim year slot at the same institution. Why? Because programs want to make sure that you will have an ACGME accredited prelim year before starting residency. Likewise, it’s harder to ensure that outside the institution.

However, if you apply to prelim and radiology spots at the same institution, you may or not be applying to a categorical position! It all depends on the residencies and agreement among the programs. Bottom line, make sure to check with the program director or the graduate medical education office.

Hopefully, you now know what you need to know about categorical and advanced positions!

 

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Things To Not To Do When Ranking A Program Number One

number one

For those of you involved in an NRMP matching process (radiology residency or fellowship), you only have a few more weeks to finalize the rank list. But, the most significant decision is to rank number one. Why? Well, you have around a fifty-fifty chance of getting that spot if you are thinking about putting it down on your rank list, better than any other place. So, how do you make sure that you are clicking the right program when you finalize it all? Well, to sure ensure your sanity and make sure you have the best likelihood of getting this spot, here are some things that you should not do with your number one ranked program.

Don’t Play Mind Games

It’s not worth thinking about whether or not the program wants you badly. That should play no part in the assessment to rank a position as number one. Only, and I mean only, should you list a program first if you want to go there. It would be best if you only took your assessment of the program into the equation. If the program selected you and you didn’t want the program, where does that leave you? In a matching spot that you don’t like, of course!

Don’t Lie

It is unethical to let a program know that you are going to be ranking a program first unless you mean it. Some programs will use this information to rank you higher if they liked you in the first place. (a residency will not change their rankings if they don’t!) Regardless, if for whatever reason, you decide on a different program than the program that you said was your first choice, and then match with another site, forever hold your peace! Radiology is a small world. And, the ramifications of doing this are myriad. Not to say the least, unbeknownst to you, programs may blackball you in the future if you decide you want a job with one of their faculty. You never know!

Don’t Get Too Invested In Your Number One Choice Before You Match There

There is one guarantee in life: that there is no guarantee! Just because you are confident that a program is going to choose you, don’t buy a condo next door. Until it is official, you never know. I know of several students that had bought all the T-shirts of the presumed institution that they will attend, only to find out that they had not matched at the program. Please. Wait until you have the residency has accepted you before telling your colleagues. You don’t want to look like a fool!

Don’t Psyche Yourself Out Of Your Number One Rank

Your number one choice selected you for an interview for a reason. Regardless of how you may feel now, you do have a chance of getting a spot at your first choice. That chance is probably better than you think!

Don’t Forget To Double Check You Number One Choice

Computers and people’s hands are finicky. You can easily click the wrong button and not realize what you have selected. Or, maybe you changed your mind about your first choice and forgot to choose the program on the match list. In either case, check and recheck that list multiple times before you click submit!

Ranking A Program Number One- Don’t Take It Lightly

The matching process is a headache. But, you’ve already made it through seven-eighths of the ordeal. Don’t screw it all up at the last minute. Make sure to dot your i’s and cross your t’s. Ranking your first choice is a big deal. So be careful and remember: many applicants get their first pick!

 

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DR Versus DR-IR Application Questions

DR-IR application

Question About A DR Versus DR-IR Application Dilemma

Hi! Love reading your blog, you’ve been a great source of information,

I’m a current M3 interested in both DR and IR. I genuinely like both fields, but it seems like there is a growing sentiment in both areas to define themselves as separate. I’m currently working on research in IR with my IR faculty, but I don’t want to lock myself out of DR programs, which is what I’m noticing has happened this cycle for some of my M4 colleagues. Applications IR weighted are not receiving much love from DR programs even if they do quite well for IR programs.

What thoughts do you have about the growing divide between fields, and what advice can you give for a medical student interested in both? Should I also do some DR research? I like the way IR is currently practiced, where IR folks will do a mix of IR and DR, but it seems like most IR leadership and PDs are interested in furthering the distinction.

Thank you!

DR And DR-IR Application Weary

 

DR Versus DR-IR Answers:

How To Apply

Having gone to the recent APDR/AUR meeting, I can tell you that you are right about some of your reported sentiments in some programs. Some programs/program directors take it in stride that many folks will be applying to both IR/DR and DR programs. But, other DR program directors did not have such favorable opinions about those applicants that are applying to both. I believe that if you are not sure about which program to choose at this point (as is normal!), the best bet would be to apply to a DR program that has IR/DR and ESIR slots. Applying to DR programs that also have both will allow you to hedge your bets a bit and give you the most flexibility. In these programs, they can usually flip a DR spot to DR/IR or ESIR or vice versa. Also, it doesn’t lock you into the IR pathway if you are not sure you want it. DR/IR is a big commitment and works if you are sure about it. If not, you can regret your decision because you will have less diagnostic radiology, and it will be a tough slog.
Also, DR research can never hurt an application and can only serve to enhance your chances of getting into a program. It demonstrates an interest in the field. And, it gives you a bit of radiology research experience. Who doesn’t want that?

The Growing Divide Between DR and IR

More and more practices are indeed allowing or requiring the interventionalists to do only interventional. However, some imaging companies still have the model of doing DR and IR work (that’s the way our practice works). It is hard to tell how difficult it will be to find a job in a practice with DR and IR in the future. But, I would imagine there should still be a role for these folks in more rural and smaller less subspecialized practices. But if corporatization of radiology takes root everywhere, that model could become rare. It remains to be seen.
My 2 cents,
Barry Julius, MD
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Should I Address My USMLE Step II Score Drop In My Statement?

score drop

Question:

Hello – I’m actively interested in applying for DR residency, but I was let down yesterday after receiving a Step 2 score which dropped 11 points from my Step 1 (230 –> 219). I’m a DO student, and I’m afraid this will be a red flag that will become detrimental to my application for a radiology residency. I planned to address this score drop in my personal statement, as I’m sure programs will wonder why it happened. I believe my Comlex Level 2 exam went very well. However, I haven’t received that score yet, and I’m not sure PDs even care about it. Do I need to apply to a backup specialty?

A Worried Candidate

 

 

Answer To How To Deal With The Score Drop And More!

I wouldn’t throw in the towel quite yet. You have to remember that there are so many factors other than board scores to add to the equation of getting into a radiology residency. Moreover, many residencies use a cutoff of 220 or higher on the step one exam. So, you will most likely get a decent number of interviews as long as your other application credentials are OK. (not having those I could not tell you where to apply)

Also, you are right about the COMLEX scores. Most programs do not care much for those scores because it is harder to compare to everyone else taking the USMLE examination. So, I don’t believe that it will change your chances of acceptance all that much.

Finally, being a DO does not hurt your application as much as it had in the past. Now, the ACGME and the AOA are one organization, so you are no longer as much of a “second class medical citizen.”

One more critical point about your personal statement that you mentioned: I would not be so keen to address the score drop. (unless there was some major life crisis that could have affected your entire application). It would call more unnecessary attention to your board scores. To begin with, really, your step I score was not so bad. Instead, it shows that you have the potential to pass the core exam. (what most residency directors care about) Your personal statement would better serve you by talking about all the other issues that I discuss in my blog called How To Create A Killer Radiology Residency Personal Statement. Make sure to read or reread it before submitting your residency personal statement.

 

 

Let me know how everything goes,

Barry Julius, MD

 

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The One Phrase You Should Ask For In All Your Letters Of Recommendation

letters of recommendation

ERAS season has recently begun. And, with applications to radiology residency and fellowships on the system now available, medical students and residents are scurrying about trying to find letters of recommendation from their faculty and mentors. On that note, if you are applying now, I would advise you to read one of my previous blogs (Cracking The Radiology Residency Application Code).  Previously, I have mentioned that references are one of the less significant discriminators in getting an interview for radiology. However, that statement only applies to decent letters of recommendation. It does not mean that you should find the wrong ones.  That can become a disaster. Remember. Program directors have so many excellent applications from which to choose. So, one lousy recommendation can lead yours into the DNR (Do Not Rank) pile. In the case of a horrible reference, it becomes a great discriminator!

In any event, as always, I want to distill the essentials of applying in the world of radiology into a few simplistic nuggets. Therefore, I am going to let you in on a little secret about what you should be looking for in a recommendation writer not only to avoid this situation but instead, I want to make your recommendation into the reason you may have success getting into your program of choice.

So, here it is, a simple phrase strategically placed within the recommendation, preferably at the end. And it is this, “Your name is the type of student that we want to take at our radiology residency program.” As an application reviewer, that phrase gives me more confidence about an applicant than any other.  If your mentor wants to take you into his program, especially another program director, then why wouldn’t I? So, how do you get that person to write that into your recommendation? I will give you some simple instructions on how to do so to achieve the results you want.

Perform Well On Rotations With Potential Reference Writers

OK. Performing well on rotation may seem obvious. But, on occasion, some residents will ask attendings to write a recommendation when their performance was marginal. Why does this happen? Well, usually, the resident feels more comfortable with obtaining this written reference due to the mentor’s easy-going personality. Don’t let that fool you! When a mentor has many other applicants to write for, your recommendation will not be of the same quality as his favorites!

Befriend Your Mentors

For many medical students, befriending your mentor is a tall order. Often, he may be twice or even three times your age. Or, your interests may significantly differ. However, make that attempt to get to know that person well before asking for a recommendation. Then, when you finally request one from this person, he will feel much more comfortable with writing one. I can’t tell you how many times a medical student or resident will come up to me and ask me for a recommendation when we have barely spoken. It reflects in the written letter!

Tell Them What To Write!

Lastly, this step can be the most critical. At this point, you know your mentor well, feel comfortable with her as a reference, and you know she feels the same about you. And, she is more than likely willing to help you out in any way she can. But, many reference writers do not know what program directors are looking for in a recommendation. So, it is your job to help them out. Ask them if they can slip the key phrase into their letter- “I want you in my program.” (Of course not that verbiage exactly but you get the point!)

Even better, some writers will ask you to make a version of the reference letter. Guess what, slip that phrase or something similar into the end. It has the potential to make your application stand out from the pile!

Capturing The Magic Phrase On Your Letters Of Recommendation

Now you know precisely how to proceed to get the best possible recommendation from your mentors to help you get into the spot you want. It does take a bit of work, forethought, and, most importantly, personal interaction. So, make sure to ask mentors on rotations where you have performed well. And, only request them from those that know you well enough to write you one. Only then will you be able to obtain a recommendation with the phrase that will significantly increase your chances of admission!

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Can I Get Into Radiology With Poor COMLEX Scores?

Question:

 

Hello Dr. Barry Julius,

I am a 4th-year osteopathic medical student that is struggling to figure out how I can pull off getting into a radiology residency with disappointing COMLEX scores and a completely sub-par application.

Background:

I finally realized what I wanted to do in medicine and now I fear it’s too late. I come from a surgical background having been a Certified Surgical Technologist and First Assistant for ten years before getting to medical school. I realized during my 3rd year that I didn’t want to be a surgeon.

I fell in love with radiology during my ER rotation this year. I loved feeling like I was finally helping patients by reading films. So many times, I felt like I never got to the root of a patient’s problems in internal medicine and family medicine but with radiology, I felt like I was solving a problem. As soon as the radiology bug bit me, I immediately started researching requirements for getting into a diagnostic radiology residency. This task broke my heart into a million pieces. All I found was how competitive the programs were and how essential board scores were.

Main Problem

Passing COMLEX level 1 was the hardest thing I’ve had to do in medical school. I failed twice and finally barely passed on my 3rd attempt. I’m both ashamed and proud of how many times took the exam. I’m proud because I never considered quitting. Medicine has always been my passion, and nothing would ever make me give up on the dream of becoming a physician. I never felt like COMLEX was ultimately going to defeat me.

I’m also proud because I learned a lot about how to study and how I learn best. I’m ashamed because it made me feel like I wouldn’t make a great physician. Many mentors and patients have told me that I would make a fantastic physician. In my heart I know I would.

My Current Situation

I made friends with the radiologist at the hospital where I did my ER rotation, and I’m doing an elective rotation with him starting next week. I’m really excited about this opportunity but lingering in the back of my mind is maybe I have no chance of getting into a radiology residency. Tons of people have told me there is no way to salvage my situation, but I can’t accept that. I’m a fighter and always have been.

Even if you never reply to this message I honestly appreciate the chance to vent. The bottom line is, I will never give up trying to achieve what I want especially now that I’m so passionate about it. After reading some of your posts, I just wanted to know what you would do in my situation. What is your advice for someone like me, with a worthless application, but a strong drive to do whatever is necessary to achieve a goal?

 

Regards,

Worried Radiology Applicant

 

Answer:

Sorry, I have been unable to get back to you sooner. It has been a crazy week. However, I have had some time to mull the issues that you present in the letter and I have come up with a potential solution. But, it will take some soul searching, grit, and determination.

Why are the medical school exam board exams so critical for radiology residencies? Simply because the radiology boards is also a multiple choice question computer exam that is difficult to pass. And, most residencies would not want to commit resources to a resident that will not be able to pass the boards.

Get To The Bottom Of The Situation

So, this is what do you need to do. First, you need to figure out why you have such a hard time with the exam. This may be the most difficult part for you, to admit there may be a psychological problem with test taking to begin with. Many times this is a simple issue that can be easily solved. They have testing psychologists that can get to the root cause. It would be well worth your time to splurge a few thousand dollars now to get the answer that may save you hardship down the road.

For some, the issue can be solved with something as simple as anxiety exercises before the test. For others, it could be a learning disability that you were not aware of. Regardless, make the time and effort to complete this step. It will be well worth it.

USMLE: The Solution

Second, you need to take the USMLE. The good news for you: Most radiology residencies do not like to use the COMLEX as a screening tool. So, if you were to do well on the USMLE, they would never even care about your score on the COMLEX.

So, finally, I would dedicate a year to studying for the USMLE exams and doing well on them. How would I approach it? I would take a year of research in radiology to stay involved in the field. And, I would study at the same time so that you can get the scores you need.

Bottom Line

It will take a lot of from you to really tackle the issue of passing the USMLE and getting into radiology residency. But, if you really want it that bad, there is a way.

Regards,
Barry Julius, MD

 

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Radiology Acceptance And Increasing Time Since Medical School: A Negative Correlation?

acceptance

Dear Dr. Julius,

Thank you, Dr. Julius, for including me in your network. I understand how difficult it is for you to take time out of your busy schedule, and I do not mean to be a pain. Here’s my question… I applied for radiology and internal medicine. Subsequently, I matched in internal medicine this year (score 247,248, pass). I am keenly interested in radiology and will apply for the match after six years (3 years of residency, three years of J1 waiver, and ten years since graduation). Also, I am working on various research projects in radiology. Will the year of my graduation many years ago negatively affect the possibility of acceptance to radiology residency? I would be highly thankful if you could guide me and give me your insight.

Thank you for your time and consideration,

A Concerned Applicant

________________________________________________________

Dear Concerned Applicant,

Concerning your question, the number of years out does make a difference in the application process and changes the acceptance rate. Unfortunately, some programs have screening criteria that prevent graduates before a specific year from getting an interview. Why does this happen? I think many program directors don’t want to hassle with some issues that come with more experienced candidates. These may be unexplained gaps in time, foreign visa issues, changes in the USMLE tests, and more. That is not to say that all programs have this screening criterion.

More importantly, however, the more significant issue is not the number of years. Instead, it is the number of years you have completed your residency program already. Once you hit the three-year mark, the government may not fund your position. And the lack of funding translates into programs that will not grant you an acceptance due to the costs to the hospital. That is, some residency programs have less need for funding than others due to external sources. So, it is not impossible to find a radiology residency. But it isn’t easy.

In your situation, your best bet is to get to know the radiologists and program directors in the hospital at your residency. Also, as you are doing, participating in research at an institution with a radiology residency may give you more of an inside track. Again, you will still potentially find it difficult because radiology has become more competitive in the past couple of years, especially for foreign grads. Presently, programs can select applicants more discriminately from American medical schools without a J1 status than in previous years.

My recommendation to you is to continue to pursue the possibility of trying to get into a radiology residency if you have the means to do so. On the other hand, go through the application process with a sense of realism that you might not gain acceptance. The good news is that you obtained a residency slot in an internal medicine program! Congratulations! As a J1 visa holder, you have achieved something many others can only dream about. Luckily, now, you have a fallback position.

Good luck with the pursuit of your goals,

Barry Julius, MD