preparing for a meeting with your chair @ home?

think about emailing a CV w/board scores/grades/etc prior to the meeting. def have a paper copy of CV w/ you with the above when you go to the meeting.

have some ideas about what you want in a program, places you might be interested in rotating, ask if he has suggestions on types of places you'd be competitive at

i was asked in a similar meeting what made me a strong applicant, be prepared for interview type questions, probably be informal, but those questions are good way for him to get to know you.

and for any first/second years that don't already have one, make a CV now and add stuff to it as you progress through med school. makes life a lot easier.

I can't stress enough how important the above post is. Having filled out ERAS twice as a reapplicant, the ability to literally just copy from a CV is so fast. I was able to fill out eras in a matter of an hour. Minus the personal statement, of course.

Also, I don't want to stress you out too much, but approach this more like an interview than an informal meeting. Every interaction you have is important. This process is a lot harder if you can't count on your home program to be your advocate. Now is the time to start putting your absolute best foot forward at all times.

Yes.. I second that as well.. someone is always watching.. including the residents at your home program. Don't think that they're there to 'help you' get an idea of other places. You want them to think they're #1, no matter what. Even if they are nice people, understanding, etc, if you admit they're not #1, they'll always remember that. It's stupid, but that's juts the way it goes.

What if they already know that you want to be back home (to a diff place)? Is there anyway to rebound from that and reassure them that they are #1?

No.. there isn't that's the gag! Psychologically speaking, if you say.. I really like it here at this program in NY, but I want to move back home to california.. no matter how you slice and dice it, it means 'I don't want to be here'.

Even if they really like you and think you're the cats meow, when rank list comes due, they're not going to think of you to put you at the top or near the top of the list. "We really like him, but I think he wants to stay in CA, let's try to figure his place on this list later" as opposed to if you said you wanted to go there: "We really like him, and he says he wants to be here, let's make sure we get him".. They're going to look at you differently if you tell them that.

It's one big game, and unfortunately no one understands how the match works, even if they do, they refuse to believe it. I've explained it to my parents many times (both professionals) and they still think 'it can't work that way'. Programs will try to rank in order of prefence and how they feel about you, even though they shouldn't. partially because they don't know, and partially because it's an ego thing.. they want to say 'oh, we went down only 1 spot past our quota..' So if they pick people who supposedly want to go there, that's what is going to happen.

It's all one big game,and despite being a purist, you have to realize that you need to play the game. It's stupid, I don't agree with it, but I learned my lesson the hard way the first time not matching.. trust me.

Oh, and whatever you do, don't bad mouth a program, you never know how it will bite you. Always avoid comparing other programs in any case (except with your fellow ortho applicants.)

I should mention that you can try your best to refute it by saying, you changed your mind, you want to go here no matter what, blah blah.

It won't erase what you said, but it will help.

When I didn't match the first time around, I asked them why I didn't match there, and they said 'We thought you were going to go somewhere else'.

That bumped me down the rank list 1 or 2 spots..and that's all it takes..

Exactly the feedback I got. My home program assumed I'd go where ever I wanted to, but since I didn't specifically tell them I wanted to stay I didn't match there.

The problem was, several other program assumed there was no way I was not matching at my home program since I have so many connections in the area and I had such great LORs from them.

If everyone thinks you're going somewhere else then you end up go nowhere. It really does sting to know I would probably have matched last year by spending 5 secs to email my home PD they were my #1, which they were. Sigh, life lesson learned...

You know its an odd thing though, because how is your home program supposed to make calls to programs that you are ranking #1 without them knowing that they aren't #1 themselves? It seems impossible to have your program help you get where you want to go, and have a good chance to end up at your own program too.

Thank you all for the replies. I've got a CV that just needs a few updates, so I'll have all that stuff ready for him a few days in advance.

I told the chairman at my home program that my #1 was somewhere else and I still matched at my home program so I don't think it is necessarily a bad move.

well.. its tricky. but you can't approach it like that. You have to approach it like, "Dr. Chairman/mentor, I would love to train here at My Home School University, but above all, I want to be an orthopaedic surgeon - that is my life long dream. I know that Orthopaedics is competitive and I need your help to match, if not here, somewhere else. Would you be willing to help me?"...

usually, that implies 'will you make a phone call for me?'

If they don't respond "sure, i'd be willing to help. Perhaps make some phone calls, etc." they may respond, "Of course, what can I do to help?" Then you should ask "Would you be willing to make phone calls to programs I interviewed at in on my behalf?"

They will say yes, usually, and when they do, they might ask you for a rank list, or to select a few to call (mind you, they don't always know people from every program, and may be willing to call people they know.)

When you give the rank list, make sure you give it in groups, and say that it isn't finalyzed, but you really like programs X Y Z. Since you can't send it as a hash (ie a bag of choices), an order will always be implied, psychologically. Keep this in mind, don't understimate the importance of psychology.

Send it as follows:
These are the programs I interviewed at, the first group are my top choices, the second group I like, but I'm not sure, etc. etc.

Home Program

program1
program2
program3

program4
program5
program6

etc. etc.

If they say 'no' then the person is a jerk, and move on. If they seem hard to approach, etc. then don't bother, they won't do a good job for you. Find someone else.

If they say yes, and tell you what to do. Say "Thank you Dr. chairman, I really appreciate all the help you have given me thus far, and I thank you for everything in advance. Your help will help me achieve my dream. I hope I can stay here! Thank you"...

Note the # of thank yous. This is important. People like to feel needed and appreciated.

When to followup? In 1.5-2 weeks, send an email, or check in with the secretary (depending on the type of advocate you have,) and say "Dr. chairman, thank you for helping me out. Are there any programs that you would like me to provide you with contact information for?"

If they don't say anything / say everything is good, etc. you're probably okay, if they say, yes, I had difficulty with etc. and therafter, supply it to them, right away.

About 1 week later, send a thank you letter specifically to that person. Make sure it's a physical letter, handwritten or typed with a personal message. Basically, reiterating everything we just said.

When I first did this, I was too shy to ask for a phone call or help. I was a ghost. That was a mistake. You can't be bashful. They know you need them. Someone probably did it for them too. Everyone gets somewhere by the hand of someone else.. that's the way it goes, even it's just the slightest of pushes. I'm not implying nepotism or anything like that, just people trust other people's words more than paper..

Also, letter writers are great, but to have a letter from a 'well known guy' will get you interviews, but in the end, if they're too well known, or intimidating (ie not approachable), people will be afraid to call them. I was told at the end of the game that multiple people called one of my letter writers, asking about me.

Also, don't get letters / recommendations from people who are too specialized, rogues, or make a lot of $$. People are resentful, and you don't want their resentment to shine negatively on you.

Okay, that's it for now
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I just want to throw in my 2 cents here.

I met with my chairman very informally, on my part anyway. I rolled in in scrubs, straight from the OR, surgeons cap still on so I didn't have to fix my hair. I hadn't shaved and I was wearing an earring. This is not the first impression to make on your chairman! he was very nice and as helpful as expected, however, in the end, I think a better first impression would have gone a longer way.

Also, throughout my home rotation, I was very open about NOT wanting to stay at my home program. I constantly asked attendings and residents about other programs they liked and where I should look. This is not a good idea The whole match process can be very political, so never burn bridges.

In the end, it worked out fine for me, and I like to think that my colleagues appreciated my honesty and straightforward manner, but in retrospect, I could have done things differently... Better to treat your home program as number 1, they may be more likely to shine a brighter light on you. Hope this helps for posterity's sake.

Everywhere should think they are your number one. You don't have to explicitly say it (and in my opinion, you shouldn't unless they truly are your number one), but I always had a reason for why I wanted to go to any given program. For your home program, tell them how much you love everything about the program. Say you would be very happy there. Until it comes time for them to make phone calls, etc, I would make them believe that your home program is your number one, even if it is not. Like I said, don't say they are your number one unless it is true, but at the same time NEVER tell them otherwise this early.

Lots of interesting points have been made. Because I used Orthogate a lot when I was a MS1-4, I feel it is my responsibility to continue to weigh in on issues, and I would encourage those that just matched to do so during their five year residency, if not longer.


1. The whole match process is very much a game. Be careful how you play it. Sometimes it is better to go all out for a program you have a good chance of matching to, than to waste your time/away rotation at a place that is not going to work out.
2. The match process is also somewhat random. Some very good people do not match, and some total losers do. I attribute some of this to the fact that most applicants look very similar.
3. You can only tell one program that they are your number one, but you can tell a lot of programs that you would be lucky to train there (as all ortho residents are lucky at some level).

We have had some very good medical students that tell us that they really want to come to our program and then not rank us high enough to match. You then see these people at regional or national meetings and you still harbor hard feelings. Don't let us go to bat for you telling the Attendings how great a fit you are and then not come to our program. Conversely, I have worked with several students that either did or did not do a great job and they say really like XYZ program. We tend to like these people better, and are more helpful to their careers in the future.
a. Will that hurt your chances at matching at your home program? Probably, but it will help your chances at matching to your more desired locations.
b. If we like you (because you did a good job), we are going to help you. Good advice about playing the game and things to do or not do on your away rotations can be very helpful. For example, we can tell you who you need to work with or how you need to behave (with specifics) at a particular away location.

So what to do...
If you like your home program, but it is not your number one. That is a tough situation. By telling them they are not your number one they probably are not going to rank you at the top of their list (because they do not like to slide down their list). I think you have to weigh how much it is going to help your chances of going to your preferred location vs. how much would you rather not match.

If your home program is not in your top few programs, I would definitely tell them that although you would be lucky to train there (which is true), but for (fill in the blank) reasons you really want to go to (blank) program. Then ask if they would mind calling that program to let them know that you really want to go there. This phone call can be the most powerful aspect of your application, because you only get one of them.

Most Attendings are nice and will make a phone call for even mediocre candidates.

In summary:
1. always be on your A-game. You never know where you are going to end up or where you are going to want to do your fellowship. Many people change their mind about sub-specialties during their residency.
2. Be honest with people, but not brutally honest (i.e. I do not want to stay here because I think the training is terrible, the location sucks, etc.)
3. figure out who is your number one (that you could realistically match to) and do everything you can to match there.

Yeah you should never say "you're my number one" and not mean it. It will bite you in the ass at some point.

One thing that really bothered me was programs asking me "Do you really want to come here?" I rotated at a place that I really enjoyed, but honestly wasn't going to be at the top of my list and during an interview was asked "Do you want to come here?" I said yes, and the attending said "Let's shake on it and its a done deal"... This was really awkward and I'm pretty sure it was a match violation.