Perspective of a late applicant

I will write this piece in parts, to keep things organized. Please bear with me if it gets lengthy.

My profile

Non-US IMG (i.e. international medical graduate needing a J1/H1 visa).
Average scores, appeared for all 3 steps, i.e. Step 1, 2 CK, and CS, in 2019. Step 3 is yet to be given. (I read somewhere that a few PD's really like seeing that all the USMLE steps are given within a short period and not spread out over 3 or 4 years, but I may be incorrect).
 
USCE before sending in applications: 2 electives, both in university hospitals, done back in 2017, from which I received 1 LoR. (Tip: The best LoRs are U.S. university hospital letters, especially from Sub-I's and Electives, that are within 6 months of your application date, i.e. September 15th. Fresh letters indicate recent exposure to the US healthcare system)
 
Volunteer work: 8-9 experiences in my home country, 0 within the US (A lot of people underestimate the volunteer section. DO NOT! PD's love seeing that we as physicians have done community service with a sentiment of goodwill and not gain. It shows you are well-rounded)
 
Research: 1 home country experience, 0 within the US, and 0 publications. 

My late application

I appeared for my CK in September 2019! Yes, just days before the application deadline. I hurried my CK to apply for the match, for which in retrospect I should have taken more time because:

1. I ended up scoring lower than my expectations (lower scores do hurt your application).
2. My application was now anyway delayed, significantly lowering the no. of interview invites.

Take aways

• Always make it your primary goal to apply ON TIME! I can't stress this fact enough. An AMG, who I met during my rotation, mentioned that 90 percent of interview invites go out on September 15th itself.​
• Don't compromise your step scores to apply for the match, since every successive year it is becoming more difficult for Non-US IMGs to get in, and your scores can make it or break it for you.

​Even if for some reason you have to apply late - stay hopeful and don't give up. It is not the end of this world.
​
I received my ECFMG certificate around October 1st week. I had my LoR's in place (i.e. uploaded to MyERAS). Also, I obtained my MSPE, medical school Transcripts, ERAS picture, and wrote and uploaded my PS by the October second week. This was VERY tedious and I was almost up till 2 AM every night, making sure every document was pit-pat perfect.
 
Although I could have applied just with my letters, PS and ECFMG certificate, I wanted to let the programs receive my ENTIRE APPLICATION. I made sure my MSPE and MS transcripts were attached to my application. A perfect application, although late, does not go unnoticed. (Tip: NEVER underestimate ANY part of your application, from MSPE to your ERAS picture. EVERYTHING has to PERFECT, hence your efforts have to be 100% while preparing these documents, because when most of us talk about being a perfectionist in our interviews, let's walk the talk).

Strategy after applying

​Luckily for me, because I knew I will be applying for the upcoming match, I had enrolled for Usmle Sarthi - Platinum Plan back in July itself, i.e. July 2019. Hence, Dr. Pawan, having read through my profile, suggested I do fresh rotations and obtain recent Letters to support my application.
 
-Hence while applying, I had uploaded 3 letters (2 home country and 1 US), leaving the slot for the fourth letter empty. (As much as possible, try uploading U.S. based LoRs)
 
- After submitting my application, I left for the US to do a month-long observership (i.e. entire November) at a large university hospital. I got an excellent letter from this rotation in the first week of December, which I uploaded as the 4th LoR in MyEras on December 14th! Yes, you heard that right. 

Tips

​It is very difficult to obtain observerships at university hospitals during the match season especially on short notice, so be smart about how and where you apply for them. I sent about 70-80 emails during August while preparing for my CK, and due to a stroke of luck, I was offered this observership for November in September. Write professional, courteous, and respectful emails, also attaching a well-crafted CV.
 
-If for instance, you are interested in Internal Medicine, then Gastroenterology or Endocrinology are sub-specialties. Hence on Frieda, under Fellowship programs, find the PD's and PC's email and send them your observership request email along with your CV. If you are truly deserving, a brilliant LoR, for instance from a Rheumatology fellowship PD, will hugely support your Internal Medicine oriented CV.
 
The same can be said for Neurology (sub-specialties include- Neuro-Oncology, Vascular Neurology, Endovascular surgical neuro-radiology, etc.), Pediatrics (same as IM), Radiology (eg Interventional oncology, etc.), Psychiatry (e.g. child and adolescent psychiatry), etc.
 
-Communicating with programs immediately after applying- explaining to them why I applied late, expressed interest, and listed skills that make me seem lucrative as an applicant. I then sent follow-up emails, once I had uploaded my 4th LoR. I used this as an excuse to let them know about my interest in their program and also how I wasn't sitting idle.

My motivation

My source of motivation despite people telling me its game-over because I applied late:
 
My parents! Each of us have those special people who root for us despite our shortcomings. My mom and dad kept telling me I could achieve anything I put my mind into, and I am telling you the same.
Find those people who will be your rock during these months. Nobody in this world can boost your confidence and tell you that you too can achieve a U.S. residency spot. You need to do that for yourself, and there will be times when you stop believing in hope, which is when your loved ones will do it for you. Hence, go find your motivation and the will to fight till the end. Remember, the season is from September 15th to the day of ROL submission, every day counts.

Tips for residency interview preparation

Since your no. of interview invites will be lower due to a delayed application, your interviewing skills will either seal the deal for you or will have you ranked lower and thus risking going unmatched.

• I started by making a word document: From YouTube videos (Sarthi and American Medical Graduates making residency interview videos), books (e.g.: The Successful Match 2017, highly suggested), to everything you can find on the internet (matched seniors posting in Facebook groups to a quick Google search), MAKE A LIST of 40-50 MOST important Interview questions. E.g.: Tell me about yourself (asked almost everywhere), Tell me why Internal Medicine/Neurology/Pediatrics, etc.
• After you have done this compilation of interview questions: Start framing answers for them from the same sources, e.g. YouTube videos, google search, guidance from matched seniors. (Since I was a Sarthi student, I attended excellent interview guidance classes meant exclusively for Sarthi students)
• Practice in front of a mirror and with at least 2-3 people. Be confident, at a normal pace, relaxed when you say your answers. Ask your friend to correct if there are any body language deficiencies (e.g., lack of smile, looking at your feet, nervous gestures, etc.)
• BE YOURSELF! Your interview answers have to BE YOUR OWN. Make the short, to the point, diplomatically worded and genuine at the same time.
• Hence, practice a lot!

How USMLEsarthi team was helpful

• ​-I was a Platinum student and hence I was assigned a mentor. Besides 1-on-1 mentoring, I could approach Dr. Pawan and Ms. Arati for any guidance or help 24X7, since they were just a text away. From navigating through Google classrooms to writing my personal statement and curriculum vitae, the whole Sarthi team guided me from A to Z.
• - Your mentor is either a resident or attending in the field you intend to apply for the match, and hence they give personal insights on how to build your specialty-specific CV, PS, and interview-specific knowledge. Personally, I am very thankful to my mentor who guided me word-by-word through my CV and PS, whenever he had the time and was like a teacher-cum-friend.
• - Another highlight is the Telegram group exclusively meant for Sarthi students- reading those messages whenever I'd get the time to do so! Constant tips and guidance about the match process is most certainly extremely helpful

Guidance for USMLE match if you are in the same boat

• A late application does hurt, and this is a fact. The number of interviews you would have been offered had you applied on the September 15th, will be much higher compared to an application submitted after that date. BUT IT IS NOT THE END OF THE ROAD! Play smart and be active during the whole season.

 

• Even if it is October or November or even December, do rotations - quality rotations (i.e. whatever you can get your hands on). Big university hospitals have big-name/credential faculty - if you can manage to upload a well-deserved LoR from them to your MyERAS even in November or December - DO IT! (Again, be smart, upload 3 letters at the time of application to pass that filter of the bare minimum requirement of 3 letters, and keep the slot for your 4th letter empty).

 

• Tips: A) During the time of ROL submission, if you have been involved in research, then politely ask your mentor to put in a good word for you for your top 3 programs. B) During June and July make a list of your top 40-50 programs and send them personalized emails expressing interest, hence this way they will remember your candidacy even if you applied late. DO NOT attach your CV to these emails, keep that for your ERAS application. C) Send thank you emails/or better yet hand-written thank you cards to EVERYONE you met on interview day, from the PC to the residents. VERY important.

 

• Always communicate with the programs after applying late - tell them in a well written, succinct email why you applied late and also use this as an opportunity to explain why you are interested in their program and what you bring to the table.

 

• If during October, November, December, and January you are doing research at an institute or doing a month-long observership at a university hospital - you get a hospital email ID - use this email ID (and NOT your Gmail or Yahoo ID) to- Let programs know of these experiences + how you have been learning a lot + how you are interested in their program. Yes! Take every opportunity to express interest. Be smart about how you word those emails and the timing for sending those emails.

 

• Even if you have 1 interview - BE YOURSELF! Your interview performance is make or break, and believe me when I say this. There is a false notion out there that programs have already made up their mind as to who they will be ranking high. NO! False! If they have offered you an interview, especially without any contacts, they are interested in meeting you, knowing you, and probably working with you. DON'T SCREW THIS UP, just because some random moron said interview performance isn't significant.

 

• Prepare well for your interviews - know your talking points, ask help from seniors who have matched and from people who are your co-applicants, especially repeat applicants, for they have been through this process once. They say you can't keep making mistakes to keep learning from them, hence learn from what others did wrong. 

​Good luck, and I hope all of us achieve our goals, and be humbled by the achievement. Most of all be grateful to the people who stood by us during these tumultuous times.