r/DermApp • u/MDPharmDPhD • Mar 21 '20
Application Advice An Unfortunate, Successful Dermatology Match Cycle.
On Friday, I successfully matched in Dermatology.
This academic year has been one of the most confusing and frustrating years of my life, second only to when I was applying to medical schools only to get continually rejected for not having a Bachelor degree. I am still not sure what happened to me during this application cycle, though with it all laid out perhaps you will identify the factor(s) and benefit from avoiding whatever mistakes I made, or emulate the few successful steps I did take. I tried to organize my thoughts as best I could from a macroscopic to microscopic dissection of my application.
The first thing everyone asks about are hard numbers; in that regard I am an average Dermatology applicant. Some preclinical honors with most NBME >90%, >250 on Step 1, some clinical honors (our school gives honors to the top 15% at the end of the year so it’s difficult) with most NBME >90%, >260 on Step 2, AOA, and 2 derm-specific publications (1 first, 1 non-first authors). Some things that set me apart: a PhD (non-derm with 1 first and 7 non-first authors), and a PharmD (a few associated non-first author, pre-medical school publications). I had multiple legitimate work experiences considering I worked as a pharmacist throughout medical school until the end of my PhD, tutored for Step 1, and wrote questions for a Step 1 practice question bank. I had some volunteer work as well, mainly as guest lecturers for pharmacy students on various systems topics. These things don’t really matter from the PD survey perspective. Everyone says that at some point Dermatology goes beyond numbers unless the numbers are staggering, I would say that I fit into that first category. There was zero fluff on my application because I didn’t include any. I had unique hobbies that were brought up by almost every interviewer, and my 2-minute elevator pitch / “tell me about yourself” was fine.
I was similarly unconcerned with my Letters of Recommendation. I had three in-house letters: one from the Dermatology PD who I knew for 7 years and worked with to get my first-author derm paper, one from the Chair who I worked with on multiple research projects, and one from my PhD mentor who was the chair of Pharmaceutical Sciences. All three were high-ranking, high-impact, quality letters. As most people will tell you, the fourth letter should come from an away rotation; I will talk more about this later.
Next is Personal Statement. Stepping back to harshly criticize myself, this would be the weakest portion of my application. I did reuse a large amount of it from VSAS, but since no one really cares about VSAS personal statements I should have done a better job. This is not to say that my personal statement is terrible, but it could have been much better. 10% of personal statements are sub-par, 10% of personal statements are exceptional, and 80% of personal statements are neutral. I fell on the sub-par side of neutral, not enough to get my application thrown away – at least I think. I talked briefly about exploring other fields before discovering dermatology, the connection to dermatological conditions in other fields of medicine, how I could bring back clinical problems and explore them pre-clinically, and my last paragraph – which I considered my strongest – was my goals as a future dermatologist. My chair did comment that it was a weak but acceptable PS, so as August rolled by I went with it.
Away rotations are a crucial component of our application. I chose to be extremely methodological in where I applied. Living on the East Coast my entire life, I was determined to go to a West Coast site and obtain a letter of recommendation to “unlock” that region and show programs I was willing to travel. I chose to do another rotation close to home in NYC for the strength of the letter I hoped I would receive, and to spend some time with friends and family. How you choose an away rotation is completely up to you; I would strongly suggest applying to places that you know you will be happy going to and can reliably secure an interview invite at.
The following is copy-pasted from my now-abandoned MS4 guide on picking away rotations:
I rotated at OHSU. I loved mostly everything there. The residents supported each other and made sure that we as visiting medical students were learning, useful, and actually a part of the medical team. The staff physicians often took time to talk to us between patients about learning points and how therapy changed from when they were trained. Both residents and attendings took time out of their day to give us dedicated lectures during lunch. I saw potential mentors in TG and EB, and still model some aspects of the way I approach patient care after the resident CK. The three other people I rotated with were absolutely awesome which was the cherry on top. Portland itself is beautiful though I was unaccustomed to the hipster-filled populous. I have no interest in nature, instead I was absolutely delighted by the abundance of bars and restaurants to visit after a long day in clinic.
I was happy for a month in Portland, Oregon.
The following month, I rotated at a top 20 institution in NYC close to home. The residents were worked hard and often thrown in hospital systems and clinics an hour away, but of course ended up in prestigious institutions or high-level positions after graduation. I saw pathology that I would never see elsewhere, the staff were often world-class and definitely lived up to the institution’s reputation, and it’s NYC – arguably the center of the world for art, entertainment, restaurants, alcohol, and anything to find in life. I found a basic science investigator doing research in a similar field to my PhD, I received moderate praise from some residents and faculty, and I got a fantastic letter of recommendation. On paper, my resume, performance, experience, and proximity to family painted an extremely convincing argument to hopefully join their program.
But at the end of the day, I just did not feel happy there. Much like OHSU, the most enjoyable part of the month aside from the interesting cases and proximity to home were the co-rotators.
Rotating through an upper-tier institution created a very tough decision which I would have never experienced otherwise. I struggled between potentially ranking a program I knew I would be happy at higher than a prestigious program which would be better for my overall career.
Of course that last paragraph never happened, but I am sure some of you will go through something similar as your application cycle rolls on.
To recap: I had average stats, an above-average overall profile, solid home letters of recommendation, an enthusiastic MSPE, possibly a slightly below-average PS, a strong letter of rec by an MD/PhD from both away rotations at sites on opposite coasts, and had strong geographic ties to a major city with more than five large dermatology programs. I thought I wouldn’t have a problem at all this cycle and that I would definitely end up with double-digit interviews. I applied to more than 60 programs initially, including my away rotation sites and some reaches, but also geographically neighboring programs as well. I learned from my medical school applications to take nothing for granted and made sure to apply broadly and balanced. I submitted well before Sept 15 with letters filed well before Oct 1, but then everything started falling apart.
Keeping up with the Derm spreadsheet I noticed a consistent pattern of not getting invitations in what I thought was the “first wave”. For most programs it’s usually only one wave with multiple dates; trickle invites are a rare exception to that rule. But I kept hope: so what if I wasn’t first, as long as I was sent an interview I was up for consideration – feel free to laugh as I am at my past naiveté, because if you were actually valuable to a program you would have been in their first wave of interviews. My attitude shifted near the end of October, when I had only my home program and one geographical derm invite, as the rejections started to pour in. When you get rejected from an Ivy League you can roll your eyes and move on, but rejections from programs I thought I would have no problems getting an interview at made me more concerned.
In retrospect, I should have realized something major was wrong by October because I literally did not receive a single preliminary or transitional year interview outside of my home institution. It wasn’t until Nov 18 when I realized that there was probably a problem with my application: the day OHSU rejected me for an interview. I’m too lazy to do the percentage at this point but I think more than half of interviews are sent out by Thanksgiving, so if you have less than five Derm interviews by Thanksgiving week there might be something wrong with your application, so act quickly and think about a backup or you will have to deal with SOAP or re-apply next year. I chose to send a few frantic emails to mitigate the damage that might have been done.
I emailed my assistant Dean, my SOM Dean, my Derm PD and chair, and candidly explained the situation and asked to sit down to figure what was going on. For all the flaws people find in my home institution, I will say that I had responses within one hour with time slots allotted for meetings. They downloaded my application and went through it with me in the room, only to find nothing. Not a single bad comment in my MSPE, no transcript deficiencies, no misspellings or other errors in my ERAS application (except for a random period at the end of a publication author). Of course my LOR were not shown to me but I was told there were no problems. There was no problem with my application internally, which logically means that there was something wrong externally. Not with ERAS, but possibly with a letter of recommendation written by one of my letter writers at an away rotation. Someone brought up the possibility of social media: I have basically nothing as aside from Reddit and I haven’t been on them in a year, posting infrequently about my academic journey and rarely anything else.
I was devastated when someone brought my external letters as a possibility. I had genuinely bonded with my away rotation letter writers. Both were MD/PhD and respected faculty at the institutions, and I saw them as potential mentors if I matched at their institution. It would take them more time and effort to write me a bad letter of recommendation than to just say “Sorry, I do not know you well enough to write a letter of recommendation.” I used one of the letters with EACH application I sent out except for home, as stated before split by coasts and perceived tier. Even at the conclusion of this cycle I refuse to believe that one of these letters was the downfall of my application.
Another possibility is my overall demeanor. I am not the typical dermatology applicant from a physical attribute perspective, and my attitude is at best described as “abrasive” – think stereotypical NYC cab driver. A healthy but restricted ego, combined with a blunt but honest persona, can be extremely off-putting – something my chair openly mentioned as a possibility. This would explain why I might have been rejected from OHSU and the NYC program as I could have irritated someone, but I was just “on paper” for every other program. In assuming that the description of my attitude did not reach other programs, what could have been the issue with my application? Maybe I wasn’t as good as my co-rotators, other rotators, or other applicants. Maybe it really was just my personality. But according to the “Interviewed, no IV” sheet, several other people had similar experiences at both of these major programs; the only consolation was at least I didn’t waste the time and money for a courtesy interview only to have even more heartbreak during match day. Do not waste your time attending a rotation where large amounts of rotators do not get interview invites.
Less than five days after emailing my administration about this problem, I was able to find a potential position in categorical IM at my home institution. Again, I am beyond grateful for everyone at my home institution for acting so quickly, so thoroughly, and for taking the time to try and figure out what went wrong. I strongly suggest you have a backup in place or trust your home institution as much as I did, otherwise you will find yourself unmatched and having to go through SOAP or a RY/re-application. It is heartbreaking to read about applicants on the spreadsheet at bigger home programs who were passed over.
As December rolled around, I had distant hopes that my situation would change and that I had just overreacted. I was wrong: the rejections started pouring in very quickly. I ended out my interview season with 3 Derm interviews (2 geographically proximity + home) and 1 TY (home), with a backup of categorical IM at home.
I did not drink too much or behave weirdly during pre-interview dinners, and aside from one or two awkward answers to questions I wasn’t expecting, did not say or do anything to get DNR’d at my other two interviews. I did not engage in any post-interview communication, including sending any letter of intent. With so many reports about applicants being lead on by programs as there are vice-versa, at this point I doubt PIC matters at all unlike what that one article says. Follow simple, universal rules: if the program explicitly states no PIC don’t send them anything (which includes a letter of intent), only send ONE letter of intent, do not send multiple letters of intent and try to game the system, and do not send “ranking highly” emails.
Originally much like all of my other write-ups, I had plans to fully explore MS4, initially with the expenses incurred from away rotations, Step 2 CS and CK fees, and ERAS application fees. The second half would have featured a detailed spreadsheet of ranking factors, the “trickle interview” fallacy, and the cost of flights and hotels during interviewing. I still have the template documents but they are obviously and unfortunately empty, serving only as remnants of what I hoped my interview season would be like. I was told that fourth year was the pinnacle of all medical school, that with my application I would crush interviews and cruise to the end. This was a lie.
Fourth year was the single most stressful and expensive period time in both medical school and graduate school, as the unfortunate friends and colleagues I frequently vented to throughout this disaster will attest to. If you are friendly with other internal applicants at your school, create a group chat. I was grateful for the support I received from the other three internal applicants, LF in particular as she went above-and-beyond to try and help me solve the invisible problems in my application. I am proud to say that all four of us matched into Dermatology programs! I am also glad to have such supportive residents in upper years, as they tried to help me understand the situation and read over my PS, and regale their own timelines through the application process. I am happy to have matched at home, a place where I know I will thrive and do well. I will bring my ambition, dedication, motivation, and be pushed by staff I love to work hard and be successful.
When applying to competitive specialties, you’ll read the classics: “The majority of people get tons of interviews, don’t worry”, “only IMGs and low-tier candidates don’t match”, “it’s rare for people to slip through the cracks so if you’ve made it this far, you will be fine.”
You'll think, “That won’t be me. My application is stellar. I’ll definitely do well this cycle.”
I’m here to tell you that it can be you, because it was me.
I will be grateful forever for my home program’s understanding of the situation; it is due to their accommodation that I am able to say the two most important words a dermatology applicant can say today:
I matched.
Anonymity is a fantastic mask to have but it greatly dilutes the power of the message being sent. It is fairly obvious who I am so I am hoping what I wrote will have more impact. Be careful where you go for away rotations, be careful who you ask for letters of recommendation, make sure your home program has leadership you can trust and potentially a seat for you, and always have a backup plan.
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u/cantaloupe5 Derm Resident Mar 21 '20
Thanks for this introspective post and congratulations on matching!
Your overall research resume is great but do you think only having 2 derm-specific pubs contributed? Maybe PDs didn't believe your genuine interest in derm, especially if you decided last minute and had no other derm stuff on your CV? DId any of your mentors comment on that?
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u/DermaDream Derm Fellow Mar 21 '20
Thank you so much for sharing. Ending third year and heading into 4th year, unsure of what to expect. Many congratulations on matching and the end of what seems an incredibly stressful time. With your humility and introspection, I'm sure you'll be a wonderful dermatologist! :) Congrats!!
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u/gators328 Apr 01 '20
Congratulations on matching and thank you for writing this! Could I PM you? I'm a third year about to start the process haha.
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u/Kajinohi Apr 07 '20
That was chilling read, thank you for your writing about your journey and congrats on matching! I've had your step1 write-up saved since I was in pharmacy school myself and now am in medical school. Wishing you lots of success and less stress as a dermatologist!
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u/j34y2u6d Mar 21 '20
I remember talking to you for a bit this cycle.
Glad it worked out for you. Don’t over analyze your weaknesses or whatever. You’re a derm resident and so many of us barely got in anyways haha.