Applying to a competitive specialty without a home program: tips and strategies for success
Written by Elizabeth L. Malphrus, MD, MPP
Medical students rely on the infrastructure of residency programs to help them prepare for The Match. This is how they learn about their chosen specialty, make connections, get letters of recommendation, find programs that are a good fit, and most importantly, find mentors who understand the quirks of applying in a certain specialty and can advise you on how best to set yourself up for success.
The first thing to know is that not having a home program is not the end of the world. It just means you need a slightly different strategy than your peers.
I matched into plastic surgery even though my medical school did not have a plastic surgery residency program. In fact, I matched into one of the top programs in the country, far exceeding my own expectations of what was possible without the support of a home program. Here are some things that I learned along the way and some strategies I used to break into the field:
Don’t let your program talk you out of it: your medical school really wants you to match, and the fact is, picking a competitive specialty where you don’t have a home program is a risk. Your program likely has very little experience with matching medical students into that field, and they will tell you (and they are right!) that it is safer to choose a different specialty. Just keep in mind: if this is what you want to do, and you’re willing to put in the extra work, the risk is probably worth it!
Connect with your nearest program: What is the closest residency program in your field to you geographically? Find this program and establish a connection with them. Start by contacting their program director or another faculty member focusing on education. Let them know you don’t have a home program and are looking for opportunities to learn more about theirs. Go meet them in person if you can so that they see you’re serious!
Find surgeons/doctors in your community, particularly early-career physicians who likely still have connections with their residency programs. Maybe you don’t have a program close by, or you haven’t been able to connect with one. You need to build the biggest network you can anyway, so you should find physicians in your community to connect with as well. Ask to shadow in the OR or in clinic. Often shadowing is an easy way for physicians to incorporate you into a busy schedule (versus scheduling a meeting or call), and that way, the experience will be useful to you regardless of whether or not they can connect you with additional opportunities.
Go to conferences: while this is a good idea for every med student, it is extra important for you! Go to conferences in your field so that you have more opportunities to learn and to make connections. Many people start with large national conferences, but I found that going to smaller regional conferences can be even more high-yield because it will expose you to a more focused group of potential mentors, as well as other trainees in your area who may be on the same path.
Consider a research year: these are becoming more and more common for competitive specialties, and if you are also coming from a school that doesn’t have a home program, that is one more reason to consider a research year. If you decide to choose this, be strategic about your selection: target a program that will strengthen your application as much as possible (priority one), but also target programs that you’re interested in matching into.
Find mentors who will support and guide you even if they are in a different specialty: just because someone isn’t in your field doesn’t mean they can’t be helpful to you. One of the key people who helped me through the interview season was an emergency medicine attending (Shout out to Dr. Jim Scott at GW SMHS!). He didn’t know a thing about plastic surgery, but he knew what kinds of things programs cared about, he helped me think strategically about how to get where I wanted to go, and he was the person I knew I could always reach out to for help.
Own it, and once you’re on the interview trail, use it as a strength: residencies know you had to work harder to get where you are. When sitting in an interview room full of people with home programs, remember: everybody knows that you had to work harder to get publications, sub-Is, mentors, etc, than the other people in the room, which shows an extra level of commitment. Don’t think of it as a weakness. Think of it as an opportunity to show how you can overcome an obstacle and go out and find opportunities for yourself. You’re a self-starter. You’re a creative problem solver. You can set a goal and accomplish it. These are the qualities it takes to choose this path, and they are the same qualities that will make you a great resident and physician.
Good luck out there! Follow me on Instagram @dr.malphrus to learn more about how I got where I am today and where I’m headed next!
