4th Year, ERAS, and the NRMP 4

Hey guys,

If you’re a 4th year medical student, your ERAS application should be in. After every medical student tried to submit their application minute 1 day 1, ERAS crashed… again… like it does every year. Don’t worry, I’m not judging you guys, I did the same thing back in 2007. Relevant

Ok, so now what?

You’re a 4th year. Apps are in. You feverishly check your “ERAS” inbox every 10 seconds.

Ivory Tower University sent you an ERAS mail!

Omg omg omg.

Ivory Tower University sent out an auto-reply that your application was received.

Sadness. In the Summertime. Summertime Sadness.

I know this is going to be hard for most, if not all of you… but… relax guys.

4th year is pretty awesome.

You most likely are either doing electives or doing a sub-I in your specialty of choice. Some of you may be doing away “audition” rotations in your specialty of choice. Obviously, you should try to schedule your interviews during your electives. However, it doesn’t always work out that way, sometimes you may have to schedule an interview during a sub-I. This may seem like the end of the world for some of you.

“I won’t honor my sub-I because I had to go do that interview… but I had no choice, they had no other dates!”

Umm… so?

You have to do what is best for you.

The number one priority for you (and your medical school) is to to prepare you for the best possible internship/residency of your choice. I have heard that there are some schools that don’t allow their students to go to more than one interview a rotation. Umm… what? I would think most medical students nowadays are going on 15+ interviews. For those of you going into competitive specialties, you may be going on 30+ interviews and then 10+ prelim year interviews. It would be impossible for you to only go on one interview a rotation.

What I’m saying is…

…it’s ok to be a little selfish as a 4th year.

You have to prioritize interviews/ERAS/The Match over everything. Your medical school, your attendings, etc. should understand that. If they don’t, well, then you must do your best to off them flexibility. For some of you, that may mean going to an interview during the week and then offering to make up the time on a weekend, doing a call shift.

This is an important year for you. After obtaining residency, your new path is laid out for at least the next 3 years, but quite possibly the next 5-10. For some of you, you will be moving to a different part of the country, and for some of you, you will be staying close to home. Your medical school friends may split off to their specialties into a different part of the country as well. It’s going to be an adventure.

However, we haven’t quite gotten there yet. Your applications are in.

Now you sit back and wait for the interviews to come in.

It’s been TWO DAYS. No interviews yet. My friend doing specialty X already has 5 interview invites. WHAT IS WRONG WITH ME? 

Should I apply to more programs?

Almost certainly nothing. Different specialties/programs handle the early part of the match differently. Some start sending out invites day 1 or week 1, and some specialties/programs wait for the:

The Medical Student Performance Evaluation  (MSPE, formerly the Dean’s Letter)

These are usually released in October or November or so. So don’t stress too much.

How many interviews do I need to go on?

Unfortunately, The Match is (and probably always will be) a numbers game. You should go as many interviews as you feel comfortable going to. I realize that is kind of a “cop-out” answer, but it’s the most truthful one.

Let’s say you are going into internal medicine and you have great scores, stellar recs, and a first author publication. However, you just really want to stay at your home institution and they love you. Well, you probably don’t need to go on too many interviews. However, you should still go on at least 5-7 in my opinion. The reason for this is that it will help solidify your decision to stay at your home institution… and also, you need to be safe. I have heard stories of “very competitive years” where my friend was “ranked to match” and then… didn’t match.

Now let’s say you’re going for Integrated Plastics or Dermatology which are historically probably the most competitive specialties out there. I think it is in your best interest to go on any interview you get in those specialties. Just about anyone and everyone applying to those programs are rock stars. And yes, you probably are too. However, you don’t know how many other rock stars just like you are also applying this year.

Now, for the rest of you, I would look at it this way: Don’t go on an interview if you would rather not match than go to that program. 

If you would rather go unmatched than go to that program, then don’t go on the interview. Now, I realize that seems pretty harsh, but it’s the truth. That is how you should look at your interview invites. For some of you, you will have 20+ interviews at great/good programs. And then you may have 10+ interviews at programs “you don’t really want to go to”. If you believe your chances are so good at the 20+ great/good programs to not go on these other interviews, then don’t go. Just remember, you have just decided you would rather be unmatched than go those programs.

How should I rank my programs?

Carefully. Very carefully. Your rank list should be something you agonize over. You should create one when you’re happy, one when you’re sad, one when you’re drunk and one when you’re sober. Then you should look at all of them together to really discern where your true feelings lie. As a student doctor, you are able to mask your true feelings pretty well. So well that sometimes you don’t even know what they are. I am a fan of “trusting your instincts”. If you feel like the program is where you will be happy and you will learn to be an excellent attending, then that’s probably a good choice.

People agonize over their #1 and #2, but not their #6 or #7. Yes, people do get their first choice, however, some people do not. Your #6 versus #7 are just as important of a decision as your #1 versus #2. It could be a “very competitive year” where you would have matched at your #1 every other year… but just not this one. Look at every number on your rank list, you should have a reason why your #6 is your #6 and not your #7 and so on. Even if that reason is “It just felt better”. That’s still a reason.

Should I go across the country for Ivory Tower University?

This is very dependent on the individual. I’m originally from Southern California, but went up to north to go to Berkeley for college, against my parents’ wishes. I then did my first 2 years of medical school on an island, and 3rd and 4th years in California. Then I did a preliminary year in Staten Island, 5 years in Albany, NY, and 1 year in Baltimore. For me, after living on an island for 2 years, I could probably live anywhere without too much trouble.

For you, it may be different. Intern year will be a difficult year, likely one of the hardest of your life (so far). You may want to stay reasonably close to family for their support. However, if you left home for college for 4 years and have been gone for medical school, perhaps you are one of those people like me who doesn’t need to be too close to family.

Just make sure moving across the country, away from friends and family is something you really want.

Being a doctor can be isolating. Combine that with the stress of being an intern and having a support system close to you is nice to have.


You’re a 4th year now.

Applications are in. Relax a bit.

Be selfish (a little).

Go on as many interviews as you think you need.

Rank carefully. Make a rank list when happy, sad, drunk, and sober. Then compare them.

#6 versus #7 is just as important as #1 versus #2. Agonize over this. Trust me.

Be sure you can handle being far away from family when you rank a program cross-country.



Agree? Disagree? Questions, Comments and Suggestions are welcome.

You don’t need to fill out your email address, just write your name or nickname.

Share this: