Yeah im not really sure why I didnt get many IIs. I made a focused effort to apply and signal to a range of schools, even a few very low ranked (HCA, first year programs, etc), but didnt hear back from any of those types. I do go to a newish low tier MD school in an area of the country I dont have ties and ended up not signaling that area of the country / many programs over there, I wonder if thats why my II yield was lower. The only real knock on my application was a poor Family medicine shelf grade and limited research experiences, but honored 6/7 clerkships with good comments, i think solid LORs (was told this in interviews), and had a strong showing in Step 2, so i was hopeful those would sorta cancel out.
And honestly, i hope im in a position to turn down interviews, lol. My new PD said he's going to give me as many days off as I need for interviews. With my career literally on the line, i dont see a reason to not apply to 200+ programs. I do understand that radiology is also competitive, but I feel like my app can be competitive in that mix. My friends at my school who applied rads had similar ECs and lower scores and got 15+ interviews at great programs. I can see myself happy in gas, rads, or some sorta IM fellowship but not much else, so i think those are what im gonna try.
First OP, sorry to hear you didn't match a categorical position. It sounds like you put in serious work and did well through med school. Your new PD sounds understanding as well. You're open to a lot of scenarios, and I'm sure you'll find some success next year.
I think we overestimate the extent to which this is an application and underestimate the extent to which this is a literal "match." It's a different mindset compared to "getting in" to college or medical school. This is why rockstars (like you) sometimes fall down their rank lists. Applicants with lopsided profiles can be hard to place. For instance, strong research and poor stats, especially from an MD/PhD, is a high risk situation. The prestigious programs have options with better stats and similar research, the lower tier programs assume you'd rather be at a big research center. Similarly, high stats without research is tricky for the opposite reason. Big name programs don't have a great reason to take you (they are
primarily research institutions), but smaller programs think you'll wind up elsewhere. Add in lack of geographical ties and it becomes hard to show a program that you're the best option.
Also, I don't think
anyone cares about the FM shelf. The fact that you got interviews at top tier academic places shows that you are absolutely solid on paper. I'd bet you wound up unknowningly competing for a small number of non-research oriented spots at top tier programs. The issue is clearly research and honing in on the type of program that would want you.
First order of business is to reach out to mentors, preferably people who see what happens when PDs decide who to interview and who to rank. You need to understand how competitive you are as a TY applicant. You need to know where to signal and where to sent LOIs (if appropriate). It sounds like your strategy was a little haphazard. Signaling to HCA programs and brand new programs with your stats was likely a waste. They knew they were a backup. Similarly, without strong research the big research institutions are unlikely to be interested. I have no idea how this changes now that you are a TY applicant, but it's absolutely imperative that you find out from several reliable sources. If you had no publications at all, definitely work on checking that box
now. That means reaching out to your home program and, unfortunately, doing some chart monkey work before starting residency. Try to find mentors who are sympathetic to your situation, either at your current institution or at your TY. Research takes a long time to publish, so aim to submit ASAP.
You're clearly level-headed and disciplined. It sounds like you slipped through the cracks, but I'm sure there's a program out there desperate for someone exactly like you. Also, keep your ear out for open spots. People leave residency, spots need to be filled. I know someone who filled a PGY2 spot in rads at a solid academic residency after leaving a community gen surg program in the middle of PGY2. When programs need to fill a spot in a pinch, people like you are
exactly who they're hoping comes knocking. Good luck!