It’s that time of year again. Rain, cold, gray skies—must be ophthalmology match time! Rumor has it that nary an open position was to be found following the match, reinforcing ophthalmology’s competitive edge. The combination of medical and surgical opportunities, expansive fellowship offerings, and a reputation (deserved or not) as a lifestyle specialty is hard to beat. Those private practice salaries are not to be ignored either.
Unfortunately, most medical students are clueless as to how to go about applying for an ophthalmology residency. I will hit the rewind button and step further back—most medical students do not have enough exposure to ophthalmology early enough in their training to make an informed decision about the process. This leads to much angst in January of their 3rd year (clinical rotations), which is where I come in. I will dispense with my musings forthwith. I am firm believer that the only bad vice is advice—Caveat Emptor!
1. Be committed. Most medical students don’t understand this one. I am reminded of the old saw that says the difference between involvement and commitment is the difference between ham and eggs—the chicken is involved, the pig is committed. An ophthalmology program is looking for someone who will number one matriculate and graduate in good standing. Any red flag that indicates otherwise will almost certainly doom the candidate. No program wants to have to advertise that they have an open PGY-2-3-4 position for the ideal candidate. This is viewed with great tedium by the program. Signs of lack of commitment—only willing to train in one region (city, county, island, program, etc.), applying in two different specialties at the same time, talking about how someone/something else is the most important thing in your life. If you really want to be an ophthalmologist, you will be happy to apply, interview, and match at Billy Bob’s Eye program in the Sticks, USA. Most applicants do not understand this. Innocuous questions during the interview may reveal your lack of commitment: what other programs are you interviewing at? An answer that reveals only California programs may demonstrate a lack of commitment to the FIELD, and raise the RED FLAG that the applicant may flake out and cause there to be a vacancy. Best not to rank that applicant and save lots of programmatic soul-searching later. For those lost medical students who make it all the way through the 3rd year of their medical school training, and then decide that they want to “do ophthalmology”, all is not lost. This candidate was not wandering around lost. Rather they were open-minded to all professions and made an informed decision after careful deliberation. They did not have the benefit of exposure to ophthalmology through a family member or earlier in their training, so this is easily excused, because the candidate is now 100% committed now that they have found their soul-mate career.
2. Be informed. Know the programs. All of the programs that you are applying to. Preferably begin researching in the Spring of your 3rd year. Find out their deadlines for applications, when they interviewed last year (ask the present group of applicants), any recent changes to curriculum, length of training, staff turnover. Learn who the chairman is and who the residency coordinator is. Be kind to the residency coordinator’s secretary—they all talk. If you’re nice to the secretary, maybe it will pay off later when you REALLY need to switch an interview date. There is no excuse for missing a deadline. Identify the drop dead date for the applications for each program, subtract a week, and get your application in one week prior to that. With a nod to knowledge is power—knowing the interview dates will give you an edge when you get the first call. Most programs offer multiple dates. If you happen to know the general (or exact) time when the programs you REALLY want to interview at are, then you won’t make the mistake of scheduling a second-tier (your book) program on that date. This will force you to call up the secretary who may not like you and ask for a favor. Usually the answers to these favors are NO! Plan ahead.
3. Interview well. Be well-groomed, early, knowledgeable about the program, and look like someone that you would invite home for dinner. Humility is appreciated, as is a self-deprecating sense of humor. It can be a long day, so patience is highly prized. If you think that you lack interview skills, check with your school’s resources department. Many offer mock interviews which are videotaped, dissected, and critiqued. They can be illuminating.
4. Be a team player. Frankly, I could care less if you scored 99% on your boards, were Phi Beta Kappa, AOA, and a Rhodes Scholar with two Olympic gold medals. So are all of the rest of the candidates. I am looking for someone who is going to show up, work hard, be enthusiastic, curious, and help to take care of my patients. My patients being anyone who happens to call in to the office/hospital/ED in search of care. You don’t have to show up early and stay late, but it is noticed and appreciated. I appreciate any candidate who displays a willingness to be trained. When your co-resident is slacking, not coping, or just buried with work, step into the fold and help out. There are two ways of viewing this—this sucks or I only have 3 years to learn the basics of ophthalmology and I will take every opportunity I get to learn it while I have the backdrop of my residency program to support me. So how do programs know if you are this kind of team player? They have ways, trust me. It comes across in the applicant’s demeanor, their interactions with others during the interview process, in the letters of recommendation, and in follow-up phone calls to the people who wrote those letters of recommendations. It never hurts to be nice.
5. Be all you can be. It is nice if your mom is chairman at Bascom Palmer, and your dad invented VEGF-inhibitors. Really nice! When I look at candidates, I am usually distressed by what is missing from their applications. Most of the candidates I see are top of their class, Ivy League-equivalent undergraduate and medical school, Phi Beta Kappa, AOA. Great! You test well and work hard. Given the combined endowments of these types of programs, you better have 2 or 3 nice first author publications. They don’t have to be in ophthalmology, they can be in any field. Lack of production on this order just tells me that the candidate is willing to squander the incredible resources that they have had at these elite programs they have trained at. Who did you work with? Did you perform any research in any field? If not, what outstanding contribution did you make to your local community (I don’t care if you won the Madden Superbowl). If I am looking at a candidate from Sticksville U and one from Harvard, and the former has 3 papers and the latter none, my nod goes to the former. It is difficult to find research opportunities that can result in publications for an undergraduate and/or medical student at lesser known schools, whereas the elite programs all you have to do is ask. I have been at both ends of the spectrum from the research haves and have nots. So you’re not in the top third/half/70th percentile? Sad, but it happens. One standard deviation above the mean on the board scores? Ditto. Not the end of the world. Your smart move is to decide on ophthalmology early (preferably as an undergraduate) and develop a long-term interest in the field backed up by creditable references, impressive publications, and nice presentations at national meetings.
If you know a candidate who did not match, likely they violated one of the 5 tenets above. Sorry to end my musings so abruptly. I know that many candidate are saying what about grades/schools/scores (they matter, but they are the foundation of an application), what about away rotations (if I had it to do over, I would do neurorays in Hawaii instead of any ophthalmology rotation during my 4th year, because I am doing ophthalmology for my career), and choosing letters of recommendations? Another set of musings in the future, probably, if I can find the time. Honest.
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