The reality is that in the last ten years, dermatology has become the most competitive specialty in medicine. Hundreds of extremely qualified applicants are disappointed each year. Therefore, not matching is not a reflection of one’s qualifications as a future doctor. It just means there aren’t enough spots. This year 700+ applicants competed for roughly ~450 spots. 250 applicants didn’t match.
If you’re applying into dermatology, you’re competing against the top medical students in the country. Last year’s mean Step 1 score for matched candidates was 249 — the highest for any given specialty. 49 percent of matched candidates are members of AOA. The reason I mention these stats is because they are both important and trivial at the same time.
What do I mean by that?
I mean that it’s simply not enough. When everyone looks the same on paper, what separates you and the applicant next to you is your advocate. And not just any advocate will do. You need an advocate who sits on the admissions committee.
First, each program receives 500 to 600 applications. There might be a Step 1 cut-off to make the process more efficient. After that, faculty members are assigned a stack of applications (probably 20 to 60 each) to screen for interviews. If programs have on average four spots per year, and they interview 1:10 applicants per spot, faculty members can only flag a few applications each. Screening applications is not easy because everyone has competitive scores, good grades, and tons of relevant publications. So you get flagged for interviews based on who your advocate is.
Who is an advocate?
An advocate is your recommendation letter-writer. She is your mentor. Your cheerleader. The one making calls for you to other program directors. If your advocate is well-known (because dermatology is a small field), her letter will bear much more weight, and your application will get flagged. If the faculty member reading your application is somehow friends with or trained with one of your letter-writers, you will get flagged. Accidents do not happen in competitive specialties. Someone felt compelled to flag your application, and it probably wasn’t your personal statement.
Where do I find an advocate?
Home institution and/or research fellowships: Cultivating a strong relationship with an advocate takes time. Establishing yourself at your home department early on is the most accessible way. But if you don’t have a home program (or even if you do), research fellowships can be just as rewarding. More applicants each year enter research fellowships. Publishing is important, but your ultimate goal should be to get to know the department. Research fellowships are essentially a year-long audition process for the department. If you show you can work hard and are well-liked by everyone, you are automatically in a more favorable position to match there. Stellar scores or 10+ publications are not going to impress anyone if you don’t have advocates.
Away rotations: Away rotations can be a double-edged sword. They are costly and picking the right one is so difficult. The best rotators are not only strong clinically, but also well-liked by the department. If you are not both of those things, you will not match there. Once again, your goal should be to impress or establish relationships with advocates on the committee. Start by identifying programs you may already have a connection to. If your letter-writer or research mentor is friends with a committee member at another institution, you now have another advocate by proxy.
After you are miraculously plucked from obscurity and placed into the coveted “interview” pile, your chances of matching skyrocket. But it’s still not over. From this point on, you’re interviewing against an even more elite group of individuals who are all somehow personally connected to the institution. Dermatology interviews are akin to speed dating. Typically, you’ll rotate through ~10 rooms with 1 to 2 faculty members each. Each room will last ~10 minutes. Immediately post-interview, the committee gathers together to rank the interviewed candidates.
The interview is immensely important because it’s another opportunity to gain advocates. Strong interviewers can win over departments with their charisma or impress them with their passion for research. Luck also plays a role. If you serendipitously sat next to an influential committee member at your pre-interview dinner, you will increase your chances of winning over an advocate.
The opposite is also true. Your interview can tank you. When committee members are trying to rank 40+ extremely qualified applicants in order, every little blunder is microanalyzed. The details matter. Yawning, appearing disinterested or shy during pre-interview dinners, sounding smug or generic, can all be reasons to tank someone. It’s like walking on eggshells. Also, don’t feel too bad if you don’t have that many interviews. The number of interviews you have will not impact your chances at a particular institution. Remember, having a strong connection to one program is better than weak connections to 15 programs.
OK, so if it’s just about who you know, why even bother trying to look good on paper?
Because it’s still easier to advocate for someone who checks all of the boxes. If you’re weaker on paper, it will be an uphill battle for your advocate to make a case for why you should be picked over someone else. But having the right advocate trumps (almost) all deficiencies. Obviously, if there are major red flags on your application, it will be that much harder to match.
Lastly, I sincerely hope that if you didn’t match — do not give up. You deserve it just as much as the person next to you. Do some introspection and address any deficiencies (we all have them!) in your application. But more importantly, find advocates invested in your journey. Whatever your calling is, you’ll get there eventually. It might just take a bit more strategy (or luck).
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