Written by Krishna V. Suresh
On March 30, 2022, the American Orthopaedic Association (AOA) endorsed participation of orthopaedic surgery in the supplemental ERAS application service for the Match 2023 cycle. Applicants will have the opportunity to send signaling preferences to up to thirty programs, an additional factor that program directors must consider when deciding which candidates merit an interview invite. In an ultra-competitive specialty such as orthopaedic surgery, there are significant questions that applicants now face. How do I select which programs to signal? Will signaling affect my chances of matching into a specific program? If I complete an away rotation at a program, should I still send that program a preference signal?
In reality, the truth of this upcoming match cycle is that nobody can predict how signaling preferences will influence a specific program’s decision to interview one applicant over another. However, it is extremely important to consider that the relative competitiveness of this specialty will not magically change. After all, the match rate is a mathematical calculation, with approximately 865 accredited residency positions available and double the number of applicants. That being said, there are definitive actions that applicants and program directors can take to maximize success in the match.
A successful match this upcoming cycle will be based upon a concerted, team-based effort between applicants at the same medical school and their mentors. Historically, it is evident that the biggest competition any single orthopaedic applicant faces is from their colleagues at the same medical school. Therefore, ensuring success for all applicants at a given medical school is reliant upon open communication and decisions.
After listening to program directors discuss Match 2023 at the Medical Student Orthopedic Symposium panel and the Columbia University/OrthoMentor panel this month, I summarized some of the discussion topics below:
To Program Directors and Mentors:
1) Please be honest about an applicant’s chances of matching into orthopaedic surgery. The quality of the applicant required to match into this specialty increases holistically year after year.
2) Encourage open communication between applicants at your medical school and help them minimize the degree of overlap in signaling preferences, away rotations, and even in the applications they send out. In an ideal world, you will be able to stratify applicants based on their tier of competitiveness and interests and strategize an extremely tailored list of programs for each applicant with zero to minimal overlap with other co-applicants.
3) Tell your students where they fall relative to the co-applicants in their class. This is often the reality check many applicants desperately need.
To Applicants:
1) Listen to your program directors and orthopaedic mentors. If you hear from them that you may not be competitive enough and still choose to apply, please have an insurance policy ready, such as a back-up specialty or a research year application ready.
2) Foster open discussion with your peers and work together to ensure that signaling preferences, away rotations, and even the applications you send out have minimum overlap. It is nearly impossible to eliminate ALL overlap, but even stratifying your application tier, your regional preferences, and specific institutional interests amongst your peers can increase the likelihood of match success for everyone. Change your mentality from “I need to match” to “We need to match.” If you are a top tier applicant, do not send out applications to 120 programs. Foster a team-based mentality (a requirement to become a successful orthopaedic surgeon) and limit the number of applications you send out, so your peers can also optimize their success.
3) Be strategic with your signaling preferences. If you have completed a formal away rotation at a specific institution, the AOA recommends that you signal the programs, but you should discuss this with the program director at that institution. In addition, sit down with your mentor and generate a variety of programs that you choose to signal. Do not just randomly signal the top programs in the country based on some arbitrary ranking system. Rather be deliberate and strategic with where you choose to signal, based on your regional interests, priorities in training, connections, and relative competitiveness.
4) Seek active endorsem*nt and advocacy for your application from your mentors. Ask your mentors to personally reach out to their connections at programs you are interested in. This endorsem*nt is beneficial at any time point during the cycle, but particularly can have a powerful impact right before the standardized interview release day and around the time of your scheduled interview date.
5) Remember, a powerful connection with a single program is enough to match. Conversely, having several lukewarm connections at multiple different programs may not guarantee a match. This year, numerous highly qualified candidates were ranked highly (top 25) at multiple programs but did not secure a match—they did not have a uniquely strong connection at any specific program. Focus on building/solidifying strong relationships at a few, select programs (especially your home program) with the help of your mentors, rather than gambling your future on many lukewarm (and often sub-optimal) connections.
