It isn't uncommon for residency applicants to rank more than one specialty. A former dual applicant and current OB/GYN resident at Ascension Saint Joseph Hospital-Chicago, Deena Kishawi, MD, gives advice on how it can be done effectively.
- Deena Kishawi, MD, PGY-4 OB/GYN, Ascension St. Joseph's Hospital
- Brendan Murphy, senior news writer, American Medical Association
- Todd Unger, chief experience officer, American Medical Association
Dr. Kishawi: Looking at it definitely in the lens of a specialty. I made the mistake of looking at it as each program individually, not realizing how much of it is in flux. Those people are not going to be there likely when you're there, right? So many of those people are going to shift. People come and go. Program directors, physicians come and go. Really, the only thing that's going to stay stagnant is the specialty itself. The clinical medicine itself and the research or the treatment options, the management, those are the only things that are going to stay the same. If you're entering a specialty or you're entering a program because of the people, as great as that might be initially, that's not going to be the crux of that specialty forever.
Unger: That was Dr. Deena Kishawi, fourth year OB/GYN resident at Ascension Saint Joseph Hospital in Chicago. On today’s episode of Making the Rounds, Dr. Kishawi talks about how to apply to two different residency specialties. She shares her experience as well as the ins and outs of the process. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer at the AMA. Today I have the pleasure of speaking with Dr. Deena Kishawi. She joins us for our Meet your Match series. Dr. Kishawi is a fourth-year resident in obstetrics and gynecology at Ascension St. Joseph's Hospital in Chicago. She's an active AMA member and a native of Chicago. How are you today, Dr. Kishawi?
Dr. Kishawi: I'm doing well. How about yourself?
Murphy: Doing great. We're excited to get to speaking on a really interesting topic today. We're going to talk about the process of dual applying for residency, when it makes sense for future physicians to apply to multiple specialties and how to do it. Of course, we're bringing you in because you have a unique expertise here. You were a dual applicant and that's not all that uncommon. In 2022, the mean number of specialties ranked for matched USMD seniors was 1.2. It was 1.6 for unmatched applicants in that category. The numbers were also fairly similar for DO applicants. So, taking back, which I guess was four years ago, how did you arrive at the decision to dual apply?
Dr. Kishawi: When I started medical school, I was unsure what specialty I wanted to go into and it basically stayed the same throughout all three years of medical school until it came time to apply. And the summer before applications were due, I still didn't know exactly what I was planning on going into.
And I was between two, OB and ortho, and I obviously had no clue what I was going to do. They're on very opposite ends of the spectrum, right? Ortho has the reputation of being a boys’ club, and OB has the same reputation on the opposite end of being a girls' club. And I loved both aspects of their surgeries, of the clinical medicine of things, but I could not really figure out which one of the two I wanted.
I loved them both equally. I could see myself in both of them equally. I could see a happy future in both of them. I loved both patient populations. I couldn't remove myself from either one of them. I had great experiences in both of the rotations. I loved working with the doctors in both ends of things. So, it was so difficult to take myself out of one and only isolate to one specialty.
I talked about it with my dean at Loyola and he was very frank with me. He's like very rarely do students apply to both specialties if they really like two of them. He's like, "I don't really recommend it, but if it's something that you're interested in, you can go for it. It's going to be incredibly tough to navigate."
And I sat on that thought for a very long time. And what I decided to do was apply to both away rotations. So, I did away rotations in OB and I did away rotations in ortho. And I tried to do that so I could see maybe my experience was just isolated to great rotations that I had in medical school, and it wasn't going to be the same when I went away outside of my bubble of Loyola, of Stritch School of Medicine.
And when I went outside to other realms and other schools, other pockets of medicine, I had similarly great experiences in those fields. So, it obviously became increasingly more difficult to narrow it down and I figured I have nothing to lose if I apply to both, so why not do it? Obviously, it's going to be a little bit more costly, but I was a little bit more strategic with how I went through the application cycle after that then.
Murphy: You mentioned that it's more costly. Is that just because there's just simply going to be more applications submitted?
Dr. Kishawi: Yeah, so I ended up obviously applying to more programs because I applied to more OB programs and then more ortho programs. I was selective because I did not want to apply to the same programs at the same hospital.
So, for example, if I was applying to OB at Hospital A, I would not apply to ortho at that same hospital. I didn't want there to be any overlap because it's a very small world and people talk, and people know one another. And I never wanted one program to know that I applied to the other.
And it was hard to keep that under wraps because a lot of my research was ortho heavy, for example, but then a lot of my volunteer and clinical experience was OB, so this stuff came up on interviews. And it was strategically navigated when it came up in interviews.
And I didn't want, for example, one hospital to ask, "Oh, you have all of this ortho research. Are you applying into ortho," as I'm sitting for an OB interview. And I didn't want them to go to that department and say, "Well, is this applicant...is Deena applying to ortho at the same hospital?" So, I made sure that if I was applying to OB at a hospital, I was not applying to that same hospital for ortho.
Murphy: And a point of clarification through MyERAS system. Schools, or residency programs rather, are not able to see the other specialties you've applied to.
Dr. Kishawi: Correct, yes. They can't see it when you're applying, but when you match, they see what specialty you matched into. They don't see what program you match into, but they see the specialty and the state that you match into successfully. So, obviously when I matched into OB/GYN in Chicago, the ortho programs that I interviewed at saw that that's where I landed.
Murphy: But at that point, the deed was done.
Dr. Kishawi: Yeah.
Murphy: Can you walk us through what the process is like of dual applying, like the technical process? Are you submitting two different sets of forms through ERAS, getting two different sets of letters of recommendation? How does that all work?
Dr. Kishawi: Yes. So, it is two sets of everything. It is two sets of personal statements, two sets of recommendation letters, two sets of basically every single thing, two completely different things for that. So, my personal statements were completely different. And you had to be really careful about labeling that because when you're uploading it, you have to release them to each program.
So, for example, I labeled Deena Kishawi, OB-GYN personal statement and made sure that I released that to all of the programs that I was applying for OB-GYN, because my personal statement was specific to women's health. And then for my ortho personal statement, I did that for the ortho programs.
My letters of recommendation, the way it works is your letter of recommendation writers are given a password and a username and access code for you in particular. And when they upload it, then you can select which physicians you're going to choose to release their letters to which programs. So, the ones who were ortho or who might've had more allegiance to certain programs, I released it to those schools, and then same for OB.
So, you were very selective about who got what forms, who got what letters, who got which personal statements to make sure that nothing crossed over. And I double and triple and quadruple checked that because my worst nightmare was one school getting or one program getting something for the other specialty and then my master plan getting crumbled in front of me and that stuff all coming forward when I went to go interview.
It is a little bit more difficult, though, if you're asking, for example, your surgery clerkship director to write you a letter of recommendation for both, because then it does open a can of worms about how are you going to strategically do this without burning any bridges. Not everybody in my medical school was very supportive of this and thought that I was shooting myself in the foot going this route.
Ortho in general is an incredibly competitive specialty, and OB was starting to become an incredibly competitive specialty. So, typically when people dual apply, they're not applying to two competitive specialties. They're applying to one competitive specialty and a backup. So, to apply to two competitive or semi-competitive specialties was not something that people were looking at with, you know, great happiness for me.
So, it was something that was discouraged by some of my physician mentors and other people were like, "You do you. We'll see what happens on Match Day. And we're happy if you match and if you don't, we're here for you if you SOAP." So, it was mixed emotions coming from some of my letter writers and obviously people who were reviewing my personal statement for that reason.
Murphy: We talk about specialty competitiveness, that is generally considered the fill rate across the specialty?
Dr. Kishawi: Yes.
Murphy: And both those specialties, OB/GYN and orthopedic surgery, have very high fill rates. They're certainly among the top five or 10, in terms of competitiveness. Also, I just wanted to mention, not to get too deep into the weeds to our listeners, I mentioned ERAS. That if you don't know, is the Electronic Residency Application Services, which is run by the AAMC.
When you were filling out applications, filling out a personal statement, talking to your mentors, I know you were torn, but was there a preference for one specialty over the other?
Dr. Kishawi: I did have a preference for specialty. Initially, it was a preference for a specialty at a certain location, but I knew that if it wasn't that I would be happy at the other specialty anywhere else.
Murphy: So, do you mind sharing what the specialty is? I won't ask you to divulge the program.
Dr. Kishawi: I was very happy to hopefully land into orthopedics, but I did not match there, obviously. And on Match Day when I learned that I didn't match in orthopedics, I was happy being in OB/GYN anywhere. Obviously, things work in ways that you don't know, and I realized in hindsight that I landed where I needed to be.
So, I'm very happy to be in OB/GYN and realize that women's health is definitely the place that I need to be to thrive, and I'm very happy to be doing what I'm doing. I'm excelling in what I'm supposed to be doing.
And I know that seeing how the state of medicine is today and seeing the kind of impact that I've had over the last couple of years, both in residency as a resident, as a student teacher, I have had better experiences today with my patients, with my colleagues in OB/GYN than I could have ever had in orthopedics. So, I'm very glad to have landed where I am, and I know that things have happened for a reason.
Murphy: As a dual applicant, you're going to be going on interviews that are going to be vastly different contextually because simply they're two different jobs. How did you prepare for that? How did you put one out of your mind and focus on ortho or OB for a specific interview?
Dr. Kishawi: I tried very much to schedule my interviews with one another. For example, I tried to schedule my orthopedic interviews closer to one another, so I was in that realm with orthopedics as much as possible, and then I tried to group my OB interviews around the same time. So, I remember a lot of my OB interviews were in November and January, and most of my ortho interviews were in December, and that really helped me isolate those specialties with one another.
So, when I was interviewing with orthopedics, my mind was very orthopedic-centered. And when they were talking about it, I had remembered seeing some of these med students at other interviews. And same with the OB interviews. When I had interviewed in November, I had seen some of those later on in January. So, it was mostly clustering them together so that I kept my mind in the same place.
Murphy: As I highlighted earlier, we know it's not rare to dual apply. Speaking to this current group of applicants, how would you advise them to go about evaluating the places they interview? Should they look at it in the lens of a specialty or just each program as its own case?
Dr. Kishawi: Looking at it, definitely in the lens of a specialty. I made the mistake of looking at it as each program individually, not realizing how much of it is in flux. Those people are not going to be there likely when you're there, right? So many of those people are going to shift. People come and go. Program directors, physicians come and go. Really, the only thing that's going to stay stagnant is the specialty itself. The clinical medicine itself and the research or the treatment options, the management, those are the only things that are going to stay the same. If you're entering a specialty or you're entering a program because of the people, as great as that might be initially, that's not going to be the crux of that specialty forever.
And I, in hindsight, realized that I made the decision to even enter orthopedics because of that. I did it because of the people that I had worked with and the environment that I was in, not realizing that, that was not going to be my life—had I gone that route—forever. So, definitely choose a specialty when you're dual applying based on the clinical aspect of it because that is the only thing that's going to last your entire career.
Murphy: So, rank order list, how did you navigate that?
Dr. Kishawi: That was so tough. It was definitely pros and cons lists for days and days. I first did it by program. I wrote down all the pros and all the cons of each program, completely taking aside whether or not it was OB or ortho. Once I figured that out, I figured, okay, where would I be happiest completely independent of specialty? Would it be at a place where I was, for example, doing call shifts, like 24-hour call shifts, or a place where I was doing night float? Would it be at a place where I am required to do an annual research project or a place where I have to do X number of publications throughout all five years?
So, when I figured out what my priorities were for all of residency, and I listed those priorities in order of most important to least important, I looked at which programs fit those criteria. Once I managed that, then it ended up being a mishmash between OB and ortho. It was not one specialty got all the top few, and then the other specialty got the next few. They were scattered within one another. Obviously, one specialty took the number one spot, but then the rest of them were just mixed in with one another.
Murphy: So, we revealed this at the beginning of our conversation or a few moments ago, you ended up matching in OB, not ortho. Can you talk about how you processed that on Match Day? Were you surprised?
Dr. Kishawi: I was very surprised. I actually very rarely look back at my Match Day video. So, to preface, I matched during COVID, so we didn't have this big grand ceremony like we were planning to at school. So, we matched, everybody matched, in the comfort of their own home.
So, my family videotaped me opening the NRMP email. It was very neutral. And I'm not one to openly express vivid excitement or sadness to begin with. But looking at that video, I can tell there's slight disappointment because it was not what I was expecting to not match at my number one, which obviously was orthopedics at the time. It took a few days for the reality to sink that it was not orthopedics, because you set yourself up to match at your number one. And this is for any applicant, whether or not you're dual applying or whether you're applying to just one specialty. You set yourself up to match at your number one for all of these weeks or months that you're setting your rank list.
And when it finally hit that, okay, I matched not only at a place that wasn't my number one, but at a specialty that wasn't even my top choice, I took comfort in the fact that, okay, well at least I'm in the same city, at least I'm in Chicago, at least I don't have to make a big move anywhere else. And at the end of the day, at least I'm in a specialty that I chose, and I did not have to scramble into. I did not have to... It was a specialty that I wanted anyway.
I try not to look at my Match Day photos still to this day because of that. I am very happy where I'm at, I'm very happy that I landed in OB/GYN, but there's still that little disappointment because you set your expectations so high, and you don't get to that point.
Murphy: Having spoken with students and program directors for a long time, you do often hear the advice, envision yourself matching at any place you rank. It sounds like you didn't do that. Would you advise students to actually follow that advice?
Dr. Kishawi: Yes. And only rank places that you can see yourself going to. Obviously, that's what we all say. And at the end of the day, you will end up putting a lot of your hopes in your top choice or your top three. It is very difficult to remove the emotion, I will say, from at least the top few choices. And if you can, and you are able to do that, then you really should because there will always be that slight bit of disappointment or resentment.
I mean, I know physicians who to this day, some of the physicians that I work with who have been in practice for 20, 30 years, who to this day feel a little bit of disappointment or resentment that they did not match at their number one. And they're so far removed from residency, but they're just a little bitter about it.
And it's hard for people to remove themselves for that as much as we tell people to. It's very inherent. You make it to medical school, you've put all of this effort into something, you've always been the top of your class at some point to get this far. And to not match at your top, you're going to feel some sort of way.
Murphy: Well, how do you feel about it in hindsight?
Dr. Kishawi: There is still a little bit of disappointment, I will not deny that. But I am incredibly grateful for the opportunity that I have to be at St. Joe's. I think obviously in hindsight, it is definitely the place that I need to be to be successful for who I want to be as a future physician, the kind of career that I want to put myself out there to be and the kind of work that I want to do. I am at a small community hospital in Chicago that serves some of the largest federally qualified health centers, which was a very big reason I went into medical school in the first place and a very big reason that I want to continue practicing medicine.
So, it is something that's been a great privilege to me, and I am very happy to be at St. Joe's where I'm on a weekly basis working at a federally qualified health center. I'm able to speak my native language. I'm able to speak multiple foreign languages on a daily basis to work with these patient populations.
So, it's just been a huge privilege, a huge advantage to work in women's health in a field that is so politically charged with obviously everything that's going on. There's a huge push religiously, politically with the bioethics, which is something that I'm heavily interested in as well. So, it's been a great opportunity for me, and I'm both incredibly grateful and incredibly happy to be where I am today.
Murphy: So, it does work out.
Dr. Kishawi: It does, eventually.
Murphy: Do you have any other advice for our listeners on the process of dual applying?
Dr. Kishawi: Make sure that if you are dual applying that you are happy in both specialties and you would be very content in either one of the two.
Murphy: Well, thanks for that advice and all your insight, Dr. Kishawi. We so appreciate you taking the time to join us today.
Dr. Kishawi: Thanks for having me.
Murphy: Thank you for listening. This has been Making the Rounds. I'm AMA senior news writer, Brendan Murphy.
Unger: Don’t miss an episode of this Meet Your Match series. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.