While they tend to prefer recent medical graduates, there are a handful of residency programs that accept old graduates due to their more lenient requirements. If you graduated some time ago and are just now getting to residency for whatever reason, you may have more obstacles in your path. Nevertheless, entering medical education once again and becoming a resident doctor is a formidable undertaking, regardless of when you initially graduated.
This article describes how certain residency programs in the United States and Canada treat older graduates and how to submit a stellar application if you are in this distinctive situation. We also cover the benefits of seeking professional residency help if you wish to get into a post-graduate program as a more mature applicant.
Disclaimer: Please note: although we have made every effort to provide the most accurate information, admissions information changes frequently. Therefore, we encourage you to verify these details with the official university admissions office. You are responsible for your own results. BeMo does not endorse nor affiliate with any official universities, colleges, or test administrators and vice versa.
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List of Residency Programs That Accept Old Graduates
When residency programs accept more mature graduates, it can mean both in age and in terms of past graduation year. These two qualifiers are inherently tied together because if a medical graduate completed their studies years before applying for residency, they are most likely older than others who have recently graduated. Many programs across the United States and Canada are vague about graduation year cut-offs, and admissions information changes every year, so there is no way to make a truly complete list. Nevertheless, here are some standard examples of how programs might accept older graduates:
1. St Joseph’s Medical Center (Dignity Health) Orthopaedic Surgery Residency Program
You’ll be less lucky with surgery programs, as they tend to be rather selective and prefer recent medical graduates. However, the orthopaedic surgery program at St Joseph’s Medical Center in Stockton, California (near Sacramento), is more open. They openly state on their FAQ page that they do not have a graduation cut-off year and that they accept any qualified candidates. This is one way that a residency program could be more open to older graduates.
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2. Hoboken University Medical Center Family Medicine Residency Program
When taking into account how to choose a medical specialty, the primary care specialties, including family medicine, usually have the highest match rates in both the US and Canada. Applying to these types of programs is better for non-traditional applicants or those who have been out of medical school for some time. The Hoboken University Medical Center family medicine program in New Jersey has no direct information about their graduation year cut-off requirements. For older applicants, sometimes not finding a specific cut-off year can be a good thing since older applicants may not be discarded right off the bat if this is the case.
3. Tower Health Internal Medicine Residency Program
On the other hand, this internal medicine residency in West Reading, Pennsylvania, does specify that they have no graduation year cut-off, rather than leaving it up to interpretation. As it is an internal medicine program, they include various subspecialties older graduates can partake in, such as cardiology, hematology, pulmonary critical care, and more.
4. St Barnabas Hospital Pediatrics Residency Program (Bronx)
Internal medical graduates (IMGs) can also be older graduates when they are applying outside of their country of origin. It is important for these applicants to find IMG friendly residency programs that are better suited to their needs. The St. Barnabas Hospital Pediatrics residency program in the Bronx does not state any particular graduation year cut-off and is very open to IMGs. New York is also listed among the top IMG friendly states overall.
5. University of Virginia School of Medicine Physical Medicine and Rehabilitation Residency Training Program
This program in Virginia is another example that does not have an explicit cut-off, but they prefer that applicants have graduated within the last five years. Many schools will also pay less attention to graduation year cut-offs if you have been involved in clinical experience since your graduation, which is the case for this school.
6. Rural Family Medicine Residency Program at the University of Calgary Cumming School of Medicine
Rural programs may also be an option for older medical graduates due to the necessity of health care in these areas. The rural family medicine program affiliated with the Cumming School of Medicine does not list any graduation cut-off year for its Canadian applicants; however, reference letters submitted through CaRMS must relate to work experiences that have occurred within the last 2 years. Therefore, if you are an older medical graduate looking for residency, having relevant clinical experiences in the years before applying is essential.
7. Family Medicine Residency Program at the University of British Columbia Faculty of Medicine
There tend to be fewer exact graduation year cut-offs listed in Canada, but there are also fewer opportunities for residency overall when compared to the US. The very well-developed family medicine program at UBC is one that does not specify any limit for its applicants. This department includes 20 potential training programs, ranging from rural to urban, and is generally IMG friendly. They are accustomed to having non-traditional applicants become successful family doctors after completion of their program.
Whatever the reason for a later application to residency, each individual program will have different requirements and preferences for when their residents graduated. Some schools will not have a cut-off at all, while others will have a cut-off of one or two years, which can be restrictive to older medical graduates. While these filters are occasionally not concrete and can be bypassed from time to time, it is a smarter decision to apply to programs without these restrictions to maximize your chances.
What Do Older Graduates Have to Do to Get Matched?
If you are an older medical graduate asking yourself “what do residency program directors look for?”, the information is out there if you seek it. What’s most important is a stellar application that can testify to your suitability for the medical profession. Even though certain programs are very strict, there are some loopholes and other programs to find if you are applying to residency as an older graduate. It does not mean that all hope is lost.
A lot of older medical graduates tend not to be considered, as their experience in school is not as fresh, and it is less likely that they have recent clinical experience to pull from. Getting matched would require superseding these expectations by having consistently worked toward a career in medicine over the years, submitting riveting personal statements, and delivering strong letters of recommendation. Applying strategically to schools that may accept you is also key to your success. Here are some specific measures you can take to increase your chances of getting matched:
1. Clinical Experience
As an older graduate, your process for how to prepare for residency applications is truly not that different, except for the years you have outside of medical school. The main question program directors will ask themselves is: What did you do with the time between then and now? Probably the most important aspect of your application is that you want to show program directors you have been consistently working toward a career in medicine, even if there are several years between your graduation and your application to residency.
Close proximity to a primary care specialty is ideal since these are the programs that are most likely to accept you, but there are other possibilities. Maybe you were enrolled in an MD-PhD program or another relevant graduate program which took up some of that time. Your education, when combined with whatever practical work experience you garner, should make you a qualified applicant.
If you completed your medical studies abroad, learning how to get into residency programs as an IMG is just as crucial, perhaps even more so. You already have fewer chances of receiving a match but being an older IMG may further reduce the probability of an acceptance. Therefore, your application really needs to be exceptional to be considered. Finding the right IMG electives and clinical experience in the US or Canada before applying for residency will be key to your acceptance. Contacting institutions yourself for potential externship opportunities can be a beneficial strategy for you since these experiences are not guaranteed for IMGs.
All in all, program directors want to see that you are still making a great effort to break into this field. You will need experience in your specialty to indicate your aspirations for a career in medicine. If you spent the years after graduation immersed within your field of medicine through shadowing hours, rotations, or another form of clinical experience, being an older graduate becomes less of a crutch.
2. Application Documents
In addition to the clinical experience you acquire to prove your candidacy, your application documents are also extremely important to the process as an older graduate. Working closely with professionals in the field in your years after graduation will lead to a strong ERAS letter of recommendation or CaRMS reference letter. Your letters of recommendation will be crucial to whether or not you are considered by a residency program. Having attending physicians vouch for your candidacy will be persuasive to residency program directors, especially if they can attest to your work ethic and clinical knowledge as an older graduate. At least one of these letters should be written by a professional in the specialty you are applying to, but you may need all of them as an older graduate to truly prove your dedication to the discipline.
While letters of recommendation rely on the perspectives of others, how you present your story in writing through a residency personal statement will showcase your passion for medicine in your own words. You may be wondering if or how to address the years after graduation since a large gap in medical education is considered one of the most prominent red flags in a residency personal statement. That said, do not make excuses or shy away from explaining your absence from medical education. As long as you connect everything back to why you want to continue pursuing medicine and the work you have been doing to get there, it is always best to be genuine in a personal statement or any other related document. The same principle also applies to a residency CV, where your list of achievements and professional experiences should account for any significant absence.
3. Exam Scores and Certification
Another aspect of your application you will need to keep in mind as a more mature applicant are your licensing exam scores. If you are from the US, even though you completed USMLE Step 1 and possibly Step 2 CK, these scores expire after seven years. There are options to retake a passed USMLE step if you meet certain requirements. Keep in mind, after passing the first two steps, you may also need complete USMLE Step 3 before residency due to the years you have spent outside of medical school. Most people complete the final step 3 after their first year of residency, but it may be better as an older graduate to have all your bases covered beforehand. Check out whatever exam requirements exist and whether you are eligible to retake tests if necessary. This will show program directors that you are on the ball and still have a strong desire to become a medical resident.
In Canada, a passing score on the MCCQE Part 1 does not have an expiry date, and the test cannot be retaken. The National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE) can be taken a maximum of three times, regardless of whether you passed or failed. Only your most recent result on the examination remains valid indefinitely and does not expire.
IMGs will need to acquire ECFMG certification to take these exams and apply to residency programs in the United States. Make sure to check out what documents and test scores you will need for whatever program interests you, as they may depend on the location, specialty, or the residency program itself.
4. Interview and SJT Prep
Brushing up on your interview skills will never hurt your chances since it may be some time since you interviewed for a medical position. It is a common misconception that you cannot prepare for interviews, but this is simply not the case, especially for an older medical graduate. Residency interviews have their own angle that is unique to them, as they ask pointed questions meant to evaluate whether you will be a qualified doctor and colleague in their institution.
You will need to draw on both current clinical experiences and former time as a medical student to truly succeed. One way to prepare for a residency interview is to read sample residency interview questions and answers. This will allow you to know the types of questions that may come your way and figure out strategies for how to respond effectively. The interview format is also important since residency programs may use a traditional, panel, or multiple mini-interview (MMI) style. Participating in simulations or a residency mock interview for the format you are preparing for will be your best bet to ace your official residency interview.
When applying for residency, many programs are now beginning to implement situational judgment tests (SJTs) as part of their application process. An older graduate may not be as familiar with these methods, as assessments such as those from the Altus Suite are currently growing in popularity. These tests are meant for residency program directors to select the best possible candidates, as other evaluation methods were no longer producing desired results. Not every program requires these, but in case you need to complete them, read up on some CASPer prep tips as an example of this type of assessment to be aware of what to expect and how to tackle these additional tests.
Technically, there is no set amount of time that constitutes how long it takes to become a doctor, so that is why older graduates are welcome in some environments. Mature and non-traditional residency applicants can often feel discouraged due to their perceived lack of options, but there are avenues available. You just have to look for them a little harder and go the extra mile in your residency applications to guarantee a match.
Partnering with a residency prep company may be the practical solution to avoid going through this process alone. Expert consultants will provide you with the best course of action for your situation, including information on how many residency programs to apply to and which schools or medical centers will be the most receptive to your candidacy. In the case of a mature applicant looking to officially start their careers, a helping hand could make all the difference, so do not overlook the value of asking for one.
1. What is considered an old medical graduate for residency?
On average, what is considered an old medical graduate for residency will be older than for medical school. Since some programs will have a graduation year cut-off of five years, anyone who has graduated more than five years before they are set to begin their residency is considered an older applicant. Someone who is over the age of 40 may also be considered a mature applicant, regardless of when they graduated. Any candidate who has completed many clinical experiences post-graduation but has not yet enrolled in a residency program will also be considered a mature applicant.
2. Is there still a chance for me to become a resident doctor if I am an older graduate?
Yes, there is, but you must do your research and apply strategically. Even if you do not match the first time around, there are measures to improve your residency application after going unmatched. That being said, these should only be used as a last resort, especially by mature applicants.
3. Which residency match services do I need to become acquainted with?
Residency match services could make your application process a little smoother. In the US, ERAS is the main application system, while pretty much every residency program in Canada uses CaRMS. In using these services, you can prioritize your applications through a residency rank order list to give yourself the best match options.
4. Will I need to retake the USMLE if I am an old graduate?
This depends on how long it has been since you took them and/or graduated from medical school. If you have previously passed these exams, your results are valid for seven years. It is possible to retake a passed step under specific circumstances. For instance, you may retake a passed step to comply with the time limit imposed by a medical licensing authority. You can find more information about eligibility requirements on the USMLE website.
5. Is it harder to get matched with a residency program as an IMG?
In short, yes. Being an international medical graduate as well as an older graduate will essentially add two strikes to your application, but it is not impossible to receive a match. If you find IMG friendly residency programs, these schools and medical centers may also be friendly to older graduates.
6. Who should write my letters of recommendation?
If you are a mature applicant, your letters should primarily be written by attending physicians or supervisors in the field who you have worked with recently, know you well, and can fervently attest to your candidacy for residency. Depending on the amount of time since you’ve graduated, academic references or professors from medical school may not be viable options for you if has been too many years.
7. What is the Altus Suite?
The Altus Suite, developed by Acuity Insights, is a trio of assessments consisting of CASPer, Snapshot, and Duet. They are meant to further illustrate your candidacy for medical school or residency programs. The school or program you apply to can choose to require just one or a combination of them. These assessments, especially CASPer and other situational judgment tests, are becoming more and more prevalent in medical school and residency admissions to evaluate potential candidates.
8. How can academic consulting services help me receive a residency match?
A residency application consultant can help with the A to Z of applying to residency programs. It is essentially having a trained expert dedicated to your success. This can include providing tailored feedback on a residency letter of intent. Consulting companies may also offer residency interview coaching that will help you at the interview stage, which is one of the last chances to secure your spot.
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