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Shooting for a Competitive Specialty, 4th Year

By: Katie Unger

About me:

Hey! My name is Katie Unger! My husband's name is Josh, and we have 2 little boys Bentley and Brody. We are 4th years, and I can’t believe we are almost done! It has been the funnest, yet most stressful journey.

After the first day of medical school my husband wanted to drop out. No joke. I literally left town with my child because I couldn’t watch it happen. I felt like my world was ending. Hahaha So the fact that we are here now, is the biggest miracle. If we can do it, so can you!! After that day, it really never got easier.

(Until third year, the golden year ) But the first two years I wondered everyday

if my husband would drop out. We wondered if we had made a mistake going to medical school. Every test was absolutely terrifying. My husband's strengths are not test taking. So the first two years were just really hard and scary for him.

But we made it to 3rd year and EVERYTHING changed! My husband's first rotation was Orthopedic Surgery. It truly wasn’t even on our radar. And we didn’t think he had the scores for it. But when he was there, everything made sense in the world and he never looked back. It was Ortho or bust. His preceptor in St. George told him he was the best student he’s ever had and that he should go for Ortho. Despite his “average” scores, Josh is amazing in person. And he’s the best people person. So his preceptor had all the confidence in Josh matching. And that’s all Josh needed to hear to go for it.

It was terrifying, yet exciting to go for ortho. Terrifying because Ortho is already so hard to get into, and having lower scores lowers that chance even more. But also thrilling and exciting because Josh had a passion for it and was ready to go all in! I was just so happy he loved a specialty after not being sure the first two years! I also knew, Josh had what it takes and can work hard. I knew if they could just SEE him and not focus on a test score. He could match.

We knew we would have to work extra hard since it would be even harder for him to match. So we booked as many rotations as we possibly could into the 6 month time frame that we had. He ended up doing 7 rotations. We also knew we could only feasibly afford this if I moved back home into my parents basement. So me and the kids are currently in Mapleton, UT!

Right now we are in our last of audition rotations! But we are almost done! It’s truly gone so so so well. I couldn’t be more proud and he’s had amazing feedback. I truly think we have a great shot at matching. This journey has been so worth it! Even if we don’t match, I would have rather seen him try than settle for something he didn’t love as much.

Common 4th Year Questions:

How do I explain 4th year to my non medical family?

Man, can I link my fb post? Haha I’ve got you covered. I made the longest post of my life about 4th year as we were going into it. Just so everyone understood why the heck Josh was going to be away so long haha

My Facebook post will be way more detailed. But here’s the jist.

During 4th year, my SO will be traveling around the country doing month long in person audition rotations at residencies. He will be gone for () months. It’s very expensive and time consuming. But it’s how they get noticed. Then the programs decide if my SO will receive an interview or not. After interviews, the hospitals rank all of the interviewees, highest to lowest. The interviewees also rank all of the hospitals they interviewed at, highest to lowest.

Then everyone sends in their ranking lists to a 3rd party organization called “The Match”. Basically a computer system that compares all of the list rankings and then places students at hospitals. The hospitals don’t choose who they get. Nor do students choose where they go. The match chooses (based off the ranks). And once someone is placed, it’s binding. You cannot change it.

Some students and hospital spots are left without being matched. Because they unfortunately weren’t ranked high enough. So these people/places enter the “SOAP”. Basically what you consider the clearance box. If you are part of the SOAP, you have 4 days to scramble through the clearance box and find a job. It may not be what you wanted, but it’s what is left. And you need a job. If you do not receive an offer from a hospital after 4 days, you will have to wait until the following year and try again.

But let’s not hope for that last part!

How does the application and finding rotation auditions process work?

I don’t know all of the nitty gritty details of the actual applications. Because I had no part in his applications for audition rotations. But I do know the general idea of what he did!

Make sure you are on the ball! Find out whenever your specialty applications open, and apply right away! Spots fill up, so you don’t want to be last. I saw many people stressed who waited too long to apply. It made it tough for them to find open spots!

My husband only applied to places that he had some kind of connection to. Whether they accepted RVU students before, if a preceptor in St George knew a program director somewhere, if he did a boot camp there before, or a fellow BYUI student was there, etc. And it made the process super easy. He was accepted to basically every place he applied for an audition to. There were only a couple places that said no. We really didn’t have any trouble at all filling our audition spots quickly.

So basically just be on time and one of the first to apply, and apply to places where you have some sort of connection.

How expensive is 4th year?

So so much hahaha At least for those who have to do a lot of rotations. Truly the only way we were able to afford this, is because I moved home. Most of the loan allotment for the first 6 months went entirely to his travels.

However, we did allot ourselves $150 a week for things like gas, eating out, fun things with the kids, etc. He got $60 of it, I got $90. (Since we lived apart we divided it. I had more because of kids.) So basically we lived on $3600 for 6 months for the day to day stuff. We lived very frugal this year. If anything was rolled over (which was rare) I put it into savings. And then we also had a phone bill/car insurance.So I would say a rough estimate of our audition rotation costs was $15,000. The other $5000 was used mostly for day to day living/bills/some savings.

The second half of the year is nicer though! Because he didn’t have to travel at all and we didn’t have any rent payments! So we used the next loan allotment for vacations, car repairs, we set aside $6000 for moving costs, and about $4000 for mortgage costs for the next place. Because if you move in June, you don’t get paid until the middle of July. So we wanted to make sure we had a mortgage payment for at least 2 months with some wiggle room. And some living expenses of course. We also have some savings in case who knows what comes up. (Something always comes up in medical school) Haha There is just so much to consider! Haha make sure you budget and think of everything before you spend it all!! Haha

How does travel and cost breakdown?

I think I touched on this in the first question enough! We spent roughly $15,000 on rotation travel and various other medical school costs. And roughly $5000 was used for bills, day to day living expenses, and some savings. For that 6 month duration.

Should we get an airline credit card? Rent a car? How does your student go from place to place?

We did not get an airline credit card. Just because I really only use one credit card to keep it simple. It’s through our bank. I compared it to many other cards, and I think ours had similar competitive benefits! But mainly, I just don’t like balancing more than one credit card. Haha

I do know there are great sign up bonuses for some credit cards that could be very helpful though. With the amount of spending you do in 4th year, I’m sure you could access those points quickly. It’s a wise choice if you don’t mind adding another card to balance!

Josh drove his car. We looked into flying him around and using rental cars and it was outrageous!!! It would have cost like $16,000 just for 3 months! Rental car prices were at an all time high though. Things may have calmed down since then. But there was no way we could have done that. I felt bad for Josh having to drive so many hours. He drove so so so many hours all over the country. But it was the better choice. And it was nice for him to have his own car anyway.

Any money saving hacks for 4th years?

Set a budget and you HAVE to stick to it! Make sure to consider alllll expenses over the 6 month loan period. You can not neglect this year and get reckless. Because if you eat into another category, you will be in a real sticky situation.

Something I love to do is save any and all cash given to us. Cash I receive from doing hair appointments, birthday cash, holiday cash, cash from selling stuff, any sort of hard cash, save it! All of that is now helping us pay for part of our vacations. :) It’s so easy just to put it away and save it since it’s like it was never in the bank anyway!

Move in with family. I know it’s not ideal and it can be hard with kids. But none of this is ideal! Haha And it’s only 1 year. This has saved us so much money. And it’s the main reason why we didn’t have to pull out extra loans.

Is my student really gone for 6 months straight?

Pretty much! But again this is for a competitive specialty. Josh did visit 3 times, 1 week each time. So I saw him 3 weeks total out of the 6 months.

Where did your student stay?

We booked most of our places through It’s the best! The people who own the homes are usually residents or other students. It’s way cheaper than Airbnb and often a better setup. And because these people are in the medical field, they understand the situation. He always just rented an open room in someone's house.

Sometimes the hospitals will have affordable recommendations too! He did stay for free at one place that the hospital recommended. So definitely ask them too. :)

He did also stay at one Airbnb. And it was a dump. He couldn’t wait to get out of there. Haha But it’s what we could afford. So definitely use if possible! You get a way better deal than on Airbnb.

What to expect family wise with your student gone? Routine?

You know I really did great the first 5 months. And it was nice to have my parents for support. I was still able to go to the gym early. Because my mom was home if the kids woke up. My mom and I traded off cooking, so I didn’t have to cook every night. I started to go walking every night with the kids, and I lost 15 pounds just from that alone! Haha it was great! I really was doing well. I just stuck to my normal routine and tried to get out with my kids as much as possible.

The last month though... that was so hard. Because now it was winter, I just felt stuck at home, and my kids were sick all the time so it made it hard to go anywhere. And I also got pregnant! I know crazy. Even though I rarely saw him, I still got pregnant! Haha So I was just really really struggling that last month he was gone because I was in my first trimester and so tired. I was dying to have him back home. I just needed to get out of the house and have a break! Haha

As far as my kids, they did about as good as I could have expected them too! Brody my youngest (1 1/2 at the time), was so young and had no idea what was happening haha I don’t think it phased him at all. (Although he loved seeing Josh when he visited!) My oldest (4 at the time) did have a hard time with it, but it wasn‘t unbearable. We FaceTimed every night and would always remind him that we would see him soon. He would say he missed Josh everyday. But I think he handled it as well as he could have! I don’t feel like he changed too much from it. But maybe towards the end it was harder for him too.

Can we visit our students? Do they have time for us?

Absolutely you can! We chose not to, just because it would be expensive to fly us all out there. Also I have heard from a few sources that it’s tough to visit too. Because they are so busy and you usually only have one car. So you are usually just stuck at home while they work all day. But who knows, maybe it would work great for you!

How is communication between Student and SO?

We try to talk/FaceTime every night! Some nights we missed. But that was the goal. We did text during the day, but I also know he was busy! So it wasn’t a lot of texting. Overall I think it was as good as it could have been!

Can I expect to have my student back for the holidays?

Unfortunately, no you can’t expect it. However, the stars aligned for us and he was able to visit during Halloween, Thanksgiving, and Christmas. We didn’t plan that. The scheduling just worked out thankfully! But I do know others that had to work around holidays unfortunately.

How many interviews can you expect?

For a competitive specialty (and based off RVU statistics for surgical positions), I would say you can expect 2-8 interviews. It’s just tough. And surgical specialties especially. Josh ended up getting 6, and that was on the higher end of what we have heard others receiving.

Is there a limit of how many interviews you can do?

No! However, there is a limit before you hit burnout from doing so many! I know some people in other specialties doing 20 interviews. But then started denying interview requests after that because it was causing burnout. You can take on as many as you want. But it can be a lot.

With competitive specialties like Ortho, you should do as many as possibly offered!

How competitive are the interviews and audition rotations?

It is competitive, but Josh has really felt comfortable with the people he’s been with. It hasn’t been super cut throat or anything. I can’t say how other specialties are, but Josh has experienced a lot of camaraderie. He made friends with all of the other 4th year students he rotated with. And many of the residents and surgeons were all very kind! It was a good experience! And his interviews all went great.

However, they interview about 10-15 people per spot. So you just have to hope and pray you are one of the lucky ones. Because those aren’t great odds.

How does the match work?

I think I explained this decently enough above! Again, for a much longer/detailed description, see my fb post!


Facebook Post From Katie Unger April 20, 2022:

“In a couple of months, Josh begins 4th year. Our last year of medical school! Ooof. This year will be filled with excitement of possibilities, imagining our future, a lot of separation, and anxiety of the unknown. I can’t believe we are here though! I feel like he was just in undergrad thinking about the MCAT, and dreaming of getting into med school just yesterday. And now, here we are almost *finished*.

As exciting as this year is, trying to get a job as a Doctor is not like any normal job haha Let me attempt to explain the craziness that’s about to happen this year. This will be a long post (but maybe read it so you can appreciate what your doctor went through to get their job) Hahaha

During 3rd year we applied for audition rotations at residencies. July 2022-January 2023, Josh will be traveling solo around the country doing 2-4 week long rotations at these hospitals. Everything is out of pocket, nothing is paid for. Flights, rental cars, housing, food, etc. He receives no compensation for the work he does at the hospitals. On average it costs about $10-15,000 out of pocket to do around 3-5 rotations. Josh is doing 7 so far, so I can’t even imagine how much this will cost us. But this is just what it takes to get a Doctor job. You are hoping and praying they like your personality and see you’re work ethic to consider you for an interview. Keep in mind, they accept hundreds of students aiming for the same goal. And all of these students are amazing candidates. You HAVE to make a good impression during those 2-4 weeks so that they will remember you come interview time. (I have no doubt Josh will leave a good impression. If you know him, he’s amazing with people. But that’s a lot of freaking pressure to be on your A-game for an entire 6-7 months trying to impress all these different residencies and not “mess up”. Burn out is a real thing during this time.) They are also supposed to be doing things like research on the side, volunteering, anything to beef up their applications. It’s a lot.

Then you start the application process just for interviews. And they aren’t cheap. Haha Because of the competitive nature of the specialty Josh wants, we were advised by program directors to spend $10,000 alone on applications for interviews. That’s 180 program applications, to hopefully get at least 8 interviews. Tell me those numbers aren’t bizarre…Normally when you buy bulk, the individual items are cheaper. However, not with med school applications. The more you apply to, the more expensive each one gets in order to try and limit the amount of programs you can apply to. Can I also add that we are paying tuition for this year on top of this? Which I’ll be honest, doesn’t make any sense to me since 4th years are completely on their own. Haha The last year of tuition should 100% go towards traveling and application fees. Just my two cents..

After interviews you wait for “Match Day”. Residencies can’t just hire you after an interview if they like you. Instead, both you and the hospitals rank each other on separate lists. Then you submit those rankings to this third party organization called "The Match". The Match compares all the rankings, and then places you somewhere in the country where you are going to live for the next 3-7 years for residency training.

On a Monday in March we will get an email that either says “You have matched.” Or not. It’s doesn’t say where or anything. Just that you’ve matched. If you don’t match, you enter the SOAP or “scramble”. Basically where you scramble for spots that haven’t been filled. All of the other students who didn’t match, are also trying to fight for those spots. Places and specialties that you probably didn’t even initially want (but you have to convince them you want to be there), because thats what you’re left with. And you need a job. So you take what you can get to pay off your insane loans. This process lasts 4 days. You have 4 days to scramble and find something. If you don’t get an offer in those 4 days, you don’t have a job. You can try the process all over again in a year from now. (Oh yea, and you have to start paying back your loans now. So find some sort of job in the meantime.)

Finally on Friday, you will find out where you are going. And it’s binding, you have to go there. You can’t try and work something out with somewhere else, unless you want a lawsuit hahaha For reals, they have lawyers just for “the match” if anyone even talks to another program. You go where the match has placed you. So you hope and pray that luck is on your side, and you match with one of your top choices. Talk about the craziest week of your life.

Again, if you initially match on that Monday, you don’t need to enter the SOAP. So we may not have all of the extra craziness. But the reality of it is, there’s a high chance we will because of the specialty he’s going for. For his specialty, statistics report (maybe even higher), he has a 55% chance of not being matched and having to enter the SOAP. There’s even a chance we could get nothing and have to try again the next year.

But I can’t say how proud I am of Josh for going for his dreams. We don’t know the outcome. Trying to become a Doctor is brutal. (As it should be, because you are dealing with peoples lives.) But man sometimes, the process is just a lot to endure and freaking scary. The amount of studying, money, and the whole application process is a lot to go through to have no guarantee of a job. But im dang proud of him for trying his best for his dream job. And I have such high hopes for him. He’s doing everything he can on his part. And we know, God doesn’t need statistics for success. He can make miracles happen.

So can you say some prayers for us you guys? Hahaha This next school year is about to be a doozy. It could be the best year of our life, or go downhill really fast Hahaha But I’m excited and anxious for our future. I know when these hospitals meet Student Doctor Josh Unger, they will be amazed. No matter what happens, I’m here for Team Josh!”


What are the pros/cons?

Pros: If he matches, it would be the most fulfilling miracle ever! I would be overjoyed if he got his dream job! It’s been such a fun process to watch him reach for the stars. And it also comes with a REALLY nice paycheck in the end.

Cons: I mean, we could end up with nothing haha There is a very high chance we will not match. Which is terrifying. And it’s obviously expensive and a lot of time apart. But right now I’m just focusing on the goal! And whatever comes, we will deal with at the time.

10 best things your student should have when off on audition rotations.

1. Do grocery pickup orders for them. I know it’s not really a “thing”. But it’s super helpful. They are so busy, grocery shopping isn’t really top of the list. It’s really helpful if they can just go pick it up at the store and not worry about it. (Do lots of easy or frozen meals because kitchen set up isn’t always ideal)

2. Comfortable shoes for rotations.

3. 1 suitcase for winter clothes, 1 suitcase for summer clothes.

4. Send them off with lots of toiletries. That way they don’t have to shop much. I sent Josh with lots of toothbrushes, toothpaste boxes, soaps, laundry detergent, etc. Just anything to save him some time from having to go shopping.

5. Xbox. I know this is random. Haha But Josh brought his Xbox with him. Most places had a tv in his room. Something to do on downtime, decompress after long days.

6. Find out what reference books or websites are popular for your specialty. Orthopedics has pocket pimped, ortho bullets, handbook of fractures, etc. a good reference manual can help you shine on rotations.

7. Bring gym clothes and running shoes. Use some of your down time to go to a gym or go on a hike. Residents like when you are enjoying the area. It shows them that you care that you may live there for 3-5 years.

8. Hangers. Some places you’ll stay might not have them so bring them just in case. Especially if you have clinic days and clothes you want to keep nice.

9. Socks, I know this is obvious but keep an extra set of socks , underwear, and toothbrush in your car or bag for when you are on call. It makes a world of difference when you can change into fresh clothes after a long night.

10. Nice clothes for an interview. Depending how long you are on the audition trail it may be difficult to track down a nice suit or shirt for interviews. Get it ahead of time so you don’t have to stress come interview season.

Any other advice or things you want others to know?

  • Go to boot camps and conferences! Go to as many as you can. Josh only went to one bootcamp. But he was offered an interview at that place just because he did a weekend boot camp there and they remembered him. (Had I known this, I would have signed him up for more!) haha But aside from that, just the confidence, knowledge, and exposure they get from these conferences and bootcamps is worth it!

  • Tell your student to volunteer in education class! You're SO will go to education class with the residents at the hospitals. They will ask for volunteers to present the case/X-ray/or whatever. Volunteer! Josh was at a new place and decided to volunteer. They told him that was one of the best reads they had ever heard. And they told him right there on the spot he would be getting an interview. They loved him from that moment on for the rest of the rotation! Haha That one brave volunteer moment could have landed us our future job!

  • Choose month long rotations over 2-week rotations if possible. Especially for competitive or surgical specialties. It’s hard to get noticed well when you are only there for 2 weeks at a surgical residency. Josh did 2 2-week rotations and those are the only places he didn’t get an interview at. We would have had better luck putting our time into just 1 1-month long one. Rather than 2 2-week long rotations.

  • Just go for it! It’s scary to go for something so competitive. But it has been 100% worth it. Whatever happens, it’s been a fun journey to watch him thrive! You got this!

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