I am a PGY-5 in an integrated vascular program.
Reality check: You are fine. You will get looks at all the programs that you apply to. Step 1 score is well over any floors that programs have and assuming that your research is in vascular surgery (or at least surgery oriented), no program is going to pass over a chance to look at you (assuming you have no red-flags). On paper, you are among the better applicants in a given cycle, so again, even if everything else is 'average', you will match somewhere if you apply broadly. A few topics to consider:
#1 Increasing your odds at matching particular programs. If you want more 'choice', the most important things for you are LOR and aways. Some 30%+ of our residents did research with us or aways with us before matching. If you are a good fit for a program, it will help you go up the program's match list. On the flip side, 70% of our residents (including yours truly) had no relationship with our program, so it isn't exactly a "must". LOR are really important in vascular surgery. The field is just so small and everyone in academics knows everyone else. A lot of phone calls/texts happen about applicants. If you don't do an away somewhere, people want to get the scoop on you and will call up the PD at your school or whoever is writing letters for you. It is normal for people to have 3+ vascular surgeons writing letters. Certainly not a requirement, but that is what most people are getting these days.
#2 Application strategy. Geographically limiting yourself will hurt your prospects of matching IVS. Purely from a numbers game, there just aren't that many programs across the country. From talking to applicants this year, it seems like most people applied to 30+ programs and interviewed at 15-20. Personally, I applied (6 years ago) to 50+ programs between IVS and GS and interviewed at 20 of them. These are clearly overkill, but given how the match system works, it is hard to imagine applying to less than 20, but I certainly can't give you specific feedback on your risk tolerances. The end point is, you need to figure out where your other programs are going to come from. Which is more important to you, geography or IVS. If geography, add in GS programs in the northeast. If IVS, add in more IVS programs further away from your desired location. But, at least initially, I'd have a list of 30 programs that you can cut down from if necessary prior to applying.
#3 How to pick a program. You gotta interview first. You can't rank programs you didn't interview at. However, in brief. You need two things to become a good vascular surgeon: #1 Availability of pathology (patients/cases). #2 Good faculty mentors that will teach you how to manage the pathology. It sounds so stupidly simply, but there are nuances to both of those. Every program in the country will get you both of those, or enough to graduate and do vascular surgery. The vast majority are successful fellowships that converted over. Obviously new programs will undergo growing pains along the way, but you will get trained. Everyone will get you your numbers. Which brings me to a pretty big warning. Numbers are misleading. Just because every program gets you to your ACGME required numbers doesn't mean that you will get an equal operative experience. There are a ton of cases that are NOT recorded/required by the ACGME, but are the bread and butter of vascular surgery. Amputations, major and minor, Tunneled lines/ports, dialysis access, veins etc. are not tracked, but they are important for three reasons: First, they are what pays the bills and makes you valuable to hospitals in the future at least initially. Second, they are the junior cases for you to cut your teeth on, senior residents are going to give up all those cases if they are in abundance to their juniors. As a PGY-2/3, you still need a lot of non-OR learning, but you want a lot of short cases for you to get into a rhythm on. Getting 10-50 cases a month does that and makes starting to take on the more complex that much easier. Third, everyone poo-poos those small cases, but I've seen enough variability among vascular surgeons (and non-vascular surgeons doing those procedures) to know that there is a HUGE difference between someone who has thought about, was taught and practiced those 'basic' procedures. There are a number of name-brand programs that will struggle to get you a high volume of these smaller cases and to me, that is a pretty big negative.
Faculty is much harder to nail down. There is a fair amount of turn-over in academics. But, faculty with a reputation of working well with residents makes a huge difference in terms of your ability to learn. I think the bigger issue is identifying the programs with bad core faculty than identifying the 'good' ones. Which leads to the actual most important thing:
Fit. It is all about fit. You are signing up for 5+ years of training with a group. This isn't like undergrad or medical school where you rotated professors, classmates, rotation sites, etc. You are stuck with the same <20 people for 5+ years, 80 hours/week. You don't have to click with everyone, but man does it make a big difference if you do.
Thanks for the tag
@Doctor-S
