4th Year, picking your specialty
 

Ok, I just need a little help....I know somewhat the basics of MATCH and applying to residencies and how test scores all play a role in determining what specialty that students will spend the rest of their life doing. But at graduation when you find out the results, could you be stuck with a field that you absolutely care nothing about?

One of my friends is in 3rd year med school and he wants ortho surgery but he is afraid he will not get it and will be stuck with something else. It seems almost ridiculous to go through all the schooling and money to be in a field you do not like.

Depends what you apply for and how willing you are to risk going unmatched. Nobody is forcing you to apply to a speciality that you can't see yourself doing, but it does help to have some kind of a safety plan if you are gunning for something competitive.

I think it all comes down to - rank every program that you would rather match to than go unmatched. And the answer to that is different for everyone.

But you have to go into medical school with the awareness that you may not be able to match to something super competitive. It's just part of the process.

i have to believe that if you are an AMG with no real black marks on your record (no failures, no professionalism issues), then you can get into any specialty you want. it might take extra time and multiple years in the Match, but you can do it. the truth is that most people get to fourth year and find that they could live with any one of several different fields, although they typically have a predilection for one. you'd be surprised at the amount of settling people do when they see that one of those is something that they might not match in the first time around, or that they might have to go to an unpalatable place if they do.

sometimes people who want ortho but have a marginal app will apply for/interview/rank several high quality prelim surg slots with the thought that they can buff their CV and get in on the next try (similar to med school reapplicants). more often they scramble once they find that they haven't matched. we don't have the scramble anymore of course but whatever.

Uh no. You aren't getting derm with a 189 step 1, etc.

You don't find out at graduation. You find out the results on Match Day in March.

You could only be stuck in a field you don't like if you also applied to the program in aforementioned undesirable field or SOAP'd (nee Scramble) into the field.

Yeah. It does. If you only apply to Ortho and don't match, then you can either SOAP into a different specialty, SOAP into a prelim in surgery and reapply, or do research and reapply.

the data beg to differ. someone is out there doing it. that's all i'm saying. i think people count themselves out of certain specialties all the time.

Oh ok, all that helps out alot, thanks guys!


What would you do in the meantime if it took multiple years in Match?

Not matching is a big deal. You'll understand better once you've been through the app process.

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No to pretty much all of this. If you have a low step 1 score but want a field like derm, you need to:

1. get an insanely high step2 score to show you can score well
2. spend a huge amount of time doing research projects in the field and making some great faculty connections
3. apply to every single program and take every interview you get and rank them all.
4. be willing to accept the possibility of not matching and having to spend a year "doing research" to boost your application for the next cycle.

A lot of programs supposedly have 230+ cutoffs to even get interviews. But some programs don't have cutoffs at all. There is a lot of self-selection that goes on because people are afraid of not matching. But if you pull up charting outcomes, you will see that people with below average step 1 scores do match into fields like derm.

Spending 5 years getting a PhD to become a clinical dermatologist is retarded.

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You're not matching derm with step 1 < 200; you're just not. Pore through the data all you want, it's just not going to happen. If you're dead set on doing it, you can try doing a number of research years first, or maybe even do another residency, although I'm not sure how much more competitive that would make you with reduced GME funding.

Agree

Oh PLEASE. Christ. I hate how people like you just speak as though they're the resident expert and therefore the "end all be all" on issues for which they have NO experience.

If I had listened to people like you, I wouldn't have matched into Derm.

It's pretty sad to see the pre-med blind enthusiasm bleeding over into Allo these days. Nobody is saying that it's impossible to match to competitive specialties with a low Step 1 score, but it's exceptionally poor advice to tell someone against whom the odds are stacked to keep pursuing his goals. You don't see me going around telling people that because I got into med school with a 3.15 GPA that they can, too - quite the opposite in fact. Out of undergrad, I didn't have much to lose. If I didn't get in, I could've gone to grad school for physics or had a fairly lucrative job consulting without much problem, so I just fired off a ton of apps and scraped in. Med school is entirely different. If you don't get a residency, you're basically done. If you go through these extra research years and work and whatnot to make yourself a better [competitive specialty] applicant, there's a good chance you'll just be throwing those years away, along with the physician salary that would have otherwise come with them. Are you willing to, in good conscience, tell someone with a 200 to drop 2 years and $300k (or more) to have a *slightly* better outside shot at that derm residency? I sure as hell am not. Please, don't be naive and extrapolate exceptions into be the rule, giving people what more than likely amounts to false hope.

OP, it is definitely possible to get stuck in a specialty you aren't interested in if you're going for something competitive. Hell, if you're a poor applicant for one reason or another, you might find yourself scrambling into whatever you can get, regardless of what you applied to originally. Dropping from ortho to gen surg is actually a fairly tame departure compared to some I've seen. Just in my class, we had ortho-->family, anesthesia-->family, neurosurg-->med/peds, and a few other shockers. As was mentioned previously, many people have an interest in more than one specialty, so you can often soften the blow of not matching your top choice pretty effectively if you apply and rank intelligently.

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This needs more attention. Way too many people think that if they apply broadly with low stats to ortho/derm/etc, that they are guaranteed to match at some community program lower on their list. Wrong. It is very common to go unmatched when applying solely to one very competitive field, and I wouldn't be surprised if those hardcore ortho prospects with low stats are thrilled to end up SOAPing into anything at all. Going completely unmatched is a HUGE deal and taking a few years to do research may not improve your app at all.

Unfortunately, there are some absolutes. In 2011, zero people matched derm with USMLE Step 1 < 190. [Reference] I don't agree with the practice of placing so much emphasis on the step 1 for residency, but one would be denial not to understand that it is common in certain fields. It's true there are some things one can do to make up for a low step 1 (research, etc.) but keep in mind, the people with high scores are doing those things too. Reapplying is not a panacea, as reapplicants statistically fare much worse. Every year, there is another crop of applicants with great stats applying for those competitive spots. I'm not trying to be pessimistic or crush anyone's dreams. I think MS 1s & 2s should know how much emphasis is being put on this one test and prepare accordingly.

Too bad more PDs don't feel this way.

National Resident Matching Program: Results of the 2008 Program Director Survey. http://www.nrmp.org/data/programresultsbyspecialty.pdf. Accessed September 15, 2010.

Is it possible that it has become a vicious cycle at this point? That the test itself isn't a good predictor of anything, but that applicants know programs value it highly and so prepare as hard as they possibly can. Thus the programs gain a measure of which students applied the most effort to studying and were able to integrate the minutiae better than their classmates.

It's to be expected that programs have cutoff scores, since they need their residents to pass standardized board exams or the program looks really bad. But this quibbling over applicants with 240's vs 250's vs 260's is not what the test was designed for.

Edit: It's also a lot easier to look at a universal number that means the same thing coming from every school... different schools give out honors and HP at very different rates, etc.

Below is his explanation elsewhere. As you can see, he was about as atypical as applicants get, and only serves to bolster the idea that yes, there are occasionally exceptions with wildly mitigating circumstances, but it is still very irresponsible to suggest to most med students that a 192 will still get you into derm.

Unfortunately I don't think it's that simple. The correlation between effort and score is not perfect. Plus, academic success and clinical success also don't correlate perfectly.

Oh I agree, I definitely think Step 1 should be a measure of competence and not a primary admissions criteria. I was just trying to look at it from a PD's point of view since so many programs still view Step 1 as the most important factor in an application.

Exactly. There were 1.4 applicants for every spot in derm last year. Specialties in 2011 that were more competitive than derm: general surgery, internal medicine, orthopedic surgery, plastic surgery, and psych (for this one, the huge number of international applicants skewed this results). Looking at only US seniors, ortho, radonc, ent, and plastics were more competitive than derm (plastics by far being the most competitive). Neurosurgery was equally as competitive as derm, and internal medicine was only 0.1 point behind derm (for every US senior applying to derm, there was one spot available. For every US senior applying to IM, there was 0.9 spots available).

Last year, 48 US seniors with step 1 scores below 220 applied to derm. 21 of those matched. 13 with scores below 200 applied. 3 of those matched.

This is raw data from the NMRP. It says nothing about whatever attributes low step1 matches in derm had.

You can draw whatever conclusions you like from this data. To me, I think a reasonable person would see that someone with a score just below 220 who is deadset on derm does not have to abandon his or her dreams.

Additionally it's worth noting that derm is not the most competitive speciality in contrast to popular opinion. It's not even second or third or fourth. What is interesting and noteable about derm is the unusually high number of applicants with AOA membership. If you're not AOA, then you would probably be naive to think that you actually have a 50% chance of matching into derm with a 215 step 1. Your chances wouldn't be zero, but they would logically be lower.

And I think it's an exaggeration to say how big of a deal not matching is. That's person-dependent. It probably would be a disaster to the applicant with $400,000 of school debt with a wife and kids and no other discernible skills or job prospects. To an independently wealthy applicant with income sources outside of medicine, it's likely not as big of a deal, and the risk these two different applicants would be willing to accept in the residency match would be wildly variable.

In summary, I would be very cautious of blanket statements about test scores thrown out by people on the internet and use your own brain to evaluate your own personal situation, talk to your own advisors at your school, and make your own personal decision.

Define "competitive."

Maybe I'm reading it wrong, but according to the charting outcomes 2011 you posted, 2 of 6 people applying with step 1 between 181-190 successfully matched into derm.

The obvious (to all but you) problem with your post is that you're choosing a poor surrogate of overall competitiveness (or you define the word differently than most). The applicants-per-spot stat does not account for numerous meaningful factors which ultimately outline the clear selection bias that occurs when someone chooses to apply to a specialty.

There are plenty that do and don't consider USMLE scores at all when granting interviews (i.e., they have no cutoffs to even look at an application the dude with the 187 still gets his application read, and if the guy looks like he'll be a good fit, he gets an interview).

But yes, there are also plenty who are either lazy and don't want to read all the apps or who truly believe step 1 scores are the best way to pick out who the best candidates are.

I have absolutely zero data to support this, but my intuition tells me that schools that screen for 230-240 cutoffs (which exist in all fields, not just derm) probably are quite malignant and are looking for people who don't have a problem putting in 18 hours a day studying, which is really all the USMLE is. It's not an intelligent test. As Dr. Goljan said, the more you read, the better you do. I have known absolutely brilliant people who failed the exam because they thought it was an intelligent test. I also knew people who couldn't find their way to the parking lot ace the exam because they spent a year memorizing every table in First Aid.

Exactly. Key words: selection bias. This phrase led me to believe that the poster knew what they were doing but just kept rolling anyway:

Quote:

and psych (for this one, the huge number of international applicants skewed this results)

You know you're doing it wrong when you come to the conclusion that derm is less competitive than psych.

Competitive relates the number applicants to spots available. This is a very basic concept, and I don't get why people get hung up on it.

If there are 800 spots available and 750 apply, it doesn't really make a difference if the average step 1 score of those applicants is 250. Many people with 200s are probably going to get spots too because programs don't want unfilled spots.

If there are 800 spots available and 3,000 apply, it doesn't really make a difference if the average step 1 score is 210. The people with 230s are still going to have a tough time.

Obviously this is an exaggeration, but these things happen from cycle to cycle. Traditonally tough specialities can have very uncompetitive years, and easy specialities can have super competitive years. People perceive specialties as competitive and don't apply to them. If they don't apply, that it makes it slightly less competitive for everyone else (losing the deadweight doesn't help much, but it helps a little).

If you're set on derm, this thread probably pisses you off because it may encourage more people to apply than otherwise would.

It's the same as the fallacious conclusions by premiers that Georgetown is a more competitive medical school than Harvard because the former has, say, a 2.5% acceptance rate while the latter has a 5% acceptance rate (I'm making up the % but the point is clear), focusing just in the raw number of people who apply to both schools while failing to understand why this discrepancy in numbers exists in the first place.

Did you just totally ignore the next sentence I wrote?

I also tend to believe this although I also have no evidence.

I understand perfectly well. You just don't like the simple definition of "competitive" and want it all to be about USMLE scores. The data is there, and the data shows it's not.

For example, It is perfectly fair to say that derm has higher average step 1 scores than ortho. But that doesn't change the fact that ortho is significantly more competitive than derm as evidenced by the data. It is a fallacy to say that derm is more competitive than ortho and use step 1 scores to back that up. The data does not support that.

I wrote it before I read yours, but I'd write it again. :laugh: Ok, how to make this understandable. Let's say there's a specialty that is notoriously easy to get into. This specialty will attract attention from applicants with weaker applications and lower Step scores, as well as those who have a difficult time getting residency spots even with above-average Step scores (IMG's). This is psych/FM/etc.

Let's say there's an extremely competitive specialty, one that is very difficult to match into. Those with weaker applications and lower scores are discouraged from applying because their chances of getting a spot are low. The result is fewer, but much higher quality (AOA, high Steps, prestigious schools, research & pubs) applicants for the same number of spots, since those applicants self-selected as having a strong chance of getting a spot. This is derm/plastics/NS/etc.

tl;dr: self-selection makes your method useless. If everyone applied to their specialty of choice without regard to their own competitiveness and chances of getting a spot, your method would be valid.

I am not even using Step I as a major metric (although I will point out that for better or for worse, Step I results often end up as the first bottleneck that causes people to completely abandon specialties that value high scores). I am using a wide variety of factors including the emphasis the field puts on AOA status, published research/advanced degrees, and unique and remarkable achievements outside of medicine.

You're choosing to use a metric that ignores the litany of trials and tribulations a medical student must endure to even feel they stand a reasonable shot at a given specialty. It is disingenuous to make your conclusions based on essentially cherry picking data.

Yes.

Blind enthusiasm? acrochordon has clearly laid out a pathway to success to match derm with low board scores.

- Apply to 126 programs
- Attend a top 10 medical school
- Go to war and lead a battalion, preferably in the Middle East
- Obtain PhD
- Do 2 years post-doctoral basic science research in Derm
- Have at least 15 publications, preferably with 4 or more in Derm
- Do a presentation at the Society for Investigative Dermatology
- Have a prominent figure (chair of a program) making personal phone calls on your behalf

If you can do that, you should be able to snag 13 interviews, which gives you a very good chance at matching (over 95%).

I also want to point out that I agree with you to a certain extent about the "numerous meaningful factors." It would be reasonable to assume that most applicants with abnormally low step 1 scores (in the 180-210 range) most likely have other features of their applications that are extraordinary, and it would be reasonable to assume that these people matched. It would also be reasonable to assume that there are those who applied with sub-standard application attributes all around against all advice and that those people did not match. The point here is that applicants with a dark spot on the application have to work harder to make other parts of their package shine because the positions are competitive. A person with a 265 step 1 who failed his surgery and IM rotation won't necessarily be in any better a position. You are more than a number on a single test. People need to make informed choices. That's all I'm advocating for. Study the data, know the risks, and figure out a plan. Spending 5 years doing a PhD trying to make up for a bad step 1 is a horrible idea. It makes more sense to do what I said, apply if it suits you, and have a contingency plan in case it doesn't work out. You'd have to be a moron to put 5 years of your life into a PhD when you could have completed another residency in that time period and then re-try for derm once you've already proven you can succeed in residency and have an excellent fall back in case it doesn't work.

This is much more sensible. Just make sure you study the data intelligently if you're going to be making major life decisions based on what you find.

It is perfectly valid to look at the results of US seniors in the match if that's what you are. I knew someone was going to slam me for putting up all the match data for IMGs and FMGs even before I did it. If you're an IMG, look at the first line of data. I have absolutely no way of disproving you. It is certainly possible that every single sub 220 applicant (including those who were rejected) from derm came from top 20 US MD schools, had a lot of publications, 250+ step 2s, and perfect clerkship grades. I highly doubt it though. The data is based solely on applicants per spot. Use your own good common sense. If the number of applicants for each derm spot drops from 1.4 to 1.1 next year, the 220 people are going to be in very good spots because it's less competitive (which brings me back to my original point, that's what competitiveness is), but there is absolutely no way of predicting if this will happen. It would be foolish to bank on that.

That sounds awesome, where can I sign up?

Keep in mind a lot of people don't even bother applying because they aren't foolish enough to run the risk, so the applicant pool is the people who BELIEVE they have a good shot/want it badly. If everyone who wanted derm applied, it'd probably be bigger, but Step 1 comes and people decide elsewhere.

Stein said it best. If everyone who thought they wanted derm and were not aware enough to know what their Step 1 score was and blah blah blah, the pool would be higher. But since most people know if you have a low Step 1 score, there are plenty of specialties to apply to, but derm is a suicide for the vast majority of people with that.

Originally Posted by JackShephard MD View Post
Blind enthusiasm? acrochordon has clearly laid out a pathway to success to match derm with low board scores.

- Apply to 126 programs
- Attend a top 10 medical school
- Go to war and lead a battalion, preferably in the Middle East
- Obtain PhD
- Do 2 years post-doctoral basic science research in Derm
- Have at least 15 publications, preferably with 4 or more in Derm
- Do a presentation at the Society for Investigative Dermatology
- Have a prominent figure (chair of a program) making personal phone calls on your behalf

If you can do that, you should be able to snag 13 interviews, which gives you a very good chance at matching (over 95%).

That sounds awesome, where can I sign up?




LOL I agree. You have to be the 1% of the 1% of doctors to even try to do all that.

That's not a good bulletpoint to follow. Unless your dream is to be a dermatologist doctor and you have a 190 and you can't be any other doctor in the world, then "maybe". Tell that to the average med student and they might laugh at you for even thinking that's feasible. But see, this would only apply to Top 10 schools, which is a minority of med students to begin with...

If you insist on using step 1 scores to tell people they shouldn't apply for a given field, it makes a lot more sense to look at the average score of unmatched applicants than matched applicants:

Plastic Surgery: 238
ENT: 232
Derm: 227
Ortho: 225
Optho: 220
Rad-Onc: 217

Lol...how is it a gunner med student thing? Everyone who even steps foot into med school is able to know that Step 1 is the most important exam for residency, unless they never talked to any classmates, blocked off all their professors and deans. Ideally, is it the best test? I think as a clinician Step 2 is slightly better, but it's hard to say what is the best measure. It's what we have got for years in the past and for years to come, unless they finally decide to merge Step 1 + 2 and/or make Step 1 + 2 a Pass/Fail test.

Different specialties change in competitiveness over time. So in the past, XXX might not have been that hard to get, but now it is for various reasons.

I agree that someone with a 210-220 who has lots and lots of other good stuff to give a shot at derm/plastics/NS. Of course these people are smart enough to apply to back-ups. it's like saying to someone with a 3.0 and a 24 MCAT to go to Harvard because one or two people did it before. Or like someone said, that if they got a 3.1 and got into med school, you can easily too. A lot of people realize that derm or NS is nice, but it's not the end of the world if they don't get that, and apply to other specialties of interest.

Strangely enough, I have no interest in competitive specialties, but I know people who do and they all have kick ass Step 1 scores since they knew what the big player is: Step 1.

Even if you wanna go into a "less competitive" specialty like Psych, FM, blah blah, getting a high Step 1 score is a huge player. Since I doubt a FM applicant is saying "Oh man I wish I didn't study hard for that 240, I coulda settled for a 200!"

I think you're severely understating the consequences of going unmatched. Being unmatched is bad enough but being unmatched with a low step 1 means you're completely f-ed. Most med students aren't stupid enough to get themselves into such a situation.

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