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4th Year, picking your specialty

Discussion in 'Allopathic' started by Hogfan10, 04.08.12.

  1. Hogfan10

    Hogfan10 WPS

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    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.
  2. tryp

    tryp

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    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.
  3. gravitywave

    gravitywave fourth year

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    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.
  4. drizzt3117

    drizzt3117 chick magnet

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

  5. dienekes88

    dienekes88

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    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.
  6. gravitywave

    gravitywave fourth year

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    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.
  7. Hogfan10

    Hogfan10 WPS

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


    What would you do in the meantime if it took multiple years in Match?
  8. drizzt3117

    drizzt3117 chick magnet

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

    officedepot

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    Last edited: 04.12.12
  10. officedepot

    officedepot

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  11. drizzt3117

    drizzt3117 chick magnet

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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.
  12. acrochordon

    acrochordon

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    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.
  13. MilkmanAl

    MilkmanAl Al the Ass Mod

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    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.
    Last edited: 04.10.12
  14. officedepot

    officedepot

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  15. SteinUmStein

    SteinUmStein

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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.
  16. PMPMD

    PMPMD 4G MD

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    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.
  17. PMPMD

    PMPMD 4G MD

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    Too bad more PDs don't feel this way.
  18. PMPMD

    PMPMD 4G MD

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

    SteinUmStein

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    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.
    Last edited: 04.10.12
  20. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    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.



  21. PMPMD

    PMPMD 4G MD

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    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.
  22. SteinUmStein

    SteinUmStein

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    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.
  23. SteinUmStein

    SteinUmStein

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    Define "competitive."
  24. Oversteer

    Oversteer

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    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.
  25. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    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.
  26. SteinUmStein

    SteinUmStein

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



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

    GuyWhoDoesStuff I got the skills to pay the bills

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    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.
  28. PMPMD

    PMPMD 4G MD

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

    SteinUmStein

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    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.
  30. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    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.
  31. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    Yes.
  32. JackShephard MD

    JackShephard MD

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    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%).
  33. SteinUmStein

    SteinUmStein

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    [​IMG]
  34. SteinUmStein

    SteinUmStein

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    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.
  35. drizzt3117

    drizzt3117 chick magnet

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    That sounds awesome, where can I sign up?
  36. SteinUmStein

    SteinUmStein

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    [​IMG]
  37. KnuxNole

    KnuxNole Sweets Addict

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    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.
    Last edited: 04.10.12
  38. KnuxNole

    KnuxNole Sweets Addict

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    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...
  39. KnuxNole

    KnuxNole Sweets Addict

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    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!"
  40. drizzt3117

    drizzt3117 chick magnet

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    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.
  41. KnuxNole

    KnuxNole Sweets Addict

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    I hope you don't have this mindset that's it's "OK" to SOAP? That's like getting stabbed in the heart 10 times, then getting stabbed in both eyes and finally your "sweet" spot :p

    I dunno why you seem so casual about scrambling/SOAP. Or worse being unmatched for a year. Everyone who is a medical student knows that it's nowhere close to applying to med school. It's a whole different ballgame. It's a horrid thing for someone to ever go through, I felt sorry for the MS4s who had to SOAP last month.

    And....uh personally no I would never said that. I EVEN said that I have no interest in competitive specialties, but still able to acknowledge how intense it is and how some people only think in "ideal" terms and they sadly won't get a reality check :(


    Also:
    Others had no idea the amount of preparation they needed for various reasons (no guidance from school or family).

    What kind of school would NOT tell them this? Certainty no M.D. school of any credibility. And any med student who doesn't think Step 1 is important at all...I dunno where that logic comes from. Med schools don't teach to the boards, but the lingering idea of Step 1 will enter every single student's mind at MS2.
  42. drizzt3117

    drizzt3117 chick magnet

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    Scrambling into a categorical residency of any type isn't easy. This year there were only 140 FM and 51 IM categorical spots available, with something like 10,000 people doing SOAP. Matching one of these with low scores is very difficult. You have no comprehension of what this is like until you experience it either as a SOAP applicant or helping someone go through the process.

    Most med students are smart enough not to put themselves into a position to fail.

    Um, the logistics of applying to more than one specialty are pretty challenging. It's hard to prioritize interviews (although the aboveformentioned applicant you're describing isn't going to get any derm interviews anyways so it's a moot point and probably a good idea for them to dual apply FM or IM)

    People who don't match competitive specialties at most schools are going to get something but it'll probably be prelim surgery or prelim medicine unless they are a very competitive high scoring candidate who just happens to get unlikely and has the ability to match into a nice program. Not matching with low scores = f-ed. Your best case scenario is getting prelim surgery at a malignant program in an undesirable location and trying to find a spot in something else either out of the match or trying again. One of my friends who initially applied ortho in 2011 (from a top 20 school, and didn't even have bad scores, just a poor strategy, I think high 230s-low 240s) ended up having to scramble into prelim surg and finally very recently got a PGY-2 spot in a notoriously malignant community gen surg program full of FMGs who recently fired someone and needed a replacement. Is that what you're considering a good outcome? Getting into categorical gen surg (of any kind) is still better than most people do, though.
  43. JackShephard MD

    JackShephard MD

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    Kristofer has no idea what he's talking about.
  44. MilkmanAl

    MilkmanAl Al the Ass Mod

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    That's the sad part. Getting a PGY2 position post-prelim in a residency remotely like what you're interested in is basically the best-case scenario for an unsuccessful applicant. It's a bit unsettling someone would actually advise other people to go that route.
  45. SteinUmStein

    SteinUmStein

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    Yeah, I gave up a while ago. Let people believe what they want to believe, we have enough voices on here to hopefully convince anyone reading this not to make the mistake of treating the Match like it's the med school application process.

    Not matching DOES NOT equal rejection from all the med schools you applied to. They're not even in the same order of magnitude of awful. Med school reapplicants are in much stronger baseline shape than match reapplicants.
  46. drizzt3117

    drizzt3117 chick magnet

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    Yeah, not matching and having to soap is a catastrophe.
  47. ArcGurren

    ArcGurren only one will survive

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    Plus to my understanding people who match prelims and have to continue applying or reapplying tend to have pretty poor match statistics themselves
  48. drizzt3117

    drizzt3117 chick magnet

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    Every single person that had to scramble from my school (top 25) applied to something they weren't competitive enough for, except for one guy who failed to match anesthesia because he only applied to one program. Almost everyone got spots (prelims mostly exc one cat IM at Hopkins! Guy had 250+ tho).

    My experiences from this cycle were that getting residency is harder than you think even if you have all your ducks in a row (competitive scores and grades, research, great LORs, etc) if you don't, and apply to something you're not competitive for, you'll probably be soaping a prelim then doing something you weren't intending to.
  49. jcu

    jcu should have been dr. who

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    Did he have a bomb attached to his chest that was set to detonate if he applied to other programs?
  50. MilkmanAl

    MilkmanAl Al the Ass Mod

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    Physician hSDN Alumni SDN 5+ Year Member
    I think it's pretty common for match info/rumors to spread like wildfire. I know where just about everyone was looking to match, probably a third of the class's top 3, and all of the people who didn't match and what happened to them. I'd be surprised if something similar wasn't the case at most places. At the very least, you'll know people who were dead set on a certain specialty and/or place who don't get what they wanted.

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