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4th Year, picking your specialty

Discussion in 'Allopathic' started by Hogfan10, Apr 8, 2012.

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  1. drizzt3117

    drizzt3117 chick magnet

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    A few did; it's very hard to do in certain specialties; I mean, I already mentioned the logistics were problematic; the only way to do this safely is to do something like IM at your home program and a few others as a backup, but if you're doing say, ortho, you're often doing it because you don't like medical management of patients. The most similar thing I guess would be FM with sports med fellowship, but most people intending to be surgeons want to do surgery (doesn't that make sense?) and figure they can scramble prelim surg worst case. It's very uncommon to get ortho if you don't get it it on your first try, though.

    We don't have a big class, everyone knows everyone and is all up in their business.
  2. modelslashactor

    modelslashactor Safety not guaranteed

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    While I don't think the average guy with a 200 on step 1 will be successful applying to derm, I do feel like kristofer actually has some good points: too many people get talked out of applying to fields they really want when they may actually be close to the average applicant for the field. It's true that failing to match is probably just about the most stressful thing that could happen to a med student, and the culture of medicine makes facing your peers/professors makes it that much worse - especially considering that many med students may have never failed at anything in their lives up until that point. However, I do believe that a US allopathic grad who is willing to do ANYTHING to get his/her field of choice can make it happen. This may just be a prelim year or it might be several years of research with a dept chairman/prog director, maybe even a PhD, which is indeed a poor choice, but would probably end up with the desired result.

    Anecdotally, I have known 5 people who failed to match in competitive fields and then reapplied after a prelim year. 4 of the 5 got what they wanted the next year (ortho, anesthesia, derm x2; the one who didn't wanted gen surg). All did prelims and used their electives to do rotations in the field they wanted, get some new letters, and reapply. Two got their spots out of the match from the elective month, a backdoor that would not appear in the match stats. I don't know what their numbers were but I assume they were all reasonably competitive applicants. One was an FMG.

    I can't speak to trying to get ophtho with a 190, and it definitely is wise to apply to a backup specialty if you think you might be on the border. But if you have scores within 10-20 points of the AVERAGE for the specialty and an otherwise solid app, why not give it a try?
  3. KnuxNole

    KnuxNole Sweets Addict

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    Agreed, med school classes aren't that big, and people hear about everyone like magic. This is coming from someone who doesn't talk much about others, but hears a lot of it...since it tends to be frequent. Most of the time, at "post exam parties" is where things tend to slip more :laugh:

    Plus, people are very social naturally, so I find it very easy to believe people hearing these things about others. Especially match stuff, unless someone isolates themselves from their classmates. For the people who just matched, I heard results from lots of people like wildfire. I can probably name what specialty 60%-70% of my class wants to go into(for now at least :p)
  4. SteinUmStein

    SteinUmStein

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    I think some of the widening disparity between reality and what faculty regularly tell us in preclinical (and even clinical) years about matching is due to the competitiveness of the match overall increasing every year. Individual specialties may fluctuate up or down in any given year, but the consistent trend has been more and more applicants applying for the same number or slightly increased numbers of spots. Some of that pressure is slowly forcing IMG's out of the picture, but it's also increasing pressure on regular allopathic and osteopathic grads in every specialty.
  5. drizzt3117

    drizzt3117 chick magnet

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    If you look at the data for us grads, it's much worse than for us seniors. Sure a small minority of individuals may get spots, but most won't, and will have given up millions of dollars in opportunity costs to go into a field they didn't want instead of doing something else they would have preferred to it instead. It's just ridiculous. Things are only going to get harder for non-matchees because of the increasing number of allo seats every year. You'll not only have to compete against the next class of seniors but all the other people who didn't match too, which will increase as med schools seats increase without a corresponding increase in residency spots.

  6. SteinUmStein

    SteinUmStein

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    Exactly. As the new allopathic schools open and increase in class size over the next few years, we'll see even more competition. It's changing fast enough that if I were a pre-med who wanted to go into something competitive but was thinking about taking a few years off before med school, I would have to think twice simply because waiting 2 or 3 years is putting you up against a significantly more competitive field. I don't see any new residency spots on the horizon, we'll be lucky to keep the ones we have if budgets get cut enough.
  7. modelslashactor

    modelslashactor Safety not guaranteed

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    i never said they had better odds and i never said it wasn't ridiculous - just that it can be done and done in both the original field desired, even if it was competitive, and that too many people don't give themselves enough credit.
  8. acrochordon

    acrochordon

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    That was my point too. Where there's a will, there's a way. People should follow their hearts -- I don't know anyone who failed to match into derm who was also committed to putting in the time to compensate for other "less than stellar credentials" (i.e. boards, non-AOA, etc.).

    Derm is a VERY small world, and personal connections and other factors go a long way further than people may imagine. What many posters here on this thread fail to understand is that networking/personal skills often go a lot further than your "test" scores in the Real World.

    I made it a point to network very heavily when I decided I was interested in derm. That's just something I don't see a lot of other applicants doing. At the rank meeting this year, a huge part of it just came down to who we liked/who had references from people we liked. Yeah. We actually didn't rank some people w/ the "know it all attitude" and instead ranked others w/ lower scores but who we felt that we could work with over an extended period of time.
  9. drizzt3117

    drizzt3117 chick magnet

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    How many people with step 1 < 200 did you interview this year? My guess is like most programs the average step 1 of your incoming class is well north of 230. Personal connections are important in every field, but it's hard to narrow down applicants without some sort of screen.

  10. JackShephard MD

    JackShephard MD

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  11. acrochordon

    acrochordon

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    A handful. And yes...the majority of people we interviewed had board scores > 240. Point is that we did interview a few with < 200 scores since they had people lobbying for them. We did rank 3 of them also, but they all withdrew from the Match prior to the rank deadline, which makes me think that they got out of the Match spots elsewhere.
  12. acrochordon

    acrochordon

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    And your sanctimonious post is helpful...how?
  13. MilkmanAl

    MilkmanAl Al the Ass Mod

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    Seriously? So you're honestly recommending that people follow your example and drop a decade resume building to get into a specialty? For the vast majority of people, that is awful, awful advice. They probably won't even get into that specialty after all their efforts, anyway. I truly hope most people reading this thread are a bit more realistic about their specialty choices, especially if they're in the low-score position we're describing. Follow your heart!...to over a mil in opportunity cost and several years down the drain. Awesome.
    That works okay for derm, but like Drizzt said, most people looking to do competitive surgical specialties probably have no interest in medicine or FP. As noted, there's also the logistical issue of attending a buttload of interviews, but then again, if you're rocking a 200, you probably shouldn't have to worry about juggling too many interviews in your specialty of choice.

    He makes a good point, actually.
  14. acrochordon

    acrochordon

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    I only spent a few years AFTER medical school working on a post-doc. That's what a lot of people that don't match do. The % of people who do pre-dermatology fellowships DO end up matching. Yes...even w/ low board scores (since they usually get personal contacts). A lot of them don't have the stint in the Middle East or the MSTP pedigree. A lot of them just do the pre-dermatology fellowship and match.

    http://www.ncbi.nlm.nih.gov/pubmed/18694691

    Again...these medical students in this thread who didn't actually MATCH into dermatology are sitting here giving "advice." Which I feel is really worth toilet paper. If you want real advice for competitive specialties, talk to those that actually matched. Not hearsay.

    FWIW, I had 13 dermatology interviews and 5 ENT interviews (the latter was my backup). I was just very productive during my pre-dermatology fellowship, as most successfull dermies are.

    Anyway...I'm done w/ this. Most of y'all think you know it all. You'll learn. Meanwhile, I'll be cutting out skin cancers....
  15. thomprya

    thomprya

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    the only things I am sure of are these:

    There is a huge bias in every bit of data collected on the match

    you don't need a 240 to be a successful derm guy

    people with less than stellar scores are matching derm

    from what I've seen derm is not for me so eh.....
  16. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    I think (but am unsure) that the "2.1 specialties" includes a prelim/transitional year application as well. The conventional wisdom is that it is unclear whether this is what's represented in these data (specialties that also often but not exclusively utilize a prelim/TY like Gas and Rads have similar but slightly lower numbers of "average number of specialties applied to").
  17. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    Not just the difficulty of juggling interviews, but of even setting yourself up adequately to apply to another specialty. Even for something as "routine" as FM or IM (routine in the sense that by default most people will already have done at least one rotation in each specialty during M3), you still have to get several letters specifically by people in that given field, formulate a different PS, and essentially do all the things that shape your application towards wanting to go into that given field. For at least some of the "better" FM residencies, they want to see a solid medicine sub-I and a solid FM sub-I (according to two of my classmates, at least....your mileage may vary). So you're talking about potentially conflicting sub-I requirements/scheduling, meeting with the higher-ups in multiple fields to formulate two essentially different personas (on paper, at least), and then shouldering the whole dual application process/fees as well as dual interview process/fees.

    Sure, it's technically doable, but it's also technically very difficult. But, as Al points out, these people probably aren't going to have the plethora of interview opportunities one would worry about managing to begin with.
  18. SteinUmStein

    SteinUmStein

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    Huge props to you for what you've done to get where you are now. It's pretty impressive. Just don't mislead med students into making huge, life-altering mistakes. Not everyone gets to be the quarterback/astronaut/neurosurgeon/dermatologist.

    Wait, why is derm competitive again? Stupid broken reimbursement system... :laugh:
  19. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    I did match into derm. And, to a large degree, I don't even feel that my opinion is worth anymore than several other contributors on this thread.

    While I agree that nepotism and backdoor dealings can work out for some in derm, it's a terrible Plan A. Even the people like drizzt who are saying you can't get into derm with <200 understand that while that is not an absolute truth, it is close enough to it that it really does tend to be irresponsible to some degree to recommend to most medical students that they follow their dreams despite reality. I'm very happy you managed to match, but you also surely must understand how atypical your results are, even given your declaration that a lot of applicants with sub-par scores can eventually get in via research fellowships. I will not offer a blanket statement that says "if you have a 200 on Step I you should forget about Derm entirely", but I will say that if this describes you, you should absolutely understand just how much the cards are stacked against you, and you should also understand the effort and expense that will likely be required of you to even have a shot, along with the always-diminishing chances that you will even be successful.
  20. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    I think to some degree we still have to understand that the 215/75% kind of figure does not take into account the other things that that person has done. It may be unfair to suggest that, for the average 215 applicant, their chances of matching rads are 75%. The data is not clear whether there is a correlation between low board score and other outstanding accomplishments in the pool of successful rads matches. Again, that does then lead one to say "well, the argument here is that a 215 shouldn't bar you from trying, it should just make you realize you have to be that much more exceptional elsewhere on your application", and I think that is the important part of this dialogue for anyone to understand (and, to some degree, what both sides are trying to convey, albeit perhaps with different wording).

    The important take home message for many medical students is that low board scores don't necessarily close all the doors to you, but it makes your journey more difficult (at times slightly so, at times almost insurmountably so), and one should truly have an understanding of what it will take to make up for a low Step I score or otherwise "mediocre" performance in medical school. It is no small price - financially, logistically, and temporally - to have to pay.
  21. JackShephard MD

    JackShephard MD

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    Well said. No one has ever said anything is impossible. Good advice is based on the most likely scenario.

    It's apparent who is giving grounded advice in this thread.


    Good job keeping it classy. :thumbup: FYI, I don't think many envy your situation.
    Last edited: Apr 11, 2012
  22. SteinUmStein

    SteinUmStein

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    Right. There may be 215 applicants to rads that have nothing else going for them, but the vast majority of 215ers who are willing to apply to rads and take that chance have more research, pubs, high clinical grades, AOA, prestigious schools, good LOR writers, etc. than the average 215er has. That's why using raw data in this process is so dangerous, everything is skewed dramatically when people's careers and futures are on the line. As was mentioned earlier, med students are not notorious risk-takers. This field attracts people looking for a steady career and solid income without a high risk of failure.
  23. sanityonleave

    sanityonleave Adrenaline Junkie

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    Guys, I think we should all just accept that if you just try hard enough, someone will come lead you to the magical land of fairies and rainbows and puppy dog tails where everyone gets exactly what they want in life.

    To the OP: it's certainly possible that you could end up not being able to match in your desired field, depending on a number of circumstances. That said, the vast majority of US medical students do match into their desired field. If you work your ass off, odds are very good that you will end up being able to do the field of your choice.

    As far as the debate about Step 1: I don't believe it correlates at all to clinical skills or "doctoring ability", but it certainly does correlate to matching. I have no idea what I want to do, but I certainly don't think I'll ever be unhappy about having too many options. The advice I was given about step 1: study your ass off for it and do well, and that way you won't have to worry about your step 1 score holding back the rest of your application.
  24. Galatasaray

    Galatasaray

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    why the heck are there so many sdners dead set on derm ? i understand that it's a high-paying lifestyle specialty, but i get the feeling that this fixation on derm is a uniquely sdn phenomenon. whenever i see derm on this forum i go -_______________-
  25. drizzt3117

    drizzt3117 chick magnet

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    Rads is a totally different story; its much more like IM than derm in that the Easy programs are easy to match into but the competitive programs are really really competitive (rads has more 260 step 1 than any specialty except IM which has 6x the applicants, it has more than derm and ortho combined and all of them are applying for the same 100-150 spots at the top 15-20 programs) where as all derm programs are hard to match into.

  26. drizzt3117

    drizzt3117 chick magnet

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    Cuz people don't want to work very much but have above average income for the medical field.
  27. SteinUmStein

    SteinUmStein

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    Sorry, I wasn't taking the particulars of the specialty into account, I was just using [insert competitive specialty that other person was talking about], which was rads. Thanks for the clarification.
  28. SteinUmStein

    SteinUmStein

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    Yep, and I think it comes down to the fact that to get a lifestyle similar to derm in any other field means taking a huge pay cut. To get similar pay to derm in any other field means 15-20 more hours per week in most cases. It's just the best bang for your buck right now.

    The schadenfreude part of me wants derm to take a nosedive in pay with all the changes that are coming to health care in the next 5-10 years. I'm sure people will still get their acne treatments. :smuggrin:
  29. KnuxNole

    KnuxNole Sweets Addict

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    The problem with that is this: the HUGE majority of medical students can never go to a "top 10" school in their life. Which makes sense. So, except for a small minority who happened to go to a top 10 school, everyone else can't use that to their advantage.

    Thankfully, medical school is more normal than law, in that you don't only have to be the elite of the elite to get a job. All you have to do is go to some type of med school, and you can be a physician :)

    And at least it's comforting to know that people aren't pathetic enough to think not matching for a year or having to SOAP is something of a good thing in any way. It's pretty much the thing that you don't even want your worst enemy to go through.

    Also, the VAST majority of people won't have the extensive research/connections, so they don't even bother applying in the first place to those insanely competitive specialties...

    Also the achro guy did a POST-DOC after med school, so there is HUGE, HUGE bias. The 190 or something that he got was probably squashed a bit compared to 99% of med students with that score.
    Last edited: Apr 11, 2012
  30. drizzt3117

    drizzt3117 chick magnet

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    Yeah at most schools you won't have the luxury of being mediocre and still matching pretty well.

  31. MossPoh

    MossPoh Textures intrigue me

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    Am I the only one that thinks that a person who is so hellbent on a single specialty that they invest 5+ years after medical school to get that specialty need help and is probably setting themselves up for misery later on?

    Very few people have only one specialty they'd be happy in with complete misery in all the others. It is a spectrum and most medical students paint their own little impressionistic painting of what the field they choose encompasses. If someone is willing to give up near a million dollars of potential net income in order to get that specialty, then have at it.
  32. JackShephard MD

    JackShephard MD

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    Agreed.
  33. ArcGurren

    ArcGurren only one will survive

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    Yeah, I mean, I don't begrudge people who genuinely enjoy dermatology or otherwise have good reasons for going into it (I know someone who went into it because their father died of melanoma and they want to spend their lives fighting against it so to speak) but there will be tons and tons of regret if derm's reimbursements suddenly get slashed to bits. You'll quickly see the field go from being the most competitive to one of the LEAST competitive.
  34. SteinUmStein

    SteinUmStein

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    I can picture the bitter, bitter 50 year old derm attendings now, making half as much as they did when they were first out of residency, teaching the IMG's that fill half of their programs. I'm trying not to savor the thought too much... I too have nothing against those genuinely interested in the field, and they do exist.
  35. Frazier

    Frazier turtle in a rabbit race Lifetime Donor

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    Many of the "bitter, bitter 50 year old derm attendings" would prob just retire early. 20+ years of the old derm salary + investments should be able to warrant that option, if desired.
  36. SteinUmStein

    SteinUmStein

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    I know, I was mostly joking. Although with how dermatologists (and wealthier specialists in general) manage their money, I wouldn't be surprised if there wasn't much in the retirement account after the luxury car/mansion/kids' private school bills were paid.
  37. Frazier

    Frazier turtle in a rabbit race Lifetime Donor

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    ;)

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