Inspired by a PM: Reality check

[DermMatch]

Received a PM, similar to a previous post on this forum, so I'm not going to repost it here in detail. I'll just summarize the situation. The words are my own, and the tone is my own:

"I've got truly killer Step I and II scores, AOA, a few pubs, two aways, but after this year's cycle, only ended up with one interview at my home derm department -- didn't even get interviews at the two aways I did. I don't want to stay in the same place I went to med school. My home derm department signalled that they'll take me, but my plan is to not rank them at all (even though I went through the interview process). Instead, I'll skip the match this year and go for a prestige master's degree -- not derm-related -- and then try derm research there. I'll network hard, then I'll reapply, hoping to shoot for somewhere more desirable than my home department."

As a partial reply, I quote, with my own emphasis added, a venerable derm SDNer, 03Doc, by pasting his/her comment way back when, in 2005 -- and note that things have only gotten worse:

In the SDN thread "10 Hardest specialites to gain a residency?", 03Doc said

Top 3:

1. Derm (50-60% senior match rate)
2. Rad Onc (50-55% generally, but 80% in 04)
3. Plastics (50-55% senior match rate)

The reason I rank them as such is this: most plastics folks who don't get in do GSurg and try again on the back end, they have 2 chances. Rad Onc for some reason was easier as of late, but Derm is getting worse. There is a HUGE reapplicant contingent in Derm such that there are about 280-300 spots each year, and ~600-650 US senior applicants, but almost 900 total applicants, who are not all FMGs or DOs, but reapplicants who are interns, derm research fellows, IM, FP, or Peds residents, etc. Even once people have their residency they want in.

The others mentioned (Ortho, Optho, ENT, Rads, NSurg) all hover in the 75-85% match rate area, which I consider difficult, but one tier down in competitiveness from the three above.

Anyone else want to add their two cents?

---

Members don't see this ad.

 

[dermie09]

Unless the home dept is absolutely horrid, then I think it's really stupid not to rank them ... in the end you WILL be a dermatologist..unless you have specific academic/whatever goals that will not be met by your home dept... but still..you could always work on stuff on the side/use elective time.

Also..if your numbers, etc are so stellar...then why DIDN'T you get more interviews...some self-reflection is in order...

 

[discontinuebed]

I call BS. Who turns down a guaranteed derm spot?

And let's be serious, I have a killer Step 1/Step 2 score. No AOA. Few pubs. No aways. And I ended up with more interviews than 1.

 

[DermMatch]

Hi--this is not a BS post. I got a PM from an applicant who is very serious about this situation.

(1) They did not state that they were getting a guaranteed spot at the home derm dpt. They stated only that they were getting favorable messages from the home derm dpt.

(2) They did state that they only had one interview.

(3) It is quite possible to get 1 interview despite stellar scores and AOA. Bad personal statement, overly selective mix of programs you applied to, weak letters of rec, an attending who is stabbing you in the back - the list goes on.

While I could be paranoid and think that this person is yanking my chain, I approach all the PMs I get at face value as they've got nothing to gain from PMing me, and no one starts off their PM by asking me to post their message in the forum.

Also, I initially told this person that I was not going to post in the forum as similar topics had been posted previously, but I found the 03Doc quote and thought it was relevant, so decided to post their dilemma anonymized.

This ain't the dermboard.

But dermie09, I agree: Why only 1 interview? The places that this person did aways at were selective but not crazy hyper. I wonder if anxiety/stress made this applicant come across less than personable? The one interview flag led me to recommend that this person NOT go kamikaze and ditch the rank this year in order to reapply with a masters under their belt. Because it only adds marginally, and you'd scuttle your home department's good will.

I raised questions in my reply PM, but wanted to get other people's input to make sure I wasn't crazy.

 

[Dermguy]

I would say that if you are really sure that you would rather not match then match at your home program then go ahead and don't rank them. Your application will likely be stronger after a bunch of research. However, is your home program really that bad? It's hard for me to imagine a program that I wouldn't rank just because I know how competitive derm is.

 

[Ignite hardcore]

Man, I feel for this person. That must be really hard to have put together a dermguy/pemphigirl-caliber application and somehow only get the one invite. I'm sorry. It is so hard to put a finger on the way things shake down in this derm application process. I think Dermmatch is head on, there is probably one variable that's working against you. My guess would be weak LORs or an angry attending from your home department. I doubt that a PS would affect you that negatively.

My recommendation would be to not rank your home program if you truly couldn't stand it. I wouldn't do the master's. I would actively pursue a research fellowship at a place who's known to take their fellows. With the solid foundation you have, you could put together a first-class application with one more year. Starting fresh in a new dept, you could work hard to get better LORs. Derm attending's job security, opportunity for promotion, bonuses, and much more depends on publications. You need to get them pubs. They especially like the quick turnaround on case reports. Pop a couple out in 3 weeks time and you will get glowing letters. Research fellows make good money, usually around 40k and work 30 hrs a week, not a bad option.

Hopefully your luck will turn and you will find something you like next time around.

 

[discontinuebed]

Research fellows make good money, usually around 40k and work 30 hrs a week, not a bad option.

The money sounds about right, the fellowship positions I've been offered all seem to require more than 30 hrs a week.

 

[laxman310]

I'm only an MS3, but I'll add my 2 cents.

Doesn't it make more sense to just go ahead and rank them, considering you only got one interview in the first place? If you are going to take extra years to do research, you could always tack it on as a fellowship after your training.

 

[Dermocrat]

A perspective I hadn't heard on doing a prestigious internship rather than jumping into a research fellowship or anything else:
http://www.derminterest.org/phpBB2/viewtopic.php?t=330

 

[DermMatch]

Following up with more PM info:

Based on input from people inside and outside the home derm department,

Poison X factor in this situation = PD

Among other things, wrote form letter for rec, and universally disliked by residents and school admin

Further supports my (yet to be finished) Application Guide:

The PD can make or break you.

 

[goodies]

The PD can make or break you.

Can you elaborate on the power of the PD and how much they can affect the rank list? Also, do chairs have a ton of power too or is it really based on a group decision?

 

[discontinuebed]

Following up with more PM info:

Based on input from people inside and outside the home derm department,

Poison X factor in this situation = PD

Among other things, wrote form letter for rec, and universally disliked by residents and school admin

Further supports my (yet to be finished) Application Guide:

The PD can make or break you.

Why is she/he still employed? Do PDs have tenure?

 

[DermMatch]

PDs are first among equals. Because they are directly responsible for the residency, their position affords them more than average power over shaping their program and evaluating applicants. I've seen chairs defer decisions regarding program details to PDs because of the very fact that the latter more directly oversee program administration.

Because they also network with other PDs who have similar power, PDs are in a position to push their favorite candidates from their school. My PD (who did not like me) wrote "walk on water" rec letters and placed strategic calls for the pets who did year-long research with her/him. They all got their #1.

PDs often work to vet applicants even after the consensus rank list is compiled, by calling other programs to get final feedback about candidates. I myself didn't realize this happened until I watched this match cycle unfold as a resident.

In this PMer's situation, the PD casually noted one day in clinic that another program's PD had called to inquire about the PMer's candidacy; later, the person found out he/she did not get an interview there -- another sign that the PD was possibly screwing this candidate over. And writing form letter recs certainly didn't help.

Yes, rank lists typically are compiled by consensus, but again, I would hazard to say that a PD's opinion carries heavier weight than the average faculty attending pitching in to screen candidates.

PDs are faculty, and it can be hard to recruit a PD because you have to go through a complicated administrative process. Entrenched ones can stay for YEARS equalling near decades.

 

[dermie09]

In this PMer's situation, the PD casually noted one day in clinic that another program's PD had called to inquire about the PMer's candidacy; later, the person found out he/she did not get an interview there -- another sign that the PD was possibly screwing this candidate over. And writing form letter recs certainly didn't help.

I wouldn't be so quick to judge..I know of at least one program that places such calls but still end up not interviewing many of them ... and it's not because whoever they called had lukewarm comments...

but it could be the PD too... but if such PD always writes form letters than it sounds like it's a school wide problem..not just him/her?? I don't think it's necessary to get a PD letter from home school honestly..

 

[DermMatch]

It is typically good form to get a letter representing the home derm department. Would be seriously considered bucking the trend if you applied without, although I'm sure it's happened before.

Given that, a bomb applicant will get a well-placed derm dept attending to write their letter -- PD, chair would be ideal; course director (who often can be the PD); supervising attending of a rotation.

Logically, PD rec letters are heavily considered. Think about it: A PD knows intimately what makes a good resident by mere fact that they herd residents.

So when PD writes letter: "I run a residency program, and this person would be an awesome resident!", other PDs take notice --> Positive reaction.

Those with letters from our PD matched to their hearts' desire. I didn't have PD letter, but only (rather average) course director letter; I matched at a solid top 20 program, but not to any of the five glamour girl programs I interviewed at. Not that the lack of the PD letter was the crux, but I'm sure it wouldn't have hurt if I had one.

 

[discontinuebed]

wow, thanks for the awesome insight

i had no idea a PD wielded so much power. I was even considering foregoing my PD's letter and am so glad I didn't now

 

[238950]

Those with letters from our PD matched to their hearts' desire. I didn't have PD letter, but only (rather average) course director letter; I matched at a solid top 20 program, but not to any of the five glamour girl programs I interviewed at. Not that the lack of the PD letter was the crux, but I'm sure it wouldn't have hurt if I had one.

So, after all the interviews are done, do programs actually go back to the paper applications, i.e. letters, scores, etc., or do they base their rank lists mostly on the interviews? I wonder because people say all the time that after you have been selected for an interview, the playing field becomes equal for everybody invited, making me think that the interview is basically what determines the rank list.

Also, how much weight do the letters REALLY carry over the other items on one's application?

 

[discontinuebed]

So, after all the interviews are done, do programs actually go back to the paper applications, i.e. letters, scores, etc., or do they base their rank lists mostly on the interviews? I wonder because people say all the time that after you have been selected for an interview, the playing field becomes equal for everybody invited, making me think that the interview is basically what determines the rank list.

Also, how much weight do the letters REALLY carry over the other items on one's application?

I have a feeling that's not true. A solid interview isn't going to erase an astoundingly low Step 1 score even if you are invited to interview. I believe applicants are still viewed as an entire package. (I understand this is a different field but on my current radiology rotation, the attending was just bemoaning how he had to look over a ton of applications again after his shift Friday night to help with the ranking meeting)

I get the feeling that letters are really really really helpful especially in a small field like dermatology. As a non-outstanding applicant, this was the only thing people consistently noticed.

 

[Ignite hardcore]

From the resident's quote from UTSW in the WTF all things derm thread, it sounds like some programs make a preliminary rank list solely on the paper application. The interview can affect your position, either negatively or positively, from there.

It seems likely that two interviewees who score similarly on the interview will be ultimately ranked one above the other based on something from their paper application (board scores, AOA).

Bitter PDs suck, this is an ugly story.

 

[106174]

From the resident's quote from UTSW in the WTF all things derm thread, it sounds like some programs make a preliminary rank list solely on the paper application. The interview can affect your position, either negatively or positively, from there.

I think you misunderstood me. The preliminary rank list at UTSW is not determined by the paper applications. Instead, it is made by compiling all the INTERVIEW SCORES. Of course, the faculty are expected to have reviewed the paper applications prior to the interviews, so that the scores they give after the interviews are reflective of both the paper application and the interviews. With the preliminary rank list in hand, the faculty then meet a week or so after the last day of interviews and deliberate whether to change the list or not. Rarely, if at all, does this list get changed. So, sending a note telling UTSW you are ranking them number one sometime this coming week (as we get closer to the ROL submission deadline) will not affect in any way one's position in the rank list (at least at UTSW).

 

[Cirrus83]

Personally I would rank the home program just because you could end up not matching elsewhere next time and only have annoyed your home program by not ranking them this time.
Of course if you're really confident in your ability to network I guess that could work, but I dunno if I'd be quite that confident.