And yet if you look at the matchlists, they look phenomenal to me. I admit I am only a second-year MSTP and don't know much about interpreting them, but the proportion of MD/PhDs matching into competitive specialties seems about on par with the general percentage (just eyeballing it). And it seems that people get residencies in desirable locations, in both competitive and less competitive specialties. But if there is one thing I have gathered by this point it's that A LOT of MSTPs are not that great at medical school, for various reasons.
When I look at my school's matchlist I can see examples of almost everything I talked about in my blog. Remember, four students failed to match last year. Though one was left off the matchlist entirely and one is in a prelim spot and it's not listed as a prelim.
The percentage of MD/PhDs who failed to match is about the same as the percentage of MDs who failed to match according to the charting outcomes 2009. But, don't get me wrong: the PhD degree usually does help. I don't want everyone to lose sight of that. I think how much it helps varies based on specialty and based on individual programs. Some places in some specialties are just known as being MD/PhD friendly and some are unfriendly. What I want people to know very clearly is the following and perhaps I should edit my entry to reflect this.
You need to be as clinically competent as your medical school classmates to match competitive specialties. The PhD helps, but it will not get you into programs on its own. There are Step I cutoffs, increasingly Step II is required, and grades are heavily weighted. The people making decisions on your app are typically clinicians. They often don't have a great appreciation for research. In the competitive specialties the MDs often have research as well. The PhD is not a golden ticket.
Of course nobody told me this until I was a 6th year. I only found out I needed a high Step I score and an exceptional clinical performance after my PhD was completed. The old advice of "You'll get whatever you want, you're an MD/PhD" was blown away. Now my program is trying to convince me to apply to a backup specialty or get away from the specialty I did my PhD in so that I can be sure I'll match. Don't get me wrong, I think I'll be okay. But, I had no sense of this before. It was a real kick in the balls. I want the junior students, who still tell me blindly "You'll be fine" without any real sense of reality, what's going on so they can really study hard for Step I and try to get honors in clerkships.
So if what you say is true it is a bit of mystery how they end up doing so well in the match. Would you argue that many of them recognized they were not competitive for competitive specialties, hence the huge number that go into IM, peds, neuro?
I have seen this numerous times. You can match at a big name place in those specialties but not match at all in Dermatology. Though some people are quite stellar and choose those less competitive specialties. You can't separate this out just from a glance. Of course, what does Step I or grades matter towards you becoming a good physician scientist? Probably not at all. But as we all know this is a hoop jumping process.
Or that MSTPs across the board actually perform phenomenally in med school, hence their good matches?
Some do. I know some guys who have matched into big name programs in competitive specialties. They also had high step I scores and AOA in many cases.
I really don't know how MD/PhDs do in med school in general. My impression is that they do similarly to their med school colleagues. i.e. There is a distribution. Some do great, some don't.
Or that the tippity top programs that value research will give the MSTP applicant a shove, and so the true disadvantage to doing MD/PhD is incurred by the MSTP applicant who doesn't want to go into a tippity top program? Or something else entirely?
Maybe I didn't explain the trap clearly.
Top programs often have stat and grade cutoffs. If you are an
average med student (and remember, average Step I is about 220), you may not make the cut for those top programs. The other problem is if you want to match community for some reason (loaction reasons usually). Make sense?
I don't want any praise for the idea that I've overcome something, but I want to know if it's interesting/readable/insightful, that sort of thing. I hope to update it with more of my rantings, so you see where I'm coming from on many issues, rather than me being viewed as simply the mad moderator of Philadelphia 
