Psych becoming an easier match

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TexasPhysician

TexasPhysician

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Match data this year shows that it was easier to match into psych this year than the previous 2 years. The total number of US applicants to all fields is increasing, but the number of US applicants to psych is decreasing. I believe this is a problem that all residents should address through better teaching and promoting the field. Thoughts?
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Maybe it's just cyclic variation. A decrease in applicants in one year doesn't really stand out as something significant to me.
 
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I thought the sky was falling. No?
 
I do recall seeing data that at least last year's MATCH was less than the previous year though this is based on memory. I believe the source was the APA newsletter.

Though even if that is true, the general trend overall in the past decade has been an overall increase.

IF there is a decrease, I'm not sure as to what would've caused it, or if it's significant. Even a stock that trends upwards consistently will have days where it's lower than it was the day before. On 3/15 Apple stock went down a bit, then a few days later went up much more than it went down. So what if it's down 1%, 2% or even 10%, it's not the end of the Earth.

IMHO the biggest losers will be patients, not us because there's an existing shortage. If anything this just makes it easier for people in our field to have more secure jobs and incomes.
 
Raise the median income to $250k. I'd bet money that even if we all became douche-bags we'd be more competitive

That's my omnipotent fantasy. :thumbup:

I think med students may have a better appreciation of psych if they had more time to observe patients recover. ie. depression can take months to resolve with medications and psychotherapy. They only stick around long enough to see the SI go away and are left with question marks.

We frequently lament over how "uncompetitive" we are compared to other fields. However, there are many challenges in our field that may discourage others from entering it. We deal with all types of character pathology and behavioral disturbances: the intimidating, the threatening, the hostile, the needy, the helpless, the manipulative, the tearful, the angry, the delirious, the psychotic, the manic, the depressed, the anxious, the obsessive, the borderline, the narcissistic....etc. The provider is faced with the challenge of engaging the affective state in an attempt to establish a therapeutic alliance and enhance communication with the medical team. This isn't "easy work" and I can see why it would be an undesirable position for others to take.

Personally, I love the challenges of dealing with difficult patients. Looking at a broken bone on an xray.... doesn't blow my skirt up.
 
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whopper said:
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IF there is a decrease, I'm not sure as to what would've caused it, or if it's significant. Even a stock that trends upwards consistently will have days where it's lower than it was the day before. On 3/15 Apple stock went down a bit, then a few days later went up much more than it went down. So what if it's down 1%, 2% or even 10%, it's not the end of the Earth.
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Since 2010, there has been almost 5% more US residents. Since 2010, there is roughly a 10% decline in US psych applicants. A 15% swing is significant in my opinion.

I'm not saying psych should become über competitive, but I see sharp declines in applicants to be a negative to the future of the field.

I wouldn't mind a few more bright minds helping to advance the field.
 
Im not sure where youre getting this data - I cant find the number of US seniors who applied in 2010. in 2011 there were 698 US seniors applying for psych, this year there were 680 - not a significant change. There have also been more applicants than ever for psychiatry so I don't think you can say it is 'becoming an easier match'. I suspect much of that increase is coming from the expansion of osteopathic schools as many IMGs have been deterred from applying in the past few years due to diminishing successes. Also you are using US applicants, which is misleading as it excludes DOs, when the figures are for US allopathic seniors.
 
I would also add many PDs told me they had had more applications than ever. This I suspect reflects the increasing number of programs applied to, and then people have been going on many more interviews than ever. My advisers applying way back when thought that me applying to 20 (even as an FMG) was ridiculous (i.e. too many), and one PD at a top program said he thought applicants only needed to rank 5-6 programs. Things are changing, I met many applicants interviewing at 12-14 programs, one who was interviewing at 21 (!) and heard of a (hopefully apocryphal) applicant who went on 28 interviews - an was a US senior...

What I would be interested to see as a measure of 'competitiveness' is what proportion got their # 1 this year? I wonder if the reason we have not seen the usual flurry of people saying where they matched because they did not get their no. 1?
 
The raw number of applicants is too blunt an instrument to tell us much about how competitive or not competitive psychiatry is. Maybe if psychiatry were getting more competitive, more marginal candidates would wind up applying elsewhere? I don't buy it either, but the raw numbers don't tell much about the quality of the applicants, and for most people, "getting a spot" isn't as important as "getting a spot you want." And the question of "how hard is it to get a spot you want" is probably the best question to ask. That's hard to answer.
 
splik said:
Im not sure where youre getting this data - I cant find the number of US seniors who applied in 2010. in 2011 there were 698 US seniors applying for psych, this year there were 680 - not a significant change.
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Actually, in 2011, there were 658. At least according to Charting Outcomes, which I trust more than the raw data tables they rush together immediately post match. This year there were 680. A slight increase.
splik said:
There have also been more applicants than ever for psychiatry so I don't think you can say it is 'becoming an easier match'. I suspect much of that increase is coming from the expansion of osteopathic schools as many IMGs have been deterred from applying in the past few years due to diminishing successes.
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This year there was actually a big increase in the number of independent applicants (meaning, FMGs, IMGs, DOs). 2011 saw 939 and this year saw 1328. I definitely haven't seen any data in a decrease in IMGs applying. I don't think that logic is correct. IMGs continue to apply to the least competitive specialties, of which psych is one of the biggies.

I do think the increase in applicants is due to the growing DO schools. So I think the brunt of the "its getting more competitive" is going to be felt more by the DOs, IMGs, and FMGs than the MD applicants.
 
splik said:
I would also add many PDs told me they had had more applications than ever. This I suspect reflects the increasing number of programs applied to, and then people have been going on many more interviews than ever.
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I think you hit the nail on the head with this. PDs are seeing more applications than seeing more applicants. The difference is going to be seeing a lot more DOs. Not just in psych, but other specialties as well. It's going to be interesting days in the years to come for DO applicants. Psych is probably feeling it, but I'd say much more so in more competitive specialties. If osteopathic programs keep increasing their enrollments without osteopathic residencies ramping up, there's bound to be a squeeze.
 
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Here's some data from the past few years matches that were published. All were from Charting Outcomes for the Match, with the exception of this year (so the data may wiggle by the time it's formally published). All data from # of ranks and below is for matched applicants.

Qual - 2007 - 2009 - 2011 - 2012
Spots - 1073 - 1063 - 1097 - 1118
USMDs - 648 - 681 - 658 - 680
IMG/FMG/DO - 671 - 882 - 939 - 1328
# of ranks - 7.0/4.0 - 7.3/5.8 - 8.5
Step 1 - 210/204 - 216/207 - 214/209
% AOA - 3.7 - 4.2 - 4.6
Top 40 School - 38.5 - 36.1 - 35.1

I don't see any trending of competitiveness of applicants. I see a static number of MD applicants applying to the allopathic match with a pretty static level of competitiveness (at least in objective measures like their step 1, how many were AOA, how many went to top 40 schools, etc.). The only big change I can see is a big increase in international, foreign and DO applicants. So the match might have been more competitive to these applicants this year.

Last year, we had the same buzz of "PDs said they got WAY more applicants this year" and "Psych is getting way too competitive this year" but it didn't bear out in data. My takeaway is that the most competitive Match year is the one in which you are applying.
 
billypilgrim37 said:
The raw number of applicants is too blunt an instrument to tell us much about how competitive or not competitive psychiatry is. Maybe if psychiatry were getting more competitive, more marginal candidates would wind up applying elsewhere? I don't buy it either, but the raw numbers don't tell much about the quality of the applicants, and for most people, "getting a spot" isn't as important as "getting a spot you want." And the question of "how hard is it to get a spot you want" is probably the best question to ask. That's hard to answer.
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Agree with this. "Percent of applicants who matched to their #1" is not a very good statistic at all (even though medical schools tend to advertise this heavily). At best it is a heterogeneous statistic that incorporates your objective competitiveness as well as the effectiveness of the medical school's career advice and your own intrapsychic processes: (a) our minds try to reconcile dissonant data ("I'm glad I matched to LECOM, I wouldn't have been happy with those arrogant snobs at MGH anyway"), (b) we tend to apply to programs where we think we have a shot, (c) irrespective of the lists we bring to our student deans, they gently counsel us towards applying to programs where they think we have a shot, (d) we don't get interviewed everywhere we would like to get an interview, and (e) our pride causes us to make realistic choices in ranking.
 
My stats are from the AADPRT.
2010: 670
2011: 640
2012: 616

This is what is circulated across psych residency programs. The people behind the AADPRT are from "Top 25" programs, and they are perceiving a drop in numbers large enough to begin addressing this concern.

My program has seen an increase in quality of applicants, so who knows.
 
TexasPhysician said:
What do y'all think should be done?
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1. LEADERSHIP: Attain leadership positions in medical schools. Deans and folks willing to sit on curriculum committees have a voice in how much emphasis (and hours allocation) to different subjects and experiences that will expose medical students to the field of psychiatry.

2. DOCTORING: Get academic psychiatrists more actively involved in the interdisciplinary medical school curriculum. Aside from the third year elective and didactic time allocated to psychiatry in the second year, most schools have interdisciplinary coursework (often PBL/TBL) that emphasizes "doctoring." These tend to go to those willing to teach them. In many of the med schools with many of the strong students going into psychiatry, these courses are dominated by psychiatrists.

3. EARLY OUTREACH: Only a small minority of applicants to medical schools do so with the intention of doing psych, and no need to preach to the converted. It's the unexposed that need to be evangelized. Because of the culture of most medical schools, psychiatry is often poo-poo'd and many students have already ruled it out as a specialty by the time they get didactics in 2nd year or clerkships in 3rd year. Early outreach through PsychSIGs and stand-alone events is necessary to get folks to keep an open mind by the time they are actually academically exposed to the field.

4. BUILD A BETTER PRODUCT: Have a diverse variety of training sites and run quality control on them. Forensic, CAP, gero, addiction, consult, etc. are all great options in addition to standard psych wards. And drop those that are negative experiences for students. This especially goes for private practice volunteer faculty environments, where QC is a problem for many schools.

5. INSPIRE FROM WITHIN: It's probably not incidental or annecdotal that med schools with stronger psychiatry departments tend to get more of their medical students to enter the field.
 
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Main problems with psych:

1. Overdiagnosis, arbitrary definitions, and disease-ization
2. Beholden to pharmaceutical industry
3. Lack of effective pharmaceuticals (ie SSRIs that can't beat placebo)
4. No significant advances in like 50 years (since ECT)
5. Low pay because no true spammable procedures
6. Low prestige, see above

Maybe DSM-V will fix some of 1. But otherwise barring major improvements in pharmacotherapy, psychiatry will remain on the fringes of medicine.
 
Asp said:
Main problems with psych:

1. Overdiagnosis, arbitrary definitions, and disease-ization
2. Beholden to pharmaceutical industry
3. Lack of effective pharmaceuticals (ie SSRIs that can't beat placebo)
4. No significant advances in like 50 years (since ECT)
5. Low pay because no true spammable procedures
6. Low prestige, see above

Maybe DSM-V will fix some of 1. But otherwise barring major improvements in pharmacotherapy, psychiatry will remain on the fringes of medicine.
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At least it's interesting. You can have your hypernatremia and GFR bro.
 
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Asp said:
Main problems with psych:

1. Overdiagnosis, arbitrary definitions, and disease-ization
2. Beholden to pharmaceutical industry
3. Lack of effective pharmaceuticals (ie SSRIs that can't beat placebo)
4. No significant advances in like 50 years (since ECT)
5. Low pay because no true spammable procedures
6. Low prestige, see above

Maybe DSM-V will fix some of 1. But otherwise barring major improvements in pharmacotherapy, psychiatry will remain on the fringes of medicine.
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1. Depends on the provider
2. BS
3. Overgeneralization of data, presumes facts not in evidence
4. Inaccurate. Psychotherapy has huge advances. Meds less toxic. TMS has huge potential.
5. Procedures isn't the only way to earn a $.
6. Depends on who you're seeking recognition from

Sounds like you just regurgitated the spiels heard from your non-psych mentors in med school.
 
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As a medical student, these are the things I see:

1. Misunderstanding the field: Even after a month rotation, many people come away with a vague picture of what we actually do. I think this extends from a bigger problem with poor self-promotion, and society not understanding what we do.

2. Salary: Many people pick the thing they liked best that pays the most. The salary stats for psych are misleading, IMO. Yeah, it's not super big money, but I think given the hours, and the low overhead, the potential IS there. We won't get into how bad the shortage is and how salaries may increase, especially as compared to things like Ortho, Rads, and Cards.

3. Work: Many people just aren't cut out for the work. Some of them want the adrenaline rush from cutting and procedures. Some people don't like all the talking. Some people don't like the uncertain nature of the work. There are many other reasons people shy away from the work, but it's kind of like Rads or Path in this regard. If we were making 350k/year I can PROMISE we'd see more people doing psych, not that we want that. I'm very happy with the shortage.
 
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I never thought I'd see "spammable " used with a positive connotation, especially when it comes to medicine.


And if youre in a field for prestige you're in it for the wrong reason.
 
Don't confuse prestige from doctors vs. the general public. So far I've received nothing but praise from the general public when I tell someone I'm going to be a psychiatrist. They usually respond with "You're going to help so many people" or "There's such a need" or "My cousin has this or that... you will help people like him that's so great." I become this humanitarian in their minds and it resonates with why I'm going for psychiatry in the first place.

Who cares what other doctors think of your specialty.

You want to talk prestige? The general public thinks radiologists shoot X-rays all day. Radiation oncologists...what the hell is that? And my favorite, dermatologists do rashes and botox. These docs get ZIP when it comes to prestige from the general public. At least psychiatrists get the "trying to help people" card.
 
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I'm doing it to piss of the scientologists
 
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Ron Mexico said:
I'm doing it to piss of the scientologists
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I'm pretty sure my career upsets the scientologists AND the Christian Scientists. Anything, ironically, that is a religion with the word "science" in its name. Any other Bostonians think it's very interesting that a major center of academic medicine (as in, this city has the same population as the one that I came from but 5x the number of academic medical centers) also is the center of a religion that opposes medical care?
 
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notdeadyet said:
5. INSPIRE FROM WITHIN: It's probably not incidental or annecdotal that med schools with stronger psychiatry departments tend to get more of their medical students to enter the field.
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I noticed this playing a role even as early as my medschool interviews, two places I interviewed at are known to have strong psych programs and during those interview days I would see several psychiatrists, whether they were deans or just interviewers. And my interviewers got excited about my psych related research experience even if they weren't psychiatrists.

However at the places I interviewed not known to be particularly good at psych, I didn't see a single psychiatrist at any of them and at one of the places the interviewers were pretty much making fun of my research and implying it was pointless which I found pretty amusing at that point, when two days before a top-10 school found it to be pretty impressive. (Interestingly I was accepted at the top10 place, but not at the other which was ranked in like the 60s).
 
Leo Aquarius said:
Don't confuse prestige from doctors vs. the general public. So far I've received nothing but praise from the general public when I tell someone I'm going to be a psychiatrist. They usually respond with "You're going to help so many people" or "There's such a need" or "My cousin has this or that... you will help people like him that's so great." I become this humanitarian in their minds and it resonates with why I'm going for psychiatry in the first place.

Who cares what other doctors think of your specialty.

You want to talk prestige? The general public thinks radiologists shoot X-rays all day. Radiation oncologists...what the hell is that? And my favorite, dermatologists do rashes and botox. These docs get ZIP when it comes to prestige from the general public. At least psychiatrists get the "trying to help people" card.
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http://pnhw.psychiatryonline.org/content/42/5/18.full

Only 38 percent of Americans believe that psychiatrists adhere to" high" or "very high" ethical standards, according to an annual Gallup poll conducted last December. The survey indicated that the public places most of its trust in other types of health professionals.

When asked about the ethical standards of psychiatrists, the majority of respondents rated psychiatrists' honesty and ethical standards as" average" (42 percent) or "low" or "very low" (12 percent).

Medical doctors in general were ranked fourth on the list of the most trustworthy professionals, just behind veterinarians; 69 percent of the public rated physicians' ethical standards as "high" or "very high."

Can't argue with the data.
 
F0nzie said:
Spamming procedures is a good way to screw yourself and your specialty
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Last I checked, GI and cardiology are doing pretty well.
 
Asp said:
http://pnhw.psychiatryonline.org/content/42/5/18.full

Only 38 percent of Americans believe that psychiatrists adhere to“ high” or “very high” ethical standards, according to an annual Gallup poll conducted last December. The survey indicated that the public places most of its trust in other types of health professionals.

When asked about the ethical standards of psychiatrists, the majority of respondents rated psychiatrists' honesty and ethical standards as“ average” (42 percent) or “low” or “very low” (12 percent).

Medical doctors in general were ranked fourth on the list of the most trustworthy professionals, just behind veterinarians; 69 percent of the public rated physicians' ethical standards as “high” or “very high.”

Can't argue with the data.
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This is pretty telling. The question is: how much of this is public perception, and how much is the fault of poor ethical standards in our field. I'm sure it's a hybrid of the two factors, and is definitely exacerbated by the lack of fully elucidated pathophysiological mechanisms of disease/treatment and the relatively poor efficacy of many of our treatments, as well as the disease states themselves.

Interesting statistics. Hmm...
 
You missed that the poll has a bias. It separates psychiatrists from the doctor category, which sends the message that psychiatrists aren't true doctors.

You can always argue the numbers, didn't they teach you that in med school? Sample another 1000 people and you will get different results.

I'm just sharing my experiences. I've received positive responses from strangers. We usually wind up chit chatting about various mental health issues and ways to improve care in America. People are interested, and I'm excited and proud to be helping those who need it the most.
 
Asp said:
http://pnhw.psychiatryonline.org/content/42/5/18.full

Only 38 percent of Americans believe that psychiatrists adhere to“ high” or “very high” ethical standards, according to an annual Gallup poll conducted last December. The survey indicated that the public places most of its trust in other types of health professionals.

When asked about the ethical standards of psychiatrists, the majority of respondents rated psychiatrists' honesty and ethical standards as“ average” (42 percent) or “low” or “very low” (12 percent).

Medical doctors in general were ranked fourth on the list of the most trustworthy professionals, just behind veterinarians; 69 percent of the public rated physicians' ethical standards as “high” or “very high.”

Can't argue with the data.
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I don't need to argue with the data, just the interpretation of the data and conclusions drawn from it. As Leo mentioned, the sample compared Psychiatrists to physicians as a whole. An actually useful data set might be comparing their opinions about psychiatrists to say surgeons, internists, and radiologists, and see how that pans out. Otherwise the format of the question itself biases the participant.
 
nitemagi said:
I don't need to argue with the data, just the interpretation of the data and conclusions drawn from it. As Leo mentioned, the sample compared Psychiatrists to physicians as a whole. An actually useful data set might be comparing their opinions about psychiatrists to say surgeons, internists, and radiologists, and see how that pans out. Otherwise the format of the question itself biases the participant.
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From talking to a bunch of people when I got accepted to medschool it seems like Rads/Anethesia/Derm were by far the least respected by my middle class extended family/friends because everyone seems to think their jobs are super easy and that they are just hungry for money. Seems like people think really highly of neurosurgeons and family docs from my sample.
 
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Tell a teacher you want to be a child psychiatrist, and watch the teacher squeal about how you should set up an office in the back of their *fill in room with a closet in the back here.*

My family was super disappointed when I first mentioned wanting to be a psychiatrist. Then when it was child psychiatry and my mother started getting feedback from folks at her school, I suddenly became the best thing ever. Plus I get to write more colorful editorials to my home town newspaper explaining how the conservative Christian Psy.D in town who advocates beating the **** out of misbehaving kids isn't a particularly reliable source of parental advice.

Psychiatry is the easiest medical specialty to think you know a lot about without actually knowing anything about it.
 
A big problem is the scope of the average psychiatry 3rd year clerkship. From our vantage, the only psychiatry we really know is inpatient, unless we've had experience outside of the med school curriculum. Since the rest of the match is so competitive, there are a lot of specialties that require away rotations and sub-internships, and you don't have a chance to explore outpatient, forensic, addiction or CAP electives. I'm willing to bet if the majority of med students spent a solid week in a nice private practice office, the applicant pool would shoot way up.
 
Salpingo said:
A big problem is the scope of the average psychiatry 3rd year clerkship. From our vantage, the only psychiatry we really know is inpatient, unless we've had experience outside of the med school curriculum. Since the rest of the match is so competitive, there are a lot of specialties that require away rotations and sub-internships, and you don't have a chance to explore outpatient, forensic, addiction or CAP electives. I'm willing to bet if the majority of med students spent a solid week in a nice private practice office, the applicant pool would shoot way up.
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That is bad. My 3rd year clerkship included inpatient, outpatient, child, VA, and Forensics.
 
My 3rd year clerkship was only inpatient, but we had ~8-10 students I know of going into psych, so it couldn't have been that bad...

I did seek out a C&A inpatient, state hospital, and C-L elective on my own though...
 
I think we're seeing what's been going on for years -- psychiatry is just not that competitive. Overall programs are filling more, and there are fewer spots in the scramble, but we're not that competitive. When your average board scores are hovering around 210, which is 10+ points below the mean, you're not picking up the rock star students.

Of course we all know psychiatry is an awesome field, so it continues to puzzle us, but most people seem to kind of hate what we do. I'm on CL right now, and it's amazing how much the medicine teams and surgery teams really dislike our bread and butter patients.
 
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Doctor Bagel said:
I think we're seeing what's been going on for years -- psychiatry is just not that competitive. Overall programs are filling more, and there are fewer spots in the scramble, but we're not that competitive. When your average board scores are hovering around 210, which is 10+ points below the mean, you're not picking up the rock star students.

Of course we all know psychiatry is an awesome field, so it continues to puzzle us, but most people seem to kind of hate what we do. I'm on CL right now, and it's amazing how much the medicine teams and surgery teams really dislike our bread and butter patients.
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FWIW, a buddy of mine is headed your way Dr. B, as a new IM intern. He almost chose psych, but didn't.
 
Doctor Bagel said:
Of course we all know psychiatry is an awesome field, so it continues to puzzle us, but most people seem to kind of hate what we do. I'm on CL right now, and it's amazing how much the medicine teams and surgery teams really dislike our bread and butter patients.
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I think there's some component of "either you get it or you don't" operative here. We find our patients fascinating, even if annoying at times, but we're not intimidated or dismayed by mental illness, so we dive in there and start trying to help folks figure out how to make things better. The rest, well, they just try to get as far away as possible. (Kind of like how I felt on my OB/Gyn rotation...:rolleyes:)
 
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What a time to have been alive


Sent from my iPhone using SDN mobile
 
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Ok. What specialty is easier to get compared to psych?
 
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