Psychiatry becoming more competitive?

[Leo Aquarius]

I could be totally wrong and am just speculating but I get the impression that psych can have a somewhat bimodal spectrum of applicants. I feel like a lot of people interested in psychiatry have a decent idea that is what they want to do even from the beginning of medical school. Some proportion of these people are going to be very competitive applicants and would be for many/most specialties come match day. On the other side of things, you may get a bunch of less competitive people for whom psych is the coolest option of those they have left. For some people, psych is the only realistic opportunity to be a specialist of any sort, so if they don't like generalist medicine of one form or another, they wind up in psych.

I wonder how much of the increase is just random ebb and flow, though. I mean, even if it's a large percentage increase, given the relatively low number of med students interested in psych to begin with, an increase of 80-150 people spread out across all the med students in the country still winds up being a difference of, on average, recruiting an extra student or so from each given class, or an average of an extra 0.5-0.9% of grads. In any case, the data I'm looking at indicate that in 2 years, there has been an overall total increase of about 4% for matched U.S. allopathic seniors, so at least some of the increase is not unique to psych.

The critical engineer that enjoys analyzing data in me actually disagrees.

You're actually, with respect, not correct. In fact, the opposite is true. The 4% refers to TOTAL PGY1 spots from 2014 to 2106, not US allopathic, and the % matched US allopathic seniors went DOWN (61.5% to 61.2%), not up, meaning more non-US seniors are getting matched. The trend is even more true looking back to 2012. From 2012 to 2016, the TOTAL PGY1 spots increased by 16%, but the % matched US allopathic seniors went down even MORE (65.5% to 61.2%).

You have to look at the numbers carefully - therein lies the trends, and there ARE trends. There's no such thing as ebb and flow, only trend vs. hover. Anesthesiology, it's taken a hit. Down 10% in US allopathic matched from 78% to 68% since 2012, just as word-on-the-street has said about it becoming less competitive. That's a trend. Look at Rads. Word-on-the-street says it's also less competitive. % US allopathic matched dropped a whopping 16% (big trend) since 2012 but bounced up this year a bit (trend starting to reverse?). For specialties where there's a difference of a few percent, it means it's perceived competitiveness hasn't changed much. Ortho has stayed around 90 to 94%, hovering until something rocks the apple cart like huge salary cuts or massive over-saturation (ie. pathology).

So, Psych seeing a 6% increase since 2012 teeters between hovering vs trend in my book, but its 10% increase over the last 2 years more favors it being a trend rather than a hover. More med students are interested and matching for sure. Let's see if the trend continues in 2017.

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[Blitz2006]

Awesome number crunching. And I thought I liked anaylzing stats.




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[sloop]

I could be totally wrong and am just speculating but I get the impression that psych can have a somewhat bimodal spectrum of applicants. I feel like a lot of people interested in psychiatry have a decent idea that is what they want to do even from the beginning of medical school. Some proportion of these people are going to be very competitive applicants and would be for many/most specialties come match day. On the other side of things, you may get a bunch of less competitive people for whom psych is the coolest option of those they have left. For some people, psych is the only realistic opportunity to be a specialist of any sort, so if they don't like generalist medicine of one form or another, they wind up in psych.

I wonder how much of the increase is just random ebb and flow, though. I mean, even if it's a large percentage increase, given the relatively low number of med students interested in psych to begin with, an increase of 80-150 people spread out across all the med students in the country still winds up being a difference of, on average, recruiting an extra student or so from each given class.

The critical engineer that enjoys analyzing data in me actually disagrees.

You're actually, with respect, not correct. In fact, the opposite is true. The 4% refers to TOTAL PGY1 spots from 2014 to 2106, not US allopathic, and the % matched US allopathic seniors went DOWN (61.5% to 61.2%), not up, meaning more non-US seniors are getting matched. The trend is even more true looking back to 2012. From 2012 to 2016, the TOTAL PGY1 spots increased by 16%, but the % matched US allopathic seniors went down even MORE (65.5% to 61.2%).

You have to look at the numbers carefully - therein lies the trends, and there ARE trends. There's no such thing as ebb and flow, only trend vs. hover. Anesthesiology, it's taken a hit. Down 10% in US allopathic matched from 78% to 68% since 2012, just as word-on-the-street has said about it becoming less competitive. That's a trend. Look at Rads. Word-on-the-street says it's also less competitive. % US allopathic matched dropped a whopping 16% (big trend) since 2012 but bounced up this year a bit (trend starting to reverse?). For specialties where there's a difference of a few percent, it means it's perceived competitiveness hasn't changed much. Ortho has stayed around 90 to 94%, hovering until something rocks the apple cart like huge salary cuts or massive over-saturation (ie. pathology).

So, Psych seeing a 6% increase since 2012 teeters between hovering vs trend in my book, but its 10% increase over the last 2 years more favors it being a trend rather than a hover. More med students are interested and matching for sure. Let's see if the trend continues in 2017.

No. I was looking at the total number of graduating seniors. I was specifically looking at the total number of matched seniors because unmatched seniors are not specifically relevant to the calculation I was trying to do regarding psych recruiting more U.S. Seniors, in relative terms. Unmatched seniors do not matter for this because nobody has recruited them. There were overall more U.S. Allopathic graduates this year than 2 years ago (18,668 from 17,373, up 6.9%), and more total allopathic grads who matched(17,057 vs 16,399, up 3.8%).Whether this represents a smaller percentage of total grads matching or not was not what I was looking at. That may be relevant to a different calculation but not to the one I was making. If you're going to say I have to look at numbers carefully, you need to read my post—which explains how I looked at the numbers—carefully. Now of course psych is seeing more U.S. Seniors in the past few years. I'm not discounting that. What I am saying is that when the overall pool of U.S. Allopathic seniors increased by 1295, matched seniors by 658, and the absolute increase in the number of U.S. Allopathic grads in psych during that period is 160 students from 125 medical schools, it makes it hard to make a convincing case that this definitely reflects an underlying trend in the competitiveness of the field rather than random chance.

You can feel free to find the data to do a formal multivariate analysis and prove me wrong, but I don't think I'm wrong to be at least skeptical.

The issue with your "trend vs hover" point is that you're trying to look at a recent trend from a data set and make a point that it is a real one—that is, not due to random chance or variables that wouldn't mean psych becoming more competitive in a typical sense. This data set only gets one new data point a year. It takes, at minimum, 2 years to establish an apparent trend—and the argument for that being an apparent trend, let alone one reflective of underlying forces, would be pretty terrible. As long as we're talking about data, I'm just going to point out that this kind of data is not very good for making the types of assertions we are making.

 

[medicool]

The 2016 match statistics are back and psych does appear more competitive with 61 percent Amgs.

 

[medicool]

If you include the DOs this is at 78 percent. The percentage of non US citizen imgs is at an all time low of less than 10 percent.

 

[MidwestMD2015]

The 2016 match statistics are back and psych does appear more competitive with 61 percent Amgs.

Would you mind linking to this report? Is this one of the reports available on AAMC's site?

 

[Blitz2006]

Would you mind linking to this report? Is this one of the reports available on AAMC's site?

US MD 61.4% (Compare to IM (47%), FM (45%), Anesthesia (69%), Radiology (67%), as benchmarks).

Please refer to Table 8: http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf

I wouldn't mind knowing where medicool found the "78% DO match" and "10% Non-US IMG" match stats.

I am also literally copying and pasting my post from another thread regarding this issue:

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http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf

If you look at table 7, 10% increase in US MDs in each of the last 2 years, highest increase among all specialties.

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

Refer to Psych, page 253. In 2014, Step 1 Avg. = 220, Step 2 Avg = 231. In 2010, Step 1 Avg = 214.

So I think its safe to predict the average this year (2016) for Step 1 was probably around 224 +/- 1. Step 2, I'm gonna guess an average of around 234. And I suspect for both, it will go up again by 1-2 points for 2017 match. But obviously, take into account inflation (everyone's scores is going up, but my hunch is that psych is increasing at a faster rate relatively and closing in on other specialities).

Is Psych impossible for DOs? Of course not. Since you got 220s, you're WILL match. No doubt. But unlike 5 years ago, you probably won't be cherry picking university programs on the coasts, unless you have stacked research and/or 235s. So if you want to bang into places like Beth Israel in NYC/St. Lukes Roosevelt/LIJ or Jefferson in Philly or Georgetown in D.C, I would aim for a 240 on Step 2, and throw in a case report or a poster, psych related. I'm not saying you can't get into these places with a step 2 of 230-235, but 240 and I think you're breathing easy. BUT, if you just want to match into any ACGME program, anywhere in the country, then you can just coast 4th year, and you'll still be fine. Like others have mentionned, geography and academic of program will impact your rank list, greatly.

IMGs/DOs will be feeling the crunch in the upcoming matches, as Psych closes in on specialities like IM/Rads (Diagnostic, NOT IR)/Anesthesia over the next 4-5 years (which is when IMGs I think will be shut out of psych (2020), and DOs will have to be super competitive). Also, psych will most likely overtake Peds/FM/PMR/Path comfortably in the next 1-2 years (if psych hasn't already, which I think it has for FM/Peds).

I mean, in terms of US MD %, Psych is way head of IM/FM (61% vs. 43/45%). But IM is still ahead of psych in terms of USMLE Avg. (step 1 231 vs. 222, 2014 averages). But as I mentioned earlier, I suspect this gap will close in the next few years. It should be noted that this year, for the first time in 15 years, IM DROPPED in number of US MDs that matched into the specialty. This is a big deal, in a speciality that over the years has seen an increase in over 100-200 US MDs/year, on average. While I have no stats to back this up, I think its safe to say that the IM Step 1 231 average of 2014 has most likely been stagnate, and maybe even dropped 1-2 points this past match.

Just my 2 cents/prediction.

Anecdotally, I have definitely seen a much stronger interest among medical students in psych these past 2 years at my institution. Interest in electives/sub-i has shot up, no question.

 

[medicool]

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

Here you go , refer to page 8 for psychiatry categorical.

Psychiatry (Categorical)
1,384 - total spots
1,373 -total matched
850 - US senior
41 - US Graduate
188 - DO
162 - US(citizen) IMG
132 - NON US IMG
11 - Unfilled

 

[FlowersFromTheSun]

Does anyone know which spots went unfulfilled? I heard 2 were at Dartmouth. Seems odd.

 

[Leo Aquarius]

% US seniors comprising matched spots in Psych: 850/1373 = 62%
% DO comprising matched spots in Psych: 188/1373 = 13.6%

% US MD + DO: 1038/1373 = 75.6%

 

[Blitz2006]

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

Here you go , refer to page 8 for psychiatry categorical.

Psychiatry (Categorical)
1,384 - total spots
1,373 -total matched
850 - US senior
41 - US Graduate
188 - DO
162 - US(citizen) IMG
132 - NON US IMG
11 - Unfilled

Very cool. I never noticed Table 2, always skipped over.

Knowing exactly the number of IMGs is also a good indicator of competitiveness, since I had no idea how many of the non US MD were DO.

But obviously, charting outcomes is the best indicator of competitiveness. For example, Rads and Peds this year had the same number of IMGs (17%). But I'm pretty sure Rads is more "competitive" than Peds (USMLE Scores, research, etc.).

And while IM IMG is 42%, Psych (21%) I think will be closing in on Anesthesia/OBGYN/Gen Surg (10%ish) over the next 5 years I suspect.

 

[notdeadyet]

I know there is a pull to look for a single metric to determine competitiveness, and US MD % can be handy, but it's not the end-all/be-all. The competition comes from what your fellow applicants look like. And psychiatry is getting more competitive (as specialties are across the board, though psychiatry likely at a slightly faster rate), but you are still not getting as many hard chargers as most specialties. We are still at the stage where a US MD with no red flags will have a near sure-fire match as long as s/he applies early and broadly. Very few specialties can say that.

Folks who go into medical school very much skew towards the worrying kind, but I'm hoping that potential applicants who are interested in psych can take some comfort in that.

 

[Moose A Moose]

First: All specialties are becoming more competitive. Nature of the beast with the residency bottleneck.

Second: Psych, like family medicine, has garnered huge federal backing from the ACA. Mental health care is now one of the top priorities in our country's new health care rubric. Adequate compensation will cease being a deterrent for interested applicants.

 

[Blitz2006]

First: All specialties are becoming more competitive. Nature of the beast with the residency bottleneck.

Second: Psych, like family medicine, has garnered huge federal backing from the ACA. Mental health care is now one of the top priorities in our country's new health care rubric. Adequate compensation will cease being a deterrent for interested applicants.

Not true about all specialties becoming more competitive. Look at Radiology for the past 5 years (until this year).

And specialties like Gen Surg/OBGYN/Anesthesia have been pretty much stagnate for the past 5 years (despite the increase in US MD grads).

 

[Blitz2006]

I know there is a pull to look for a single metric to determine competitiveness, and US MD % can be handy, but it's not the end-all/be-all. The competition comes from what your fellow applicants look like. And psychiatry is getting more competitive (as specialties are across the board, though psychiatry likely at a slightly faster rate), but you are still not getting as many hard chargers as most specialties. We are still at the stage where a US MD with no red flags will have a near sure-fire match as long as s/he applies early and broadly. Very few specialties can say that.

Folks who go into medical school very much skew towards the worrying kind, but I'm hoping that potential applicants who are interested in psych can take some comfort in that.

Agree 100%. But thats not the point of my argument. No one is saying US MDs are at risk. Its the IMGs/DOs that will be feeling the crunch in the next few years (as I'm sure they already have the past 2 years).

5-7 years ago, Psych was so non-competitive that even US IMGs could practically walk into a university program with a red flag here and there. Now thats not the case.

My posts aren't meant to fear monger US MDs/Strong DO applicants, its to raise awareness for IMG applicants/'weaker' DO applicants. I personally know of a few US IMGs (Carribean grads) that did not match into psych this year, which would not have been the case 5 years ago. But I also believe that while US MDs will have no problem matching the next few years, I don't think they will be a shoe-in anymore for Top 20 programs, without some solid stats.

 

[notdeadyet]

Agree 100%. But thats not the point of my argument. No one is saying US MDs are at risk. Its the IMGs/DOs that will be feeling the crunch in the next few years (as I'm sure they already have the past 2 years).

Agreed. We've been predicting that for the last few years. It's arrived.

5-7 years ago, Psych was so non-competitive that even US IMGs could practically walk into a university program with a red flag here and there. Now thats not the case.

And this is a good thing. Psych used to be the clearinghouse for folks who could not get into other residencies. When you see many of the psychiatrists out their practicing (and inherit their unnecessarily messed up patients), you see why that's a problem. We SHOULD be a specialty that requires quality applicants. This is good for the field and good for our patients.

My posts aren't meant to fear monger US MDs/Strong DO applicants, its to raise awareness for IMG applicants/'weaker' DO applicants. I personally know of a few US IMGs (Carribean grads) that did not match into psych this year, which would not have been the case 5 years ago.

It's going to continue to be a problem. Medical school options have gotten progressively (ahem) broader. If you are willing to take on the debt and willing to study anywhere, you will get in somewhere if you graduated from just about any undergrad with a B average. The number of seats among MD/DO programs domestically alone has increased, while residency slots haven't.

This will likely self-correct when the idea that you are guaranteed employment for life once you get your medical degree is no longer the case. My hope is that exploitive schools get the reputation for not being able to place folks, they will dry up and wither on the vine. Though that may be wishful thinking.

But I also believe that while US MDs will have no problem matching the next few years, I don't think they will be a shoe-in anymore for Top 20 programs, without some solid stats.

They never were in top 10 programs. I don't know what constitutes top 20 programs, but I do notice that there are more and more amazing applicants to psychiatry every year and they exceed the number of available slots at top programs. This causes these applicants that don't match at the top programs to match into otherwise awesome programs, succeed, and make them better. It's a positive trickle down effect.

In short: these developments are good things for psychiatry, for psychiatrists, for residencies, for residents, for applicants, and most importantly, for our patients.

 

[MLT2MT2DO]

I know there is a pull to look for a single metric to determine competitiveness, and US MD % can be handy, but it's not the end-all/be-all. The competition comes from what your fellow applicants look like. And psychiatry is getting more competitive (as specialties are across the board, though psychiatry likely at a slightly faster rate), but you are still not getting as many hard chargers as most specialties. We are still at the stage where a US MD with no red flags will have a near sure-fire match as long as s/he applies early and broadly. Very few specialties can say that.

Folks who go into medical school very much skew towards the worrying kind, but I'm hoping that potential applicants who are interested in psych can take some comfort in that.

Other specialties that I think would match the "no red flag us md=match if applying broadly" would be fp, im, peds, rads,PM&R, and possibly GAS. Playing devils advocate but I think many specialties can actually say this.

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[Leo Aquarius]

Other specialties that I think would match the "no red flag us md=match if applying broadly" would be fp, im, peds, rads,PM&R, and possibly GAS. Playing devils advocate but I think many specialties can actually say this.

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Sounds right. Add to the list - Gen Surg has really fallen in competitiveness too.

 

[Blitz2006]

Sounds right. Add to the list - Gen Surg has really fallen in competitiveness too.

True, but Psych is still behind Gas/GenSurg/Rads, but give it 3-4 years....

 

[Blitz2006]

Agreed. We've been predicting that for the last few years. It's arrived.

And this is a good thing. Psych used to be the clearinghouse for folks who could not get into other residencies. When you see many of the psychiatrists out their practicing (and inherit their unnecessarily messed up patients), you see why that's a problem. We SHOULD be a specialty that requires quality applicants. This is good for the field and good for our patients.

It's going to continue to be a problem. Medical school options have gotten progressively (ahem) broader. If you are willing to take on the debt and willing to study anywhere, you will get in somewhere if you graduated from just about any undergrad with a B average. The number of seats among MD/DO programs domestically alone has increased, while residency slots haven't.

This will likely self-correct when the idea that you are guaranteed employment for life once you get your medical degree is no longer the case. My hope is that exploitive schools get the reputation for not being able to place folks, they will dry up and wither on the vine. Though that may be wishful thinking.

They never were in top 10 programs. I don't know what constitutes top 20 programs, but I do notice that there are more and more amazing applicants to psychiatry every year and they exceed the number of available slots at top programs. This causes these applicants that don't match at the top programs to match into otherwise awesome programs, succeed, and make them better. It's a positive trickle down effect.

In short: these developments are good things for psychiatry, for psychiatrists, for residencies, for residents, for applicants, and most importantly, for our patients.

Yep. We also need to do better jobs as residents/attendings to inform medical students more. Most medical students have no clue about the worlds of Forensics/Addiction/Geriatric/Child/Neuropsych.....and are even shocked to know that psych can apply to Sleep/Pain fellowships. I mean, 90% of my psych attendings don't even know we can apply to pain, so how are medical students supposed to know?

Most med students just do inpatient, maybe CL if they are lucky, and possibly a few days of outpatient. Just the tip of the iceberg for psych.

 

[bonedrone14]

Does anyone know which spots went unfulfilled? I heard 2 were at Dartmouth. Seems odd.

I emailed their coordinator practically begging for an interview there too. What's that say about me? Ouch lol

 

[Leo Aquarius]

True, but Psych is still behind Gas/GenSurg/Rads, but give it 3-4 years....

Yep yep.

 

[OldPsychDoc]

Just playing with the 2016 Match Data--note that the International category only indicates the location of the medical school, and doesn't distinguish between US citizen and non-citizen. For 2016, that represented 162 and 132, respectively, of the 294 International grads that matched. (Bottom line--don't send your kids to the Caribbean.)

 

[Shikima]

Just playing with the 2016 Match Data--note that the International category only indicates the location of the medical school, and doesn't distinguish between US citizen and non-citizen. For 2016, that represented 162 and 132, respectively, of the 294 International grads that matched. (Bottom line--don't send your kids to the Caribbean.)

View attachment 203985

The good times from the Caribbean are over?

 

[MacDonaldTriad]

Anyone know any stats on what % of Caribbean grads match in the US?

 

[COUNTER FIT]

Just playing with the 2016 Match Data--note that the International category only indicates the location of the medical school, and doesn't distinguish between US citizen and non-citizen. For 2016, that represented 162 and 132, respectively, of the 294 International grads that matched. (Bottom line--don't send your kids to the Caribbean.)

View attachment 203985

The bottom line of "US matches" is so low due to the fact that every US senior decides to participate in the match minus 1% (I was the only one in my class for example). While the number of spots granted is interesting data, maybe only 15 are applying.