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What Do You Do If You Can't Get Into The Specialty You Want?

Discussion in 'Pre-Medical Allopathic [ MD ]' started by done12812, 03.09.12.

  1. done12812

    done12812

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    SDN Members don't see this ad. (About Ads)
    I have a couple of questions I hope you guys can help answer.

    The primary one is lets say you want to go into the R.O.A.D. specialties for whatever reason. After spending 3 years of medical school working your tail off (I heard 4th year is not that bad) what do you do if you can't get into the specialty you want? What options exist. Lets say you want to do derm, and after acing your pre-clinical grades you fail to score that 240 you need for derm on Step1. If you end up with a 226, what then? Do you just give up on derm, and enter something else?

    How do medical students deal with the blow not matching into their specialty?

    My other question is that I know a ton of medical students do research between MS1 and MS2. Most end up doing research in the field that they eventually want to go into. If an MS1 and MS2 student does research in Derm, cranks out a publication or two in that field, but fails to match into Derm, what then? Is that research experience considered a waste?

    Do publications in undergrad count? Lets say a student will be a 3rd/4th author in a REALLY high impact medical journal (New England Journal of Medicine, JAMP, Nature, etc) and that article will be cited roughly a couple hundred times (roughly 500) . If this research work is not related to the field of medicine the student wants to go to, is it still helpful on residency apps? I heard the saying that "Publications, especially in HIGH IMPACT Journals (Impact factor greater than 7) will stay with you for life".

    My final question is why is Anesthesiology included in the notorious ROAD specialties. I have been looking at step 1 scores for Anesthesiology and they seem to be much lower than Orto,Derm, Radio. Is it because nothing else is even remotely competitive for US MD grads?
  2. armybound

    armybound future urologist. Moderator Emeritus

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    Any publication on your CV "counts"

    ROAD specialties are known for their lifestyle. Anesthesiology has a good lifestyle.
  3. IlDestriero

    IlDestriero Ether Man

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    Anesthesia can be lifestyle friendly and it can be very lucrative. Avg salary is >400. It's the easiest road.:D and the most interesting.
  4. done12812

    done12812

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    Armybound, I sent you a PM, I have some questions about some Texas schools.
  5. jdh71

    jdh71 si vis pacem, para bellum

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    [​IMG]
  6. done12812

    done12812

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    Anesthesiology is not 400k lol on average. Even I know that (undergrad), lol. :)
  7. Brachyury

    Brachyury

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    Any pubs count, even if they are from undergrad. For the most part, at this point in your career, quanity trumps quality (most physicians will not be able to differentiate journals that are not in their field, unless they are major journals). The rule of thumb is that the more competitive the specialty is, the more important research is, and the more important it is to have research in that particular field. If you want to go into peds, any research will help your application, but if you want to go into plastics, you really, really should have plastics-specific research.

    ROAD residencies are broad. If you passed Step I and II and are a US allopathic student, you should be able to match somewhere in anesthesiology. It might not be at a good program or in a desireabel location, but there are enough spots that you should be able to find someplace. Radiology also has a lot of spots, so as long as your scores aren't too bad, you'll likely match somewhere. Ophto and derm, however, have fewer spots and are more competitive, especially derm.

    If you scored a 226 and wanted to do derm, your options would be to pursue a less competitive field or to try for derm. If you do the latter, you will need to take Step II early and score well, do research, and get to know the derm department at your school very well. Since derm requires a prelim year, if you don't match, you'll do a prelim year, during your prelim year, many derm applicants will apply for 'research' year for the following year where they are hired by a university derm department to run clinical studies/assist their program. During the prelim or research year, you can apply again (with a stronger application) for derm residencies, and hopefully you land a spot.
  8. Brachyury

    Brachyury

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    The poster who quoted 400k is an anesthesiologist; I doubt he's going to pull an inaccurate number out of his butt for the hell of entertaining anonymous posters on an internet forum. Starting gas jobs may not be 400k, but if you are a partner in a practice, 400k doesn't sound unreasonable.
  9. jcu

    jcu should have been dr. who

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    [​IMG]
  10. colbgw02

    colbgw02 Delightfully Tacky

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    Match rates are as high as they are because a lot of self-selection goes on. Most people who get a Step I score of ~225 will adjust their interests accordingly during third year. Those that don't typically have the real world explained to them in very blunt terms by a dean. The rest are the ones that scramble during match week. Some of them will eventually get to their goal specialty, through hard work and persistence. Some will not, so they readjust expectations, albeit involuntarily. How do they deal with it? Not well. We're talking about a population accustomed to reaching their established goals, after all. Everything else is taken care of by denial and/or self-delusion. It's amazing what someone can convince themselves of when faced with no other reasonable alternative. "Oh really? You always wanted to practice prisoner medicine in a Siberian gulag? Lucky for you, then. Maybe you can get promoted to family medicine in Barrow, AK, once that opens up."
  11. IlDestriero

    IlDestriero Ether Man

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    One of us has been an anesthesiologist for over a decade.:idea: Decide for yourselves who to trust.
    2010- $416.
    I'm sure this is covered in freshman bio though. ;)
  12. gasblaster

    gasblaster ASA Member

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    Lol also backed by the MGMA survey.
  13. colbgw02

    colbgw02 Delightfully Tacky

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    "Come at the king, you best not miss."
  14. pingouin

    pingouin just chillin' Administrator SDN Senior Moderator

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    Yep. Moving.
  15. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    The salary is so nice. I really enjoyed anesthesia, but I feel as if the continuity of care (lack there of) is really a killer. However, there's that looming thought in the back of my head about the money and how I wouldn't be unhappy doing it but not as thrilled as my current plan, FM. Decisions decisions decisions.
  16. mipp0

    mipp0

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    Bacchus, our country needs FM heroes. Will you answer the call?
  17. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    Can I have a check worth my medical school loans written to me?

    My concept of practice, all through this, was to be a GP. However, you can't ignore the costs. I know things will work out, but it's still scary to think about. The downside is I'm picking between three different potential fields and I feel at this point in time I will think about what-ifs in the future. However, the biggest what-if will be if I don't practice FM so that's what I am going with.
  18. armybound

    armybound future urologist. Moderator Emeritus

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    are you private practice? I didn't know anesthesiologists made this much. I don't really know much about physician compensation at all.
  19. drizzt3117

    drizzt3117 chick magnet

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    So you'd like to essentially take step 2 cs (with rectal and pelvic exams) +/- ob/gyn, every single day for the rest of your career? Where can I sign up???
  20. GoSpursGo

    GoSpursGo Allons-y! Administrator SDN Senior Moderator

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    Wow, standardized patients are showing up at FM offices these days? I had no idea :rolleyes:
  21. MilkmanAl

    MilkmanAl Al the Ass Mod

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    "Killer" in the positive sense, if you ask me. That's one of my favorite parts about the specialty.
  22. drizzt3117

    drizzt3117 chick magnet

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    They gotta go somewhere, right?
  23. mfrizzo3

    mfrizzo3

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    1) You cry
    2) You bash the specialty you didn't match in
    3) Proclaim your *new* specialty the best evaaarrrrr
  24. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    I also thought about doing OB/GYN/Women's Health. However, I don't want a surgical lifestyle. So, to be honest, some paps and discharges here and there is not a big thing.
  25. IlDestriero

    IlDestriero Ether Man

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    It doesn't look like you really got your answer. If you aspire to a very competitive specialty you have to hit the ground running and don't look back. Some people self select out after scoring significantly lower than average on step 1, grades, rank, etc. These folks just select another specialty. Others don't match on match day and scramble into something else. You could take a year off and do some research in your desired field in an attempt to match the following year, but I don't think many put their careers on hold to try that. If you had support from your home program that might be an option.
  26. drizzt3117

    drizzt3117 chick magnet

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    If you add ob to your practice you'll have a lot more call.
  27. ChartaBona

    ChartaBona MD Class of 2017 Gold Donor

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    How does anyone deal with these types of setback? You try again, or you suck it up, and find the next best thing to do.
  28. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    You don't like FM. I get it. Really, is this comment necessary?

    This whole "let's cut down other specialties because I wouldn't want to do them" is old. I would rather not be an MD AT ALL than be a radiologist, but I don't say that at every single opportunity.

    [/rant]
  29. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    I'm aware. Most FPs in desirable locations don't do OB but do gyn. There's enough OBs up and down the eastern coast to deal with pregnancy and delivery. You sometimes have to give things up in life. Like I originally said, which you quickly and inconsiderately cut down, my specialty choice is one where I'll be happiest. I know I'm giving something up for whichever choice I make. I may never deliver another child after residency, but for my own sanity and my own happiness I may have to deal with that.

    You enjoy radiology. I enjoy family medicine. We all know you're top of your class, at a top 25 school, have multiple publications. Does that make your specialty choice better than mine? Absolutely not. You'd never want to be a general practitioner, I'd never want to be a radiologist. But, the difference is I'm not here making gross generalizations and downplaying the importance of another field.
  30. KnuxNole

    KnuxNole Sweets Addict

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    I agree. I don't even look at competitive specialties even as a pre-med, because they never interested me at all. But, I would do primary care in a heartbeat, since that's what I loved about being a doctor in the first place...
    Anything surgery based, and path/derm/rads I would rather kill myself than ever spend one day doing....but I don't tell people who like those that :/
  31. Paaakwasi

    Paaakwasi

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    :thumbup::thumbup::thumbup::thumbup: Well Said!!!!!

  32. Moebius

    Moebius

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    Anesthesiology wasn't always a highly paid profession. There was a time (a decade plus ago) when it was one of the "low" paid position.
  33. dd128

    dd128

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    Don't worry too much about what that guy says, I see him post all over the place arguing with everyone about everything. Unfortunately some people just use this forum as an outlet for their need to argue.
  34. IlDestriero

    IlDestriero Ether Man

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    That's not exactly true, there was fear of oversupply and groups were not hiring in the 90's. The groups that were paid very poorly, but the partners were still banking big money. The number and quality of applicants went down, and many foreign physicians went into the field. Then there was an explosion of ASCs, office based procedures, etc. And it all turned around again. This is what really opened the door for CRNA growth as well. Earnings now are actually down compared to a couple decades ago. The partners retiring now after 35+ years lived through the glory days. Of course taxes were higher in the 70's and 80's.
    Some of the more pessimistic are worried that this is starting to happen again, with fewer groups offering partnership tracks, no signing bonuses, holding off on hiring until Obama care shakes out. But, the partners are still making bank. Another new trend is selling small groups to management companies. Partners win, everyone else loses. I think the spread of anesthesia management companies is a larger threat to the profession than CRNAs. Time will tell. This uncertainty is not just an anesthesia problem. If single payer govt control comes, the management companies will all be out of business. The trends could switch with small groups taking contracts back from huge faceless management companies as well. The hospitals would love to employ the anesthesia teams directly and take the profits for themselves, but that's harder to do.
    All I can tell you is that the residents and fellows I work with are all getting jobs and the tightest markets want fellowship trained people and are getting tighter. But there are also many people who held off on retiring over the last few years because of what had happened to the economy, they're not getting any younger. You can only hold off for so long. Several in my group will be out in the next few years.
  35. drizzt3117

    drizzt3117 chick magnet

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    For the record, I think FP is an essential specialty and also a very important referral base for rads so I'm glad they exist; that being said, I am just having difficulty understanding why people choose the field given the financial landscape, and wonder if 3y is long enough to learn everything they need to know (essentially all of medicine)
  36. Moebius

    Moebius

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    What I was trying to say was it is hard to predict what will happen in 1-2 decades in the future. If you were a medical student in the late 80s and early 90s, anesthesiology was not a top choice for US graduates because not many people were expecting to be running their own practice.


  37. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Fair enough, this is a reasonable question. Saying that FM is the same as "essentially take step 2 cs (with rectal and pelvic exams) +/- ob/gyn, every single day for the rest of your career" is...not.

    The "financial landscape" gets overblown, I think. Yes, outpatient primary care gets paid less than other specialties. And no, you probably won't make enough to buy the vacation home in Maui or the garage full of Jaguars. But not everyone wants that, and you'll certainly make enough to pay off your loans, buy a decent house, and send your kids to a decent school.

    I do feel that there needs to be more loan repayment options for people who choose to go into primary care. Most practices DO offer some form of loan repayment, but I think that there needs to be more, in order to get people into primary care. I came out of intern year being completely debt free (thanks to the NHSC), and I will say that the lack of debt is extremely freeing. It really gives you the freedom to do what you want, work where you want, etc.

    Is 3 years enough to learn "everything" you need to know? No. But is 4 years enough to learn "everything" you need to know about radiology? Again, no. The purpose of residency is not to max out your clinical knowledge....anyone who said that to you on the interview trail lied. The purpose of residency is to learn how to think like a doctor, increase your clinical knowledge, but also to know where to turn to find the answer when you don't know. There is SO much in medicine that it takes a lifetime.

    One of the ENT attendings at my hospital told me that his first year as an attending was his biggest learning curve - bigger than MS1, bigger than internship. So even a 5 year ENT residency wasn't enough to teach him "everything."

    Finally, I really like FM because of the job flexibility. I can go pretty much anywhere and find a job. Portland, Austin, Miami, NYC, Hawaii, New England, USVI...they all need FM primary care and are willing to pay to get you to come out there.

    I can find a job where I don't have to work nights or weekends if I don't want to...good luck finding that as a specialist or as a radiologist.

    And I like the variety. Last Friday in clinic, I saw a sprained wrist (although sorry, didn't order an x-ray ;)), diagnosed zoster opthalmicus, did a couple of paps, managed acute anxiety, started a young asthmatic on meds. And I was done all my work by 5:30. It must not be THAT universally un-appealling, because I have met 3 former-radiology residents who are now in Family Med. It does happen.
  38. Gigantron

    Gigantron Robot

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    I found it interesting that the only two people to call out IlD on Anesthesia salary were undergrads.
  39. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    So, a practice offering some form of debt repayment would not have been a motivator for you since you had no debt anyway.

    Primary Care practices might get more interest if they raised the salaries of primary care providers. That way they aren't limiting these benefits only to those who have large student loans.
  40. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Maybe. I do feel that it's harder for a practice to increase salary, than to offer student loan assistance, though.

    If I had been looking to sign with a practice that is in the position to negotiate, I would have asked if it would be possible to convert some of that loan assistance money to a one-time sign-on bonus. They still save some money on me, but I don't leave it all on the table. Make sense?
  41. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    Yeah, you're right. A sign-on bonus would be a better replacement for loan payoff, and everybody would benefit. A high salary would last forever.
  42. Skinceutical

    Skinceutical

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    This is a specious argument. Why do we need to "get more people" into primary care?

    As it stands, in 2011, there were 3,551 applicants for 2,708 FP residency positions. Over 94% of positions filled through the match alone; once you factor in pre-match contracts and the scramble, I'm sure few, if any positions were left unfilled.

    Why do we need to spend money incentivizing primary care, when we already have no trouble recruiting potential applicants as is?
  43. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    True, but in the 2011 match, less than 50% of those positions were filled by US seniors.
  44. KnuxNole

    KnuxNole Sweets Addict

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    I want to do IM, but on the same subject with primary care(since I ideally want to be in a clinic setting)
    1) Because the financial landscape means ****. Everyone knows going in to med school we are gonna get a ton of loans. So it doesn't matter to me. I mentioned this in another topic, I'd rather be happy than make a ton of money.

    smq said it best:

    The "financial landscape" gets overblown, I think. Yes, outpatient primary care gets paid less than other specialties. And no, you probably won't make enough to buy the vacation home in Maui or the garage full of Jaguars. But not everyone wants that, and you'll certainly make enough to pay off your loans, buy a decent house, and send your kids to a decent school.

    I'd rather live in a small house, have only one car or two(or even take a subway 30mins to work), and live comfortably. I won't be sad or envious if I don't have 5 sports cars, or a few vacation houses or yachts.


    2) Do you think you can learn all of XXX specialty in 3-5 years? Maybe it's residency dependent. A program which has a wide variety of pathology, a wide variety of rotations, and ample amount of readings. Also, I assume most brand new attendings aren't experts in their fields, they are probably "Jr. attending" at least for the first few months of practice.

    And for the record I would LOVE to take a "CS" like day, since talking to patients is the best part of the job. I like to take the history, do the physical, figure out the plan and do the workup/treatment/consulting. Also, following patients, managing them, being the person they go to for additional medical concerns. But this is person-dependent. I dont knock others who hate the clinic-like days(which from my personal experience is a lot of med students). I'll admit I would feel bored looking at path slides, looking at CTs/X-rays, and moan/groan stepping into an OR or doing tons of invasive procedures.
    Last edited: 03.11.12
  45. Skinceutical

    Skinceutical

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    Why does that matter? The remaining 50% were filled by thoroughly vetted American osteopaths and foreign medical graduates who met all licensing criteria to practice medicine in the United States.

    You know as well as I do that there are far more residency positions in the ACGME match than than there are American MD graduates each year. I suspect that as the new crops of medical schools start graduating their first classes, the percentage of positions filled by Americans will only increase.
  46. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    A) You're assuming that the current number of residency positions will provide enough primary care physicians for the future, and that we don't need more residency slots. And B) you're assuming that all the FMGs who go into primary care either stay in the US or provide adequate care for patients, despite the usual concerns about language barriers, etc.

    I hope that the percentage of positions filled by Americans will increase, but I don't know for sure.

    I'm curious as to why you do NOT think people should be incentivized to go into primary care.

    Why not incentivize the general IM physician who leaves residency to do primary care and not to specialize? Or the general pediatrician?
  47. Skinceutical

    Skinceutical

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    I made no such assumption. In fact, I agree that we likely do need more primary care physicians. Your plan to increase interest in primary care among American MD's does nothing to address this shortage.

    The problem isn't a dearth of applicants to ACGME primary care residencies; rather, the bottleneck is the number of residency positions available, which has been stable for decades. Your plan may marginally increase the "prestige" of FP (by increasing the percentage of American MDs filling residency positions), but it will not create more PCPs in absolute numbers.

    Please. Non-US IMGs comprised only 14% of FP matches in 2011. I'm sure DOs and Caribbean graduates (who comprise the bulk of the non-US seniors matching in FP) speak English just as well as you do, and have every intention of staying in the US.

    If you'd like taxpayers to take on the burden of incentivizing your specialty, then I think it's your job to prove with solid data that primary care trained IMGs provide poorer care, have worse outcomes, or leave the US in significant numbers.

    We live in an era where the government is having an increasingly difficult time justifying why medical school/residency trained physicians are even necessary to provide care in a number of fields (both in primary and specialty care). I don't think a measure that essentially only serves to increase the prestige of primary care is a responsible use of resources. Honestly, if we can make it through the next 5-10 years without seeing significant cuts to physician compensation across the board, I'll consider it a win.

    If you're concerned about an impending shortage of PCPs, then why not use that money to fund additional FP residency positions (esp. in underserved areas)? There's more than enough potential applicants to fill a couple hundred additional residency positions annually.
    Last edited: 03.11.12
  48. drizzt3117

    drizzt3117 chick magnet

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    Fair enough; I'm definitely on the surgery side of the ideological divide (going into IR) so I find the clinic setting intolerable.

  49. Morsetlis

    Morsetlis SGU MS-4

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    Oh, I'd probably jump off a bridge, or something.

    I'd make sure there were water underneath first, though.
  50. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Basically this. Not everybody is going to have a shot at the most competitive things. You go in with an open mind and your sleeves rolled up and do your best, and when the time comes you see what doors are open to you.

    All research is good for any field. Its ideal if you do targeted research for your ultimate specialty, but research and publications still look good for other specialties. If you have to do targeted stuff, you can always add in a research year later (after 3rd or 4th year). All publications look good, but in general more recent trumps older stuff, so someone's med school publication is going to look more impressive than someone's similarly placed college publication. Part of the reason for this is that residencies feel that college students are more likely to just get gifted an inclusion in a paper than folks further down the road, part of it is just that recent research shows more of an ongoing interest in research. As for inclusion in ROAD, this is based on which residencies were competitive and lifestyle friendly at the time the acronym was created. Anesthesia has had a roller coaster history of competitiveness. By the time you apply, some things will be more or less competitive or lifestyle friendly. Best to not be wed to specialties prematurely.

    I usually tell premeds that if you could only see yourself doing one uber competitive field, don't bother doing medicine -- for most it wont happen. It's fine to ave lofty dreams. But if you can't foresee a fallback into a clinical less competitive field, you are better off doing something else.

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