What specifically is going on with the match for psychiatry?

[Breaking Free]

This post brings up some general concerns (that I believe are now quite common amongst those "in the know" about GME), and some personal concerns, from the perspective of medical student. If you notice any misconceptions, incorrect statements or unfounded interpretations, I respectfully welcome you and ask you to shine your light into the matter. I'll give a tiny personal background and then jump into the main theme. Lastly, my goal is not to make anyone anxious. It is to create awareness.

I am an MS2 at a mid-tier U.S. M.D. school. I came to medical school to become a psychiatrist. One of the reasons why I was confident this was a good decision versus getting a PhD in Psych was how seemingly uncompetitive and guaranteed psych seemed. And I value a psychiatrist's job description more. I've tried, but I can't see myself being nearly as happy long-term in another specialty or a job outside of medicine. I have done well academically and will probably have ~225-239 for Step 1, and it will be obvious based on my CV that I was strongly committed to psych starting year 1. My kryptonite has been research. The field and process of research have crushed me and put me in my place thus far. The fruitlessness of my long-term (since summer before MS2) research efforts has been disheartening. I have grown from these challenges, but it doesn't change the fact that I am not yet published in any sense. In 2014, the average research # of abstracts/posters/pubs was 3.8. I have 0. Luckily the distribution shown was bimodal (i.e. many with 0, many with 5+). Other than research, I see myself being solid in most other facets.

It's just my luck (and many other's luck) that psychiatry as a specialty is going through such a rapid and unexpected change over such a short period of time. There are so many variables involved in this I sense, that nobody is clearly saying/or can clearly say what the reality is and what its consequences are for future applicants. The only people who talk about the increased #'s of U.S. M.D.'s applying and matching and apparent increased competitiveness (whether it is due to genuine passion or Psych as 2nd choice to ROADS) as if it's a good thing are those who are already comfortably in the field. From my perspective, it has me a bit scared, and it doesn't help that "something" about getting into psychiatry is changing so fast that there isn't enough time to accurately draw conclusions and make changes in my extracurriculars, research, study habits, etc. (if necessary) before it's time for me to apply for residency. I'm concerned that from starting medical school in 2014 to finishing in 2018, that psych will go from being competitively on par with family medicine to being equal with surgery by the time I apply. It feels surreal that it may be changing in ways that would have once been thought to be unlikely by most. In 2013, saying that this evolution could happen in the next 2 years, between 2014-2016, would have drawn chuckles.

I knew psych was growing more attractive, but in TWO years, 10% more of the total psych spots are being consumed by U.S. M.D.'s. From 2014 to 2016, we have gone from 51% of total matches being U.S. M.D. to 61% of the matches being U.S. M.D. It also happens to be that, on average, the #1 hallmark of a competitiveness is the exclusivity to U.S. M.D. students. With this trend, we'll be at 71% by 2018.

I have been following the NRMP's data and SDN's forums regarding the match this year, and it seems this year once again continued this increasingly competitive trend. For example, in 2016, roughly 61.4% of all medical students matching into psychiatry were U.S. M.D. students, compared to 2015 which was 57.2%, compared to 2014, which was 51.8%. The total absolute # of U.S. M.D. Students matching in 2016 went up by ~80 compared to 2015 and is up by ~170 since 2014. The total increase and psych residency spots across the country was ~30 from 2015-2016, which does not fully account for the ~80 total increased U.S. M.D. students that matched this match. Lastly, there were ~200 more TOTAL U.S. M.D seniors involved in the whole match compared to last year, which also doesn't fully account for the ~80 total increased U.S. M.D. students matching this year. Heck, from 2014 to 2015 unmatched U.S. M.D. rates went from ~3% to ~6%. NRMP hasn't said what it was for 2016, yet. And I don't know anything about how the average individual applicant's stats (e.g., step scores and research) has been changing since 2014's Charting Outcomes.

Can we have a frank discussion about what is specifically going on? If it's not just 1 thing, then what are the multiple powerful variables at work? What does it mean? Why? Is this trend likely to plateau anytime soon or regress (like it did from 2012-2014 w/ 55% to 51% U.S. M.D. match %)? What does a medical student need to do differently in today's medical education system if they are hellbent on matching somewhere decent in psychiatry? I would love to hear perspectives from people different than myself. The facetious old adage of "Got a pulse? No red flags? Then welcome to psychiatry!" seems like a sentiment that may no longer apply.

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[hebel]

Love the enthusiasm, but you've got to relax! Even if your predictions occur, as long as you don't totally screw up you will be fine. I would understand the concern if you were an IMG or even DO student, but coming from a mid tier MD school puts you in a VERY good position to match and last on the chopping block if (or when) competition increases.

So here's how it could possibly affect you, assuming your grades and boards are what you predict: you will match... you just might have more competition matching at the higher tier programs than previous years.

 

[scruffy821]

man, the anxiety in this post is just palpable

things are gonna be fine. yes, it is going to get increasingly difficult to match into the top 20 psychiatry programs, but we are nowhere NEAR being too competitive to match into any sort of "decent" psychiatry residency. the fact that you've done research stuff at all is still a plus, and I'm sure they aren't going to discount it. and you still have plenty of time to try to get a poster done if you take some initiative. and don't forget that programs are looking at so much more than just research, the other things that you're already doing will matter too! and the fact that you're in a US allopathic school is a HUGE plus.

your projected step 1 sounds perfectly fine, now stop procrastinating on SDN and study for the darn test so you can be as competitive as possible! that's a much better use of your time right now as an M2

 

[IlDestriero]

It's still not competitive. Are you in a foreign school, bottom of the class, repeated classes, failed USMLE steps? If not you'll be fine. You may not match at a top 10 psych program, but you'll still be a head shrinker. If the above apply, then maybe you should be worried, and double down on research, apply very broadly, etc.


--
Il Destriero

 

[Blitz2006]

Trending it out, a US MD senior 71% fill rate, puts us below OB, EM, and in line with pediatrics. More competitive than before no doubt, but still in the pulse and no red flags to match somewhere territory.

True, but you should also remember that these percentages are also biased. I'm fairly certain that med students who apply to pediatrics have lower board scores overall (based on 2014 charting outcomes) compared to anesthesia and radiology (who have lower US MD%, I believe both around 68% this year). So does that mean peds is more competitive than gas? Don't think so. So while US MD% is a relative marker, I think charting outcomes is the best way to measure an individual's competitiveness.

2014 charting showed psych avg. Step 1 score of 222 (EM and IM was 230, for comparison). I believe this increased from 214 in 2010. So I'm gonna go on a hunch and assume this increase will continue into 2018 (next charting outcomes) and put the step 1 score around 230, and close in on IM. But this is just a prediction.

So yes, psych is becoming more competitive. But you are coming from US MD. You will definitely match. I don't think psych will become middle competitive (like gen surg, obgyn. Anesthesia) until close to 2020.

But I do think if you want to match into top 10, or even top 20, you will probably need to crack 240 and have a couple pubs. Psych, for a relatively low competitive specialty, puts a fair amount of emphasis on research at "big names". I actually read an article somewhere that psych is relatively quite popular among MD/PhDs, because of all the cutting edge neuroscience research that is going on.

But in summary, no need to stress. You will match. Just a matter of where.

 

[Leo Aquarius]

Given the insane shortage of psychiatrists, it doesn't matter where you go for residency. Once you're done, you'll be in demand everywhere. So take a deep breath because you're on your way to matching and that's all that really matters.

 

[deleted314290]

Lifestyle. Thats whats going on.

 

[deleted736562]

2014 charting showed psych avg. Step 1 score of 222 (EM and IM was 230, for comparison). I believe this increased from 214 in 2010. So I'm gonna go on a hunch and assume this increase will continue into 2018 (next charting outcomes) and put the step 1 score around 230, and close in on IM. But this is just a prediction.

Step scores are even a worse predictor of competitiveness for psychiatry especially. Steps just don't matter as much as they do in other specialties.

PDs are the best people who can answer this question. Are they seeing a significant increase in competitive applications? There's still a possibility that the increase in US MDs is mostly due to the newer schools opening, which attract a higher percentage of less competitive applicants in the first place. These students will be likely to pick what they (perceive) as a less competitive specialty.

 

[Acyl chloride]

I am an MS2 at a mid-tier U.S. M.D. school. My kryptonite has been research. The field and process of research have crushed me and put me in my place thus far. The fruitlessness of my long-term (since summer before MS2) research efforts has been disheartening. I have grown from these challenges, but it doesn't change the fact that I am not yet published in any sense. In 2014, the average research # of abstracts/posters/pubs was 3.8. I have 0. Luckily the distribution shown was bimodal (i.e. many with 0, many with 5+). Other than research, I see myself being solid in most other facets.
.

First off I agree with everyone else who has said to stop freaking out. At this point in MS2 you don't have any control over how other applicants feel about psychiatry, let alone how other students at your school feel. Inevitably someone you know with AOA and amazing step scores will "discover" their love of psychiatry after doing a subi in that dream specialty and realizing it wasn't as great a fit as they thought. That being a little drawn out way of saying yes there will be people out there with what you will perceive as less commitment to psych than you who will get "better" interviews than you but that shouldn't stop you from doing your best and matching somewhere great.

To address your question about research and publications, also please understand that how eras and NRMP calculates research experience can be very different than what you are used to. If you submit a case report as a poster for a national meeting like APA or IPS, this will count as a publication since you wrote an abstract that is published. Similarly if you do a project that you give an oral presentation, this can count as well if you had the abstract for it accepted. Many people have more than one "publication" for the same project if they present in more than one setting, perhaps a local meeting and then a national one. This is very much within your reach as a medical student if you want to do a case report or literature review during ms3. Especially if you have a good case and offer to write it up, your residents and or attending would probably be happy to give you some feedback if you list them as an author on the poster. This is a great way to show your interest in psychiatry, while also checking that box and not getting filtered out of programs that do want at least one research experience or publication. If you have already done research, even better! You have a topic all set. You only needs to write the abstract to submit, you make the poster itself after it gets accepted. You don't have to publish in nature to have it count.


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[FlowRate]

Research Concerns: It's not the quantity of the research, it's the quality. While publishing does matter, if you can present your work in a compelling way/your involvement was substantial, it doesn't "count for nothing." People with 5+ "research" items are a combination of: PhD, Prior Degree/Research, and Writing Papers for PI's. If you really want to go for the number, do that last one--find a faculty member who wants to do some review articles and has some data that they want to turn into a paper.

Competitiveness: It's hard to extrapolate these short-term metrics (step scores, percent filled) to linear trends because they're on an inherently (nonlinear, bounded) scale. Probably is more competitive, thanks to lifestyle and increasing focus on MH/funding.

 

[notdeadyet]

But I do think if you want to match into top 10, or even top 20, you will probably need to crack 240 and have a couple pubs. Psych, for a relatively low competitive specialty, puts a fair amount of emphasis on research at "big names". I actually read an article somewhere that psych is relatively quite popular among MD/PhDs, because of all the cutting edge neuroscience research that is going on.

I agree with the rest of the post, but I do think the emphasis on research is over-rated (as other posters have mentioned). Even at the top programs, most applicants are not researchers. If you are gunning for a research track, yes, you need to have some good pubs. But even at top programs, most applicants do not have peer-reviewed articles on their applications and most who have anything in the "research" section have posters and the like.

I participated in the AdCom for a couple of years at a top psych residency and research was heavily discussed only for research track applicants. For most residents, it wasn't mentioned at all in committee, unless the applicant had a bunch of articles, then it was mentioned along the same lines as AOA, fluent in Spanish, former Peace Corps Volunteer, etc. Getting one or two case reviews published in a journal ticks a box, but that box doesn't usually exist, even at some/many top programs.

 

[MacDonaldTriad]

I will not repeat what everyone else has said, but I know psychiatrists who are in their sixth decade of practice. They remember when 15% of domestic graduates were trying to go into psychiatry. Now we have leaped up to 5%, it isn’t time to panic.

Very few domestic medical students fail anything during their 4 years. If you don’t stick out, you will get in somewhere. Most programs do try and fill with domestic graduates. Even the most open minded programs that do believe that finding diamonds among the IMGs is the right strategy admit that they curb their enthusiasm to a certain number because it is actually the students who look askance at programs that have “too many” IMGs. People blame the PDs for their elitist feelings about US grads, but unless this culture changes at the applicant level, it will remain a reality. 61% domestic grads in psych means that 39% are IMG. If this drops even further, it will be because domestic grads are still getting in. If the culture I mention continues, yes, this would suggest that going to an international medical school will become increasingly less viable. Not getting into medical school may become a louder message more people will have to start listening to. This isn’t dire, it is just supply and demand. There are more domestic slots to get into so the utilization of IMG slots will drop, it will get easier to get into a US medical school.

 

[Blitz2006]

Fair enough. I didn't interview at top programs so I was presuming places like MGH and Columbia likes research.

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[W19]

I share your concerns OP... I also went to med for the sole purpose to become a psych doc... I am attending a low tier US MD and I have passed all my classes but I am in the lower quartile in term of ranking in my class... I am afraid I won't a get spot in psych. I am considering IM as a back up now... I have not taken step 1 yet; maybe a 240+ in step 1 might help, but I am not banking on that since I am just a below average med student.

 

[Blitz2006]

First off I agree with everyone else who has said to stop freaking out. At this point in MS2 you don't have any control over how other applicants feel about psychiatry, let alone how other students at your school feel. Inevitably someone you know with AOA and amazing step scores will "discover" their love of psychiatry after doing a subi in that dream specialty and realizing it wasn't as great a fit as they thought. That being a little drawn out way of saying yes there will be people out there with what you will perceive as less commitment to psych than you who will get "better" interviews than you but that shouldn't stop you from doing your best and matching somewhere great.

To address your question about research and publications, also please understand that how eras and NRMP calculates research experience can be very different than what you are used to. If you submit a case report as a poster for a national meeting like APA or IPS, this will count as a publication since you wrote an abstract that is published. Similarly if you do a project that you give an oral presentation, this can count as well if you had the abstract for it accepted. Many people have more than one "publication" for the same project if they present in more than one setting, perhaps a local meeting and then a national one. This is very much within your reach as a medical student if you want to do a case report or literature review during ms3. Especially if you have a good case and offer to write it up, your residents and or attending would probably be happy to give you some feedback if you list them as an author on the poster. This is a great way to show your interest in psychiatry, while also checking that box and not getting filtered out of programs that do want at least one research experience or publication. If you have already done research, even better! You have a topic all set. You only needs to write the abstract to submit, you make the poster itself after it gets accepted. You don't have to publish in nature to have it count.


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For myself:

1) are publications more valuable than posters/oral presentations?

2) if you publish a case report, can you present it 6 months later at a conference or is that not allowed?

Sorry to thread jack

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[MacDonaldTriad]

1. yes
2. conference venues have their own rules about the originality of presentations and posters. You will have to talk to the conference sponsors. It will probably be OK if you beef it up with some literature review of what the case illustrates.

 

[notdeadyet]

I share your concerns OP... I also went to med for the sole purpose to become a psych doc... I am attending a low tier US MD and I have passed all my classes but I am in the lower quartile in term of ranking in my class... I am afraid I won't a get spot in psych. I am considering IM as a back up now... I have not taken step 1 yet; maybe a 240+ in step 1 might help, but I am not banking on that since I am just a below average med student.

If you came to medicine solely with the intent on being a psychiatrist and your application reflects that (PsychSIG, volunteer opportunities, etc.) and made it through a US MD program without any red flags (failed steps, unprofessionalism tag, etc), you will match into a U.S. psych program if you apply broadly and early and with an open mind.

As MacDonaldTriad points out, 61% of slots going to U.S. domestic grads means 39% is going to IMGs. As a whole, MDs are considered more competitive for allopathic residencies than DOs, so your odds are good. Early, broadly, open-mind and you'll find a good home somewhere.

One trend consistent on SDN is that many, many more applicants worry about matching at all than wind up not matching. The anxiety is totally normal and what folks are describing here is what most of us went through, regardless of when we graduated. Worrying about matching into your specialty of choice is a common trait among all but the uber-confident.

 

[Acyl chloride]

I share your concerns OP... I also went to med for the sole purpose to become a psych doc... I am attending a low tier US MD and I have passed all my classes but I am in the lower quartile in term of ranking in my class... I am afraid I won't a get spot in psych. I am considering IM as a back up now... I have not taken step 1 yet; maybe a 240+ in step 1 might help, but I am not banking on that since I am just a below average med student.

Are you talking about passes in clinical or pre-clinical? If these are just pre-clinical grades then no one really cares- go on to MS3, get honors in psych and as many other things as possible and then do well on steps. If those passes are from MS3 then it really depends how tied you are to a particular location. If you are willing to apply broadly you could still match, but you might want a backup if you are tied to a location.


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[J ROD]

I share your concerns OP... I also went to med for the sole purpose to become a psych doc... I am attending a low tier US MD and I have passed all my classes but I am in the lower quartile in term of ranking in my class... I am afraid I won't a get spot in psych. I am considering IM as a back up now... I have not taken step 1 yet; maybe a 240+ in step 1 might help, but I am not banking on that since I am just a below average med student.

Relax. Get 225 plus and you will be ok. It is not that competitive yet. Maybe in 5 to 10 years.

 

[OldPsychDoc]

I will not repeat what everyone else has said, but I know psychiatrists who are in their sixth decade of practice. They remember when 15% of domestic graduates were trying to go into psychiatry. Now we have leaped up to 5%, it isn’t time to panic.

Very few domestic medical students fail anything during their 4 years. If you don’t stick out, you will get in somewhere. Most programs do try and fill with domestic graduates. Even the most open minded programs that do believe that finding diamonds among the IMGs is the right strategy admit that they curb their enthusiasm to a certain number because it is actually the students who look askance at programs that have “too many” IMGs. People blame the PDs for their elitist feelings about US grads, but unless this culture changes at the applicant level, it will remain a reality. 61% domestic grads in psych means that 39% are IMG. If this drops even further, it will be because domestic grads are still getting in. If the culture I mention continues, yes, this would suggest that going to an international medical school will become increasingly less viable. Not getting into medical school may become a louder message more people will have to start listening to. This isn’t dire, it is just supply and demand. There are more domestic slots to get into so the utilization of IMG slots will drop, it will get easier to get into a US medical school.

Agree with all of this, but in the 61/39% discussion above, everyone seems to be forgetting about the expanding number of US-DO grads, which I believe are part of the 39--since all of the discussions I've seen about the 61% designate it as MD or US allopathic. We experienced a surge in DO applications (and matches) this year, which appears to have really cut into prospects for US-IMGs and FMGs--at least from our vantage point.

[edit: Just confirmed that DOs are not included in the 'US Seniors' category by NRMP. They don't give data for Osteo by specialty, but it is notable that DO grads are up by ~600 overall over 4 years, and their match rate is up from 75% to 80% over that period.
http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf]

 

[notdeadyet]

Agree with all of this, but in the 61/39% discussion above, everyone seems to be forgetting about the expanding number of US-DO grads, which I believe are part of the 39--since all of the discussions I've seen about the 61% designate it as MD or US allopathic. We experienced a surge in DO applications (and matches) this year, which appears to have really cut into prospects for US-IMGs and FMGs--at least from our vantage point.

Ah, is this 39% being tossed around referring to the "independent applicants" mentioned in the data (like Charting Outcomes and the like)?

If that's the case, the 61% refers to US-MD seniors. The 39% would refer to international medical graduates (foreign and domestic-born), osteopaths, and US-MD graduates who are not applying in their MS-4 year of medical school.

Good catch, OPD.

 

[MacDonaldTriad]

IMG schools are a result of our doctor shortages. If our schools step up and supply the demand, IMG schools will shrink. Students will just look at the cost, the odds, and do the math.

I agree with OPD and the DO thing. There are some differences in the DO system, so they aren’t just sort of “half way (or ¼-3/4) in between” they do have their own match, and their own set of training programs. I do know they lean towards ACGME programs because of fellowships. As AOA and ACGME unite more, it will be interesting to see how things play out.

 

[Psychotic]

Many if not most of the folks who have posted that they did not match are IMGS and FMGs. Sometimes it is hard to know that unless they explicitly state it in the post, or if you bother to read through their post history.

AMGs still just need to avoid red flags (course failures, Step failures, time gaps, etc) and do well on the Steps, do well on clerkships and get good letters. And as someone else pointed out, with the shrink shortage, ANY residency will do. There is a huge bias on these threads for the name brand, academic / research oriented programs, and some of the most prolific posters share this bias. Ignore them...apply VERY broadly, to more programs than even I have recommended in the past (15 to 20) - shoot for 20 to 30 apps if you are an "average" AMG. If you are barely getting by and have low-ish Step scores, or if you have any red flags, though, be smart and apply to many, many more programs than just 20 to 30.

And get Step 2 CK and CS out of the way early and have those passes recorded before interview season, or at least before it is too late to have a CS pass for the match. That is not a red flag, per se, but it damn sure akin to a yellow card...

 

[W19]

Are you talking about passes in clinical or pre-clinical? If these are just pre-clinical grades then no one really cares- go on to MS3, get honors in psych and as many other things as possible and then do well on steps. If those passes are from MS3 then it really depends how tied you are to a particular location. If you are willing to apply broadly you could still match, but you might want a backup if you are tied to a location.


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I have passed all my preclinical classes so far. No red flags except for ranking low in my class... still a MS2 yet to take step1.

 

[W19]

If you came to medicine solely with the intent on being a psychiatrist and your application reflects that (PsychSIG, volunteer opportunities, etc.) and made it through a US MD program without any red flags (failed steps, unprofessionalism tag, etc), you will match into a U.S. psych program if you apply broadly and early and with an open mind.

As MacDonaldTriad points out, 61% of slots going to U.S. domestic grads means 39% is going to IMGs. As a whole, MDs are considered more competitive for allopathic residencies than DOs, so your odds are good. Early, broadly, open-mind and you'll find a good home somewhere.

One trend consistent on SDN is that many, many more applicants worry about matching at all than wind up not matching. The anxiety is totally normal and what folks are describing here is what most of us went through, regardless of when we graduated. Worrying about matching into your specialty of choice is a common trait among all but the uber-confident.

I am open to go ANYWHERE. In fact, I will be targeting programs that take mostly IMG and/or are in undesirable locations...

 

[Mad Jack]

True, but you should also remember that these percentages are also biased. I'm fairly certain that med students who apply to pediatrics have lower board scores overall (based on 2014 charting outcomes) compared to anesthesia and radiology (who have lower US MD%, I believe both around 68% this year). So does that mean peds is more competitive than gas? Don't think so. So while US MD% is a relative marker, I think charting outcomes is the best way to measure an individual's competitiveness.

2014 charting showed psych avg. Step 1 score of 222 (EM and IM was 230, for comparison). I believe this increased from 214 in 2010. So I'm gonna go on a hunch and assume this increase will continue into 2018 (next charting outcomes) and put the step 1 score around 230, and close in on IM. But this is just a prediction.

So yes, psych is becoming more competitive. But you are coming from US MD. You will definitely match. I don't think psych will become middle competitive (like gen surg, obgyn. Anesthesia) until close to 2020.

But I do think if you want to match into top 10, or even top 20, you will probably need to crack 240 and have a couple pubs. Psych, for a relatively low competitive specialty, puts a fair amount of emphasis on research at "big names". I actually read an article somewhere that psych is relatively quite popular among MD/PhDs, because of all the cutting edge neuroscience research that is going on.

But in summary, no need to stress. You will match. Just a matter of where.

LOL, psych won't shoot up from a 222 to a 230 in the next couple of years. That's a massive difference, percentile wise, given the way USMLE curves work. Just chill the hell out, having any research at all puts you in a strong place for psych, along with decent board scores.

 

[Acyl chloride]

I have passed all my preclinical classes so far. No red flags except for ranking low in my class... still a MS2 yet to take step1.

Don't obsess over your pre-clinical class rank. Sure, you won't make AOA, but besides that, you still have an open path ahead. If you want to go to a "top" program you will need to up your game in the next two years with test taking (shelf exams in particular might need a little more prep) but many people find pre-clinical and clinical to be completely different worlds, and the grading can be highly subjective. Someone who has a great work ethic, genuine enthusiasm, and studies hard can potentially do extremely well even with average or below average pre clinical grades. That and the majority of med schools these days are moving towards pass/fail pre clinical so most people don't even have a class rank before MS3!


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[W19]

LOL, psych won't shoot up from a 222 to a 230 in the next couple of years. That's a massive difference, percentile wise, given the way USMLE curves work. Just chill the hell out, having any research at all puts you in a strong place for psych, along with decent board scores.

I will not be surprised if it in the high 220s by the time I apply... I am ready to apply to 100+ psych programs and 100+ IM in programs that mostly accept IMG and/or are in undesirable locations even if I end up scoring 220+ in step1... I can't even fathom the idea of not having a job after med school.

 

[W19]

Don't obsess over your pre-clinical class rank. Sure, you won't make AOA, but besides that, you still have an open path ahead. If you want to go to a "top" program you will need to up your game in the next two years with test taking (shelf exams in particular might need a little more prep) but many people find pre-clinical and clinical to be completely different worlds, and the grading can be highly subjective. Someone who has a great work ethic, genuine enthusiasm, and studies hard can potentially do extremely well even with average or below average pre clinical grades. That and the majority of med schools these days are moving towards pass/fail pre clinical so most people don't even have a class rank before MS3!


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AOA! I just want to have a job after that grueling four years.

 

[MacDonaldTriad]

W19, there is no reason to shoot low. The beauty of the match is that it allows you to get the best you can without changing your chances at less competitive places. The match makes us all hyper interview and spend all kinds of time and money, but it does do this well. Now get into your meditation hum and repeat, "I will be fine, I will be fine...." Psychiatry may not be the very least competitive field (ignoring very small and obscure specialties), but we are still in the bottom 3 or so. Still a buyers market so be happy.

 

[FlowRate]

MGH and Columbia likes research.

Impactful research. And an ivy league education and baller step scores and grades.

The most prestigious anything wants the most prestigious candidates, whether that be consulting firms, residency programs, or what have you. It's how they maintain their brand.

Edit: My point being that you shouldn't judge the field by the very most exclusive players.

 

[Blitz2006]

LOL, psych won't shoot up from a 222 to a 230 in the next couple of years. That's a massive difference, percentile wise, given the way USMLE curves work. Just chill the hell out, having any research at all puts you in a strong place for psych, along with decent board scores.

No I disagree. While splitting hairs, I said around 230. Definitely won't surprise me if psych in 2018 is 228, etc.



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[Blitz2006]

W19, there is no reason to shoot low. The beauty of the match is that it allows you to get the best you can without changing your chances at less competitive places. The match makes us all hyper interview and spend all kinds of time and money, but it does do this well. Now get into your meditation hum and repeat, "I will be fine, I will be fine...." Psychiatry may not be the very least competitive field (ignoring very small and obscure specialties), but we are still in the bottom 3 or so. Still a buyers market so be happy.

Wise words as usual.

But I think we have slowly climbed out of the basement 3 (FM/peds/PMR?). But that doesn't mean psych isn't still obtainable for US MD or DO.

The only ppl that should be concerned right now are IMGs.



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[Mad Jack]

No I disagree. While splitting hairs, I said around 230. Definitely won't surprise me if psych in 2018 is 228, etc.



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If you compare the percentiles for the given year, however, the competitiveness to match into psychiatry has not changed. A 222 in 2014 corresponded to the 36.3rd percentile of test takers. A 214 in 2010 corresponded to the 36.6th percentile of test takers. The sky is not falling, chill out.

http://medstudentbooks.com/usmle-step-1-percentile-calculator/
https://en.wikipedia.org/wiki/USMLE_Step_1

 

[scudiera]

And if Psych is at 228 in 2018 then the mean step score will still be 5-7 points higher. Psych is not competitive. Outside of the biggest East and West coast names, it's just not. Maybe it feels more competitive than previous years but frankly it's a great thing that perhaps more highly qualified or academic-minded people want to go into the field. I don't want co-residents who want to be in a field they feel they can get into if they just have a pulse. I want badass, intelligent, motivated residents who are proud of their success and driving the field forward, either with research, service, or clinical excellence.

You will be fine. Aim for a 235+. Do your best, and trust that the match will put you in a place where you can learn and thrive. You need to be amazing to match at an amazing program in any field. But as stated above, you don't need to match at a big name program to be an excellent clinician or even academic psychiatrist (unless, again, big coastal progs). At the end of the day, it's about you and your fit. Who cares if you get rejected by BWH and NYU if you find out you fit better at UIC anyway and match there? I didn't sweep the interviews and I didn't even rank #1 the "most prestigious" programs on my list, because of fit considerations.

The match works. If you don't match consider the message that sends about the strength of your app, your fit, and your interviewing skills and take it constructively.

PS: Don't compare with GS. Academic Gensurg is very competitive. Don't compare with or consider an IM backup, academic IM is insane. Psych is not going to get the sort of rise EM got in the past 3 years where I won't be surprised if the 2016 average step score is closer to surgical subspecialties.

 

[notdeadyet]

W19, there is no reason to shoot low. The beauty of the match is that it allows you to get the best you can without changing your chances at less competitive places. The match makes us all hyper interview and spend all kinds of time and money, but it does do this well. Now get into your meditation hum and repeat, "I will be fine, I will be fine...." Psychiatry may not be the very least competitive field (ignoring very small and obscure specialties), but we are still in the bottom 3 or so. Still a buyers market so be happy.

Completely agree with MDT here.

Intentionally aiming low is bad practice for any endeavor because the best you can achieve is low.

Apply broadly. This applies to geography and your preconceived level of "prestige" of a given program
Apply early. chronologically in the cycle and have your Step's completed
Apply with an open-mind. Do not specifically target programs based on only preconceptions and don't avoid them based on the presence (or absence) of things like DOs/IMGs and the like.

Do this and you'll be fine.

And as an aside, you can apply to loads of programs, but I would put a cap on how many you interview at. If you're trying to interview at too many programs, there is a diminishing return and you can (and likely will) end up with a sub-standard interview because you've overextended.

 

[IsWhat]

I friend of mine from a top 10 US MD school with a 265+ step 1 just matched at his 5th spot in Ortho. Psych may be getting more competetive, but let's not blow this out of proportion.

 

[Doctor Bagel]

I am open to go ANYWHERE. In fact, I will be targeting programs that take mostly IMG and/or are in undesirable locations...

Why are so pessimistic about your chances of matching? This seems like an ongoing theme with you that as mentioned by others could turn into a self-fulfilling prophecy. If you read through the match thread, you'll see as others have noted that pretty much everyone who posted about not matching was an IMG or a DO. AMGs without red flags with a somewhat reasonable application strategy will match (yeah, sure, there will be some random outlier who you can attach your worries to), but almost 100% will match. And red flags are not average grades, a below average class rank or low step scores (assuming you're say 200 or geater). You might actually hurt yourself though if you specifically apply to programs that historically only take IMGs and DOs because those programs aren't used to interviewing AMGs and might assume you won't want to be there anyway and are just using them for a safety.

Regarding the op's questions about research, yes, that ACGME number including anyting you put down, which could include presentations for rotations (seems a little weak sauce to me, but I've seen it done) and certainly includes undergrad experiences too. Most psych applicants are not going to have any substantive research experience.

 

[yanks26dmb]

Why are so pessimistic about your chances of matching? This seems like an ongoing theme with you that as mentioned by others could turn into a self-fulfilling prophecy. If you read through the match thread, you'll see as others have noted that pretty much everyone who posted about not matching was an IMG or a DO. AMGs without red flags with a somewhat reasonable application strategy will match (yeah, sure, there will be some random outlier who you can attach your worries to), but almost 100% will match. And red flags are not average grades, a below average class rank or low step scores (assuming you're say 200 or geater). You might actually hurt yourself though if you specifically apply to programs that historically only take IMGs and DOs because those programs aren't used to interviewing AMGs and might assume you won't want to be there anyway and are just using them for a safety.

Regarding the op's questions about research, yes, that ACGME number including anyting you put down, which could include presentations for rotations (seems a little weak sauce to me, but I've seen it done) and certainly includes undergrad experiences too. Most psych applicants are not going to have any substantive research experience.

Is the field becoming increasingly more difficult for DOs? I'm a DO very interested in psych, top quarter of my class, and thought continuing this trend and doing at least average on boards would mean a match. I hate to add to the tension in this thread, but should average DOs start worrying about matching psych?

 

[Mcluvin5000]

Psychiatry is not in the slightest a competitive specialty. Just because a few 4th year med students come on here and claim that it is to make themselves feel special, it ain't. If you have a pulse, you'll match.

Trolls like blitz2006 are deluding themselves and creating panic threads. Don't feed this troll. He probably couldn't match derm but still needs to feel superior to the people who matched in primary care.

 

[clausewitz2]

You might actually hurt yourself though if you specifically apply to programs that historically only take IMGs and DOs because those programs aren't used to interviewing AMGs and might assume you won't want to be there anyway and are just using them for a safety.

Yeah, of the two programs that did not invite me for an interview this cycle, one of them was a program that was almost 100% IMGs/DOs that I applied to mainly for location. I am sure they did not take my app as a very serious one, and I suppose they were not wrong to do so really.

@W19 I wonder exactly what formula would reduce your anxiety about matching, because numbers and reassurances from more advanced students, residents, and PDs historically have not done the trick.

 

[Mad Jack]

Why are so pessimistic about your chances of matching? This seems like an ongoing theme with you that as mentioned by others could turn into a self-fulfilling prophecy. If you read through the match thread, you'll see as others have noted that pretty much everyone who posted about not matching was an IMG or a DO. AMGs without red flags with a somewhat reasonable application strategy will match (yeah, sure, there will be some random outlier who you can attach your worries to), but almost 100% will match. And red flags are not average grades, a below average class rank or low step scores (assuming you're say 200 or geater). You might actually hurt yourself though if you specifically apply to programs that historically only take IMGs and DOs because those programs aren't used to interviewing AMGs and might assume you won't want to be there anyway and are just using them for a safety.

Regarding the op's questions about research, yes, that ACGME number including anyting you put down, which could include presentations for rotations (seems a little weak sauce to me, but I've seen it done) and certainly includes undergrad experiences too. Most psych applicants are not going to have any substantive research experience.

Some of us are DOs that want to match psych, for the record For us, these numbers look scary. I really wish they'd stop combining DOs with the rest of the independent applicants now that our residency system (and therefore match, since all of our programs are basically going NRMP from here on out) is well on its way to merging. Makes it much easier to parse out how many of the unmatched are IMGs vs DOs, which tend to perform much better overall.

 

[MacDonaldTriad]

The nrmp really doesn't show much about DOs in the report. I'm sure the DO schools may have some idea of the numbers applying psych and getting into psych.

 

[MidwestMD2015]

I know psychiatrists who are in their sixth decade of practice. They remember when 15% of domestic graduates were trying to go into psychiatry.

Could you share any additional information about this? I'm definitely not familiar with that historical interest, and I think it's really surprising. Would enjoy reading some historical information/data about physician interest in psychiatry as a specialty, beyond the last 5-10 years anyway. (I've read about my department's history mostly, but not too far beyond that yet!)

 

[OldPsychDoc]

Is the field becoming increasingly more difficult for DOs? I'm a DO very interested in psych, top quarter of my class, and thought continuing this trend and doing at least average on boards would mean a match. I hate to add to the tension in this thread, but should average DOs start worrying about matching psych?

I think that if you're from an established school, top half, average boards, and a demonstrable interest in psychiatry you'll be fine for a few years at least.

 

[MacDonaldTriad]

http://www.nytimes.com/1982/11/02/science/psychiatry-s-anxious-years-decline-allure-career-leads-self-examination.html?pagewanted=all

We have a vol. faculty member in her 80s that says it was 15% in the late 60s. The above article confirms at least 11% in the early 70s. This says it dropped for a decade and this was written in 1982.

 

[MacDonaldTriad]

Here is a better one:

https://books.google.com/books?id=G...aduates going into psychiatry in 1960&f=false

 

[psychattending]

As a PD and getting up in the years, I just want to emphasize

1) Don't get freaked. Good people easily get into psychiatry.
2) These things go in cycles. Yes, psych is going up but we have been here before. While it would be great that we stay up, more likely than not we will go down again. We have had more US graduating MD seniors in the past. According to my numbers in the last two decades about 50% of the time we have been above the 60% US senior level. The maximum was 66.4% in 2005. The absolute lowest was just in 2014 - 51.8%. In my mind not until we consistently get above the 2005 mark can we state that things are different now (and above the pattern of the past 20 years).

 

[Blitz2006]

Psychiatry is not in the slightest a competitive specialty. Just because a few 4th year med students come on here and claim that it is to make themselves feel special, it ain't. If you have a pulse, you'll match.

Trolls like blitz2006 are deluding themselves and creating panic threads. Don't feed this troll. He probably couldn't match derm but still needs to feel superior to the people who matched in primary care.

How am I troll? I am merely reporting stats.

I even said in my posts that OPD will have no problem matching since he/she is US MD.

All I am saying is that over the past 2 years, psych has increased in RELATIVE competitiveness. I never said psych is ROAD competitive.

People here are blowing it out of proportion and pretending like psych is on par with derm and ortho.

No one is saying that. The point is that 5 years ago you could match psych (US MD) with red flags, like failed steps. Now you probably have to crack 210 to guarantee match. That's all. I don't get how predicting a 228 mean step 1 score is trolling.

I never said you need 260s or that it's tough for US MD. But I definitely do believe it's tougher for IMGs to match nowadays.

That's not trolling, that's being realistic for future applicants who come here wanting real world advice, AMG and IMGs. I'm trying to help people prepare for the match, since there are very strong candidates that don't end up matching. Again, relatively strong (for psych). So before you twist my words, I never implied that strong = US MDs with 260. Strong for psych is 220/220 for IMG.

http://forums.studentdoctor.net/threads/didnt-match-what-to-do-for-next-year-now.1189679/

Not fear mongering, but hopefully making people realistic (ie. IMGs with scores of 210/210 should not think it will be a straightforward match into psych, as many still have perception you can just walk into it).

The whole point of these forums is to help applicants, particularly relatively "average" applicants, for lack of better words. I don't think people with 260s and 20 publications need too much advice on matching.

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[luckyt66]

As a PD and getting up in the years, I just want to emphasize

2) These things go in cycles. Yes, psych is going up but we have been here before. While it would be great that we stay up, more likely than not we will go down again. We have had more US graduating MD seniors in the past. According to my numbers in the last two decades about 50% of the time we have been above the 60% US senior level. The maximum was 66.4% in 2005. The absolute lowest was just in 2014 - 51.8%. In my mind not until we consistently get above the 2005 mark can we state that things are different now (and above the pattern of the past 20 years).

I pray to God that you are right...