What determines residency placement

(removed)- realized that this is inaccurate info.

epr1 said:

I'm not sure where this should go, but at any rate I was wondering if the medical school you attend really determines how well you do when it comes to getting placed for residency. I heard that the playing field basically levels out according to USMLE's. I'm applying to schools this summer so this has somewhat of an effect of where I ultimately go. Thanks for reading

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This question is too broad to answer intelligently. What schools are you considering?

TheRealMD said:

1) What med school you went to. Top-tier > state school.

2) Your USMLE score

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I think the school reputation isn't nearly as important as people claim. Higher ranked schools will probably give you more opportunities to set yourself apart from everyone else. i don't think that a 260 from Hollywood Upstairs SOM will be looked negatively on compared to a 260 from Stanford. But the extra research, interest groups etc that you were able to participate in at stanford will!

speaking of which, research can be important...

the more i hear about it, the more it sounds like applying for med school all over again.

1. grades
2. scores
3. research
4. extra curriculars
5. letters of rec

apply broadly!

and don't forget, the match system is a bitch!

I talked to a friend in med school earlier today who told me the order is something like: your second two years (clinical years), first two years, USMLE, and extracurriculars.

no one knows except the people in charge of residency programs, though

ecs?? by ecs do you mean research or are we supposed to be "well-rounded" in med school too?

Green Pirate said:

ecs?? by ecs do you mean research or are we supposed to be "well-rounded" in med school too?

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i asked the same question.. he said there are clubs/organizations you can get involved in, as well as research and volunteering.

he did say that his father (who is chief of vascular surgery at a major academic hospital) will turn away people who try to "overload" their ECs by joining every club they can get in to, so don't go overboard.. pick a few quality ECs and milk them.

50% of dermatologists were AOA members?

btw, can someone tell me why dermatology is so competitive?

TheRealMD said:

50% of dermatologists were AOA members?

btw, can someone tell me why dermatology is so competitive?

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40 hours/wk, $200,000 a year, low stress job.

sound like a good deal to you?

in one of my favorite Scrubs scenes:

J.D.: I need a dermatologist over here, stat!

Dr. Johnson: [Throwing down his magazine] Oh yeah! Time to shine!
[Crouching over the "patient"] What do you need? Is it a rash?

J.D.: Look, I paid this guy to fake a heart attack. He wants fifty bucks, we only have twenty.

Dr. Johnson: You know, I feel like you guys just use me for my money.

armybound said:

40 hours/wk, $200,000 a year, low stress job.

sound like a good deal to you?

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I think derm residents only work ~45 hrs/wk so the sweet life starts before private practice.

armybound said:

40 hours/wk, $200,000 a year, low stress job.

sound like a good deal to you?

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Oh my f*%&ing god.

It ALL makes sense now. A doctor with a social life!

This brings me back to my visit to a dermatologist last December. No wonder he was so laid back!

makes no difference what med school you go to, imo. go wherever you like.

at the end you'll be whatever you want to be, as long as you stay on top of your grades and clinical work.

johnnydrama said:

Hey, I can name another job where you earn > 200 K a year and spend most of it clearing brush on your ranch and making an a$$ of yourself... It's only high-stress if you care...

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is there a machine to clear the brush or do you have to do it manually?

armybound said:

I talked to a friend in med school earlier today who told me the order is something like: your second two years (clinical years), first two years, USMLE, and extracurriculars.

no one knows except the people in charge of residency programs, though

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considering most of your 4th year performance isn't on your app, and pre-clinical grades are rated above step 1, your friend has no idea what he/she is talking about

SeventhSon said:

considering most of your 4th year performance isn't on your app, and pre-clinical grades are rated above step 1, your friend has no idea what he/she is talking about

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I would argue that MS3 grades are too arbitrary to be taken that seriously. Many of you posting here have not yet entered wards. There you will see how absolutely silly the grading in the wards can be. Imagine your entire rotation grade being based upon the opinion of someone that may have interacted with you for 5 minutes total during a rotation. That said, all honors is impressive, just as all pass is not. In addition, every school has a different threshold for what constitutes an honor, high pass, etc so H at school A may not be equal to H at school B.

Thats why Step 1 is such a huge deal. It is the equalizer because everyone everywhere takes the same test. Since Step 1 tests basic sciences, it pretty much negates preclinical grades. I have never heard of preclinical grades being a important factor.

AOA doesnt exist at some schools, and at some schools, there is only senior AOA which may or may not be announced in time to make it into the app, so I would also discount AOA. Like all honors, having AOA is great, but not having it isnt that bad.

Also, to the person that said ECs dont matter. Thats hardly true. Since your clerkship evals are all thrown into the deans letter, the meat of the letter discusses what you've done in medical school outside of those clerkship evaluations. Typically they will discuss what you have done your first two years of medical school - participated in a meaningful student group, did intersting summer research, worked in admissions, did community service, etc. In fact, your ECs are pretty much the only thing you have control over in the deans letter, so it is your chance to shine and differentiate yourself from others!

Also, depending on the area you are going into, research and the quality of your LORs may be a huge factor.

In short, there is no way to objectively quantify what determines good residency placement. It would be to simplistic to say great boards great grades great research and great LORS. Personally, I think rocking step 1 really put you ahead of the game. Then followed closely by clinical grades (and AOA since they are often tied together), followed by LORs and research, then ECs, then other stuff.

TheRealMD said:

1) What med school you went to. Top-tier > state school.

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I love the implication that top-tier schools and state schools are mutually exclusive.

Each specialty is different. Orthopaedics tends to put a huge weight on audition rotations. Radiation oncology seems to be a lot of emphasis on research, and not just any research but specifically on rad-onc. Radiology leans more toward class rank and step score(s). Yada, yada, yada...

With the exception of places like Harvard, Johns Hopkins, UCSF, Wash. U., etc., there is typically a regional bias regarding your school quality. However, within that region, school quality can go a long way.

Critical Mass said:

Throw out the grades. The trend is moving toward grading systems that are qualitative rather than quantitative (i.e. honor/pass/fail or just pass/fail vs. the old school ABC). PGY programs have no way to interpret your grades since schools are so diverse.

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My school used H/HP/P/M/F, and our Dean's letters contained neat little histograms for every medical school course we took, demonstrating the class grade distribution and where we placed in each one. Sounds horrifying, I know.

And yes, EC's in med school are about as useful as the tits on a bull.

EDIT: That's not to say you shouldn't do EC's in med school, but you can limit them to the ones you are truly interested in. I know, I know, such a concept seems far out compared to the standard pre-med approach.

TheRealMD said:

From the very little information I've heard from my bro, there are 4 things you need to worry about. In no specific order:

1) What med school you went to. Top-tier > state school.

2) Your USMLE score

3) Your rank in your med school

4) Interviewng skills (if they stink, you're screwed!)

Now, this list is something I made up, but there is some truth to it. Also, it matters WHAT residency you want as some are much more competitive than others.

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Step 1 score and clinical year evaluations are the most important. Things like connections (including away residencies), class rank, AOA, research also matter. What med school you went to is more like #10 in a long list of criteria -- it counts, but no one should ever put that anywhere close to #1 on their list. People who made it into med school already have survived one interviewing process to get there so I doubt too many stink at interviewing. The people with the top step 1 scores and good clinical grades generally get the top residencies, regardless of where they are coming from.

And I agree with the other poster that a good handful of state schools are top tier schools, BTW.

epr1 said:

I had to make my question very general because I don't have a damn clue about how medical school works, even less about how residency placement works. Other people seemed to be able to answer the question intelligently enough though.

I'm considering all the New York schools and some northeast schools
(I live 2 blocks away from Cornell med so that's my #1 choice )

Would love to be a surgeon one day, or go into emergency medicine but all that could obviously change once in school... essentially I would like to know if I should go private or public... maybe even carib (DISCIPLINARY PROBATION , maybe I'll make a thread about how much that will effect my app.)

again, thanks for reading/replying

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OK, now that we have more info, we can answer your question more clearly. Right now, none of the responses in this thread really apply to you.

I think you are putting the cart before the horse. Based on your previous post, the implication was that you had some acceptances, and that you were trying to choose which school would give you the best opportunity to choose a competitive residency. However, you can't even make that choice until you actually have some options in front of you.

The best response I can give is a very general one since you really aren't "there" yet: U.S. MD > DO >>> off-shore school in terms of ability to give you the most flexibility with residencies. This is a very general statement -- I am sure many at SDN could post notable exceptions.

For other people who are further along in their route to medical school, the response from exmike above is probably the most realistic.

armybound said:

40 hours/wk, $200,000 a year, low stress job.

sound like a good deal to you?

in one of my favorite Scrubs scenes:

J.D.: I need a dermatologist over here, stat!

Dr. Johnson: [Throwing down his magazine] Oh yeah! Time to shine!
[Crouching over the "patient"] What do you need? Is it a rash?

J.D.: Look, I paid this guy to fake a heart attack. He wants fifty bucks, we only have twenty.

Dr. Johnson: You know, I feel like you guys just use me for my money.

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Dr. Cox: You do realize that Dermatologist is Greek for "fake doctor"?

johnnydrama said:

P.S. I know that dermatologists and plastic surgeons can do noble things as well, and I understand why the competition is so fierce for those jobs, but everyone has to admit that it's pretty funny that those are the most competitive fields...

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Yes sir. You would think that all these self-righteous, "heal the world" premeds and medstudents will somehow go to the fields where their help is actually needed; but when it all comes down to it, they flock to derm and plastics.

So, so far we have that leaderships/ECs can be thrown out b/c they're used to get free food, that MS3 grades don't matter b/c they're too subjective, that pre-clinical grades don't matter b/c there are too many grading systems that it's hard to know what any given grade means. Mrrrrrr. . . research and step 1, anyone?

sirus_virus said:

Yes sir. You would think that all these self-righteous, "heal the world" premeds and medstudents will somehow go to the fields where their help is actually needed; but when it all comes down to it, they flock to derm and plastics.

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Actually, plastic work is one of the most frequently requested surgeries in third world countries. Plastics isn't just about nose jobs and face lifts. Can you imagine being a kid in Mexico or the Philippines with a cleft palate -- how hopeless would you feel in those circumstances?

Plastic surgeons also help burn victims, cancer patients who have undergone huge and deforming excisions, diabetics who are post surgical and demonstrate poor wound healing, and they are the first person you would consult for someone with limb threatening compartment syndrome (ah... did you think it was ortho...?). Many plastic surgeons I know don't even perform cosmetic procedures.

Like radiology, derm suffers from lack of in depth knowledge regarding the specialty. Even other physician specialists often don't have a true appreciation of how valuable a smart rads or derm person can be (and partly this is related to envy over income and lifestyle) -- until they need one.

ana said:

Actually, plastic work is one of the most frequently requested surgeries in third world countries. Plastics isn't just about nose jobs and face lifts. Can you imagine being a kid in Mexico or the Philippines with a cleft palate -- how hopeless would you feel in those circumstances?

Plastic surgeons also help burn victims, cancer patients who have undergone huge and deforming excisions, diabetics who are post surgical and demonstrate poor wound healing, and they are the first person you would consult for someone with limb threatening compartment syndrome (ah... did you think it was ortho...?). Many plastic surgeons I know don't even perform cosmetic procedures.

Like radiology, derm suffers from lack of in depth knowledge regarding the specialty. Even other physician specialists often don't have a true appreciation of how valuable a smart rads or derm person can be (and partly this is related to envy over income and lifestyle) -- until they need one.

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True, but lets not kid ourselves. When a medstudent or premed starts gunning for derm, they are typically doing it for lifestyle and money.

There was a survey given to 1,200 residency program directors of which 793 responded: (http://www.ncbi.nlm.nih.gov/entrez/q...bmed_docsum ).
The Ophthamology program directors ranked the relative importance of academic criteria for selecting residents as follows:

1) Grades in required clerkships
2) Number of honors grades
3) Class rank
3) AOA honorary membership
5) Senior specialty elective grades
6) USMLE Step 2 score
7) USMLE Step 1 score
8) Academic awards in medical school
9) Med school's reputation
10) Other senior elective grades
11) Published research
12) Grades in preclinical courses

Interestingly, the medical school's reputation is ranked much lower than grades and board scores. Also there is no mention of the applicant's state residency. It seems that whether you can match successfully depends mostly on your academic performance, rather than where you are from.

Stupid question, but what does AOA stand for? Is it like some type of dean's list?

johnnydrama said:

Hey, I can name another job where you earn > 200 K a year and spend most of it clearing brush on your ranch and making an a$$ of yourself... It's only high-stress if you care...

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haha. well done.

I never knew that plastic surgery was so competitive. With the med students I do speak to, it seems as if everyone in their entire schools are gunning for radiology or derm. I think this shows the true colors of all the students that claimed to be compassionate, caring, and wanted to help people in need. But I guess it is human nature for wanting the most amount of money with putting in the least amount of time and work.

UnderdogMD

AOA = Alpha Omega Alpha, med school honor society

sirus_virus said:

True, but lets not kid ourselves. When a medstudent or premed starts gunning for derm, they are typically doing it for lifestyle and money.

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Well, OK... but when would you start "gunning" for derm if not as a med student? As indicated in this thread, it is a highly competitive residency. Your Step I's are instrumental in helping you get a position. You take your Step I after 2nd year. You start applying at the end of year 3. If you are waiting for late in year 3 or 4 to "gun" for it, you will be waaaayyyy too late.

But yes, premeds probably do not have any idea yet what derm is about (but I think my point is that many practicing physicians don't either). But they at least know they are interested in doing something highly competitive. That doesn't mean they are necessarily greedy -- just ambitious in their goals. Nothing wrong with that, or with wanting to have more time for a family (which is why most people choose a specialty with better hours).

To the OP: sorry for hijacking the thread. I hope you are finding it instructive anyway.

I, by the way, am not a gunner.

I wonder if where you went to medical school matters more for some residency programs rather than others. For instance, for the residency program at Hopkins in optho, a very high percent of the residents went to schools that are highly ranked.

Third year residents' med school: Harvard, Yale, Hopkins, UCSF, Baylor, Hopkins, WashU

From perusing various sites, my impression is that for most residency programs, where you went to school is not particularly important, but for some of the more academic ones, it makes a difference (the effect of research opportunities and connections).

rpm said:

I never knew that plastic surgery was so competitive. With the med students I do speak to, it seems as if everyone in their entire schools are gunning for radiology or derm. I think this shows the true colors of all the students that claimed to be compassionate, caring, and wanted to help people in need. But I guess it is human nature for wanting the most amount of money with putting in the least amount of time and work.

UnderdogMD

AOA = Alpha Omega Alpha, med school honor society

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Uh, well... Derm = 4 years/poss fellowship; Rads 5 = years/most do fellowship; Plastics = 6-7 years/must do research.

These are not exactly short residencies. These folks are putting in more time up front with longer residencies and fellowships. But yes, once out of training, rads and derm make more money and work more regular hours than PC docs (who only do 3 years residency and no fellowship).

Compensation, by the way, is influenced greatly by the HCFA reimburses. HCFA reimburses at a higher rate for procedures (more $ for "doing" than "thinking") by specialists who required more years of training. In addition, dermatologists have the additional bonus that they are one of the few specialists whom consumers are willing to pay out of pocket (however, they do train longer than a PC). T

I agree with other posters when they have said the most important things are Step 1 and M3 grades. Step 2 may not even have a bearing on the match if you did well on Step 1 (if you did well you shouldnt take Step 2 until later in M4 apparently). First, I would concentrate on getting into a medical school period. After that, do as well as you possibly can. Names do matter, but not nearly as much as you might think. An Ivy name will look good--all things being equal--but will by no means get you into a residency program by itself. If you go to Hopkins and get straight C's in every class and barely pass your boards, dont think someone with amazing grades, board scores and evals from a few well known PD's from the Carib wont beat you for a spot hands down. For purposes of simplicity, its all about doing well with what you have, just like when you apply to med school.

Old ortho said:

There was a survey given to 1,200 residency program directors of which 793 responded: (http://www.ncbi.nlm.nih.gov/entrez/q...bmed_docsum ).
The Ophthamology program directors ranked the relative importance of academic criteria for selecting residents as follows:

1) Grades in required clerkships
2) Number of honors grades
3) Class rank
3) AOA honorary membership
5) Senior specialty elective grades
6) USMLE Step 2 score
7) USMLE Step 1 score
8) Academic awards in medical school
9) Med school's reputation
10) Other senior elective grades
11) Published research
12) Grades in preclinical courses

Interestingly, the medical school's reputation is ranked much lower than grades and board scores. Also there is no mention of the applicant's state residency. It seems that whether you can match successfully depends mostly on your academic performance, rather than where you are from.

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I think you would find that many/most places use a very different ranking system than this. Step 1 tends to be looked at before things like class rank because it is the only cross-school barometer they have -- it's irrelevant that someone is high ranked in their med school class when their Step score doesn't demonstrate they are better than many crosstown rivals. Some schools don't even have AOA so it's unlikely to be that high on the list. As mentioned by a poster above, I'm not sure everyone would necessarilly have a Step 2 score by the time they applied. And school reputation tends to be less important than research for a lot of residency paths. At many of the best residency programs you will see folks from many many schools, not just the top ones.

To the extent the top folks predominate in certain programs, it probably has less to do with school reputation and may just be that they accepted smart people who also did well on the USMLE etc.

Law2Doc said:

I think you would find that many/most places use a very different ranking system than this. Step 1 tends to be looked at before things like class rank because it is the only cross-school barometer they have -- it's irrelevant that someone is high ranked in their med school class when their Step score doesn't demonstrate they are better than many crosstown rivals. Some schools don't even have AOA so it's unlikely to be that high on the list. As mentioned by a poster above, I'm not sure everyone would necessarilly have a Step 2 score by the time they applied. And school reputation tends to be less important than research for a lot of residency paths. At many of the best residency programs you will see folks from many many schools, not just the top ones.

To the extent the top folks predominate in certain programs, it probably has less to do with school reputation and may just be that they accepted smart people who also did well on the USMLE etc.

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This is a good point.

Law2Doc said:

Some schools don't even have AOA so it's unlikely to be that high on the list.

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well you're right...Harvard and I believe about 2 or 3 other American MD schools lack AOA, but its Harvard...

goto the SDN residency boards, read Iserson's "How to Get Into a Residency"...AOA is important.


EDIT: see pg. 15 of http://www.aamc.org/programs/cim/chartingoutcomes.pdf

Clearly, it is a credential valued by program directors as an indication of diligence and learning.

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QuantumMechanic said:

AOA is important.

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"Important" and ranking it above Step 1 scores are two very different things. I doubt Iserson would go that far. I sure wouldn't.

Depakote said:

Dr. Cox: You do realize that Dermatologist is Greek for "fake doctor"?

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That is an awesome quote, thank you sir.

These questions always come down to the same thing. Those at high ranked schools say that rank matters quite a bit (not that they're just making it up, but they've been told by faculty at their high-ranked school). Those at unranked schools will say that it doesn't matter one bit (they've most likely been told this by faculty at their school as well).

My feeling on it is that it can matter quite a bit or it can not matter at all, depending on what you do with your 4 years and who you get to know. Go where you want, be happy, and do as well as you can and you'll be fine.