If your step 1 is over 230, you'll match in GS

Take a look at this report on the characteristics of applicants to general surgery.

Interesting points include

2005 US Senior Applicants: 1522
2005 Other applicants: 932
2005 Total positions: 1051


Unmatched US Seniors in GenSurg by Step 1 Score

180-189 46% unmatched
190-199 33% unmatched
200-209 23% unmatched
210-219 14% unmatched
220-229 11% unmatched
230+ 1% unmatched


US Senior Unmatched Rate in GenSurg by Contiguous Rank List Length

1-2 62%
3-4 41%
5-6 44%
7-8 18%
9-10 13%
11-12 6%
13-14 4%
15+ 5%

This data is the relation of contiguous rank list length to success in matching. Contiguous rank list length is the number of GS programs in a row on your list. "Success" is defined as matching into any GS program. So if you matched to IM after ranking 5 GS and 5 IM programs alternating 1 GS and 1 IM, you would have a CRLL of 1 and would count as not-matching. If you only ranked 4 programs, all GS, and didn't match your CRLL would be 4 and you would count as not matching. Take home message here seems to be that adding programs to your rank list is very valuable up until 11-12 after which you abruptly hit diminishing returns.

Hot damn! I have a >67% chance of matching!

What I meant to say was that those odds kind of suck. I guess I better apply to a ton of places!

Pilot Doc said:

Take a look at this report on the characteristics of applicants to general surgery.

Interesting points include

2005 US Senior Applicants: 1522
2005 Other applicants: 932
2005 Total positions: 1051


Unmatched US Seniors in GenSurg by Step 1 Score

180-189 46% unmatched
190-199 33% unmatched
200-209 23% unmatched
210-219 14% unmatched
220-229 11% unmatched
230+ 1% unmatched


US Senior Unmatched Rate in GenSurg by Contiguous Rank List Length

1-2 62%
3-4 41%
5-6 44%
7-8 18%
9-10 13%
11-12 6%
13-14 4%
15+ 5%

This data is the relation of contiguous rank list length to success in matching. Contiguous rank list length is the number of GS programs in a row on your list. "Success" is defined as matching into any GS program. So if you matched to IM after ranking 5 GS and 5 IM programs alternating 1 GS and 1 IM, you would have a CRLL of 1 and would count as not-matching. If you only ranked 4 programs, all GS, and didn't match your CRLL would be 4 and you would count as not matching. Take home message here seems to be that adding programs to your rank list is very valuable up until 11-12 after which you abruptly hit diminishing returns.

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I really feel sorry for some of the Americans that have to go through all these hoops even once you are in med. school just to be able to get into the career you want. It's understandable that some are more competitive thans others, but generally speaking if you want a specialty, getting it should be easy. In Canada, I am almost certain that if you want general surg. and you decide this relatively early on, you'll get it. That goes for most surgical specialties except for plastics, ent, and probably urology.

For other specialties, it goes the same, if you demonstrate interest in a career, chances are you will get it. The most competitive in Canada where people who only apply for this particular specialty go unmatched more than some others include emergency medicine, derm, plastics, ent, internal at some locations (alberta), and maybe diagnostic radiology (not entirely sure though).

Has this ever been considered a problem....medical students not ending up in specialties of their primary choice because of Step 1?

Just my opinion though.

akinf said:

Has this ever been considered a problem....medical students not ending up in specialties of their primary choice because of Step 1?

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Sure...it probably happens every year where a student wants to match into a competitive specialty but doesn't have the numbers to support their application. For less competitive specialties and those programs who aren't "just about the numbers" they might have a better chance, but there is no guarantee that a medical student can pursue the specialty of his choice (coming from someone who didn't match into her first choice either). 🙁

akinf said:

I really feel sorry for some of the Americans that have to go through all these hoops even once you are in med. school just to be able to get into the career you want.

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You aren't the only one. I find it ridiculous that a single score can make or break your career goals, and I'm damn happy I'm in a system that judges me on 4 years of med school, and not 2 months of step 1 preparation (that exam looks even more brutal than LMCC). My hat goes off to my US counterparts for putting up with this, with no complaints.

Blake said:

You aren't the only one. I find it ridiculous that a single score can make or break your career goals, and I'm damn happy I'm in a system that judges me on 4 years of med school, and not 2 months of step 1 preparation (that exam looks even more brutal than LMCC). My hat goes off to my US counterparts for putting up with this, with no complaints.

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To my knowledge, this is the first time the data has been publicly available at this level. Everyone knew Step I was important, but I don't think many people knew how important it was. I was quite surprised. At a casual perusal, the same pattern holds in almost every specialty where 95% of unmatched students fall below a USMLE threshold and the chance of scrambling rises linearly as scores fall away from that threshold.

There's a possibility that the Step I scores are partially a proxy for more important issues - e.g. work ethic - but I think they're much more a reflection of test taking skills.

If the details become widely known, I suspect US med students will start complaining!

Pilot Doc said:

To my knowledge, this is the first time the data has been publicly available at this level. Everyone knew Step I was important, but I don't think many people knew how important it was. I was quite surprised. At a casual perusal, the same pattern holds in almost every specialty where 95% of unmatched students fall below a USMLE threshold and the chance of scrambling rises linearly as scores fall away from that threshold.

There's a possibility that the Step I scores are partially a proxy for more important issues - e.g. work ethic - but I think they're much more a reflection of test taking skills.

If the details become widely known, I suspect US med students will start complaining!

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It's hard to argue with the numbers.......I feel like I've fallen victim to the same faulty mentality, where I assume that Step 1 score is a direct reflection of competence/work ethic......it shouldn't affect the way I look at students and coworkers....but it does.

Maybe as Gen surg gets more competitive, it will carry the same buzz that Ortho/Derm/plastics do that there is a MINIMUM step 1 score, and that your step 1 is drastically more important than other factors.

Blake said:

You aren't the only one. I find it ridiculous that a single score can make or break your career goals, and I'm damn happy I'm in a system that judges me on 4 years of med school, and not 2 months of step 1 preparation (that exam looks even more brutal than LMCC). My hat goes off to my US counterparts for putting up with this, with no complaints.

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Certainly, however, I feel for those denied because of such a test....it sort of reminds me of the MCAT. I think it is because of stuff like this that Canadians don't place as much emphasis on such standardized tests, but try to enforce overarching standards rigorously.

Blake said:

You aren't the only one. I find it ridiculous that a single score can make or break your career goals, and I'm damn happy I'm in a system that judges me on 4 years of med school, and not 2 months of step 1 preparation (that exam looks even more brutal than LMCC). My hat goes off to my US counterparts for putting up with this, with no complaints.

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The problem is that standardized tests are just that that: standardized.

Every med school is different, some grade on curves, some don't. Some have easier clinical work than others. Student A might do his Surg rotation with a hardass attending and get a "P" while Student B might do his with the nicest surgeon in the world and get an honors.

If we didn't have stuff like standardized tests PDs would have one less way to sort through the thousands of applicants they get each year. Think of how many more people would apply to stuff like Ortho and Derm if there weren't any cutoffs... Then the process would be even less fair.

AmoryBlaine said:

The problem is that standardized tests are just that that: standardized.

Every med school is different, some grade on curves, some don't. Some have easier clinical work than others. Student A might do his Surg rotation with a hardass attending and get a "P" while Student B might do his with the nicest surgeon in the world and get an honors.

If we didn't have stuff like standardized tests PDs would have one less way to sort through the thousands of applicants they get each year. Think of how many more people would apply to stuff like Ortho and Derm if there weren't any cutoffs... Then the process would be even less fair.

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I think it would be better to standardize things during the training not at the end of training. So for each section, have constant curriculum reviews, accreditation meetings etc. It's important to ensure that the education is standardized through out instead of testing whether it was at the end. Because, I could see people who don't know jack study like crazy for a month or two for a test, smoke it, and then it suddenly looks like they have a medical genius on their hands. Standardized testing is a poor excuse to ensure adequate education a large number of people, because I don't think it measures what it was intended to.

akinf said:

I think it would be better to standardize things during the training not at the end of training. So for each section, have constant curriculum reviews, accreditation meetings etc. It's important to ensure that the education is standardized through out instead of testing whether it was at the end. Because, I could see people who don't know jack study like crazy for a month or two for a test, smoke it, and then it suddenly looks like they have a medical genius on their hands. Standardized testing is a poor excuse to ensure adequate education a large number of people, because I don't think it measures what it was intended to.

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I've never met a person who smoked the boards and had a poor fund of knowledge. Doing well on the boards doesn't make you a good clinician. But it demonstrates a certain fund of knowledge.

akinf said:

I think it would be better to standardize things during the training not at the end of training. So for each section, have constant curriculum reviews, accreditation meetings etc. It's important to ensure that the education is standardized through out instead of testing whether it was at the end.

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While this sounds good in theory, it would be difficult to achieve a completely equal experience for all. I mean, we are dealing with human beings here. Each rotation of the third year clinical experience will be colored to some extent by the people you are with -- the residents, attendings, and by the setting -- VA vs academic center vs community hospital. Some may be more into teaching, some services may be busier than others,... This doesn't mean there aren't standards for accreditation and curriculum reviews. (It's not like any Joe Schmoe can open a medical school.)

akinf said:

Because, I could see people who don't know jack study like crazy for a month or two for a test, smoke it, and then it suddenly looks like they have a medical genius on their hands.

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Some people may be better than others at test-taking, but I don't think an otherwise qualified, highly-motivated applicant would allow a standardized test to be the only impediment in the way of their goal. They may have to work harder than their peers to achieve the same score, but they will find a way. Also, preparation for Step I isn't 2 months. You lay the foundation by working hard and not slacking during the first 2 years. The 2 months of studying are a final review to solidify your knowledge and fill in the gaps, not learning it for the first time.

akinf said:

Standardized testing is a poor excuse to ensure adequate education a large number of people, because I don't think it measures what it was intended to.

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I agree that doing great on step I doesn't mean you will be a good doctor or even indicate you have the ability to make clinically-sound decisions. However, there must be at least some correlation between step I performance and fund of knowledge. Also, PDs need a standardized way to assess applicants, and for lack of a better tool, Step I is the best we have so far. In addition, Step I is only one component of the decision -- letters, clinical evals, activities, research, personal statement all play a role.

For some people step I is not a problem, but getting strong clinical evals and getting noticed during third year is a challenge. They may be the more soft-spoken, less aggressive students who, although they have a solid knowledge base, are overlooked and don't get their due credit because they don't speak up on rounds or know how to play the political game. I think for the most part, these things kind of balance out in the end -- although it is far from perfect.

I try to remind myself that practicing medicine is a privilege, not a right. Some people may have the desire, the work ethic, and noble intentions to become a surgeon (and they may be a good person to top it off), but just because they have all of that, doesn't necessarily give them a rubber-stamp right to do surgery. If they lack a solid fund of knowledge, have weak critical thinking skills, or lack clinical judgment, they may not be able to.

Personally, I think the underlying issue is coming to grips with our own limitations. While it may have been easy for all of us to be the top student in high school or college, it gets progressively harder to maintain that level relative to our peers, the farther we advance along this path. For some of us, Step I might highlight our limitations. For some, it is the MCAT, for others, the ABSITE. There is no guarantee in life that we can all achieve our dreams. For example, every year, there are 40 pediatric surgery fellowship spots and way more applicants than spots. That's just how it is. When we hit a wall or some set-back in our careers, each of us will make a decision to try even harder to reach our goals or to simply re-assess what we want in life.

I saw this report a while ago. When did Gen Surgery become so competitive? I had always thought it was moderate, but nearly 1.5 applicants per spot? By that alone it seems more competitive than Derm and Rad-Onc...

prazmatic said:

I saw this report a while ago. When did Gen Surgery become so competitive? I had always thought it was moderate, but nearly 1.5 applicants per spot? By that alone it seems more competitive than Derm and Rad-Onc...

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Ever since the 80 hour rule kicked in... surgery has become insane and becoming harder.

dont forget that a lot of people still apply to gen surg as a back up... ie: those who want ENT/Uro/Plastics/etc... it's probably a small portion, but they're still there... (this is what i tell myself for comfort anyways)

tho i will say that this application season has already been frustrating... i already know my number 1 choice (i want to stay where i am) but with all this talk about competitiveness, i'm worried about being able to match there... it's kind of depressing to think that a program who knows you very well (ie: you've spent 5+ months w/in the realm of the department) would not choose you, but would rather choose someone based on one number ... sigh. it's like unrequited love😛 it's like being a 14 year old freshman in h.s. crushing on the hottie senior football captain.

i cant wait until march 17th at 12:01pm... til then.. it's gonna be a ruff ride.

Faebinder said:

Ever since the 80 hour rule kicked in... surgery has become insane and becoming harder.

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imalwayshungry said:

dont forget that a lot of people still apply to gen surg as a back up... ie: those who want ENT/Uro/Plastics/etc... it's probably a small portion, but they're still there... (this is what i tell myself for comfort anyways)

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Those people aren't included in the stats - everything is based on the specialty of your first ranked match choice. Of course ... that means that GS would be disproportionately competitive. Lots of sub-specialty backup applicants that don't show up in the GS numbers, but presumably very few people apply to ortho as a GS backup. That said, this increased competition would be more for interview slots than match spots.

imalwayshungry said:

i cant wait until march 17th at 12:01pm... til then.. it's gonna be a ruff ride.

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I Second that -AMEN 😉 ... com'n y'all - let's gidee-yup 👍

Faebinder said:

Ever since the 80 hour rule kicked in... surgery has become insane and becoming harder.

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This is the only reason why I would consider a surgery residency. As much as I like procedures and the field, and as little a life you have during residency, I want to be able to have it. When I heard the 80-hour rule went into effect, it opened up surgery as a possibility for me.

RxnMan said:

This is the only reason why I would consider a surgery residency. As much as I like procedures and the field, and as little a life you have during residency, I want to be able to have it. When I heard the 80-hour rule went into effect, it opened up surgery as a possibility for me.

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I hate to break it to you, but many programs still don't comply. You better ask the residents lots of questions when you interview so you don't end up at one of these, if it's that important to you. Of course you'll never know if they're lying or not....

my bubble's been burst 🙁
ah well.. what can ya do

Pilot Doc said:

Those people aren't included in the stats - everything is based on the specialty of your first ranked match choice. Of course ... that means that GS would be disproportionately competitive. Lots of sub-specialty backup applicants that don't show up in the GS numbers, but presumably very few people apply to ortho as a GS backup. That said, this increased competition would be more for interview slots than match spots.

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that's ******ed.
last month every member of my team (except maybe the med3s) worked >90 hours a week. it was never up to 120 like in the old days... i found it pretty hard to have a life when i was getting to the hospital at 4AM and leaving at 845PM (yes those were my real hours)

there are some of us who would still go into surgery if we had to work 120 hours per week.

RxnMan said:

This is the only reason why I would consider a surgery residency. As much as I like procedures and the field, and as little a life you have during residency, I want to be able to have it. When I heard the 80-hour rule went into effect, it opened up surgery as a possibility for me.

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80 hour compliant general surgery program? Have you found the cure for cancer while being struck by lightening too, because that is just as likely.

tooshorttoolong said:

80 hour compliant general surgery program? Have you found the cure for cancer while being struck by lightening too, because that is just as likely.

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You are very, very wrong.

imalwayshungry said:

that's ******ed.
last month every member of my team (except maybe the med3s) worked >90 hours a week. it was never up to 120 like in the old days... i found it pretty hard to have a life when i was getting to the hospital at 4AM and leaving at 845PM (yes those were my real hours)

there are some of us who would still go into surgery if we had to work 120 hours per week.

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Does anyone know how to electronically send a cookie over the internet?

randomedstudent said:

You better ask the residents lots of questions when you interview so you don't end up at one of these, if it's that important to you. Of course you'll never know if they're lying or not....

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The residents I've talked to have said their program is in compliance. And yes, they could have been lying.

imalwayshungry said:

that's ******ed...there are some of us who would still go into surgery if we had to work 120 hours per week.

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Forgive me for my naivete. I'm just a poor med student, and I can't afford the luxury of name calling and elitism.

tooshorttoolong said:

80 hour compliant general surgery program? Have you found the cure for cancer while being struck by lightening too, because that is just as likely.

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Really? That would surprise me but I am willing to be enlightened. In my randomized study of 4, all were non-compliant.

tooshorttoolong said:

Really? That would surprise me but I am willing to be enlightened. In my randomized study of 4, all were non-compliant.

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the one i have observed is definitely compliant...they are very strict about it..

imalwayshungry said:

i cant wait until march 17th at 12:01pm... til then.. it's gonna be a ruff ride.

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March 17? why torture yourself?..just wait until March 15th like the rest of us. 😉