Minorities in Otolaryngology, Dermatology and other competitive specialties

From my understanding by talking to minority faculty, the process for matching into the ROADE specialties is about USMLE, clerskhip grades, and research. Diversity does not play a role (from what they have observed) whatsoever when it comes to residency application and the matching process.

Hey,
I can ask my sister to respond she matched in Derm this pass Match cycle.

URM status, as efex stated, will not play any role in residency match what-so-ever. I have seen a pretty good deal of minorities in all specialties, competitive ones as well. Specifically, I have seen quite a few in (very competitive specialties only) ortho surg, rads, and optho. G-surg (pretty competitive), emergency (middle of the road), the more sought after IM fellowships, and neuro (not so competitive) are also specialties where I have seen a good representation of minorities. This is only my experience, reality could be pretty different though.

I second what MSKallthway says. Diversity with all else being equal gets us in the door (medical school), but after that it doesn't matter.

MSKalltheway said:

URM status, as efex stated, will not play any role in residency match what-so-ever.

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DoctaJay said:

I second what MSKallthway says. Diversity with all else being equal gets us in the door (medical school), but after that it doesn't matter.

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I mostly agree with the above quotes.

I'm a Derm resident. In my field, there are very few traditional URM's (black, hispanic, puerto rican, native american). Although I wish there were more URM's in Derm. But I believe this same trend is seen in all super competitive residencies (Plastic surgery, Rad Onc).

Here's my experience with Derm:
Applying to Derm residency is very competitive. Most Derm programs demand strong academic performance in med school. Before offering interview invitations, many programs FIRST look at your academic performance (class ranking, AOA status, USMLE scores, etc), research, and publications BEFORE they even consider your race, ethnicity, & background. Programs typically want applicants to be >top 20% of their class, AOA, USMLE scores >235, and have published research. If you do not pass the initial academic screening/filter, then your application gets thrown away. The initial screen can be very objective (without any regard to race or ethnicity).

Although I do admit, if you pass the initial academic screen & you're an URM, then I believe your chances of being offered a Derm interview increases.

NOTE: Howard (in Wash, DC) is the 1 and only Derm residency program associated with a traditionally black med school. UCLA-Drew's program folded this past year.

I'm an anesthesia resident and I have to say that I think race or cultural background can play a role in getting into medical school because many schools want to promote diversity.

Many programs exist to help URM enter the medical field. However in terms of matching and residency, in my opinion there is no such thing. I have seen no personal evidence or evidence from my friends who have matched into surg, radiology, and derm of race playing a role in getting invites to interview or even a match. Clinical performance in 3rd and 4th year is the most important followed by board scores, letters, research, etc. Diversity seems to take a back seat in residency.

Its kind of sad that this is the case, because most of the academic centers that we will be rotating at as a 3rd or 4th year or even in residency will be void of minority attendings. I'm not in my clinical years yet, but from the 2 week ward experience they put us through before school starts, I saw like 2 minority residents, and no minority attendings. Are minorities mostly in private practice or is our hospital just odd?

I'm not sure how accurate it is, but recently i heard that ony 2-3 % of the attendings in the US are black (african american, carib, african, etc) Thats not a lot.

Also it depends on the field. There are some fields that have a higher population of minorities than others. For example i think oggyn has a large minority pop compared to others.

black/jamaican Currently applying for rads so if anyone wants to know anything about applying to rads however i could help would be happy to. Also have black friends applying for urology, ortho, and neurosurg

I agree with the above comments and feel that this issue must be widely publicized and addressed.

I understand that entering the fields of optho/derm/neurosurg/ortho may be difficult for anyone, regardless of race/ethnicity. But I also believe that the current residency selection system in competitive specialties makes it almost impossible for some URM’s to gain admission. The current system relies too heavily on quantitative factors such as USMLE/AOA status to offer interviews. Many URM’s tend to score lower on these standardized exams (MCAT/USMLE/NBME-shelf), which are sometimes used for inclusion in medical honor societies. More qualitative factors should be considered such as rotation evaluations and letters of recommendation.

In my journey to become a dermatology resident, I have seen many people (including URM’s) match and not match into competitive specialties. A disproportionate not matching tend to be URM’s. We need role models, advisors, mentors who reflect our ethnicity in all field of medicine, but this is sorely lacking in the competitive specialties. I also feel that many program directors don’t know (or may not even care) that URM’s are extremely underrepresented in their competitive residency programs.

With your help, I’d like to chronicle our experiences as URM’s in medical specialties, especially in term of the residency selection process. I’m not aware of any book that has been written about this, but I want to change that. Any opinions, suggestions, or anecdotes about this project will be appreciated. Please let me know what you think as medical students, residents, attendings, or post-doc fellows already in or attempting to get into competitive specialties. You may respond to me privately here on SDN.

Thank you.
URM4all

Quite an interesting post for your very first post URM4all, and great username too.

Thank you DoctaJay. From your previous posts, I read that you didn't see many minority attendings on the wards. This was certainly true for me as well, although I did see more URM attendings during my Family Medicine
rotation and internship.

Although I don't yet know the geographic facts yet, I bet many minority attgs may be out in the community and/or rural areas serving underserved populations, primary or specialty care.

It would be interesting to see where minority attgs end up, and the reasons for choosing private practice vs academia.

I hope that you get your bearings on what the term "racist" actually means. The user was simply stating that their are less role models in medicine for URMs than non-URMs. People often make role models of people that are similar to them. I'm sure that your attending wouldn't be as much of role model if he was actually a female black attending. You can relate to him because he is male, therefore are you sexist? Of course not. People form role models for numerous reasons, so lets not derail the conversation.

Nolagas I think its difficult for u to empathize with the plight of URM in medicine in general and in completive sub specialties. Some of the best mentors I have for rads are white men but there certain connection that u share with someone who can relate to ur experience as a white guy u have people like that all the time and probably take it for granted u never need to think about ur race. As a black man I'm always forced to think about my race not just in medicine but in society in general look at incidents such as the jenna six, the lack of minorities in medicine, countless police shooting, racial profiling and tell me if you were on the other end of these outrages if you would feel the same way.

Hi,
I haven't posted in this portion of the forum before, but I used to post in the pre-allo forums, and noticed it was quite racist against URMs. I stopped posting for that reason, and it is nice to see a place where people can encourage eachother....that's what it is all about.

I am currently applying in anesthesiology, and I am usually the only African American there, with the exception of a few places. I am disappointed with the lack of representation of AA faculty and residents, but it is a reality that hopefully will change with time. Sometimes it is nice to have a role model that looks like you or may have a similar upbringing (regardless of race or gender) that you can look up to. I definitely miss that in the institutions I've gone to. We have to remember to encourage each other regardless of status or specialty...the medical community of African Americans in particular is pretty small...

Sorry, back on topic, I think you need some type of research,strong board scores and/or AOA to match a relatively competitive specialty (IMHO anesthesiology is not as competitive as derm...)

I don't think race has anything to do with actually getting the interview or getting ranked, and I don't think it should at this point in the game. However, the sad thing is that race sometimes influences how you are graded and evaluated in medical school...which is the little known and talked about dirty secret. I think that the only equalizer sometimes ends up being board scores sadly, but this is true for everyone. The AA students at my school actually rocked the boards overall...there isn't anyone I know that didn't pass, and there were 14 of us total in my year. I think if individuals know they want to pursue a specialty with more stringent cut offs, then the preparation for step 1 in particular needs to be more intense, and hopefully the URM community can support each other. My friends and I studied together for step 1 and like I said most of us did well, one I know for sure was at around 260.

I hope that by pursuing the ROAD specialties and mentoring other URMs that the numbers will eventually increase. I know that there is an orthopedics society that mentors urm med students (forgot the name), and they seem to have a pretty successful model for mentorship.

I don't want to throw the thread too much off topic mdqueen, but could you expound a little more on who minorities are graded and evaluated differently in medical school? Is it only during 3rd and 4th year when you get evaluations or during the preclinical years also?

While I'm not MDqueen I can tell you about my experience. First and second year, everyone is on the same playing field because everyone takes the same test, and either you know your stuff or you don't. I was very suprised in my 3rd year when I failed my first rotation. I went to a faculty, a black female, who gave me the verbal beatdown and almost made me cry. She basically told me that I was living in an ideal Utopia I thought that we all get treated equally in the medical field, and that people look at us and expect higher standards from us, and we have to go above and beyond to prove ourselves just because of our skin color. She's not the only one I've heard that from. I have to agree that I was living in an ideal world where I thought everyone was cool with me, I was cool with everyone, did what I was supposed to, and the world was a rosy place. I failed due to clinical evals, nothing else. Didn't have problems with OSCE or the shelf. After that, I became more aware of my sorroundings, didn't joke around with the group as much, did well all my other clerkships with glowing evals. So yes, it does exist, and it's probably more common than we might think, since we are always taught that the more educated a person is, the less likely they are to be racist/ignorant. And while I'm not saying that I didn't make some mistakes, I strongly believe that I shouldn't have failed and "others" likely wouldn't have failed. But anyway, that's just my experience.

I'm applying for Urology. In 23 interviews, I'm pretty sure I only met two black applicants. One is a friend of mine from the same med school. Few women too, but I think that goes with the specialty. Saw several AA attendings (but a lot more white), including one at my school. Don't remember any black urol residents during the interviews.

BTW, I'm a white guy. An old white guy - 35 yo.

I would guess that in a specialty like Urol where each school is only going to take one or two people each year, "fitting in" with the residents already there is critical for these guys. So, being from a different race, gender, or even area of the country from most of the people they already have in place might be a bigger obstacle (consciously or subconsciously). I suspect my age is a bit of a "fit" hurdle for some places.

That being said, I still think the biggest hurdle must be in interest level of URM med students or in the pre-interview "cutoff" numbers. Otherwise, I would have expected to see more at the interviews.

General comment - why the regular talk about need for role models? I don't have any. No one in my class is like me (gray haired, with kids). There is no support network I can tap into... and I refuse to need one. But, I am in Louisville KY, and have a buddy who is a private practice Urologist and an AA. I've known him for about a decade. He's a good fellow, and I'm sure he'd be willing to discuss medicine with anyone interested - just PM me. His wife is ER.

Anyway, good luck all.

I agree with many of the above posts. Considering the process in which one matches for residency usually board scores, grades, and cv are more important. However, many programs are recruiting URM academic physicians on to their boards in order to help diversify their residency programs. I personally have had several black interviewers tell me that because of my scores and my competitveness that they would help push for me during the match screening process where the interviewers sit down at the end of the season and review candidates. So diversity does matter somewhat. Of course that doesnt guarantee anything. I'm sure some male dominated fields have academic female physicians on the board to help diversify the program by recruiting more women.

TO TUGBUG:
Hello fellow louisvillian! Just wanted to comment on something you stated in your previous post about not understanding the need for a support network. I must say that as an aa, having a support network is very important. As an older gentlemen you've practically already paved your way in life and probably have already made some pretty important relationships along the way - but for younger generation african americans or other minorities that may be the first generation in their family to even graduate from college there is a need for mentorship - someone to help pave the way and offer advice, encourgement, and guidance. Many dont have parents, aunts, uncles, or family friends to ask for advice. Like you mentioned - you have a friend thats a urologist - well I'm sure he must be a big help to you while you're applying for your urology residency. Sometimes i hear fellow collegues state that their parents or family members advised them to pursue a particular residency because of their personal experience - or they were key in helping them find preceptorship sites to shadow doctors - or they're currently advising them on what type of roth IRA to invest in while in residency before their income increases. Its that support network thats lacking. Also if you're not used to being "the only one in the room" you probably just wont understand. I'm from a historically black university and i moved to the Ville for med school - culture shock!!! If it wasnt for the minority affairs office making sure that the only 10 black students out of a class of 200 had some type of support - the transition would've been very difficult. Not just for the aa students - think about the indian (eastern)students you see in your class that are the very first generation from their family in the US - straight from india. They need support.

GYN DOC said:

I agree with many of the above posts. Considering the process in which one matches for residency usually board scores, grades, and cv are more important. However, many programs are recruiting URM academic physicians on to their boards in order to help diversify their residency programs. I personally have had several black interviewers tell me that because of my scores and my competitveness that they would help push for me during the match screening process where the interviewers sit down at the end of the season and review candidates. So diversity does matter somewhat. Of course that doesnt guarantee anything. I'm sure some male dominated fields have academic female physicians on the board to help diversify the program by recruiting more women.

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What's the climate like for URM's with great numbers (>250, AOA etc) that will get them past the initial screening and into some interviews? Does URM status help (I know some programs say they want to increase diversity but do they mean it?) or hurt (problems fitting in, particularly in small fields like rad onc, derm, and integrated prs). Just wondering what the general sentiment is

njbmd said:

The "climate" is the same as for any other applicant with > 250, AOA and other things. Your color isn't going to make you a good "fit" for a program unless you were already a good "fit" for said program. Residency program directors want people who can get the work done and who can fit in with the team so that the work can get done. Being able to do well on a board exam and with test-taking will only go so far in terms of actually being able to do the clinical work of residency. There are plenty of people who may not have the best "numbers" but can "smoke you" when it comes to being able to treat patients clinically.

We have interviewed folks who looked "good" on paper but the residents couldn't "stand" them at the interview dinner or during lunch. Needless to say, we didn't rank them because the the residents currently in the program are the ones who will supervise and work with anyone who is yet to come into the program.

When a field is small, being able to work with the team and get the work done becomes more important. Many times, in the smaller more competitive fields, you will be the only resident of your year there or in the hospital after hours. This means that you have to be efficient with your clinical skills and able to get along with others well as you treat your patients. Medicine isn't practiced in isolation.

Once your training is done, your colleagues accept you as they find you. If you are a good professional clinician with a strong knowledge base and good training, they will refer patients to you regardless of color. This has nothing to do with diversity but everything to do with you being a good physician regardless of color.

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I understand 100% what you're saying and I agree with it. I think I did not make my question clear enough. I did not mean to imply that being a URM will get one a undeserved spot. I should have said: all things equal - numbers, clinical skills, LOR's etc., does being a URM affect one more positively or negatively?

Let's say there's a program that only accepts 2 residents per year and for the last 5 years they have not had one URM resident. If there are 3 applicants with strong numbers who interviewed well and 2 are non URM and 1 is URM, URM status will not matter negatively or positively in how they are ranked? I find that really hard to believe

2012mdc said:

I understand 100% what you're saying and I agree with it. I think I did not make my question clear enough. I did not mean to imply that being a URM will get one a undeserved spot. I should have said: all things equal - numbers, clinical skills, LOR's etc., does being a URM affect one more positively or negatively?

Let's say there's a program that only accepts 2 residents per year and for the last 5 years they have not had one URM resident. If there are 3 applicants with strong numbers who interviewed well and 2 are non URM and 1 is URM, URM status will not matter negatively or positively in how they are ranked? I find that really hard to believe

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I would like a response to this too if anyone has an idea? I am an URM (female) that will be applying to derm this year. I have enjoyed reading this thread and hope to look forward to more posts!

mimi53751 said:

I would like a response to this too if anyone has an idea? I am an URM (female) that will be applying to derm this year. I have enjoyed reading this thread and hope to look forward to more posts!

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I matched EM so I have no authority to talk about derm, but the example is only looking at the issue with one parameter.

What if 2 of the applicants are male and one is female and the previous classes have been male heavy? what if one of the applicant has significant ties to the program and surrounding area? Also, this doesn't take into account the randomness of rank list combinations.

The whole URM issue with residency is complicated, there is no box in ERAS for disadvantaged like there is for AMCAS. So programs won't even know. Things like URM, are similar to anything else on your app that might make the reader intersested in interviewing you, like if you're a career changer, AOA, have really exotic hobbies. Whatever. However, you will still have to pass muster on the academics (Steps 1/2, grades, LORs).

BTW, I have less and less faith in the argument about URMs and USMLE. That's not to say that URM haven't struggled with these tests, but I wonder if that is more a reflection of economic hardships and access to outside resources (in-home tutors, kaplan courses for MCAT, etc) prior to med school that may be too much to recoup. Also, this is not completely unique to URMs. I read many med school appls where the candidate is white, from a family of multiple physicians and still struggles with the MCAT. It happens, somepeople aren't good testtakers and some have had hardships keep them from reaching their full potential.

Of course there are less URM attedings, fewer URMs get into medical school. You have to do you and be a resource, show others how you navigated the process (and be active in seeking them out). It's not fair, but ghandi said "you have to be the change you want to see in the world".

2012mdc said:

I understand 100% what you're saying and I agree with it. I think I did not make my question clear enough. I did not mean to imply that being a URM will get one a undeserved spot. I should have said: all things equal - numbers, clinical skills, LOR's etc., does being a URM affect one more positively or negatively?

Let's say there's a program that only accepts 2 residents per year and for the last 5 years they have not had one URM resident. If there are 3 applicants with strong numbers who interviewed well and 2 are non URM and 1 is URM, URM status will not matter negatively or positively in how they are ranked? I find that really hard to believe

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The question you are asking is, "What are the program directors thinking when they rank me"? This is a question every applicant would die to know as they are applying. The simple answer is that you and I will never know.

I was told at one ortho interview that the PD has an X number of spots and he/she wants one of those spots filled by a minority. I was totally taken back by the comment but clearly this was the exception, not the rule. If that was the rule then you would see minorities in every ortho program. I know of another (not to be named) but well known program who has never taken a black resident in its entire history (> 50 years).

So clearly, there are some programs with (all things being equal) will prefer diversity while others prefer to keep themselves as white or as male as ever. The only thing I believe that will help your situation will be that most applicants are ranked by a committee. So if you can impress more than 1 of your interviewers or residents that should improve your chances. But in the end, I think the best way to improve your chances for a competitive specialty is really what improves the chances for any other applicant:

- A very strong away rotation performance. Make the attendings and residents love you and your work ethic
- Strong board scores. > 240 should do it for most specialties except derm maybe
- AOA status
- Top ranking your class
- Glowing LORs

If you have this, and being a minority or woman is important to them to rank you higher, then fine. You can't help that. But to say that across the board, your skin color changes things for residency, that is wholly an ignorant statement (this last statement wasn't directed to anyone in this thread.)

LOL orthopedic surgery is such a country club


My understanding of the minority effect in residency applications is that it does not make up for having subpar credentials, so like doctajay said make yourself competitive. I decided I wasn't even going to bother applying to a competitive specialty if I didn't have the numbers.

One more thing, I need some validation on these claims that minorities do worse on the USMLE and shelf exams. From personal experience I find that EXTREMELY hard to believe. I think people may be unfairly extrapolating performance on the MCAT to the USMLE but I may be wrong.

SlickNickMD said:

LOL orthopedic surgery is such a country club


My understanding of the minority effect in residency applications is that it does not make up for having subpar credentials, so like doctajay said make yourself competitive. I decided I wasn't even going to bother applying to a competitive specialty if I didn't have the numbers.

One more thing, I need some validation on these claims that minorities do worse on the USMLE and shelf exams. From personal experience I find that EXTREMELY hard to believe. I think people may be unfairly extrapolating performance on the MCAT to the USMLE but I may be wrong.

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On as slightly unrelated note, I have heard we do worse on rotations at my school and I am really anxious to know if that is due to shelf exams or due to subjective evaluations. I have my own dark suspicions but I'd like to see data.

scarletgirl777 said:

On as slightly unrelated note, I have heard we do worse on rotations at my school and I am really anxious to know if that is due to shelf exams or due to subjective evaluations. I have my own dark suspicions but I'd like to see data.

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In responding to this post, and as someone who has personally been affected by poorer subjective grading resulting in less than ideal grades in third year, I have to say this is true especially in places where there are not that many URM attendings. Also if the views of URM in the school you attend are more skewed towards negative, you tend to receive worse subjective grades in the wards. This affects your overall grade even if you do really well on shelf exams.

If your attendings/residents/superiors are uncomfortable approaching you to offer constructive criticism, even after you ask, but only write it in your evaluation, then it proves to you that they are not comfortable around you. As such, when it comes to getting your letter of recommendations, they do little to help you improve or be better. They might also be more reluctant in providing the "hook up" to colleagues in other institution. Sometimes a very unofficial recommendation between peers really matters in small and competitive fields. Most physicians in these fields tend to know one another because they trained in similar places and see each other at annual meetings.

In very competitive fields, every one looks great on paper because they have the scores, AOAs, research etc...but it is usually the LORs that differentiate among people. If you have faculty members that are slightly supportive of you, but do not think very highly of you, or do not have real connections to you, your LOR becomes weaker and that may affect your goals to match into the uber-competitive fields.

cArdiomyopathor said:

In responding to this post, and as someone who has personally been affected by poorer subjective grading resulting in less than ideal grades in third year, I have to say this is true especially in places where there are not that many URM attendings. Also if the views of URM in the school you attend are more skewed towards negative, you tend to receive worse subjective grades in the wards. This affects your overall grade even if you do really well on shelf exams.

If your attendings/residents/superiors are uncomfortable approaching you to offer constructive criticism, even after you ask, but only write it in your evaluation, then it proves to you that they are not comfortable around you. As such, when it comes to getting your letter of recommendations, they do little to help you improve or be better. They might also be more reluctant in providing the "hook up" to colleagues in other institution. Sometimes a very unofficial recommendation between peers really matters in small and competitive fields. Most physicians in these fields tend to know one another because they trained in similar places and see each other at annual meetings.

In very competitive fields, every one looks great on paper because they have the scores, AOAs, research etc...but it is usually the LORs that differentiate among people. If you have faculty members that are slightly supportive of you, but do not think very highly of you, or do not have real connections to you, your LOR becomes weaker and that may affect your goals to match into the uber-competitive fields.

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I had not really thought of that in terms of LORs. I find personally that I just do better with subjective evaluations the longer I am around someone, so I am just making sure that I get a lot of facetime with attendings in my chosen field so they have ample time to realize how awesome I am

I also think a big issue is family connections. When I got to med school I was shocked to see how many students had at least one physician parent--many even had a parent who trained at my med school or were/are on the faculty (this is what would be considered a "top" school, so many people would be interested in going here not just those with a connection). There is also a less striking but still surprising phenomenon where a lot of students are going into a specialty that their parent went in to. Even if they do not have a parent in that specialty, that parent often has friends that they can connect them with that can give them advice. Obviously a URM is going to be less likely to have that kind of family connection, and especially in the very small competitive specialties, this can be a very important missed opportunity...perhaps that's not the right phrasing because it can't be controlled, but you know what I mean.