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I thought that's what nurses do...
2014 Charting the Outcomes?
- Thread starter mybubbles627
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I thought that's what nurses do...
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They clean earwax sometime in between their brunch breaks and lunch breaks
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Gotta say, I don't understand the flocking into ENT.
If you're a surgery brah, I get it. You love flaps, tumors, facial trauma, high tech implants, robots, cool anatomy, sorta decent lifestyle that comes eventually etc...
But a lot of the people I see going into ENT these past few years actually fit more of a derm stereotype, eg high maintenance women and men. Why is the lifestyle crowd herding to ENT? Is it for facial plastics? Or do people plan on doing 1 day of tubes + tonsils per 4 days of clinic?
If you're a surgery brah, I get it. You love flaps, tumors, facial trauma, high tech implants, robots, cool anatomy, sorta decent lifestyle that comes eventually etc...
But a lot of the people I see going into ENT these past few years actually fit more of a derm stereotype, eg high maintenance women and men. Why is the lifestyle crowd herding to ENT? Is it for facial plastics? Or do people plan on doing 1 day of tubes + tonsils per 4 days of clinic?
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I think it's the latter. People started realizing that you could do your 1-2 days/wk of tubes + tonsils and 2-3 days of relatively relaxed clinic and make pretty decent money doing it. You also have the option of doing higher volume and making serious money if you want to...there's less of a ceiling, kind of like derm and plastics. I don't think there was a sudden influx of people who suddenly found out they loved doing bilateral neck dissections.
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Yeah, you're probably right. I guess I've always heard that there's are only two ways to make a killing in ENT: facial plastics and being uber business savvy with ancillary services in a practice that you own. The latter is a much trickier road to take, and I'd wager the lifestyle types would probably lean more toward facial plastics. ENT pays well otherwise, but from what I've gathered the reimbursements aren't that much higher than other specialties with better lifestyles. The big whacks don't pay well and more operating generally correlates with a worse lifestyle, which the classic ENT types probably don't mind as much.
I've heard multiple people this year say they were deciding between derm, plastics, and ENT, which seems like an odd trio to me. The only common thread to all three is cosmetics, unless there's a well-kept secret that I'm missing here.
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ENT hits a nice sweet spot. If you like everything, are pretty good at everything, then ENT gives you a very broad scope of practice with almost limitless flexibility. No, the lifestyle is not as good as some other similarly competitive fields, but it can be decent compared to other surgical fields.
I haven't seen the lifestyle crowd going for it, at least not after a busy free flap week! I see a lot of people who love surgery, love the breadth of the field, don't quite fit the gen surg mold, etc. At my school, the people are a big selling point -- very happy, kind, brilliant faculty who really love to teach. Ive routinely seen our attendings and fellows take shadowing MS1s and teach them how to scrub and let them help out in some big cases, teach them to sew and to tie, etc. It's not hard to imagine that attitude plus a cool field pulling in a lot of students.
Anyone with numbers for ENT would be a solid applicant in any field; I can't imagine someone seeking a cushy lifestyle signing up for a surgical career when they probably have solid numbers for derm or rads or rad onc or and host of other competitive fields.
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Yeah plastics vs ENT I understand, but not derm. Maybe it's a case of "let's see what this 260 can do for me" more than interest in the work? I sure hope not - recipe for being unhappy later. I hope anyone with numbers that good has the self awareness to know what makes them happy.
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Depends. Part of the problem for many students is knowing WHAT makes them happy. What makes one happy as an MS-3/MS-4 will be quite different in what makes them happy in residency and beyond. Also hard to know even with audition rotations whether the interest will stick.
Contrary to opinion, there are tons of people in Derm who actually like reading about and learning about Derm.
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The only people I know who were considering ENT as med students who were interested in it as a "lifestyle" specialty changed their minds during their subI. I can actually think of 4 people who switched last minute (1 to derm, 3 to IM [hah]).
The consensus medical student path for ENT is: smart medical student with good personality who loves H&N anatomy and surgery and applies to ENT intending to be a H&N surgeon, then decides mid-free flap salvage at 3am on Sunday that he wants to do facial plastics.
I think @operaman sells it pretty well above.
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average Step 1 has been rising as well. Most specialties tracked the rise in Step 1 scores. So actually not that bad at all.
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Most people I've met going into ENT, Plastics, and Urology (not in NRMP report but had a 67% match rate for US MDs) are those who love surgery, are hard workers, and just prefer their niche to General Surgery. Sure all those specialties can allow for more relaxed office based practices afterwards, but anyone who goes into them for the lifestyle is in for a rude awakening and a brutal 5-6 years of residency.
As an above poster pointed out, its probably much more common that people who were originally gung ho about free flaps, head and neck dissections, and cystectomies with neobladders end up changing their mind while operating in middle of the night for the umpteenth time.
As an above poster pointed out, its probably much more common that people who were originally gung ho about free flaps, head and neck dissections, and cystectomies with neobladders end up changing their mind while operating in middle of the night for the umpteenth time.
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It goes without saying that the most competitive specialties just so happen to be the ones with the highest compensation/hr ratio. I know talking about money in medicine is akin to satan worship (at least in my school), but coinkydink?
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damn i was thinking ent but now maybe not
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Oh definitely, I think that compensation is playing a large role. Even among the 5 or 6 most competitive specialties there is great variety and I think people do ultimately settle on something where they like the work (or think they do). Strong applicants do have a lot more choice, however, and understandably will gravitate toward things where they like the work AND will likely be well compensated.
Personally, even if what I'm planning to do were the lowest paid field, I think I would still do it because of the work and because of my reasons for coming to medicine in the first place. That said, I would have probably looked more strongly at other fields on the chance I might like them as much or more.
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Don't let the numbers scare you too much. Competition is insane but the flip side is that you can get great training in any program out there. There is also a lot more to it than just numbers. Numbers are important to a point, but beyond that it becomes much more about what work you've done and how productive you'll be as a resident, what you're like to work with, whether they want to spend 18 hours in the OR with you, etc. Honestly, past a certain score, everyone is smart enough to do the work and other soft factors become more important.
The point of all that rambling is that if you're thinking about it, get involved in your department and start making connections, doing research, etc. I've seen some stellar scores (270+) not match at all and seen some low scores (<220) match very well. The difference is people. Get to know the people, work hard, be awesome, and people will advocate for you and help make things happen.
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I lol'd @ how Rad/Onc's probability of matching as a non-U.S. Senior goes down with increasing board score. wat
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I see a lot of people get this wrong. It's not a probability of matching. It's a depiction of previous match results. It gives you an idea of what your success will be like with various factors but there are plenty of confounders
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My understanding is that since it is so desirable in terms of money and hours, they don't want people who get a 260 and decide to go for lifestyle. So they focus more on research; many applicants have PhDs (which makes sense given the technical/experimental nature of the field), then the people with high scores throw in a couple apps for the hell of it and apply to the top IM programs they would have applied to anyway.
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Oh, I just assumed it was a fluke. The sample size was something like n = 25 between both matched and unmatched non-U.S. Seniors. Plastic Surgery has the same inverse trend with a similar sample size. The data could be completely thrown by a couple of high-scorers applying for the hell of it, like you're saying.
Well I mean, the Outcomes pdf even calculates % match data, producing probabilities. Yes, it controls for single variables at a time, but you can still make statements like "the probability of matching goes down as x variable moves in y direction"
Unless you're saying that past results don't predict future performance, ya stock broker.
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You don't need charting outcomes to say that if you have more research, a higher step score, etc. the probability of matching goes up
it's not a probability calculator, it's a description of results
it's not a probability calculator, it's a description of results
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One being that Rad Onc is HEAVILY research based so it's not unusual for many of them to have MD/PhDs. Rad Onc is still one of the ones that having an MD/PhD can still mitigate a lot.
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Posted this in the general residency forum but figure it's worth a possible repost. The overall charts on the first few pages are quite illuminating.
Table 1: The only specialty with less total applicants than spots is child neurology. Followed closely by Radiology and Med/Peds.
Chart 2: Breaking that down into us grads/independent applicants, the vast majority of specialties still have a lot more spots than US applicants. The only exceptions are derm, neurosurg, ortho, ent, integrated plastics. Rad Onc is at parity.
Chart 3: Specialty with the highest match rate is Radiology. This is consistent with the data in table 1 and the fact that the last 3 years running radiology has had the highest number of unmatched slots every year. Lowest match rates are the same derm+surgical subspecialties that have the most applicants. Everyone else is in the low-mid 90s.
Table 2: No huge surprises. Of note, the mean number of contiguous ranks (a pretty good proxy for the # of interviews) for matched applicants has gone up to 11.5.
Chart 4: Breaks the contiguous ranks down by specialty. Everyone is in a pretty narrow range, with people applying to smaller subspecialties tending to rank more places. Going back to the above point regarding rads, people still seem to think it's more competitive than the data shows, so applicants to that are going on a lot of interviews (with an average of 14 being closer to the surgical subspecialties than anything else).
Chart 5: Shows the number of people applying to multiple specialties. No surprises, people applying derm, plastics, rad onc are more likely to have backup fields.
Chart 6: USMLE scores are all up 4-5 points from the prior charting outcomes, completely consistent with the increase in average scores. No big surprises.
Chart 7: Step 2 scores are way inflated, but this has been a chronic issue. No wonder the pass margin is almost 210 these days.
I won't comment on the research/volunteer/work experience graphs. That stuff is so subjective I think it's worthless data.
Table 1: The only specialty with less total applicants than spots is child neurology. Followed closely by Radiology and Med/Peds.
Chart 2: Breaking that down into us grads/independent applicants, the vast majority of specialties still have a lot more spots than US applicants. The only exceptions are derm, neurosurg, ortho, ent, integrated plastics. Rad Onc is at parity.
Chart 3: Specialty with the highest match rate is Radiology. This is consistent with the data in table 1 and the fact that the last 3 years running radiology has had the highest number of unmatched slots every year. Lowest match rates are the same derm+surgical subspecialties that have the most applicants. Everyone else is in the low-mid 90s.
Table 2: No huge surprises. Of note, the mean number of contiguous ranks (a pretty good proxy for the # of interviews) for matched applicants has gone up to 11.5.
Chart 4: Breaks the contiguous ranks down by specialty. Everyone is in a pretty narrow range, with people applying to smaller subspecialties tending to rank more places. Going back to the above point regarding rads, people still seem to think it's more competitive than the data shows, so applicants to that are going on a lot of interviews (with an average of 14 being closer to the surgical subspecialties than anything else).
Chart 5: Shows the number of people applying to multiple specialties. No surprises, people applying derm, plastics, rad onc are more likely to have backup fields.
Chart 6: USMLE scores are all up 4-5 points from the prior charting outcomes, completely consistent with the increase in average scores. No big surprises.
Chart 7: Step 2 scores are way inflated, but this has been a chronic issue. No wonder the pass margin is almost 210 these days.
I won't comment on the research/volunteer/work experience graphs. That stuff is so subjective I think it's worthless data.
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I think this is spot on. ENT has retained this perception of being a lifestyle specialty (Early Nights and Tennis) because the med school curriculum hasn't quite caught up yet with the breadth and scope of the modern ENT practice. I was actually dumping a lot of med school powerpoints off my computer to free up room for my iOS 8 download last night, so for curiosity I browsed through my old lectures to actually see how much of the medical school information pertained to ENT. The answer: very little. And the information that was taught pertaining to ENT was very, very basic. From my experience, unless you take the personal initiative to meet with the ENT residents/staff, you won't have any exposure until maybe your 4th year of medical school. I had to schedule specific meetings with faculty members on my own accord just to get some exposure. Like urology and ophthalmology, it just isn't emphasized much.
The new generation of ENT's are focused more on surgery than anything and pursue ENT because it offers a broad scope of operations. The private guys I have worked with do septorhinoplasties, parotids, thyroids/parathyroids, tubes, tonsils, trach's, direct laryngoscopies, vocal cord injections, uncomplicated tymp/mastoids, LOTS of sinus surgery, and many other operations on a very regular basis. There are guys out in the community who are doing tubes/tonsils only, but they are mostly the older guys now in their late 50's and 60's who are very far removed from training and don't have the stamina or interest for the long cases anymore.
As for the monetary aspect, if you're in private practice you're going to choose between making money and working your butt off vs. having a leisurely lifestyle and not making much money. The days of making a fortune while having a great lifestyle are disappearing. For example, if you want to be a big time head and neck surgeon doing massive resections with free flap reconstruction, be prepared to start off at around $250,000 per year. The entry level neurosurgeons I know are making $400-450k. The big head and neck whacks are as difficult as the most complex brain or heart surgery but earn a fraction of the RVU's. Not really fair, but the head and neck surgeons love it so much they don't care.
If you talk to a lot of ENT residents and ask them if they could do anything differently (if they couldn't do ENT), most will probably tell you that they would go to dental school instead of medical school and do OMFS, because it's very similar yet a relatively easier path (dental school is easier academically than medical; I'm sorry, it just is) and has a great lifestyle. But as the above poster said, most ENT's are happy with their specialty choice and wouldn't want to do anything else.
Also, awhile ago I had some post that said most of our applicants we were interviewing were coming in with scores above 250. I was told that I was full of ____ and that there was no way ENT could be that high...I was 2 points off. Just sayin
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I would be ****ting myself if I were them right now. We all really need to appreciate the fact that we're US allo.
*jumps to valuemd.com*
"YOU GUYS CAN DO ANYTHING IF YOU PUT YOUR MIND TO IT...ITS LYKE SO BS THAT WE HAVE TO WORK HARDER TO GET THE SAME RESIDENCY... THAT MAKES US BETTER."
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IIRC, you said the matched average was over 250, not that your program is interviewing only >250 which wouldn't be surprising in any way. Hell, there are still radiology programs that only interview 250+. To say the matched average is over 250 is still full of ish, as charting outcomes 2014 shows.
I understand and agree with all the above posts about ENT, but what everyone has provided are reasons why the "classic" ENT applicant likes the field. ENT/uro/plastics always gets the high scoring surgical folks, and that is nothing new IMO.
What's new to me, is the influx of lifestyle oriented people. People who wouldn't be caught dead in neurosurgery or gen surg. Your typical uro or ENT applicant doesn't want to do gen surg/nsurg, but they'd probably prefer those fields to IM/peds/derm/rads/etc... Urology is getting more of these folks as well. I saw a lot of applicants from my own medical school deciding between derm and uro/plastics/ent, which makes no sense unless they are chasing "good lifestyles" and prestige. The problem is that a "good lifestyle" in urology/plastics/ENT is still ~60 hrs a week for most practicing physicians in those fields, as the study in my sig illustrates.
Among the surgical fields, ENT and uro appear to be the ones markedly getting more competitive each year. IMO, it's unlikely that more people are just falling in love with those fields, and it's more likely that the perception of "good lifestyle" is stronger than ever.
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Are there similar data for ophtho and uro matches to the NRMP data? Would be interesting to compare.
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Nothing official.
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If I hear one more story about how somebody broke a few bones when they were younger and subsequently fell in love with ortho...
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Or their experience in athletics making them realize they wanted to do Ortho.
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What did I say to draw the high horse comment? I'm not chastising anyone, just making conversation about what I think is an interesting trend. I honestly didn't mean to hurt your feelings...
I don't understand how anyone could be dead seriously considering derm vs ent/plastics, but I never said anything to disparage those people. I have no problem with anyone entering any field for whatever reason, monetary or lifestyle. Who am I to judge?
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Some data for Urology here. Basically only match rates, no step scores or other data.
https://www.auanet.org/education/urology-and-specialty-matches.cfm
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Really? There's a fair amount of cross over between these three, and especially Derm and plastics. I could absolutely see students having a hard time deciding between the two (particularly if there is an interest in cosmetic interventions, as taboo as that is in an academic setting).
Also, much of what Mohs surgeons do is plastic surgery lite.
It's not uncommon or unreasonable at all for students to be stuck deciding between Derm and Plastics. At that point, you just need to decide whether you want mostly operating with some clinic thrown in there, or mostly clinic with some procedures thrown in.
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My exact quote was, "Most ENT applicants receiving interviews nowadays have STEP 1 scores in the 250s-260s." Your reply was, "lol @ ENT step 1 average being 250-260. That dude's FOS." So you actually just validated my original statement with "...not that your program is interviewing only >250 which wouldn't be surprising in any way." I said receiving interviews, not matching. Thanks.
I think you need to separate out residency from actual practice. All specialties have the option of providing a good lifestyle post-residency if that's what you're looking for. There are a lot of neurosurgeons out there who do spine only, make a killing, and have a phenomenal life style. Then there are academic neurosurgeons who take call all the time and are up at all hours operating on head bleeds and trauma. You want to do ortho - if you decide to do spine, shoulder, ankle, pretty much anything that can be done on an outpatient basis and isn't at an academic center, you will have a good lifestyle and make a lot of money (more than ENT and plastic surgery). Yet you don't call ortho a "good lifestyle" specialty. That's "full of ish" in your words. Is the residency bad? Yes, but it's not the only difficult residency there is; you'll find that out when you're a resident one day.
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I mentioned this earlier, but I can see how cosmetics is a common thread between the three. That said, this cross over is basically just shared subject matter, there is essentially no cross-over in the clinical practice.
You're last sentence sort of trivializes the difference between procedures and surgery. Keep in mind that there's some pretty huge baggage that comes along with surgery that doesn't come along with small clinic procedures.
So sassy. First, "most ENT applicants receiving interviews" and applicants receiving interviews at your program are two entirely different populations. Second, the population receiving interviews will have a lower average than the population actually matching, since not everyone matches. And we know the unmatched average is lower than matched average. So what's your point again? Charting outcomes still doesn't support your original comments at all, so the original post is still FOS.
When did I say any of this? I haven't commented on ortho lifestyle once in this thread (or any other SDN threads in the last few months, that I can recall). You're making stuff up and then refuting your made-up arguments.
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You two are having a dumb argument
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Probably better to just say "I was wrong, my bad"
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Where was I wrong? Note that we both misquoted her original post, but that original post is still inaccurate anyway.
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I thought being sassy was what this whole forum was all about. If you can't be sassy on SDN, where can you? I really don't care about the STEP scores being that high, it actually scares me some because I know that there are some applicants who don't have rockstar STEP scores but are going to be amazing doctors who get left out when the field is flooded with high STEP scores. But that's the nature of the beast, I guess. I also know you didn't call ortho a lifestyle specialty, but you had several posts referring to ENT as a lifestyle specialty; my point was to say that ENT or ortho or plastics or etc. once you're out of residency, they're all pretty good lifestyle specialties. So to refer to ENT as a lifestyle specialty and insinuate that it's so popular because of the lifestyle just isn't correct.
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Will there be a 'charting the outcomes' for the 2016 match?
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