2021-22 Residency Interview Thread

[navigator]

We're at that time of year when most programs have concluded their interview season. As with last year, most have saved money this year from virtual interviews precluding the necessity for travel and lodging expenditures. In the past, however, some applicants have depended on late-cycle interview cancellations from applicants who have exhausted their finances, allowing them to bring their number of rank possibilities up to parity.

With fewer interview cancellations occurring, these applicants have clearly suffered. With Step 1 scores becoming pass/fail this year, next year's applicants from international and osteopathic schools (or M.D. schools without significant pedigree) will continue to bear the brunt of current trends. In the future, changes will need to be made for match-opportunity parity to be re-established between these applicants and those from higher-pedigree schools.

No matter what happens, it seems clear that Psychiatry is becoming the new Derm.

What are everyone's thoughts on how this season went?

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[Old&InTheWay]

I totally agree that there needs to be some sort of mechanism that forces applicants to prioritize programs that they are most interested in. With the current set up, there is an incentive to apply incredibly broadly and accept as many interviews as you can fit into your schedule. It's ironic because the argument at our institution for not permitting our program to do in-person interviews (which is what our PD wanted) was based on equity. And while it may have an equalizing factor between students coming from the same institutions, the current situation clearly favors the most privileged applicants (i.e. those who come from elite medical schools).

 

[Celexa]

I know it's rough on the applicants, but as a senior resident involved in education I'm just so happy we have so many talented medical students going into psych. It feels like such an invigorating change even from when I was in medical school a few years ago. And we are still very far from being as competitive as things like derm or plastics.

 

[OldPsychDoc]

It's hard on the programs' side too--pressure to squeeze in "just one more" person who looks good on paper without really knowing if they're really interested in being a part of your program or just trying to "cover their bases". And then you end up sorting through twice as many interviews as you really needed, trying to build a rank list that pulls the ones you truly want to the top.
It would be interesting to see if some sort of "preference signaling" program could be implemented for psychiatry as it has for ENT, where applicants can designate their 4 highest priority programs in the application process.

 

[StilgarMD]

It's hard on the programs' side too--pressure to squeeze in "just one more" person who looks good on paper without really knowing if they're really interested in being a part of your program or just trying to "cover their bases". And then you end up sorting through twice as many interviews as you really needed, trying to build a rank list that pulls the ones you truly want to the top.
It would be interesting to see if some sort of "preference signaling" program could be implemented for psychiatry as it has for ENT, where applicants can designate their 4 highest priority programs in the application process.

I heard from a friend at an ENT program doing this that the program proceeded to only interview people who gave them the 'token'. It was a top tier place, so it seems it would might limit your ability to apply to competitive places. I imagine a simple cap of 20 - 30 or so programs would be more effective (judging by the Match rates, this seems like it should be enough). Has this idea ever been entertained?

 

[Cath Up]

We're at that time of year when most programs have concluded their interview season. As with last year, most have saved money this year from virtual interviews precluding the necessity for travel and lodging expenditures. In the past, however, some applicants have depended on late-cycle interview cancellations from applicants who have exhausted their finances, allowing them to bring their number of rank possibilities up to parity.

With fewer interview cancellations occurring, these applicants have clearly suffered. With Step 1 scores becoming pass/fail this year, next year's applicants from international and osteopathic schools (or M.D. schools without significant pedigree) will continue to bear the brunt of current trends. In the future, changes will need to be made for match-opportunity parity to be re-established between these applicants and those from higher-pedigree schools.

No matter what happens, it seems clear that Psychiatry is becoming the new Derm.

What are everyone's thoughts on how this season went?

1) There does not have to be match opportunity parity between IMGs/DO schools/low pedigree MD schools and high pedigree MD schools. Changes do not need to be made. Sure, it would be nice, though, as this will exacerbate the issue. But higher quality students attending on average more prestigious/competitive residencies doesn't seem unreasonable to me. It is unfortunate that residencies will have 1 less metric apart from the school/region that a student is coming from.

2) Psychiatry had almost no change in the number of USMD/DO applicants this year, and a decrease in total applicants when factoring in IMGs. Dermatology had an 11% increase in USMD/DO applicants. Psychiatry has become more competitive in the last 5 years but is nowhere close to dermatology. It is not the new derm.

For me, this season was mediocre. I applied to ~105 places and received 11 invites. I had mostly well above average stats. I likely applied to too many reach programs and programs that I have no affiliation with. I would apply more inteliigently if I could do it again. I received invites from some far away competitive institutions, likely because they actually opened my app, but was rejected from many less prestigious/competitive places, likely because they were inundated with applications and didn't have any reason to open my app. I don't think this was the case 10 years ago, when an app had some semblance of meaning. That was frustrating this cycle.

I would have liked to see more interviews come in outside of the span of a couple weeks- it was my understanding that there is more activity in December and January but I didn't experience that.

Residency applications badly need reworked. There should be something like app caps signaling to top x number of programs, or something in that vein, which limits the ridiculous proliferation of applications.

 

[NickNaylor]

I'd argue that if one's plan for obtaining interviews to programs relies on others canceling their interview invitations, something has gone awry, and the actual problem is not the application process. The problem(s) probably started a few years before the application cycle even started.

I mentor applicants going into psychiatry (via an organized program in our department), and my mentee this year told me that the academic leadership of the medical school actually encouraged students to cancel interviews if they met some arbitrary threshold so that other students might have a chance to interview at programs. I actually couldn't believe that this advice was given and that the motivation was so transparent. It's not the responsibility of applicants to ensure that other applicants have the best chance possible to match somewhere, and trying to guilt applicants into giving up interviews after they meet whatever number of interviews someone thinks is sufficient is total nonsense. Nor is it the responsibility of the NRMP or residency programs to ensure that all applicants have the best chance possible to match.

Psychiatry is not the new derm. Just over 90% of applicants applying into psychiatry successfully match. The mean step 1 score for applicants that successfully match into psychiatry is below the mean step 1 score among medical students as a whole. Yes, the process has become more competitive, but let's not be hyperbolic. At our institution, at least, the simple reality is that the overwhelming majority of students applying into psychiatry match, and the people that struggle generally have problems in their application, be it poor academic performance, professionalism issues, or a general lack of depth in their application. I can understand why programs aren't particularly enthusiastic about these applicants, especially when psychiatry is becoming a more desirable field to go into and programs' ability to be more selective in the match increases. That doesn't mean that the process is flawed. That means that students who performed relatively poorly as students struggle in the application process. In a system that is theoretically meritocratic, that seems like an expected and desirable outcome to me.

 

[navigator]

Psychiatry is not the new derm. Just over 90% of applicants applying into psychiatry successfully match. The mean step 1 score for applicants that successfully match into psychiatry is below the mean step 1 score among medical students as a whole. Yes, the process has become more competitive, but let's not be hyperbolic.

Not accurate. While just over 90% of US MDs applying into psychiatry successfully match, that is not the case for applicants in general.
There were 1907 positions offered in the 2021 match, of which 1904 were filled (1205 by US MDs; 332 by US DOs; 367 by IMS, AMGs, MD grads, and DO grads). 9.4% of US MD applicants with psychiatry as their preferred specialty (either only specialty or ranked first in their rank order list) went unmatched; for US DO applicants, that number shoots up to 26.5% (see: Figure 6, p. 45).

https://www.nrmp.org/wp-content/uploads/2021/08/MRM-Results_and-Data_2021.pdf

Also, for the Step 1 data, are you referring to the Texas STAR data? Because that data is incredibly off the mark when it comes to how many applications programs received, for example, so I'm not sure it's reliable as a measure for average board scores of matched and unmatched applicants.

 

[navigator]

1) There does not have to be match opportunity parity between IMGs/DO schools/low pedigree MD schools and high pedigree MD schools. Changes do not need to be made. Sure, it would be nice, though, as this will exacerbate the issue. But higher quality students attending on average more prestigious/competitive residencies doesn't seem unreasonable to me. It is unfortunate that residencies will have 1 less metric apart from the school/region that a student is coming from.

2) Psychiatry had almost no change in the number of USMD/DO applicants this year, and a decrease in total applicants when factoring in IMGs. Dermatology had an 11% increase in USMD/DO applicants. Psychiatry has become more competitive in the last 5 years but is nowhere close to dermatology. It is not the new derm.

Just because students with more educational resources are able to achieve higher MCAT scores and better grades in college and therefore win entry into schools like HMS and UCSF does not mean they are significantly more qualified (or of higher quality) than those with much less educational equity and/or fewer financial resources in their lived experience who excel at schools like West Virginia University, Howard, or Michigan State Univ COM.

If you're a medical student who aced the boards, received stellar LORs, conducted salient research, and clearly exude passion for psychiatry (e.g. personal statement, interview), it shouldn't matter which school you attend. Medical education is fairly uniform already, which is why applicants take standardized exams like USMLE and COMLEX. Board scores becoming pass/fail will exacerbate the issue of pedigree becoming increasingly valued unless necessary changes are considered and implemented in the GME application process.

Fair enough. It's not like derm... yet.

 

[Cath Up]

Just because students with more educational resources are able to achieve higher MCAT scores and better grades in college and therefore win entry into schools like HMS and UCSF does not mean they are significantly more qualified (or of higher quality) than those with much less educational equity and/or fewer financial resources in their lived experience who excel at schools like West Virginia University, Howard, or Michigan State Univ COM.

If you're a medical student who aced the boards, received stellar LORs, conducted salient research, and clearly exude passion for psychiatry (e.g. personal statement, interview), it shouldn't matter which school you attend. Medical education is fairly uniform already, which is why applicants take standardized exams like USMLE and COMLEX. Board scores becoming pass/fail will exacerbate the issue of pedigree becoming increasingly valued unless necessary changes are considered and implemented in the GME application process.

Fair enough. It's not like derm... yet.

You imply that the MCAT/grades are measures of wealth/access to education resources. While we can definitely agree that there is an uneven playing field, it is among the least bad systems in place- there is at least some meritocracy still present in med school admissions. Achievement is not exclusively related to socioeconomic status. Education equity is important but having some objective measure of students is way way way better than exclusively quotas. Merit should be rewarded, though I do believe some form of assistance to low SES background students should be present (some form of affirmative action).

That medical student you hypothesize- one who excelled in med school- should succeed, I agree. Medical education being "fairly uniform" is a risky take. Clinical education is not fairly uniform. Many DO schools (and some MD schools) farm out their students to remote sites that often do not have a formal teaching team. If I were a PD, I would prefer students that had interacted with residents more often- they'll better understand their role during residency. This is more common at MD programs with teaching hospitals. I don't exactly agree that a student learns more in a team with residents than solo with an attending, but from a PD perspective, at least they have been through the socialization process of medicine more thoroughly.

I agree that board scores going pass/fail will exacerbate pedigree's importance. It is eliminating one objective measure (that suffers from similar issues as undergrad GPA and MCAT, with lower SES students performing worse) that is among the least bad options available. Though, step 2's subsequent increase in importance may be better because it is more clinically-oriented. The timing of when students take it and decide on specialties is just terrible though. I frankly don't understand how you can dismiss GPA/MCAT as poor measures of merit while disliking Step 1 going P/F. They are all objective measures with similar issues, but permit some semblance of meritocracy.

 

[NickNaylor]

Not accurate. While just over 90% of US MDs applying into psychiatry successfully match, that is not the case for applicants in general.
There were 1907 positions offered in the 2021 match, of which 1904 were filled (1205 by US MDs; 332 by US DOs; 367 by IMS, AMGs, MD grads, and DO grads). 9.4% of US MD applicants with psychiatry as their preferred specialty (either only specialty or ranked first in their rank order list) went unmatched; for US DO applicants, that number shoots up to 26.5% (see: Figure 6, p. 45).

https://www.nrmp.org/wp-content/uploads/2021/08/MRM-Results_and-Data_2021.pdf

Also, for the Step 1 data, are you referring to the Texas STAR data? Because that data is incredibly off the mark when it comes to how many applications programs received, for example, so I'm not sure it's reliable as a measure for average board scores of matched and unmatched applicants.

The data I quoted is from the NRMP Charting Outcomes data. The mean step data is from the USMLE directly.

 

[StilgarMD]

I'm curious if now that we are post match, whether the overall competitiveness of Psych has increased, decreased, or stayed the same this year. I feel like I haven't heard as many stories of disappointing matches this year compared to the 2 - 3 years prior.

 

[calvinhobbes]

About the same but some spots around 20? went unfilled but these were from mostly newish programs … but compare that to FM IM and EM which has manyyy more (hundreds I think) spots left over (some of which could also be from newish programs)

 

[kopftonmd]

I'll want to see the charting outcomes and the rest of the data from this year, but my anecdotal sense was that even if psych isn't the new derm in terms of competitiveness, the top - aka the applicants who are the cream of the crop and go to harvard/penn/insert fancy place - are dramatically more competitive than they have been in the past. So even though the likelihood of matching is the same, it's much harder to place at a tippy top tier program.

But like I said, I want to see the data before drawing any real conclusions.