Article on Specialty Competitiveness

[bcsmith]

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Click here (MD Consult) for an interesting article on the competitiveness of residency positions "utilizing the percent of positions filled through the match... [and] the percent of positions filled by graduates of American medical schools..." The author, an MS3, calculated a "selectivity index" based on this data for the 2005 NRMP match (which excludes the SF match).

The top ten specialties and their respective indicies:
1. 1.210 Orthopaedic Surgery
2. 1.197 Plastic Surgery
3. 1.163 Radiation Oncology-PGY2
4. 1.162 Emergency Medicine-PGY2
5. 1.158 Transitional
6. 1.139 General Surgery
7. 1.128 Emergency Medicine
8. 1.098 Dermatology-PGY2
9. 1.094 Radiology Diagnostic-PGY2
10.1.092 Radiology Diagnostic

I found it interesting that the PGY2 EM spots ranked higher than the PGY1 spots. I suspect this is not statistically significant, beacuse the n for PGY2 EM spots is much less than the n for PGY1 spots. Also of note is that EM seems to be trending upward in popularity as noted in the article.

All in all, this is good news for EM. The more competitive our specialty, the stronger students we will attract.

B

 

[Hercules]

Nice article. For the 2-4 EM programs it must be all those stud residents pulling in the top students 😉

 

[southerndoc]

Emergency medicine is certainly getting more competitive. I feel sorry for those who truly want to do emergency medicine but aren't competitive enough to get a position. Even the unmatched positions attract highly qualified candidates.

I think as our specialty matures with more research, education, and better academics through fellowships, emergency medicine will continue to attract more qualified applicants and be a bigger presence in hospitals and universities. Medicine, surgery, and radiology have been around many, many years, but emergency medicine has only been around for 25 years -- 10-15 in most universities.

Viva la EM!

 

[GeneralVeers]

Emergency medicine is certainly getting more competitive. I feel sorry for those who truly want to do emergency medicine but aren't competitive enough to get a position. Even the unmatched positions attract highly qualified candidates.

I think as our specialty matures with more research, education, and better academics through fellowships, emergency medicine will continue to attract more qualified applicants and be a bigger presence in hospitals and universities. Medicine, surgery, and radiology have been around many, many years, but emergency medicine has only been around for 25 years -- 10-15 in most universities.

Viva la EM!

The "competitiveness" of residencies is a sad state of affairs. It means that qualified students can't go into the fields that they love because of arbitrary grade cutoffs and board scores. Speaking as one who ALMOST didn't get to do EM, it's quite depressing. What do you tell those people who love EM, but are forced into Internal Medicine, and end up doing something they don't like for the rest of their lives?

 

[docB]

What do you tell those people who love EM, but are forced into Internal Medicine, and end up doing something they don't like for the rest of their lives?

You tell tham the same thing you tell people who loved medicine but didn't get into med school. How would you suggest going about making a specialty artificially less competitive?

 

[GeneralVeers]

You tell tham the same thing you tell people who loved medicine but didn't get into med school. How would you suggest going about making a specialty artificially less competitive?

Make primary care pay more. That is the crux of the current problem. A lot of people considered primary care, and then decided against it based on salary. Primary care doctors are the most important doctors, even moreso than self-important surgeons.

Disclaimer: I am by no means certain how one goes about doing this.

 

[southerndoc]

I don't think people are choosing emergency medicine because of money. I think they are choosing it because of lifestyle while still seeing interesting patients. Radiology has the pay and lifestyle, but not the interesting patients. Dermatology is the same. The other specialties have the pay and/or patients, but not the lifestyle.

 

[docB]

Make primary care pay more. That is the crux of the current problem. A lot of people considered primary care, and then decided against it based on salary. Primary care doctors are the most important doctors, even moreso than self-important surgeons.

Disclaimer: I am by no means certain how one goes about doing this.

That's not a bad idea. Years back the powers that be (HCFA then and CMS now) decided that primary care was the ticket to salvage the sinking ship of health care. Typical of the government they proclaimed this and then didn't fund it properly. What they did do was create a lot of grants for med students to go into primary care. Once you were there you had your reimbursements continually reduced. That being the case primary care was forced to see ever increasing patient loads for ever diminishing amounts of money. So, I agree that increasing reimbursements for a primary care office visit might disimpact the EM residency race. I don't think the government has any incentive to do this.

 

[Trajan]

Click here (MD Consult) for an interesting article on the competitiveness of residency positions "utilizing the percent of positions filled through the match... [and] the percent of positions filled by graduates of American medical schools..." The author, an MS3, calculated a "selectivity index" based on this data for the 2005 NRMP match (which excludes the SF match).

The top ten specialties and their respective indicies:
1. 1.210 Orthopaedic Surgery
2. 1.197 Plastic Surgery
3. 1.163 Radiation Oncology-PGY2
4. 1.162 Emergency Medicine-PGY2
5. 1.158 Transitional
6. 1.139 General Surgery
7. 1.128 Emergency Medicine
8. 1.098 Dermatology-PGY2
9. 1.094 Radiology Diagnostic-PGY2
10.1.092 Radiology Diagnostic

I found it interesting that the PGY2 EM spots ranked higher than the PGY1 spots. I suspect this is not statistically significant, beacuse the n for PGY2 EM spots is much less than the n for PGY1 spots. Also of note is that EM seems to be trending upward in popularity as noted in the article.

All in all, this is good news for EM. The more competitive our specialty, the stronger students we will attract.

B

I couldn't connect to the article for some reason, but this ranking seems like absolute garbage. How is emergency medicine, a field in which around 95% of US senior applicants match, more competitive than dermatology? Who cares how many places go unfilled--in EM there are well over 1000 positions available in the match. Perhaps the only relevance here is to FMG's who do have difficulty matching into EM, as so few positions are left after programs pick US grads (no offense to anyone, it's simply true, fair or not). But for US grads hoping to match into EM, please. EM is competitive in the sense that you can't match by default, i.e. you will have to actively seek a position to get one.

Sounds like some third-year student needed a publication on his or her cv and gave us another worthless addition to the scrap heap of bad journal articles.

 

[maxheadroom]

Primary care is important. PCPs get paid pretty well. It's rare to find an IM or FP job that doesn't start well above 100K. That's good money for three years training, especially when most of those physicians will see patients in clinic 4 1/2 days per week and take little to no hospital call. Compare that to just about any surgeon who spends 5-10 years in residency/fellowship, spends a whole lot more time in the hospital and/or clinic, and then takes much busier ER/hospital call. Surgeons work a whole lot more than their IM/FP colleagues and should get paid more for their work.

 

[Celiac Plexus]

Click here (MD Consult) for an interesting article on the competitiveness of residency positions "utilizing the percent of positions filled through the match... [and] the percent of positions filled by graduates of American medical schools..." The author, an MS3, calculated a "selectivity index" based on this data for the 2005 NRMP match (which excludes the SF match).

The top ten specialties and their respective indicies:
1. 1.210 Orthopaedic Surgery
2. 1.197 Plastic Surgery
3. 1.163 Radiation Oncology-PGY2
4. 1.162 Emergency Medicine-PGY2
5. 1.158 Transitional
6. 1.139 General Surgery
7. 1.128 Emergency Medicine
8. 1.098 Dermatology-PGY2
9. 1.094 Radiology Diagnostic-PGY2
10.1.092 Radiology Diagnostic

I found it interesting that the PGY2 EM spots ranked higher than the PGY1 spots. I suspect this is not statistically significant, beacuse the n for PGY2 EM spots is much less than the n for PGY1 spots. Also of note is that EM seems to be trending upward in popularity as noted in the article.

All in all, this is good news for EM. The more competitive our specialty, the stronger students we will attract.

B

i'd like to see the methodology for this one...

"graduates of american medical schools" must include all of the d.o.s who match in er residencies. if greater than 95% of allopathic applicants get a spot, it's not a competitive specialty.

can any reasonable person believe that emergency medicine is more competitive than dermatology? i doubt that this study takes into account the qualifications of applicants for the different fields. the average derm matchee on average has far superior academic credentials than the average er matchee. don't believe everything you read.

 

[Pikevillemedstudent]

i'd like to see the methodology for this one...

"graduates of american medical schools" must include all of the d.o.s who match in er residencies. if greater than 95% of allopathic applicants get a spot, it's not a competitive specialty.

can any reasonable person believe that emergency medicine is more competitive than dermatology? i doubt that this study takes into account the qualifications of applicants for the different fields. the average derm matchee on average has far superior academic credentials than the average er matchee. don't believe everything you read.

Ask and you shall receive!

Methods

Publicly available match data is scarce and of limited use. Board scores and medical school grades of accepted residents would be the most obvious and objective predictors of the competitiveness of a certain specialty. However, in the conspicuous absence of this information, surrogate markers of competitiveness must be used. The percent of positions filled through the match is commonly cited as a predictor of interest in a given field.[3]The percent of positions filled by graduates of American medical schools is also used as a gauge of competitiveness,[3] as these institutions tend to give preference to graduates of American medical schools.[4] This bias persists despite the absence of evidence denoting a significant qualitative difference between the groups.[5] This approach admittedly ignores the great variability between foreign graduates. This is, however, an unfortunate consequence of the lack of more pertinent data.

These two fractions were combined to give a selectivity number in the range of zero to two. The selectivity number was then standardized by year. This was accomplished by dividing the selectivity number of a specialty by that of the cumulative total of all specialties, yielding a selectivity index. The selectivity index indicates how competitive a specialty is compared to the average, across all specialties. A selectivity index above one indicates a specialty having above average competitiveness [Figure 1], where one indicates a specialty of average competitiveness, and a score below one indicates a specialty of below average competitiveness[Figure 2].

I think the guy tried but failed in his attempts. ER above derm!?!? Give me a break ppl!! And what's up with transitional being number 5? This article is crap!! 👎

 

[Willamette]

This is what I consider to be the "definitive" source for the whole "competitiveness" thing:

http://residency.wustl.edu/medadmin...62353a93c5c35cb186256f850071bd86?OpenDocument

(It's been posted before)

Willamette

 

[southerndoc]

I agree, emergency medicine being more competitive than dermatology is far fetched. Emergency medicine is competitive, but it's not that competitive. I would consider it one of the more competitive residencies (perhaps in the top 5), but one must admit that radiology, neurosurgery, dermatology, and even general surgery is more competitive than emergency medicine.

One of my colleagues suggested why the true smartest people of a class don't enter into emergency medicine: he suggested many of these people have egos or want to be correct all the time. In emergency medicine, every patient you see is under a scope. If the patient is discharged, the patient's primary care physician scrutinizes what you do. If the patient is admitted, the admitting team scrutinizes what you do. Patients have already been worked up and diagnosed (correct probably 80-90% of the time), and it's easy for individuals to "Monday morning quarterback" your workup after several things have been eliminated.

It is the constant whining, ridiculing, etc. that emergency physicians endure that deters many highly qualified individuals from pursuing a career in emergency medicine.

All emergency physicians agree that emergency physicians must have thick skins and be able to shrug off any criticism. Constructive criticism I take and honor, but simply poking fun of an EP makes me laugh.

 

[Willamette]

(perhaps in the top 5)

Probably more like top 10, but your point is well taken.

As far as "Monday Morning QBs" go, they can talk about it all they want (and about how "dumb" we all are) while I'm on my way to the slopes (or whatver fill-in-the-blank outside interest makes you smile).


Willamette

 

[NinerNiner999]

Constructive criticism I take and honor, but simply poking fun of an EP makes me laugh.

Very well stated. In fact, the only thing that makes me laugh more is when the consultant who is skeptical about the diagnosis has no choice but to admit my patient. Waaa Waaa...

 

[WilcoWorld]

"So, I agree that increasing reimbursements for a primary care office visit might disimpact the EM residency race."

Hey, it may have gotten competitive, but it's not anal yet.

...Thanks folks, I'll be here all week.