Avoiding programs with open scramble spots?

[Frijolero]

Hi all,
I'm looking at electives for 4th year and realized that both programs I've scheduled aways with had open scramble spots this or last year. Big deal or not? I like both of them based on the fact that they are unopposed, in larger cities, don't have crazy (admittedly self-reported) hours on freida, and the people on scutwork said nice things about them. Wonderfully scientific, right? I'm just wondering if any of you use scramble spots or the lack thereof as a criterion for picking programs? I asked one of the residency coordinators about it in a roundabout manner and she told me they get some of their best interns from the scramble. What she didn't mention, of course, was that they actually wanted ortho and derm....

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[iatrosB]

Hi all,
I'm looking at electives for 4th year and realized that both programs I've scheduled aways with had open scramble spots this or last year. Big deal or not? I like both of them based on the fact that they are unopposed, in larger cities, don't have crazy (admittedly self-reported) hours on freida, and the people on scutwork said nice things about them. Wonderfully scientific, right? I'm just wondering if any of you use scramble spots or the lack thereof as a criterion for picking programs? I asked one of the residency coordinators about it in a roundabout manner and she told me they get some of their best interns from the scramble. What she didn't mention, of course, was that they actually wanted ortho and derm....

Good question. Two of the programs very high on my list don't fill fairly consistently. Personally, I don't put a lot of weight on that since it's family medicine and it is hard for programs to recruit anyone period (and no-body wants to move to their location). I'm interested in hearing thoughts on this as well.

 

[deleted87716]

Lots of good programs didn't fill before the scramble, especially the ones who were more selective about who they ranked. I wouldn't consider it a red flag.

 

[lowbudget]

Programs that don't fill consistently I think are red flags. You just have to find out what those flags are and if you're comfortable with those flags being there.

A program can alter their fill rate by simply ranking more applicants to fill, even though those applicants may be crap. Conversely, a program can rank less applicants to fill because the applicant pool didn't meet program standards, essentially making a bet that they can do better in the scramble (like pick up a ortho/derm/rad reject). So the fill rate doesn't always tell you how good a program truly is.

The best measure is actually spending an elective to test drive the program with consideration of the faculty, residents, and location. Pretty unscientific or quantitative. But your heart won't lie to you.

 

[razorback58]

In Louisiana, there are 398 medical graduates between LSU New Orleans, LSU Shreveport and Tulane.

In the 2006 match, only 39 of the 398 went into Family Medicine. 17 selected family medicine programs in Louisiana and 22 left the state for other family programs.

There are 58 PGY-I family positions offered total. They are trying to add a new rural program with 4 additional PGY-I spots which would bring the total number of PGY-I spots up to 62.

Programs are having to select FMG's to fill these spots. I think this is a key reason why so many spots are in the scramble. That is less than 10% of all Louisiana graduates going into family medicine. I think this years match is even less than that.

You also have to take into consideration that some of the community based programs pre-match which keeps them from having to scramble many people or none at all.

 

[Frijolero]

Programs that don't fill consistently I think are red flags. You just have to find out what those flags are and if you're comfortable with those flags being there.

A program can alter their fill rate by simply ranking more applicants to fill, even though those applicants may be crap. Conversely, a program can rank less applicants to fill because the applicant pool didn't meet program standards, essentially making a bet that they can do better in the scramble (like pick up a ortho/derm/rad reject). So the fill rate doesn't always tell you how good a program truly is.

The best measure is actually spending an elective to test drive the program with consideration of the faculty, residents, and location. Pretty unscientific or quantitative. But your heart won't lie to you.

Good point, I hadn't considered programs that purposely left spots open to fill them with the derm/plastics/ortho rejects. Personally I'd rather have someone I interviewed and knew than a random dude, regardless of how great their board scores are. All other things being equal I'd also rather work with a guy who's heart was in FM.

I'd love to be able to test drive every single program I'm applying to. The problem is that I can't find solid ways to narrow my scope without feeling I'm excluding programs that may be great. Even throwing out the opposed programs excludes some that may function like an unopposed program anyway. It seems that right now my favorite programs are based on just word of mouth and 4 year old reviews on scutwork that could have written by a PD for all I know. This process is exciting, but frustrating for sure. I'm hoping that the AAFP convention will help, but by that point it'll be too late to do more aways anyway.

There's just no way to evaluate these places fairly without a rotation or possibly an interview, but my budget and energy won't allow for 100 interviews. I can't be alone, right? Does someone have a solution that I haven't considered?

 

[Faebinder]

Programs that don't fill consistently I think are red flags. You just have to find out what those flags are and if you're comfortable with those flags being there.

A program can alter their fill rate by simply ranking more applicants to fill, even though those applicants may be crap. Conversely, a program can rank less applicants to fill because the applicant pool didn't meet program standards, essentially making a bet that they can do better in the scramble (like pick up a ortho/derm/rad reject). So the fill rate doesn't always tell you how good a program truly is.

The best measure is actually spending an elective to test drive the program with consideration of the faculty, residents, and location. Pretty unscientific or quantitative. But your heart won't lie to you.

It's those kinda programs that end up with 2 open PGY2 the next year because they ended up going for an ortho/derm/EM reject that easily picked up a PGY2/1 after showing that for 1 year he/she can function as an intern.

 

[sophiejane]

It's those kinda programs that end up with 2 open PGY2 the next year because they ended up going for an ortho/derm/EM reject that easily picked up a PGY2/1 after showing that for 1 year he/she can function as an intern.

You are right on there. It makes me mad that programs are so blinded by dazzling step 1 scores and grades that they don't stop and think about whether or not this person is going to actually stick with FM, be happy, and complete the program.

I mean, you don't go from desiring to be an orthopod/derm/rad onc etc. with all your heart to being a perfectly happy and effective FP.

 

[Faebinder]

You are right on there. It makes me mad that programs are so blinded by dazzling step 1 scores and grades that they don't stop and think about whether or not this person is going to actually stick with FM, be happy, and complete the program.

I mean, you don't go from desiring to be an orthopod/derm/rad onc etc. with all your heart to being a perfectly happy and effective FP.

Residencies have changed strategies.. with abundancy of applicants, now they use scores as filters. J-1 visas and H-1 visas are easy enough to sponser as long the as the score is the double 99/99.

I actually spoke with some family medicine program directors/coordinators and some were demanding things like 2 years US clinical experience and they are specifying those to be only ACGME clinical experience so 2 years of residency. My first thoughts: "You want a second year resident somewhere (who is going to be a third year) to quit and become a first year resident in your program???". Then when I thought about it... translation.... someone either dropped out of their careers after two years or someone has been doing prelims for 2 years and finally gave up and went to FM. So the program wants some surgery/IM drop out.

 

[iatrosB]

Good point, I hadn't considered programs that purposely left spots open to fill them with the derm/plastics/ortho rejects.

That's just wrong. It seems so un-FM as well.

 

[deleted109597]

Yeah. I called a few FM programs, and was told that I could have a spot if I wanted it, but since I didn't want to take up a spot for a year to reapply, I decided against scrambling into an FM position. I don't know how I feel about people who abuse the programs by taking those spots, but then again, I don't like how the NRMP abuses students. There really has to be a better way to get a residency spot.

 

[justwondering]

since u dont have time to do electives at a lot of places, one strategy would be to do one at the one u are most interested in (if u have a #1) then do any other away rotation(s) in a city where there are multiple programs u like. if ure spending time with other med students and residents in a particular program, u can politely ask about what they thought about other programs in the area (ie why they chose their own program over others). of course, u have to take this with a grain of salt, but sometimes ppl can tell u abt red flags that locals know about (things u might still miss at ur interview).

 

[RuralMedicine]

It's those kinda programs that end up with 2 open PGY2 the next year because they ended up going for an ortho/derm/EM reject that easily picked up a PGY2/1 after showing that for 1 year he/she can function as an intern.

In time those programs usually become even weaker because they are so lacking in cohesivity and upper level leadership because they basically end up reassembling the housestaff on an annual basis. Although at the same time I suppose that some people may reflect and opt for a career change if not matching into a more competitive specialty so perhaps it's always hard for PDs to gauge sincerity. I do have a friend from medical school who considered both derm and FP but didn't feel confident he was competitive enough for derm and opted to apply and rank both programs. He matched at his top FP choice and continues to be quite happy with how everything worked out.

I'm also really sorry to hear about your match struggles. I'll keep you in my thoughts and perhaps something will open up between now and July. Would you consider doing a prelim somewhere recognizing that it's a dead end but it may also put you in position to recognize an internal opening and perhaps it increases your competivity for the 2008 cycle. Either IM or surgery might also give you some credit towards FM if your subsequent program director was feeling reasonable and generous.

 

[Faebinder]

In time those programs usually become even weaker because they are so lacking in cohesivity and upper level leadership because they basically end up reassembling the housestaff on an annual basis. Although at the same time I suppose that some people may reflect and opt for a career change if not matching into a more competitive specialty so perhaps it's always hard for PDs to gauge sincerity. I do have a friend from medical school who considered both derm and FP but didn't feel confident he was competitive enough for derm and opted to apply and rank both programs. He matched at his top FP choice and continues to be quite happy with how everything worked out.

I'm also really sorry to hear about your match struggles. I'll keep you in my thoughts and perhaps something will open up between now and July. Would you consider doing a prelim somewhere recognizing that it's a dead end but it may also put you in position to recognize an internal opening and perhaps it increases your competivity for the 2008 cycle. Either IM or surgery might also give you some credit towards FM if your subsequent program director was feeling reasonable and generous.

IM and Surgery prelims are more competitive than FM. Thanks for the good thoughts though.