Balancing out picking a specialty and preparing to apply for it

[965978]

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So I’ve asking multiple med students and residents about when they decided their specialties and I got different answers. Most of them said sometime between the end of second year and the beginning of third year. Some said first year and others said the end of third year.

So my question is, if many students are deciding during their third year, isn’t that effectively only giving them 1 year to build up the specialty specific portion of their application? Cause I know that some program directors really want to see dedication to the specialty being applied to.

So for example, if someone decides to switch their decision during beginning of third year and now wants to pursue ophthalmology, how would they be able to engage in activities to show their interest in ophthalmology during their third year alongside all their clerkships so that they can be ready to apply in fourth year?

 

[Lucca]

If extra buffing is needed, many schools will support you taking a 5th yr to do that, typically in between 3rd and 4th yr. it is something that takes a lot of foresight tho

 

[theKingLT]

If extra buffing is needed, many schools will support you taking a 5th yr to do that, typically in between 3rd and 4th yr. it is something that takes a lot of foresight tho

What do you mean by "it takes a lot of foresight"? One of my student hosts was in the middle of a research year between MS3 and MS4 and he said he literally just decided out of the blue when nearing the end of 3rd year because he was sick of clerkships . He did already have a lab he was working in though that just let him come on full time.

 

[Lucca]

What do you mean by "it takes a lot of foresight"? One of my student hosts was in the middle of a research year between MS3 and MS4 and he said he literally just decided out of the blue when nearing the end of 3rd year because he was sick of clerkships . He did already have a lab he was working in though that just let him come on full time.

Well, Ur friend had to do the leg work to have options for that research yr. Probably depends on your institution but for most med students they’d likely have to apply for things, maybe even outside support, and the opportunity won’t just fall out of the sky. There are some schools however where like at least half the class takes a 5th yr (Yale, Stanford).

 

[Med Ed]

So I’ve asking multiple med students and residents about when they decided their specialties and I got different answers. Most of them said sometime between the end of second year and the beginning of third year. Some said first year and others said the end of third year.

So my question is, if many students are deciding during their third year, isn’t that effectively only giving them 1 year to build up the specialty specific portion of their application? Cause I know that some program directors really want to see dedication to the specialty being applied to.

Historically this hasn't been much of a problem because most medical students are in the same boat, with a relatively narrow window of time to make a decision and build a case. Back in my day (shakes cane), with a classic Flexner 2+2 curriculum, anyone who didn't want to pursue one of the core specialties only had a 3-4 months of electives prior to ERAS opening.

My fear is that 5th years are now going to become an unwritten standard, and drive a growing number of medical students to lengthen their educations out of paranoia.

 

[dodolol21]

My fear is that 5th years are now going to become an unwritten standard, and drive a growing number of medical students to lengthen their educations out of paranoia.

literally same issue happening with gap years. All of sudden 2+ years will be added to the total length of medical education

 

[deleted962973]

I would be curious about this especially for competitive specialties like derm, ENT, ophtho, etc. Given that a good number of people applying into these specialties don’t match, is it now almost a requirement to start getting specialty-specific publications starting in first or second year? I’m not sure if this question would be better suited for the MD forum.

As an aside, it’s a shame that you seemingly get rewarded for being a gunner for a competitive specialty moreso than if you took your time to explore your options over 3 years. The entire system is set up to promote neuroticism.

 

[theKingLT]

Just to add some data to this, 82% of US MD-only students graduate in 4 years, increasing to 94% in 5 years and 95.9% in 6 years. BTW, the overall attrition rate has remained relatively steady at 3.3% for nearly 20 years
https://www.aamc.org/download/492842/data/graduationratesandattritionratesofu.s.medicalstudents.pdf
https://www.aamc.org/download/37922...onratesandattritionfactorsforusmedschools.pdf

That's interesting that the 4 year graduation rate has also been steady since the late 80s. Hopefully it doesn't start dropping like @Med Ed predicts. Last thing we need is another factor contributing to physician shortage

 

[965978]

I would be curious about this especially for competitive specialties like derm, ENT, ophtho, etc. Given that a good number of people applying into these specialties don’t match, is it now almost a requirement to start getting specialty-specific publications starting in first or second year? I’m not sure if this question would be better suited for the MD forum.

As an aside, it’s a shame that you seemingly get rewarded for being a gunner for a competitive specialty moreso than if you took your time to explore your options over 3 years. The entire system is set up to promote neuroticism.

I’m still a pre-med so I’m not allowed to post on the MD forum lol

 

[theKingLT]

Even if the US MD graduation rate drops, it will likely have little impact on number of physicians. Any decrease in US grads for filling residency slots will be an increase in both US and non-US IMGs getting the slots. Each of these groups has a nominal 50% or so match rate in NRMP.

Well sure, but if average retirement age doesn't change (unproven assumption), a 1 year increase in the average age of incoming residents x20,000 incoming residents per year would mean 20,000 less physicians working at any given time in the long term, no?

 

[OrthoTraumaMD]

I would be curious about this especially for competitive specialties like derm, ENT, ophtho, etc. Given that a good number of people applying into these specialties don’t match, is it now almost a requirement to start getting specialty-specific publications starting in first or second year? I’m not sure if this question would be better suited for the MD forum.

As an aside, it’s a shame that you seemingly get rewarded for being a gunner for a competitive specialty moreso than if you took your time to explore your options over 3 years. The entire system is set up to promote neuroticism.

Exactly. I despise this about my specialty. People have to commit themselves in first year to have a leg up… I hate it. I would much rather have a well-rounded person who considered all their options, than somebody with tunnel vision.

 

[965978]

I hesitated making this post because I thought it was a stupid question to ask.

But I’m kinda glad everyone else has thought about this and has feelings about it. Makes me feel less stupid

 

[DokterMom]

My suggestion is that you try to maintain an open but inquisitive mind toward future specialties, identifying several that you potentially like as well as a list of those you suspect you really don't want. Keep it general -- Do you belong in the OR? Outpatient clinic? Hospital? Do you actually like working with patients? Parents? Children? The Elderly? Do you want something more procedural? More cerebral? More lab or research-based? How do you respond in emergencies?

Many of the less-well-known specialties understand - and even appreciate - that their residency applicants may not have chosen their specialties until they actually had some substantive exposure during med school. For example, how many pre-meds or M1s really want to do Ophtho or ENT? And of those who do, are their reasons actually good ones based on previous life experiences rather than prestige, money and lifestyle?

Yeah, maybe the ideal derm applicant became passionately interested in dermatology after suffering from adolescent skin problems that a good dermatologist cured. That makes a cohesive story that early field-specific research can substantiate. And so long as this student scores 250+ on their STEP 1 and impresses on away rotations, they're probably good. But now imagine this same student has multiple derm research projects and published papers but scores only a 220 on STEP 1. While there's still a hail Mary chance for Derm, they'd be foolish not to cross-apply to a less competitive specialty. And good luck convincing those IM programs that they aren't really just a backup...

Had those early research experiences been more general, there'd be virtually all the upside with none of the downside. Or had that student spent more time volunteering in the clinic and written up several interesting case studies in multiple disciplines -- that would be golden all around, no matter what specialty they choose. Plus, wide exposure to multiple fields makes a good case for "why XYZ specialty?"

Bottom line, it's risky to commit too much to a highly-competitive field before knowing if it's realistic. Keep an open mind and explore your options until you have enough information to narrow them down realistically.

 

[Lucca]

literally same issue happening with gap years. All of sudden 2+ years will be added to the total length of medical education

I think it would be somewhat of an oversimplification to attribute the increase in gap years / 5 yr MDs purely to increased competition. Certainly, those play an important role in that increase but I would also argue -- based on my own experience and the people I've met taking gap years -- that ppl in my generation are more likely to want to have the best lifestyle possible at all times as opposed to only at the end of the tunnel for a variety of reasons.

Personally, I didn't technically *need* to take 2 gap yrs, I would've been competitive through the traditional path, although I do believe my gap year experiences made me more competitive. There were, simply put, things I wanted to do before medical school and I was feeling the burnout from a very intense undergraduate experience. I didn't feel comfortable applying just yet, the thought even made me kind of nauseous. Now I'm aching to get started and I'm glad I got to do many of the things I wanted to before medical school.

I wouldn't be surprised if many of the students taking 5th yrs are doing so for similar reasons: not just to become more competitive for a specific specialty, but to start a family, take a breather before residency, pursue other interests, etc. Many of the places which strongly encourage 5th yrs have ample financial support for them and they are usually all expenses paid and happen to pre-select for students more likely to have that inner academic bent that pulls you in many directions at once.

In general, I'm not a fan of the idea of over-focusing on the length of training or lost-income or whatever (obviously, that's one reason I was attracted to MD/PhD programs) because it's not how I personally make decisions about my life. I want to enjoy my life *now*, and do what I want to do *now*, and I make career choices based on where/how I can best do those things *now* the most comfortably, but then again I suppose I don't have all that much interest in making as much money as possible and am happy enjoying my youth by taking it a bit slower.

 

[theKingLT]

No, even if there is an increase in the number of US Med Students who delay graduation, the surplus of off shore students seeking residency would fill the slots. Hospitals that have these residency slots rely on them being filled as part of there workforce. Additionally, this 12% of US MD who take 5 instead of 4 years to complete has be steady for at least a decade. Even if there is a trend towards more med students taking a 5th year, it would happen gradually and the "lag" from the previous year would fill the current year (if that makes sense).

Well certainly there wouldn't be a problem filling residency spots, but in the longterm not all residents are "worth the same" in working years. If you assume retirement age doesn't change, a resident entering at age 30 is worth one less year of work than a resident entering at age 29. If we graduate 20,000 residents per year at the average age of let's say 35 (highballing it for math's sake), and they go on to work until age 65, then that means every year you graduate 20,000 physicians x 30 years of work each=600,000 future work years. If this average age increases one year to 36, whether from pre-med gap years or med school gap years, and independent of how long the increase takes to occur, the net change is that now each physician on average is only worth 29 working years and suddenly each year you are only producing 580,000 future working years, 20,000 less than previously. that translates to a 3.3% drop in number of working physicians in 30 years when the "more mature" class of physicians reaches retirement. My understanding is that this effect is one of the biggest reasons many countries with severe physician shortages keep the vast majority of their medical school matriculants as fresh 18 or 19 year olds. The more mature, well-rounded, ambitious students that we have make for high quality physicians, but the extra years take away from the number of working physicians in the country. However, all of this runs under the assumption that retirement age doesn't change based on your graduation age, which I don't if that's true or not.

 

[Med Ed]

I wouldn't be surprised if many of the students taking 5th yrs are doing so for similar reasons: not just to become more competitive for a specific specialty, but to start a family, take a breather before residency, pursue other interests, etc. Many of the places which strongly encourage 5th yrs have ample financial support for them and they are usually all expenses paid and happen to pre-select for students more likely to have that inner academic bent that pulls you in many directions at once.

What I am now seeing are students who want to take a year between M2 and M3 to "do research" while giving themselves an extra 12 months to study for Step 1.

In my experience this is a new phenomenon, and one that I find deeply troubling.

 

[Lucca]

What I am now seeing are students who want to take a year between M2 and M3 to "do research" while giving themselves an extra 12 months to study for Step 1.

In my experience this is a new phenomenon, and one that I find deeply troubling.

I agree that is very troubling. More so because of what it implies about the medical students, but also because the data shows that people who study more than 10 weeks for step 1 see a significant diminishing return on the effectiveness of prep, no?

 

[deleted962973]

What I am now seeing are students who want to take a year between M2 and M3 to "do research" while giving themselves an extra 12 months to study for Step 1.

In my experience this is a new phenomenon, and one that I find deeply troubling.

Troubling in the sense that this will become the new normal? Or what exactly do you mean

 

[Med Ed]

I agree that is very troubling. More so because of what it implies about the medical students, but also because the data shows that people who study more than 10 weeks for step 1 see a significant diminishing return on the effectiveness of prep, no?

It's not rational, but this is what stress does to decision making.

 

[965978]

@Med Ed How does tuition work for research years taken between M2 and M3?

 

[Med Ed]

Troubling in the sense that this will become the new normal? Or what exactly do you mean

Yes. I don't want it to become "common knowledge" that you need 5 years to match in something other than primary care in rural Arkansas.

 

[Med Ed]

@Med Ed How does tuition work for research years taken between M2 and M3?

Typically there is no tuition that year, and you get into a lab that can support you with a stipend. Conceivably someone could take out an additional year of loans to cover living expenses if a stipend is not available, but that would be ill advised.

 

[965978]

Typically there is no tuition that year, and you get into a lab that can support you with a stipend. Conceivably someone could take out an additional year of loans to cover living expenses if a stipend is not available, but that would be ill advised.

Gotcha. Btw, how does Duke get away with making M3 a research year? How was LCME ok with that? And what's your opinion on it.

 

[DokterMom]

What I am now seeing are students who want to take a year between M2 and M3 to "do research" while giving themselves an extra 12 months to study for Step 1.

In my experience this is a new phenomenon, and one that I find deeply troubling.

I came across this very enlightening article this morning and it seems apropos -- Certainly thought-provoking and worth the read.
The Religion of Workism Is Making Americans Miserable - The Atlantic

 

[Med Ed]

Gotcha. Btw, how does Duke get away with making M3 a research year? How was LCME ok with that? And what's your opinion on it.

Duke has been doing that forever, so the LCME would have a difficult time saying it hasn't worked. Dell adopted the same model. It's doable if you compress the basic sciences to one year and have a median MCAT of 519.