SLUser11

CRS
10+ Year Member
Feb 22, 2005
2,879
775
281
Status
Attending Physician
I found a couple pdf files on the nrmp website that were interesting. While we won't have super-detailed info until they release "Charting Outcomes in the Match," it seems that there are more SDNers this year who didn't match or who went relatively far down their ROL.

Here are the numbers

Here is the press release/summary


So, how do we determine the competitiveness of surgery this year? Is it by % spots filled by US Seniors? Match rate of US Seniors? Total spots filled? How about average Step 1 scores? It's hard to say. The national average on Step 1 has been creeping up as students figure out the test. When I was a student, the national average was 217. I think it's now around 222.

The senior students on SDN are not just unhappy in the surgery forum, but across the board. I just don't remember it being this bad over the last few years. However, 93.3% of US seniors matched this year, 82% in their top 3. That number (93%) has varied less than 1% in the last 5 years, despite an increasing number of outside applicants.

As for surgery, there were 1,262 US seniors for 1,077 spots (2006: 1522 for 1051). 895 matched for a match rate of 71%, but we have to assume that a small % of the unmatched went into other specialties like ortho, and had surgery as a backup.

Looking at table 7, there are less US seniors taking prelim surgery positions than in 2006-2008. The categorical spots were taken by 83% US seniors (table 8), the same as 4 years ago. The % of all US seniors going into surgery hasn't changed either, at 5.7-6.2% (highest in 2006).



So, are we seeing a real increase in competition? I don't know. My evidence is anecdotal, and I don't think anyone will argue that there's a sample bias here on SDN. Is it possible that there has been a trend of increased SDN use among marginal applicants? Maybe...if so I just accidentally gave you all the middle finger......but I doubt it.

The real explanation is pending the NRMP's future publications, but I think that there's really been a lot less change over the last 5 years than we think. We're just caught up in the cluster#$k and hysteria that is the NRMP match. When everything settles down, it will just be another pdf on their website, and won't differ much from the prior years.

What do you guys think?


Man, I just realized there's a typo in the title, which I can't change. That's going to drive me nuts.
 
Last edited:

plauto

10+ Year Member
7+ Year Member
Sep 16, 2007
1,056
4
141
Status
Attending Physician
thanks for posting this!
 

Moonglow

Removed
Sep 2, 2009
282
1
0
Maryland
Status
Fellow [Any Field]
Many GS programs are still offering a percentage of the number of slots that they are accredited for... why?
 

Moonglow

Removed
Sep 2, 2009
282
1
0
Maryland
Status
Fellow [Any Field]
Lack of what funding? If the GS program is accredited for 20 PGY-1 slots, why take only 16? Or, is it a really a matter of the program only wanting 16? (In IM, we take every live body we can get.)
 

Winged Scapula

Cougariffic!
Staff member
Administrator
Lifetime Donor
15+ Year Member
Apr 9, 2000
39,217
27,808
631
forums.studentdoctor.net
Status
Attending Physician
Lack of CMS funding.

Hospitals are funded as a whole and the proceeds divied up amongst the various departments. CMS has capped the number of positions funded since the Clinton administration so hospitals get a set amount of $$.

If a surgery department had an extra accredited position over what they usually utilize, to get the funding for that position (at least from CMS funding), another program would have to give up a position and its funding (or the surgery department would have to get funding from an outside source).

See aPD's explanation of above (in a slightly different context) here.
 
Last edited:

RxnMan

Who, me? A doctor?
Moderator Emeritus
10+ Year Member
7+ Year Member
Jan 13, 2006
4,112
15
141
Somewhere in time and relative dimensions in space
Status
Medical Student
...So, are we seeing a real increase in competition? I don't know. My evidence is anecdotal, and I don't think anyone will argue that there's a sample bias here on SDN. Is it possible that there has been a trend of increased SDN use among marginal applicants? Maybe...if so I just accidentally gave you all the middle finger......but I doubt it...
I have been running a survey of SDN applicants in EM, and there is definitely a SDN bias (nat'l EM average USMLE vs SDN EM a average is 222 vs ~230). I've not got much to support an increase in competitiveness, but I can get back to you after I look at this year's data. The NRMP does report more applicants this year than any previous, without an attendant increase in residency positions.
 

Winged Scapula

Cougariffic!
Staff member
Administrator
Lifetime Donor
15+ Year Member
Apr 9, 2000
39,217
27,808
631
forums.studentdoctor.net
Status
Attending Physician
I have been running a survey of SDN applicants in EM, and there is definitely a SDN bias (nat'l EM average USMLE vs SDN EM a average is 222 vs ~230). I've not got much to support an increase in competitiveness, but I can get back to you after I look at this year's data. The NRMP does report more applicants this year than any previous, without an attendant increase in residency positions.
SDN traditionally has been "home" for more competitive or neurotic applicants. As it becomes more popular, there may be more marginal candidates using it but I'd venture that your survey is probably accurate.
 

thedrjojo

10+ Year Member
Jun 20, 2008
23,875
16,146
281
Status
Attending Physician
I found a couple pdf files on the nrmp website that were interesting. While we won't have super-detailed info until they release "Charting Outcomes in the Match," it seems that there are more SDNers this year who didn't match or who went relatively far down their ROL.

Here are the numbers

Here is the press release/summary


So, how do we determine the competitiveness of surgery this year? Is it by % spots filled by US Seniors? Match rate of US Seniors? Total spots filled? How about average Step 1 scores? It's hard to say. The national average on Step 1 has been creeping up as students figure out the test. When I was a student, the national average was 217. I think it's now around 222.
Thats a good question. I think there is kinda an aggregation of it all... % filled by US Seniors, Step 1 score both being big factors. I have seen both used to explain the competitiveness of programs, and not sure which I think is more useful. Another thing I think could be more useful in comparing specialties is finding the step 1 score range where US Seniors match at a rate lower than the national match average (look at charting the match, they have a curve that shows odds of matching based on step score...). Why is this? Well, the average score for surg could be 235, but if someone with a 200 matches at 95%, it really isn't that competitive... conversely, average score could be 225, but someone with 210 matches only 80% of the time, then it would be considered more competitive.

Looking at the numbers, one of the specialties that seems to be gaining the most in competitiveness is OB/GYN. They have gone over the past 3 matches from 72% AMG to 77% AMG. Conversely, Advanced Gas (categorical is flatline) is becoming less competitive, as they have gone from high 70's to low 70's

The senior students on SDN are not just unhappy in the surgery forum, but across the board. I just don't remember it being this bad over the last few years. However, 93.3% of US seniors matched this year, 82% in their top 3. That number (93%) has varied less than 1% in the last 5 years, despite an increasing number of outside applicants.
Yeah... I guess it seems that people used to accepting AMG's kept accepting AMG's and people used to accepting FMG's kept accepting FMG's. The number of US seniors has yet to increase significantly (400 more than last year, only 1000 more than 5 years ago), but 3-4 years from now (or even next year, my wife who is in the class below me, they increased class size about 10-15% for her class...) when that increase of 30% AMG hits the match, unless something gives those numbers will drop

As for surgery, there were 1,262 US seniors for 1,077 spots (2006: 1522 for 1051). 895 matched for a match rate of 71%, but we have to assume that a small % of the unmatched went into other specialties like ortho, and had surgery as a backup.

Looking at table 7, there are less US seniors taking prelim surgery positions than in 2006-2008. The categorical spots were taken by 83% US seniors (table 8), the same as 4 years ago. The % of all US seniors going into surgery hasn't changed either, at 5.7-6.2% (highest in 2006).
There was one girl in my class who ranked both ENT and Surg (but actually had Surg higher on her rank list then ENT at the end) who matched ENT... another guy in my class who ranked both Plastics and Surg and matched Plastics. I think the NRMP should do a better job analyzing the statistics and remove these type of individuals. That would let people applying for Gen Surg alone have a better idea of the chances


So, are we seeing a real increase in competition? I don't know. My evidence is anecdotal, and I don't think anyone will argue that there's a sample bias here on SDN. Is it possible that there has been a trend of increased SDN use among marginal applicants? Maybe...if so I just accidentally gave you all the middle finger......but I doubt it.
lol. Yeah, slight sample bias, if not only in stats but also by sheer volume (what, like at most 20 people posted ROL, and that includes all comers, not just AMG's.

The real explanation is pending the NRMP's future publications, but I think that there's really been a lot less change over the last 5 years than we think. We're just caught up in the cluster#$k and hysteria that is the NRMP match. When everything settles down, it will just be another pdf on their website, and won't differ much from the prior years.

What do you guys think?


Man, I just realized there's a typo in the title, which I can't change. That's going to drive me nuts.
Yeah, like I said, the change over the past 5 years is probably more that everyone's Step scores have increased, so across the board all specialties look more competitive. The ensuing madness once the 30% increase in AMGs hits the match is where the number crunching will really be needed. But as someone mentioned in the NRMP/ERAS forum, this is the first time EVER that there were more unmatched AMG's then there were available slots in the scramble
 

youngdoc8205

10+ Year Member
7+ Year Member
Feb 28, 2008
57
5
151
Status
Resident [Any Field]
with respect to this thread quick question about likelyhood of matching at good program:
internal medicine prelim
PGY2 Radiology
Step 1 243, step 2 263, step 3 235
5 published papers in major journals (not surgery)
2 oral presentations at national meetings

I'm sure I could match at a good program if I was applying as a 4th year, but with me being a pgy3 next year, how bad will it affect me with regards to getting a decent surgery spot. Am looking mostly at high end community programs eg. William Beuamont, Washington Hospital Virginia Mason
would program directors be likely to give me a spot outside of the match.

thanks for your help.
 

Winged Scapula

Cougariffic!
Staff member
Administrator
Lifetime Donor
15+ Year Member
Apr 9, 2000
39,217
27,808
631
forums.studentdoctor.net
Status
Attending Physician
with respect to this thread quick question about likelyhood of matching at good program:
internal medicine prelim
PGY2 Radiology
Step 1 243, step 2 263, step 3 235
5 published papers in major journals (not surgery)
2 oral presentations at national meetings

I'm sure I could match at a good program if I was applying as a 4th year, but with me being a pgy3 next year, how bad will it affect me with regards to getting a decent surgery spot. Am looking mostly at high end community programs eg. William Beuamont, Washington Hospital Virginia Mason
would program directors be likely to give me a spot outside of the match.

thanks for your help.
You certainly have a strong medical school application and programs will want good references frm your current attendings (which I assume you have).

The biggest sticking point however is funding. You will have used up 3 years of funding, leaving surgery programs only 2 years of full funding. It can be done but you'll need to convince them that you're worth the loss of funding over a fresh grad.
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
Lack of CMS funding.

Hospitals are funded as a whole and the proceeds divied up amongst the various departments. CMS has capped the number of positions funded since the Clinton administration so hospitals get a set amount of...
Yep, I know of a number of surgery programs that historically had larger numbers of categorical residents per class. Some tried to demonstrate fiscal responsibility or something and voluntarily decreased their class sizes... simultaneously, hospitals increased their ER medicine, cardiology, and other such residency sizes. For General Surgery programs to come back and ask to regain categorical size is a costly thing.
 

Guile

1K Member
10+ Year Member
5+ Year Member
Jul 26, 2006
1,664
5
0
Status
with respect to this thread quick question about likelyhood of matching at good program:
internal medicine prelim
PGY2 Radiology
Step 1 243, step 2 263, step 3 235
5 published papers in major journals (not surgery)
2 oral presentations at national meetings

I'm sure I could match at a good program if I was applying as a 4th year, but with me being a pgy3 next year, how bad will it affect me with regards to getting a decent surgery spot. Am looking mostly at high end community programs eg. William Beuamont, Washington Hospital Virginia Mason
would program directors be likely to give me a spot outside of the match.

thanks for your help.
So you're switching from radiology to surgery? And your home program won't take you?
 

youngdoc8205

10+ Year Member
7+ Year Member
Feb 28, 2008
57
5
151
Status
Resident [Any Field]
actually not even considering staying at my home program, though it is a good one, they have a research requirement, and I am not in the mood for research, particularly b/c I already "lost" 2 years and don't want to start practice in my 40s. Also, I would like to try to get out of the location that I am in, it is kind of dreary most of the year, and I can't imagine the effect the climate will have on me during a surgery internship.
 

igap

7+ Year Member
Jul 10, 2009
169
33
161
Status
Attending Physician
actually not even considering staying at my home program, though it is a good one, they have a research requirement, and I am not in the mood for research, particularly b/c I already "lost" 2 years and don't want to start practice in my 40s. Also, I would like to try to get out of the location that I am in, it is kind of dreary most of the year, and I can't imagine the effect the climate will have on me during a surgery internship.
Have you considered finishing your radiology residency and doing a fellowship in interventional radiology? It's a procedural based subspecialty without the inpatient burden.
 

youngdoc8205

10+ Year Member
7+ Year Member
Feb 28, 2008
57
5
151
Status
Resident [Any Field]
I have considered doing IR, it's actually the whole reason I did radiology, which in retrospect may not have been the best idea. But I'm tired of the turf wars, don't want to worry about the stability of the field, i.e. doing PICC lines and abscess drains, while IR invents all the "cool" new procedures, they invariably go to surgery, rightly or wrongly. aside from that, I actually enjoy the day to day management of patients, excluding the hassle of social work, for which the burden is not as high in surgery as it is in medicine.
 

SLUser11

CRS
10+ Year Member
Feb 22, 2005
2,879
775
281
Status
Attending Physician
Bump for some perspective.


I found a couple pdf files on the nrmp website that were interesting. While we won't have super-detailed info until they release "Charting Outcomes in the Match," it seems that there are more SDNers this year who didn't match or who went relatively far down their ROL.

Here are the numbers

Here is the press release/summary


So, how do we determine the competitiveness of surgery this year? Is it by % spots filled by US Seniors? Match rate of US Seniors? Total spots filled? How about average Step 1 scores? It's hard to say. The national average on Step 1 has been creeping up as students figure out the test. When I was a student, the national average was 217. I think it's now around 222.

The senior students on SDN are not just unhappy in the surgery forum, but across the board. I just don't remember it being this bad over the last few years. However, 93.3% of US seniors matched this year, 82% in their top 3. That number (93%) has varied less than 1% in the last 5 years, despite an increasing number of outside applicants.

As for surgery, there were 1,262 US seniors for 1,077 spots (2006: 1522 for 1051). 895 matched for a match rate of 71%, but we have to assume that a small % of the unmatched went into other specialties like ortho, and had surgery as a backup.

Looking at table 7, there are less US seniors taking prelim surgery positions than in 2006-2008. The categorical spots were taken by 83% US seniors (table 8), the same as 4 years ago. The % of all US seniors going into surgery hasn't changed either, at 5.7-6.2% (highest in 2006).



So, are we seeing a real increase in competition? I don't know. My evidence is anecdotal, and I don't think anyone will argue that there's a sample bias here on SDN. Is it possible that there has been a trend of increased SDN use among marginal applicants? Maybe...if so I just accidentally gave you all the middle finger......but I doubt it.

The real explanation is pending the NRMP's future publications, but I think that there's really been a lot less change over the last 5 years than we think. We're just caught up in the cluster#$k and hysteria that is the NRMP match. When everything settles down, it will just be another pdf on their website, and won't differ much from the prior years.

What do you guys think?


Man, I just realized there's a typo in the title, which I can't change. That's going to drive me nuts.
 

Leforte

Member
Moderator
10+ Year Member
15+ Year Member
Feb 2, 2004
493
17
251
Visit site
Status
Attending Physician
Lack of CMS funding.

Hospitals are funded as a whole and the proceeds divied up amongst the various departments. CMS has capped the number of positions funded since the Clinton administration so hospitals get a set amount of $$.

If a surgery department had an extra accredited position over what they usually utilize, to get the funding for that position (at least from CMS funding), another program would have to give up a position and its funding (or the surgery department would have to get funding from an outside source).

See aPD's explanation of above (in a slightly different context) here.
Absolutely correct here. If a hospital has 500 CMS spots and a GS or ENT program is allocated an extra resident a year - if the hospital has already allocated the 500 positions, they have to wait for additional funding or pay out of their own pocket for the extra 5 residents (1 per year). In general CMS provides the hospital ~ 2.8 x the annual salary, which is used to not only pay the resident, but also the extra labs/test/imaging that a resident would order that an attending would not. Most hospitals are paid by DRGs for a disease/procedure and anything that is ordered or done cuts into their reimbursement. So those daily labs that everyone likes to get for the stable patient on the floor are costs that the hospital eats (which the extra payment from CMS for the resident helps with). There is SO much in the finances of having residents that I was unaware of as a resident....