Can docs pick their residency?

[grinley]

Hi, I learned from a friend that is a MD, that his rank fell a little his last year and he was stuck with Pathology. How does this work? Basically don't you get to pick your specialty if you are qualified? Thanks everyone!

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[Pinkertinkle]

There is quite a lot of choice but there are specialties so competitive that it takes a lot of hard work to get into.

 

[ChubbyChaser]

Residencies that most ppl have a decent shot at: family practice, internal meds, Peds, pathology, Emergency Medicine, Psych, Anesthisiology, and GS.


Tougher: radiology, radonc, ortho, urology, plastics, Derm, and ENT

 

[DoctorDreamer]

How it basicall works is that you take all your classes, do your major rotations and take Step 1 of the board, and based on your class and rotation grades and your USMLE score you have a good feel for how competitive you are.

You decide what specialty you would like to pursue and apply to some residencies in those programs, keeping in mind that if you have a low board score, you won't likely fare well in the more competitive subspecialties.

Your advisor will help you decide what residency programs to apply to and how many. The application process is very similar to med school, with lots of fees, forms, and interviews.

You then go to about 10 interviews (on average), and see each of the residency programs. After you're finished, you get on a computer and rank each of the schools you interviewed at and would go to from the one you want the most to the least. Each residency program will do the same with their applicants.

At that point, all the information gets put into a computer, and the computer spits out a match for you. Most schools have a "match day" in March where each student gets an envelope with thir residency match and you open them together. You then go to your residency wherever your match was.

If by some chance you did not match at any of your schools you ranked, a couple of days before match day the people will call you and tell you so. You will then have an opportunity to enter a scramble match, which is where they quickly place you in a residency program that did not fill its slots.

You may end up in a location or even specialty that is not ideal if that happens. Many people who do not match choose to sit out a year and try the match the following year.

In most cases, as long as you apply reasonably for your situation, you should match. However, if you had bad LORs, a questionable grade, or particularly a low board score, and you applied for a competitve location (ie MassGen residency), or a super-competitive residency (dermatology, radiology, neurosurgery, ENT, etc), you run the risk of not matching.

That's where great advisors come into play, as they will let you know where you should realistically be applying.

 

[grinley]

So you graduate with a MD, then what exactly?

 

[ChubbyChaser]

So you graduate with a MD, then what exactly?

Then you apply for you residency, hoping to god you match in one of your top choices, and then spend anywhere from 3-7 years completing the residency working under other doctors. The pay isnt very good 40-50K, but good enough to live on. After you finish your residency you then have an option to do a fellowship in a subspecialty, like if you did General surgery you could go into CT surgery, or if you did ortho you can specialize in Hand surgery.

After that you are free to practice on your own, and then you must recertify every few years (not sure how many).

Its a never ending process.

 

[sunny1]

Because some people want a really competitive specialty but know the chances of matching aren't as high, they may also apply for a residency spot in another specialty at the same time. Say, derm and path. Just an example.

If your friend didn't get matched into any position, maybe he had to scramble or something and found an open Path spot somewhere? I don't know his situation.

Regardless, you choose which specialty you end up with...though it may not have been your first choice. That's another reason he may feel he was "stuck with" path.

 

[DoctorDreamer]

So you graduate with a MD, then what exactly?

Technically, match day happens during your "senior" year, so assuming you matched, you head off to your residency. Then it's time to work as a doc or sub-specialize with a fellowship. It's a never-ending cycle of education, tests, and ladder-climbing.

 

[TheRealMD]

Hi, I learned from a friend that is a MD, that his rank fell a little his last year and he was stuck with Pathology. How does this work? Basically don't you get to pick your specialty if you are qualified? Thanks everyone!

He either isn't telling you the full story or you heard an oversimplified version. (probably the former). He probably does like Pathology, but wanted something else a lot harder to get into. I wouldn't misinterpret what he said.

However the only thing that would greatly influence what speciality you get into is your Step I score. Everything else has importance, but not as much.

 

[Dienekes]

So you graduate with a MD, then what exactly?

A better question....have you graduated with HS diploma yet?

 

[grinley]

Yes, I have and I am in my last semester from an ivy league university with a 3.9.

 

[Drogba]

Yes, I have and I am in my last semester from an ivy league university with a 3.9.

Nice response.

Dienekes, I guess you gave up entirely on contributing to constructive discourse in pre-allo during your sabbatical and instead decided you would just stir up as much trouble as possibe.

 

[grinley]

thank you everyone for the information. As of right now, I have decided podiatry at DMU. I just wanted to verify the "match" information for residencies.

 

[Law2Doc]

thank you everyone for the information. As of right now, I have decided podiatry at DMU. I just wanted to verify the "match" information for residencies.

Podiatry is not an allopathic medicine field and thus the match isn't applicable to it.

With respect to your original question, some specialties are more competitive than others, so some people will have the credentials to get into some things and not others. If your friend got pathology, he likely chose it over a number of other options. But there were also a number of specialties he didn't have a shot at. But it isn't really class rank that determines this. Things like board scores loom large.

 

[RySerr21]

Yes, I have and I am in my last semester from an ivy league university with a 3.9.

ivy? as in a genus of 15 species of climbing or ground-creeping evergreen woody plants in the family Araliaceae? there is a league of ivies? what exactly is it you are referring to. doesn't sound too special to me. i'm sure i could get a 3.9 at a university dedicated to studying ivy.

 

[Dienekes]

Nice response.

Dienekes, I guess you gave up entirely on contributing to constructive discourse in pre-allo during your sabbatical and instead decided you would just stir up as much trouble as possibe.

No, I haven't. It was a serious question. I mistakenly thought the OP was a high school student, since we normally see this sort of thing from the "pre-pre-med" trolls on here.

 

[167649]

Yes, I have and I am in my last semester from an ivy league university with a 3.9.

C'mon, everyone knows those "ivy schools" inflate their grades. This equates to a 3.4 at a state school.

 

[spanamit]

Out of curiosity:
Is it possible to match somewhere (lets say your last choice), then choose to decline it, and try to match again next year? Or are you banned from entering the match ever again if you decline a previous match offer?

 

[167649]

Out of curiosity:
Is it possible to match somewhere (lets say your last choice), then choose to decline it, and try to match again next year? Or are you banned from entering the match ever again if you decline a previous match offer?

I am pretty sure that, by entering the match, you are bound to the program you are matched to. Same applies vice versa, they have to take the matched applicant into the program.

 

[45408]

Out of curiosity:
Is it possible to match somewhere (lets say your last choice), then choose to decline it, and try to match again next year? Or are you banned from entering the match ever again if you decline a previous match offer?

If you really don't want to go there, don't put it on your match list. I'm not positive, but I really don't think you have to rank every program you interview at.

 

[PeepshowJohnny]

I am pretty sure that, by entering the match, you are bound to the program you are matched to. Same applies vice versa, they have to take the matched applicant into the program.

Indeed, entering the match is like signing a contract. There are some ways to get out of a match, but they're rare exceptions. Incidentally, people have sued the match as being a monopoly.

In this situation, if you really didn't want to go to the last one on your list, don't rank it. If you hadn't you would have "failed to match", and you can participate in the "scramble" where you apply outside the NRMP match to fill in any open slots.

 

[Law2Doc]

Indeed, entering the match is like signing a contract.

It's not "like" signing a contract, you ARE signing a contract. By agreeing to enter the match, you are contractually bound to attend whatever school you match into, and not go outside of the process.

 

[nevercold]

Follow this link: http://www.nrmp.org/data/chartingoutcomes2007.pdf

It has information on people who match in various residencies. Of note, despite the large ranges for all specialties, stronger programs generally take students from the upper end of the range.

 

[crimson138]

So you graduate with a MD, then what exactly?

Then you are $300,000 in debt, and a bottom feeding resident who works 80 hours a week for moderate pay.

 

[mbk21]

How it basicall works is that you take all your classes, do your major rotations and take Step 1 of the board, and based on your class and rotation grades and your USMLE score you have a good feel for how competitive you are.

You decide what specialty you would like to pursue and apply to some residencies in those programs, keeping in mind that if you have a low board score, you won't likely fare well in the more competitive subspecialties.

Your advisor will help you decide what residency programs to apply to and how many. The application process is very similar to med school, with lots of fees, forms, and interviews.

You then go to about 10 interviews (on average), and see each of the residency programs. After you're finished, you get on a computer and rank each of the schools you interviewed at and would go to from the one you want the most to the least. Each residency program will do the same with their applicants.

At that point, all the information gets put into a computer, and the computer spits out a match for you. Most schools have a "match day" in March where each student gets an envelope with thir residency match and you open them together. You then go to your residency wherever your match was.

If by some chance you did not match at any of your schools you ranked, a couple of days before match day the people will call you and tell you so. You will then have an opportunity to enter a scramble match, which is where they quickly place you in a residency program that did not fill its slots.

You may end up in a location or even specialty that is not ideal if that happens. Many people who do not match choose to sit out a year and try the match the following year.

In most cases, as long as you apply reasonably for your situation, you should match. However, if you had bad LORs, a questionable grade, or particularly a low board score, and you applied for a competitve location (ie MassGen residency), or a super-competitive residency (dermatology, radiology, neurosurgery, ENT, etc), you run the risk of not matching.

That's where great advisors come into play, as they will let you know where you should realistically be applying.

Hi sorry if this sounds like a completely dumb question, but is the board score you're referring to the USMLE 1, and steps 2 and 3, are not part of the board?

But thanks for the rest of the info about the post-med school stuff its very helpful as is this whole site.

 

[Doublecortin]

C'mon, everyone knows those "ivy schools" inflate their grades. This equates to a 3.4 at a state school.

seriously, but addcomms will do the opposite, they'll penalize you if you are from a state, less "prestigious" school, and will give you bonus points for going to an ivy

 

[metalmd06]

Why is derm so competitive? I am not the least bit interested in dermatology, why are so many doctors/prospective doctors interested in it?

 

[PeepshowJohnny]

Why is derm so competitive? I am not the least bit interested in dermatology, why are so many doctors/prospective doctors interested in it?

There are very few dermatologic emergencies. It's very lifestyle friendly.

You will be so swamped with patients you can afford to only take patients with great insurance or who will pay out of pocket. Thus, your reimbursements will be good and you'll make a good salary.

In addition, a lot of derms open their own practice (due to lack of competition) and often suppement their income through employing aestheticians and selling products. This again increases your income and some people enjoy this small business aspect.

 

[lord_jeebus]

Why is derm so competitive? I am not the least bit interested in dermatology, why are so many doctors/prospective doctors interested in it?

In addition, the scarcity of residency positions relative to the number of applicants makes the field extra competitive. This does not mean that "so many" are interested in it. There are many fields that attract more applicants than dermatology. An equally significant question is why there are so few training spots.

 

[bob123456]

C'mon, everyone knows those "ivy schools" inflate their grades. This equates to a 3.4 at a state school.

You must be very perceptive to be able to notice this grade inflation, because after almost 4 years at an Ivy I have yet to see it. I find it a little odd that the average pre-med GPA here is about a 3.5 and the MCAT score is 33, while I know of some public universities where it's more like a 3.8 and the average score is a 25. That should tell you something about the caliber of the school.

 

[patzan]

Hi sorry if this sounds like a completely dumb question, but is the board score you're referring to the USMLE 1, and steps 2 and 3, are not part of the board?

But thanks for the rest of the info about the post-med school stuff its very helpful as is this whole site.

Yes, Step 1 is the "boards" that we refer to. If you have a low Step 1, a better Step 2 can help make up for it, while many who do well on Step 1 wait until after match to take Step 2 and risk a lower score.

 

[mbk21]

Yes, Step 1 is the "boards" that we refer to. If you have a low Step 1, a better Step 2 can help make up for it, while many who do well on Step 1 wait until after match to take Step 2 and risk a lower score.

Thanks for clearing that up for me.

 

[DoctorDreamer]

Hi sorry if this sounds like a completely dumb question, but is the board score you're referring to the USMLE 1, and steps 2 and 3, are not part of the board?

But thanks for the rest of the info about the post-med school stuff its very helpful as is this whole site.

You're welcome. Yes, when I say "board score" I mean your USMLE atep 1 score. You will actually get a raw score and then a scaled score (up to a 99), and the scaled score is what most residencies look at. You can take your step 2 before or after match depending on your school. Either way, they are not considered nearly as much as step 1 by residency programs. You take step 3 after your first year of residency, or your intern year.

The USMLE is likely going to change in the next couple of years to have step 1 and 2 combined and taken at the end of the third year (1/3 basic science, 2/3 clinical on the test). When and if this happens, that will be the score that will count in residency matches.

 

[NCF145]

However the only thing that would greatly influence what speciality you get into is your Step I score. Everything else has importance, but not as much.

Wrong. Your third year rotations are VERY IMPORTANT. I have heard from several advisors that they are just as important or more important than your step 1 score. I could almost guarantee you that an applicant with a 240 on his step 1 and a Pass in his Surgery and Internal Medicine rotations would get very few interviews for a competitive residency (i.e. plastics, derm, neurosurg, ortho, rad onc, etc.)

 

[Doublecortin]

You're welcome. Yes, when I say "board score" I mean your USMLE atep 1 score. You will actually get a raw score and then a scaled score (up to a 99), and the scaled score is what most residencies look at. You can take your step 2 before or after match depending on your school. Either way, they are not considered nearly as much as step 1 by residency programs. You take step 3 after your first year of residency, or your intern year.

The USMLE is likely going to change in the next couple of years to have step 1 and 2 combined and taken at the end of the third year (1/3 basic science, 2/3 clinical on the test). When and if this happens, that will be the score that will count in residency matches.

are you serious? . Do you think for class of 2012 it will be in effect?

I am also wondering how it's going to affect AOA selection since some schools use Step1 for selecting Junior AOA?

 

[NCF145]

The USMLE is likely going to change in the next couple of years to have step 1 and 2 combined and taken at the end of the third year (1/3 basic science, 2/3 clinical on the test). When and if this happens, that will be the score that will count in residency matches.

IF this happens, it won't be for a while. They also wouldn't use the combined test for residency purposes. In order for students to begin rotations, they must pass the Step 1 or the NBME End of Basic Sciences exam (proctored at schools who begin their rotations before the start of 3rd year). All medical schools would probably begin using this exam to decide who will be promoted to the wards or not. It will also probably replace Step 1 for the residency criteria.

 

[nevercold]

The USMLE is likely going to change in the next couple of years to have step 1 and 2 combined and taken at the end of the third year (1/3 basic science, 2/3 clinical on the test). When and if this happens, that will be the score that will count in residency matches.

I'm skeptical of this change happening too soon.

 

[spanamit]

are you serious? . Do you think for class of 2012 it will be in effect?

I am also wondering how it's going to affect AOA selection since some schools use Step1 for selecting Junior AOA?

http://www.usmle.org/General_Information/review.html

According to this, such a test cannot be logistically administered at least till 2011 (ie class of 2012 is quite safe). Read bottom of page:

"This will not occur any earlier than spring 2009. If changes are approved, it will take at least two additional years to work out the details for a reasonable transition to the new design and structure, and to begin implementation."

 

[patzan]

and the scaled score is what most residencies look at.

Not true. No one ever quotes their scaled score. At every one of my interviews, they had a cover sheet with many of my grades (mostly medicine, peds, surgery), and my step 1 score (three digit). I don't know why they have the scaled score as I have never heard anyone using it....ever.

 

[UCLAstudent]

Residencies that most ppl have a decent shot at: family practice, internal meds, Peds, pathology, Emergency Medicine, Psych, Anesthisiology, and GS.

Anesthesiology and emergency medicine are fairly competitive.

 

[patzan]

Anesthesiology and emergency medicine are fairly competitive.

only 66 out of 1071 U.S. applicants didn't match in anesthesia and the mean Step 1 score was basically the national average.

Basically the same story for Emergency Medicine. I'd say they're average competitive.

 

[TheRealMD]

Wrong. Your third year rotations are VERY IMPORTANT. I have heard from several advisors that they are just as important or more important than your step 1 score. I could almost guarantee you that an applicant with a 240 on his step 1 and a Pass in his Surgery and Internal Medicine rotations would get very few interviews for a competitive residency (i.e. plastics, derm, neurosurg, ortho, rad onc, etc.)

Ahh.. I didn't mean to say that nothing else is as important as the Step I, but it's the first thing most people thing of when you're talking about trying to match to a competitive residency.

 

[PeepshowJohnny]

only 66 out of 1071 U.S. applicants didn't match in anesthesia and the mean Step 1 score was basically the national average.

Basically the same story for Emergency Medicine. I'd say they're average competitive.

As for EM, my friends who are interested tell me they place greater relative emphasis on personality and work ethic than grades and boards scores. So, that may drive some of the competition.

Also, don't worry about the USMLE restructuring (I believe they're going with the term "Gateway" to replace Step 1/2.) It's still far, far up in the air what's going to happen with this thing to worry. I don't think they've even decided if it's going pass/fail or not.

 

[UCLAstudent]

only 66 out of 1071 U.S. applicants didn't match in anesthesia and the mean Step 1 score was basically the national average.

Basically the same story for Emergency Medicine. I'd say they're average competitive.

True, they're definitely not like derm or ophtho. But they do seem out of place on that list with IM, peds, FP, and psych.

 

[SocialistMD]

I don't know why they have the scaled score as I have never heard anyone using it....ever.

Did you know that the billionth digit of pi is 9? (randomfacts.org)
Just because you haven't heard of it doesn't make it true. There are programs out there that use the two digit number.

 

[Blade28]

There are some good FAQs and stickies in the General Residency forum, if you guys want to read more about the whole process.

 

[Tensyle]

Not true. No one ever quotes their scaled score. At every one of my interviews, they had a cover sheet with many of my grades (mostly medicine, peds, surgery), and my step 1 score (three digit). I don't know why they have the scaled score as I have never heard anyone using it....ever.

what do they grade you on during rotations? I mean, you really cant do any significant procedures other than take histories and patient exams right? I mean take surgery for example...how and what criteria can they use to grade you as a med student during your 3rd (or 4th) year?

 

[Doublecortin]

what do they grade you on during rotations? I mean, you really cant do any significant procedures other than take histories and patient exams right? I mean take surgery for example...how and what criteria can they use to grade you as a med student during your 3rd (or 4th) year?

yeah, good question, I was wondering the same. The first two basic science years seem pretty straight forward, but I have no clue how you are graded in your "clinical" years

 

[SocialistMD]

yeah, good question, I was wondering the same. The first two basic science years seem pretty straight forward, but I have no clue how you are graded in your "clinical" years

For starters, there is a shelf exam for each core rotation that is very similar to the shelf exams you take for biochem, pharm, path, etc... This can count anywhere from 1/3-1/2 of your final grade. The rest is based on clinical evaluations. This is more subjective, but is an evaluation based on how your attendings and residents felt you performed on the rotation. The areas evaluated include knowledge base and how well you can apply what you learned during the first two years to treating a patient, presentation skill, interest, work ethic, reliability and how much we like you (read: personality).

 

[Tensyle]

For starters, there is a shelf exam for each core rotation that is very similar to the shelf exams you take for biochem, pharm, path, etc... This can count anywhere from 1/3-1/2 of your final grade. The rest is based on clinical evaluations. This is more subjective, but is an evaluation based on how your attendings and residents felt you performed on the rotation. The areas evaluated include knowledge base and how well you can apply what you learned during the first two years to treating a patient, presentation skill, interest, work ethic, reliability and how much we like you (read: personality).

true story: i was watching a cardio bypass surgery while shadowing a doctor. While me and this doctor are standing in the operating room, the surgeon turns around randomly and asks me which blood vessel runs along the inside left side of the chest. I just stared blankly back at him and he shook his head at me. But just before he turned back around to the patient, there was a real medstudent there and said the answer, and the doc I was shadowing explained that I was a measly undergrad and not a med student.

lol just think what kind of eval that surgeon woulda given me....