Competitive Specialty vs Competitive Program

[JABWS]

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I'm not sure how you can say the bolded part with any real confidence. The average applicant coming out of the top schools is going to be a lot stronger than the average applicant from other schools. It stands to reason that those students will fill the majority of those slots. I mean I can think of a couple dozen examples of 'randoms' from non-top schools that are all over the most competitive/"top" residencies that make no sense if 'prestige' had any real value.

Also, I'm not really sure what "top 10 medical school" means or "top 10 program" since those are essentially pre-med terms that are fairly nebulous.

Have you seen the match lists for top medical schools? Do you really think every single person coming from these places is that much stronger than say the top 10% at a school with a lesser reputation, however you define it. Hell no. We all learn the same stuff, take the same exams, and yet somehow everyone from Harvard is deemed a rockstar, and the kid from Podunk U who finished near the top of his class and crushed the Step has to scratch and claw just to get an interview at the "big name" places.

Coming from a lesser known university, I can tell you this was absolutely true for me when applying to medical school. My stats were comparable, and often times better, than your "average" applicant at most of the big schools, but interview after interview, it become abundantly clear that I was at a disadvantage. Sure, there are exceptions, but inbreeding very much seems to be the rule.

For instance, how do you explain the match list for a place like Yale, which is purely P/F with optional exams etc. Obviously their students must have been stellar pre-meds, but when it's all said and done, does anyone truly know how well they did in medical school, or how prepared they are to begin a residency? I mean really, the P/F system is only possible by way of a school's reputation, that's why you don't see Podunk U implementing it.

Anyways, I'm in no position to argue with residents/attendings. Prestige matters, from my experience, and I'm going to continue operating under this assumption until proven otherwise.

 

[mycatishuge]

I love how people dump on academia. You like money, so do I. But I'd rather make 100K less/year and see interesting pathology than do ear tubes and T&As day in and day out for decades. Also, residents are there to do scut work for me.
Now, for those who think all academic clinicians are pi$$ poor, here is the AAMC faculty salary data for this year. >80% of academic medical centers report their numbers to AAMC so this is as close to the truth that you'd get. I will only post medians for assistant professors - in $100,000. Peds has too many specialties and I am too lazy to type all of them out.

Anesthesia - general: 315
Anesthesia - Pain: 297
Anesthesia - Peds: 324
Derm w/o Mohs: 259
Derm w Mohs: 405
Medicine
A&I: 150
Cards - Invasive Interventional: 308
Cards - Invasive non-interventional: 296
Cards - Non-invasive: 253
Critical care: 245
Endo: 148
Gastro: 252
GIM: 172
Geriatrics: 152
Hem/Onc: 201
Hospitalist: 194
ID: 140
Nephro: 170
Pulm: 191
Rheum: 147
OB/GYN General: 226
OB/GYN Onc: 279
OB/GYN Fetomaternal: 284
OB/GYN RE: 222
Path - anatomic:192
Path - clinical :181
Peds - all: 162
Psych - all: 170
Rads - all: 338
Nuclear med: 308
Rad Onc: 331
Surgery - General: 276
NS: 440
Ortho: 380
Surgery Peds: 361
Surgery Plastics: 300
Surg Onc: 251
CT: 360
Surgery Transplant: 293
Surgery Trauma: 292
Uro: 286
Vascular: 288
EM: 237
FM: 166
Neuro: 163
Ophtho: 204
Oto: 274
PMR: 189
Preventive: 140

You are welcome. 🙂

 

[ijn]

You're taking a lot more than a 100k cut for many of the high-end specialties. For example, compare your numbers to mean MGMA data...

Rads: 338k academics vs 515k private practice
Derm w/ Mohs surgery: 405k academics vs 674k private practice
Rad onc: 331k academics vs 543k private practice
NS: 440k academics vs 676k private practice

Also, can't you always hire a nurse practitioner or PA to do a lot of your scut work?

 

[mycatishuge]

You're taking a lot more than a 100k cut for many of the high-end specialties. For example, compare your numbers to mean MGMA data...

Rads: 338k academics vs 515k private practice
Derm w/ Mohs surgery: 405k academics vs 674k private practice
Rad onc: 331k academics vs 543k private practice
NS: 440k academics vs 676k private practice

Also, can't you always hire a nurse practitioner or PA to do a lot of your scut work?

Comparing apples to oranges. Sure, if you are a partner in a group in the middle of nowhere, you'd pull in that kind of money working 70+ hrs/wk. Medscape survey 2013 says that only 16% of rads guys make >500k. Their mean is 349. Partners make 413.

 

[anonperson]

Anyways, I'm in no position to argue with residents/attendings. Prestige matters, from my experience, and I'm going to continue operating under this assumption until proven otherwise.

I'll comment as a resident and basically agree with you. Prestige is important. The whole process of matching for residency and fellowship is somewhat of a gamble for programs and they minimize their risk by going after "known" commodities. It isn't perfect but a lot of PDs and fellowship coordinators think this way. There are exceptions and some schools/programs who have produced weak residents/fellows will be disadvantaged but this is the exception.

As an OB GYN resident going through fellowship interviews, I have seen first hand how much name can carry an applicant. This is anecdotal, but I know of one resident from my old med school who had no research, basically showed some interest in a specific fellowship around the latter part of third year and matched with ease in a competitive fellowship based a lot on the strength of the residency. She had a big name institution on her CV and it helped.

I'm coming from a small community program with no known faculty and started busting my ass during my intern year knowing I wanted a specific fellowship. I know I'm well trained. I have a good amount of research and high in service exam scores but I'm still a step below someone who did their training at an IVY league or other big time academic place, even if I have a technically 'stronger' application. Echoing what you said, after a couple of interviews, you get the hint relatively quickly that breaking into their 'club' is tough for an outsider.

 

[ijn]

Comparing apples to oranges. Sure, if you are a partner in a group in the middle of nowhere, you'd pull in that kind of money working 70+ hrs/wk. Medscape survey 2013 says that only 16% of rads guys make >500k. Their mean is 349. Partners make 413.

MGMA data is routinely used in contract negotiations and in determining initial offers. I highly doubt Medscape's free survey is anywhere near as utilized as MGMA. What reason do you have to believe that everyone surveyed by the MGMA is in the middle of nowhere?

Now just speaking from anecdotal experience, my buddy who was 1 year fresh out of residency training from Baylor Dallas was offered 700k initial starting salary as a diagnostic radiologist in urban Dallas. N=1, but meh.

 

[notbobtrustme]

my buddy who was 1 year fresh out of residency training from Baylor Dallas was offered 700k initial starting salary as a diagnostic radiologist in urban Dallas. N=1, but meh.

I just becamse really interested in reading film.....

 

[Stellar Clouds]

I'm not sure how you can say the bolded part with any real confidence. The average applicant coming out of the top schools is going to be a lot stronger than the average applicant from other schools. It stands to reason that those students will fill the majority of those slots. I mean I can think of a couple dozen examples of 'randoms' from non-top schools that are all over the most competitive/"top" residencies that make no sense if 'prestige' had any real value.

Also, I'm not really sure what "top 10 medical school" means or "top 10 program" since those are essentially pre-med terms that are fairly nebulous.

Have you seen the match lists for top medical schools? Do you really think every single person coming from these places is that much stronger than say the top 10% at a school with a lesser reputation, however you define it. Hell no. We all learn the same stuff, take the same exams, and yet somehow everyone from Harvard is deemed a rockstar, and the kid from Podunk U who finished near the top of his class and crushed the Step has to scratch and claw just to get an interview at the "big name" places.

Coming from a lesser known university, I can tell you this was absolutely true for me when applying to medical school. My stats were comparable, and often times better, than your "average" applicant at most of the big schools, but interview after interview, it become abundantly clear that I was at a disadvantage. Sure, there are exceptions, but inbreeding very much seems to be the rule.

For instance, how do you explain the match list for a place like Yale, which is purely P/F with optional exams etc. Obviously their students must have been stellar pre-meds, but when it's all said and done, does anyone truly know how well they did in medical school, or how prepared they are to begin a residency? I mean really, the P/F system is only possible by way of a school's reputation, that's why you don't see Podunk U implementing it.

Anyways, I'm in no position to argue with residents/attendings. Prestige matters, from my experience, and I'm going to continue operating under this assumption until proven otherwise.

Mimelim didn't say anything about the top applicants. He said the average applicant at the top schools is going to be much stronger than the average applicant from other schools. The top applicants from other schools can and do compete with applicants from top med schools. Top students who knock step out of the water don't scratch and claw to get interviews at big name places. I go to an average at best medical school (by SDN standards). I crushed step 1. I received invites to every single top program in my specialty. My classmates who also crushed step 1 and applied to different fields also received invites to top programs. Would it have been easier for us to have the same stats and be from a big name school? Probably. But bottom line, if you work hard and do well, you can go to big name programs from "little name" schools.

 

[Instatewaiter]

So I guess we can summarize the thread like this:

Some med students have said: Prestige matters and helps to land top academic internal medicine programs (i.e. top 10 programs). Btw, no one said it's the end all be all, just that it is an important factor - like a Step 2 score or something.

Residents have said: Prestige doesn't matter for top academic internal medicine programs.

Ok. Well, no one has any data to back either of these statements - but I'll be the first to say I would trust a more experience person over a medical student. I'm just referring to advice I've received from a variety of people who have matched (current residents). Maybe they lied to me. Good luck bottom tier schools - wish you the best.

Prestige matters for each step- in some steps it is minimal, in others massive. It is not the end-all-be-all for anything.

I came from a low tier state school and am a resident at one the big 4 IM programs. Most of my co-residents came from Harvard, hopkins, stanford, penn, UCSF and the like.

For med school it matters some. You'll see your med school is full of people who went to top 100 schools.

For residency it matters a little more, especially the competitive specialties.

For fellowship it matters most for competitive programs in some specialties (Cards, GI, Onc come to mind). It matters more than residency. Again, it is not the end all be all.

For academics your pedigree matters so much it is ridiculous.

For private practice it matters only slightly.

In the end, shoot for as high as you can, and take where you'd be happy.

Yes--top academic programs pay terribly compared to their "low tier" peers in private practice

I think this is hilarious too. Where I am, the attendings have to pay their own salary with their research gants and are allowed roughly 1/3 the going rate in the community for salary. I guess it is easier to get grants but there's no wonder we are not getting a whole lot of young faculty and faculty are leaving enmasse.

 

[Instatewaiter]

Still rather be a radiologist at the worst program in the country than an internist at MGH.

I would rather gouge out my eye with a spoon than be a radiologist. If I wanted to sit in a dark room all day and not talk to anyone I'd shank a prisoner.

 

[Noegrus]

.

 

[yehhhboiii]

I would rather gouge out my eye with a spoon than be a radiologist. If I wanted to sit in a dark room all day and not talk to anyone I'd shank a prisoner.

I feel like 500k could be a little convincing.

 

[Textbookversion]

I feel like 500k could be a little convincing.

There are medicine fellowships that pay as much as rads, and the rads job market is cratering. Don't expect that 500k to be there for you.

 

[John Lannister]

Prestige matters for each step- in some steps it is minimal, in others massive. It is not the end-all-be-all for anything.

I came from a low tier state school and am a resident at one the big 4 IM programs. Most of my co-residents came from Harvard, hopkins, stanford, penn, UCSF and the like.

For med school it matters some. You'll see your med school is full of people who went to top 100 schools.

For residency it matters a little more, especially the competitive specialties.

For fellowship it matters most for competitive programs in some specialties (Cards, GI, Onc come to mind). It matters more than residency. Again, it is not the end all be all.

For academics your pedigree matters so much it is ridiculous.

For private practice it matters only slightly.

In the end, shoot for as high as you can, and take where you'd be happy.

Good to hear what I've been told was accurate from someone who is actually doing it. All the sarcastic remarks earlier were making me second guess myself.

Anyway, like you said - everyone can just do the best they can with what they have.

 

[John Lannister]

There are medicine fellowships that pay as much as rads, and the rads job market is cratering. Don't expect that 500k to be there for you.

Yeah, diagnostic rads could drop twice as fast as the best IM sub specialties. If we've seen anything, it's that being on the top of those specialty income surveys puts a target on your back. And Rads was sitting pretty for many years.

 

[loveoforganic2]

Say you had the scores to match into a competitive specialty (derm, rads, ENT, Ortho, etc.) but not the scores to match into one of the top programs in those specialties. However, your scores are good enough to match into a top program in a less competitive specialty (Gas, IM, Gen Surg, etc.). And say you enjoyed each specialty equally. Which would you choose and why?

c/o 2017 shining through loud and proud

 

[johnmendes]

This is now the thread of the day. The first step in becoming a leader in your field is done

 

[mimelim]

Have you seen the match lists for top medical schools? Do you really think every single person coming from these places is that much stronger than say the top 10% at a school with a lesser reputation, however you define it. Hell no. We all learn the same stuff, take the same exams, and yet somehow everyone from Harvard is deemed a rockstar, and the kid from Podunk U who finished near the top of his class and crushed the Step has to scratch and claw just to get an interview at the "big name" places.

Coming from a lesser known university, I can tell you this was absolutely true for me when applying to medical school. My stats were comparable, and often times better, than your "average" applicant at most of the big schools, but interview after interview, it become abundantly clear that I was at a disadvantage. Sure, there are exceptions, but inbreeding very much seems to be the rule.

For instance, how do you explain the match list for a place like Yale, which is purely P/F with optional exams etc. Obviously their students must have been stellar pre-meds, but when it's all said and done, does anyone truly know how well they did in medical school, or how prepared they are to begin a residency? I mean really, the P/F system is only possible by way of a school's reputation, that's why you don't see Podunk U implementing it.

Anyways, I'm in no position to argue with residents/attendings. Prestige matters, from my experience, and I'm going to continue operating under this assumption until proven otherwise.

Have you actually met people from HMS? I have. Father, uncle, brother, and first cousin. Never mind a good number of my brother's classmates. Also interviewed there a couple years back. There is a huge gap in applicant quality between HMS and whatever 'average' US MD school you want to pick out. Sorry, but it is volumes bigger than MCATs or GPAs or other things like that. That isn't to say that every HMS student is a super genius rockstar, but to say that their match list is primarily due to pedigree is just silly. How does anyone "truly know" whatever that means how someone did in HS or undergrad? Sorry, but a lot of less competitive US MD schools use P/F. It has nothing to do with a school's reputation.

You need to have minimal competency to match a competitive program. ie. your grades, step score, research etc. After that, it all comes down to your LOR and phone calls. My current chairman called my letter writers before I showed up for the interview. He asked me only one question, "What would Dr. chairman at old medical school say about you if I called him?" After I responded he said, "Ya, I talked to him last week, thats pretty much what he said." After having been on the other side now, I know that we basically screen based on your paper app and then we make phone calls based on who we like. The biggest problems with looking at rank lists is that you are missing too much data. People can not match somewhere because the program didn't rank them high, or they didn't apply, weren't good enough to get an interview, had less interest in going to that program.

I mean if you look at the percentage of people from a random US MD school that matched their #1 choice, the % will surprise you. Go out to top 3 and it will blow your mind.

In addition, there are just too many counter examples of people coming from other US MD schools going to the top residencies in the country.

I'm not trying to say that prestige matters zero. What I'm saying is that it is a small factor compared to just about everything else in your application. The only 'evidence' that prestige plays a large role are the match lists, which as previously addressed are shaky at best.

 

[JABWS]

Have you actually met people from HMS? I have. Father, uncle, brother, and first cousin. Never mind a good number of my brother's classmates. Also interviewed there a couple years back. There is a huge gap in applicant quality between HMS and whatever 'average' US MD school you want to pick out. Sorry, but it is volumes bigger than MCATs or GPAs or other things like that. That isn't to say that every HMS student is a super genius rockstar, but to say that their match list is primarily due to pedigree is just silly. How does anyone "truly know" whatever that means how someone did in HS or undergrad? Sorry, but a lot of less competitive US MD schools use P/F. It has nothing to do with a school's reputation.

You need to have minimal competency to match a competitive program. ie. your grades, step score, research etc. After that, it all comes down to your LOR and phone calls. My current chairman called my letter writers before I showed up for the interview. He asked me only one question, "What would Dr. chairman at old medical school say about you if I called him?" After I responded he said, "Ya, I talked to him last week, thats pretty much what he said." After having been on the other side now, I know that we basically screen based on your paper app and then we make phone calls based on who we like. The biggest problems with looking at rank lists is that you are missing too much data. People can not match somewhere because the program didn't rank them high, or they didn't apply, weren't good enough to get an interview, had less interest in going to that program.

I mean if you look at the percentage of people from a random US MD school that matched their #1 choice, the % will surprise you. Go out to top 3 and it will blow your mind.

In addition, there are just too many counter examples of people coming from other US MD schools going to the top residencies in the country.

I'm not trying to say that prestige matters zero. What I'm saying is that it is a small factor compared to just about everything else in your application. The only 'evidence' that prestige plays a large role are the match lists, which as previously addressed are shaky at best.

Quite a few, actually. As it turns out, they put their pants on one leg at a time, the same way I do. Your whole argument sort of lends credence to the point I'm trying to make. Someone goes to HMS, and all of the sudden everyone assumes there must be a "huge gap in applicant quality" between that person and everyone else. I interviewed at Harvard. I didn't get accepted, maybe because I was far inferior to all of the other interviewees, or perhaps my interviewer didn't like the way my hair was parted that day. Who knows, but do you really think there's a huge difference between someone like myself, who didn't end up going to a "top 10" program, and someone who did? My credentials were clearly on par with HMS or "Ivy league" standards, but ultimately I took a scholarship and went to a state school, like so many other applicants opt to do.

Yet somehow the vast majority of Ivy league medical school graduates manage to secure an Ivy league residency, while everyone else is left to fight over the scraps. You say it's based on merit, but my gut tells me that's only partially true. I think there are a lot of great medical students - who will go on to make great doctors - at so-called "average" MD programs, for whatever reason, and even though they may still be successful at getting into a top program, their chances are greatly diminished as compared to the HMS graduate, who, by virtue of the fact they got into Harvard, must be of higher quality.

 

[Textbookversion]

Quite a few, actually. As it turns out, they put their pants on one leg at a time, the same way I do. Your whole argument sort of lends credence to the point I'm trying to make. Someone goes to HMS, and all of the sudden everyone assumes there must be a "huge gap in applicant quality" between that person and everyone else. I interviewed at Harvard. I didn't get accepted, maybe because I was far inferior to all of the other interviewees, or perhaps my interviewer didn't like the way my hair was parted that day. Who knows, but do you really think there's a huge difference between someone like myself, who didn't end up going to a "top 10" program, and someone who did? My credentials were clearly on par with HMS or "Ivy league" standards, but ultimately I took a scholarship and went to a state school, like so many other applicants opt to do.

Yet somehow the vast majority of Ivy league medical school graduates manage to secure an Ivy league residency, while everyone else is left to fight over the scraps. You say it's based on merit, but my gut tells me that's only partially true. I think there are a lot of great medical students - who will go on to make great doctors - at so-called "average" MD programs, for whatever reason, and even though they may still be successful at getting into a top program, their chances are greatly diminished as compared to the HMS graduate, who, by virtue of the fact they got into Harvard, must be of higher quality.

5 star post. If the reality was that top schools had 250 averages on Step 1, I'd buy the argument that they are just all super stars. The reality is they don't. Most of them are rocking something in the 230's. To me that means a healthy chunk of my class is going to blow their average student out of the water (obviously their average > our average). But their average student ends up matching better than our 75th to 97th percentile. Obviously the top 3% of my class matches just as well. It is what it is.

I mean on its face the argument is pretty silly. Are there 1500 elite students (or whatever it is) that are just on a "whole different level" than the other 17,500 US MD students, and however many DO students there are (5k?). I mean really? Of course not. Especially not given the existence of affirmative action and tasty scholarship money.

Human intelligence and ambition are not granular enough, nor discontinuous enough, for our surgery friend's conception of reality to be true. He tells himself a story about prestige because it's a story that he likes to believe. Confirmation bias, etc, do the rest.

 

[Wordead]

5 star post. If the reality was that top schools had 250 averages on Step 1, I'd buy the argument that they are just all super stars. The reality is they don't. Most of them are rocking something in the 230's. To me that means a healthy chunk of my class is going to blow their average student out of the water. But their average student ends up matching better. It is what it is.

I mean on it's face the argument is pretty silly. Are there 1500 elite students (or whatever it is) that are just on a "whole different level" than the other 17.500 US MD students, and however many DO students there are (5k?). I mean really? Of course not. Especially not because of affirmative action and the existence of tasty scholarship money.

Human intelligence and ambition is not granular enough, nor discontinuous enough, for our surgery friend's conception of reality to be true. He tells himself a story about prestige because it's a story that he likes to believe. Confirmation bias, etc, do the rest.

I don't think that the worst of the elite schools are going to be better than the top of the middle-tier schools. But from a PD's perspective, I'm guessing that the idea is that the FLOOR for a HMS student is very high - even the worst student is pretty damn good. At a mid tier, there are unfortunately a much greater % of people who are just plain incompetent (I'm sure everyone can think of 5+ people right off the top of their head). So go with the known quantity and caliber of students.

 

[John Lannister]

5 star post. If the reality was that top schools had 250 averages on Step 1, I'd buy the argument that they are just all super stars. The reality is they don't. Most of them are rocking something in the 230's. To me that means a healthy chunk of my class is going to blow their average student out of the water (obviously their average > our average). But their average student ends up matching better than our 75th to 97th percentile. Obviously the top 3% of our class matches just as well. It is what it is.

I mean on it's face the argument is pretty silly. Are there 1500 elite students (or whatever it is) that are just on a "whole different level" than the other 17,500 US MD students, and however many DO students there are (5k?). I mean really? Of course not. Especially not given the existence of affirmative action and tasty scholarship money.

Human intelligence and ambition are not granular enough, nor discontinuous enough, for our surgery friend's conception of reality to be true. He tells himself a story about prestige because it's a story that he likes to believe. Confirmation bias, etc, do the rest.

👍 Good post.

 

[eject]

I have no insight into the specific importance of prestige at various levels of medicine. Perhaps this is obvious, but it's worth remembering that many people just use Ivy-status as a shortcut in the vetting process. It wouldn't surprise me if there were a lot of Scalia-type thinkers in medicine (and probably some Thomas-types, too):

"By and large, I’m going to be picking from the law schools that basically are the hardest to get into. They admit the best and the brightest, and they may not teach very well, but you can’t make a sow’s ear out of a silk purse. If they come in the best and the brightest, they’re probably going to leave the best and the brightest, O.K.?" —Justice Antonin Scalia, explaining to students at American University Washington College of Law, which was ranked No. 48 this year, why roughly half the law clerks who served since Chief Justice Roberts joined the court have come from Harvard or Yale. Justice Thomas, who looked outside the Ivy League, said bloggers “referred to my clerks last year as TTT — third-tier trash.”

 

[ijn]

I don't think that the worst of the elite schools are going to be better than the top of the middle-tier schools. But from a PD's perspective, I'm guessing that the idea is that the FLOOR for a HMS student is very high - even the worst student is pretty damn good. At a mid tier, there are unfortunately a much greater % of people who are just plain incompetent (I'm sure everyone can think of 5+ people right off the top of their head). So go with the known quantity and caliber of students.

Disagree. People burn out at all levels of their career. There are plenty of superstars in college matriculating into an ivy med school who in turn have a hard time passing the Steps and clerkships for whatever reason. If I were a PD i'd be wary of interviewing the guy who's in the bottom 5% at an Ivy versus a 50th percentile state school candidate.

 

[ijn]

I have no insight into the specific importance of prestige at various levels of medicine. Perhaps this is obvious, but it's worth remembering that many people just use Ivy-status as a shortcut in the vetting process. It wouldn't surprise me if there were a lot of Scalia-type thinkers in medicine (and probably some Thomas-types, too):

If there were a Step 1 equivalent in law school required for first year post-grad jobs, then they'd have something to go on besides school prestige. But there's no way to objectively compare students between different schools. Thank god for standardized exams. I would hate to have the end result of 4 years of hard work in medical school be entirely determined by what I did in undergrad.

 

[notbobtrustme]

Quite a few, actually. As it turns out, they put their pants on one leg at a time, the same way I do. Your whole argument sort of lends credence to the point I'm trying to make. Someone goes to HMS, and all of the sudden everyone assumes there must be a "huge gap in applicant quality" between that person and everyone else. I interviewed at Harvard. I didn't get accepted, maybe because I was far inferior to all of the other interviewees, or perhaps my interviewer didn't like the way my hair was parted that day. Who knows, but do you really think there's a huge difference between someone like myself, who didn't end up going to a "top 10" program, and someone who did? My credentials were clearly on par with HMS or "Ivy league" standards, but ultimately I took a scholarship and went to a state school, like so many other applicants opt to do.

Yet somehow the vast majority of Ivy league medical school graduates manage to secure an Ivy league residency, while everyone else is left to fight over the scraps. You say it's based on merit, but my gut tells me that's only partially true. I think there are a lot of great medical students - who will go on to make great doctors - at so-called "average" MD programs, for whatever reason, and even though they may still be successful at getting into a top program, their chances are greatly diminished as compared to the HMS graduate, who, by virtue of the fact they got into Harvard, must be of higher quality.

5 star post. If the reality was that top schools had 250 averages on Step 1, I'd buy the argument that they are just all super stars. The reality is they don't. Most of them are rocking something in the 230's. To me that means a healthy chunk of my class is going to blow their average student out of the water (obviously their average > our average). But their average student ends up matching better than our 75th to 97th percentile. Obviously the top 3% of our class matches just as well. It is what it is.

I mean on it's face the argument is pretty silly. Are there 1500 elite students (or whatever it is) that are just on a "whole different level" than the other 17,500 US MD students, and however many DO students there are (5k?). I mean really? Of course not. Especially not given the existence of affirmative action and tasty scholarship money.

Human intelligence and ambition are not granular enough, nor discontinuous enough, for our surgery friend's conception of reality to be true. He tells himself a story about prestige because it's a story that he likes to believe. Confirmation bias, etc, do the rest.

yep, these two posts sum up my feelings on prestige/pedigree precisely. It's also why I choose to focus on what I can accomplish rather than bitching about what could have been. Focus on what you can control!

 

[cowme]

I would rather gouge out my eye with a spoon than be a radiologist. If I wanted to sit in a dark room all day and not talk to anyone I'd shank a prisoner.

I'm gonna recommend so many rectal exams on my reports for that comment

 

[imer]

I would rather gouge out my eye with a spoon than be a radiologist. If I wanted to sit in a dark room all day and not talk to anyone I'd shank a prisoner.

I'd go pick up a bar of soap in the prison shower.

 

[Medstart108]

Say you had the scores to match into a competitive specialty (derm, rads, ENT, Ortho, etc.) but not the scores to match into one of the top programs in those specialties. However, your scores are good enough to match into a top program in a less competitive specialty (Gas, IM, Gen Surg, etc.). And say you enjoyed each specialty equally. Which would you choose and why?

If i enjoyed each specialty equally i would definitely pick the top program. The difference in pay is there but i've never wanted to or expected to make over 300k a year anyways so might as well take a program you can brag about. Anyways IM and surgery you can sub-specialize so the pay can very dramatically increase.

 

[cowme]

I'd go pick up a bar of soap in the prison shower.

Heh. Ill laugh at that one when I'm strolling in at 9 am tomorrow

 

[mimelim]

5 star post. If the reality was that top schools had 250 averages on Step 1, I'd buy the argument that they are just all super stars. The reality is they don't. Most of them are rocking something in the 230's. To me that means a healthy chunk of my class is going to blow their average student out of the water (obviously their average > our average). But their average student ends up matching better than our 75th to 97th percentile. Obviously the top 3% of my class matches just as well. It is what it is.

I mean on its face the argument is pretty silly. Are there 1500 elite students (or whatever it is) that are just on a "whole different level" than the other 17,500 US MD students, and however many DO students there are (5k?). I mean really? Of course not. Especially not given the existence of affirmative action and tasty scholarship money.

Human intelligence and ambition are not granular enough, nor discontinuous enough, for our surgery friend's conception of reality to be true. He tells himself a story about prestige because it's a story that he likes to believe. Confirmation bias, etc, do the rest.

To be blunt, I'd consider 3-4 of the people who got 260s+ in my class to be some of the worst future physicians possible. Board scores are important, but in terms of potential of being a good/great physician, I really think that comparing a 240 to a 260 pretty stupid. Once you enter the residency level your 'scores' really fall by the wayside.

 

[Textbookversion]

To be blunt, I'd consider 3-4 of the people who got 260s+ in my class to be some of the worst future physicians possible. Board scores are important, but in terms of potential of being a good/great physician, I really think that comparing a 240 to a 260 pretty stupid. Once you enter the residency level your 'scores' really fall by the wayside.

I was using it as a proxy for quality, but use whatever metric you want. The students at UCSF aren't all somehow superhumans that make the 75th percentile at a mid tier look stupid, and yet match lists make it look like that at times.

I could care less frankly, but to pretend we live in a meritocracy is wallowing in a just world fallacy that isn't consistent with reality.

 

[John Lannister]

To be blunt, I'd consider 3-4 of the people who got 260s+ in my class to be some of the worst future physicians possible. Board scores are important, but in terms of potential of being a good/great physician, I really think that comparing a 240 to a 260 pretty stupid. Once you enter the residency level your 'scores' really fall by the wayside.

I agree with this 100% and I'm not exactly sure why this field gets excited about a 260+ compared to say a 240 or 250 score. How does that translate to being a better physician?😕

 

[ijn]

I agree with this 100% and I'm not exactly sure why this field gets excited about a 260+ compared to say a 240 or 250 score. How does that translate to being a better physician?😕

Indeed the sweet spot is 250-259. Definitely can be considered smart, but not weirdo Asperger's club. >260 actively hurts in cool guy professions like vascular. We all know step score past that point is inversely related to social IQ. What we really need is a LizzyM-like "adjusted" Step 1 score that takes into account this fact.

 

[John Lannister]

Indeed the sweet spot is 250-259. Definitely can be considered smart, but not weirdo Asperger's club. >260 actively hurts in cool guy professions like vascular. We all know step score past that point is inversely related to social IQ. What we really need is a LizzyM-like "adjusted" Step 1 score that takes into account this fact.

Haha, I never said anything like that.

I think you or anyone else who scores 260+ is obviously very intelligent - and I don't think it means your socially inept. You're obviously a smart guy and you probably are socially intelligent also - all I stated is that I don't know how scoring in the top 1% on a multiple choice exam means you're going to be a good physician.

Maybe I'm wrong. Anyway, good luck with your applications - hope you do well.

 

[Substance]

If there were a Step 1 equivalent in law school required for first year post-grad jobs, then they'd have something to go on besides school prestige. But there's no way to objectively compare students between different schools. Thank god for standardized exams. I would hate to have the end result of 4 years of hard work in medical school be entirely determined by what I did in undergrad.

This is the way Canada is. There is no standardized exam for comparison of knowledge between schools. Because of this, some programs, namely derm and plastics programs, are requesting undergrad transcripts.

Bonkers.

 

[Medstart108]

Canada is so obsessed with egalitarian equality and fear of standardized testing that they promote this ridiculous system. All Canadian universities are easily accessible by anyone who's remotely intelligent. Basically, our most "difficult" universities are equivalent maybe to the University of Virginia. We don't do SATs, APs, anything really. Canadian unis don't care about ECs. They only look at marks in school and they are widely inflated and determined by individual teachers. Once had a teacher give 100% to everyone in the class for a quiz cuz we answered this question right: "who is taller, student A or teacher B?" Literally. Total joke. Then, there are these private schools springing up everywhere where you can pay $800 to take a shame course and get 90-98% on your "course". Unis take these shame marks at face value.

Then med school is probably the only time Canada gets serious. They want ECs, MCATs and good grades. Afterwards, no Step 1s, just a final exam called MCCQE pt 1.

 

[Instatewaiter]

I'm gonna recommend so many rectal exams on my reports for that comment

IMHO, still better than being a radiologist for the rest of your life.

I'd go pick up a bar of soap in the prison shower.

It's close but I think prison rape is not better than being a radiologist.

 

[tco]

IMHO, still better than being a radiologist for the rest of your life.



It's close but I think prison rape is not better than being a radiologist.

Sounds like someone has a closet to come out of.

 

[jerseytrash]

IMHO, still better than being a radiologist for the rest of your life.



It's close but I think prison rape is not better than being a radiologist.

 

[SlickNickMD]

Damn apparently all those ortho guys getting 250s/260s have aspergers and think women have cooties. This website is I thought this type of mentality only existed in high school.


Anyhow to answer this question, I would go with the specialty you have a genuine interest in and can see yourself doing for the rest of your life. If interest is equal would let rely on location to make my decision (matching in a desired location for less competitive than matching in Idaho for ortho). I would also consider pay but with Obamacare there is quite a bit of uncertainty when it comes to physician compensation.

 

[QuesoAndFromage]

You have to follow your interests, and I find my interests changing all the time.

For example, if I score > 80% on a UWorld test, I find myself really interested in diseases of the skin. If I score < 60% on a UWorld test, I find myself more interested in the psychosocial aspects of medicine.

this is the best post I have ever seen here👍

 

[Anon212]

I was using it as a proxy for quality, but use whatever metric you want. The students at UCSF aren't all somehow superhumans that make the 75th percentile at a mid tier look stupid, and yet match lists make it look like that at times.

I could care less frankly, but to pretend we live in a meritocracy is wallowing in a just world fallacy that isn't consistent with reality.

Disagree. People burn out at all levels of their career. There are plenty of superstars in college matriculating into an ivy med school who in turn have a hard time passing the Steps and clerkships for whatever reason. If I were a PD i'd be wary of interviewing the guy who's in the bottom 5% at an Ivy versus a 50th percentile state school candidate.

I don't know. I'm gonna play devil's advocate here- why shouldnt your performance in undergrad matter as much or more than your performance on one test- a test that admittedly was never designed to be used to compare different students in terms of quality or future success? Can't you make the argument that a student at HMS who has always done well, who obviously once tested well enough to get into Harvard in the first place, but who bombs Step 1 should get more credit than someone who maybe just happened to do better on that one test? I just don't know that it's ever as simple as you guys make it out to be...
Instead of focusing on testing, I'd focus on clinical experience. A lot of the "best medical schools" have relatively weak clinical experience- in the sense that they don't tend to be very hands-on. Patients expect the great doctors, there's tons of residents who have to learn stuff, lots of pressure, and the med student gets shafted. Instead, at "lower tier" places they may have a more "see one, do one, teach one" attitude. The ugly truth of medical education is that for all that we're standardized- we have standardized testing, standardized information we all must learn- clinicals are remarkably not standardized at all. Grading is different among teams/ clerkships/ med schools. And a student at school X may have done 3 central lines while the student at school Y has sutured once ever.

And also this whole argument presupposes the fact that the "high ranked residency" is inherently better, and I still am not convinced by that. The truth is that most residents dont want to go into academics. Except for a chosen few fellowships, most of them are reachable from most residencies as long as you're competent. So what's left? Why is MGH surgery that much better? If anything you'll operate less there than a lot of other places, so why go there? The only way I can really see it mattering is if you're absolutely fascinated by a niche research topic that is only studied at MGH/ Hopkins at all. Otherwise I'd argue that most mid-range places will give you research opportunities as well if you're committed.

I also generally find it sort of frustrating that the same students who complain that HMS students get all the credit despite arguably not having miraculously brilliant students also complain that the big-named residencies won't take them as readily. So wait, should prestige matter at all? Why is residency ok but med school isn't?

 

[ophthodude]

.

 

[rocketbooster]

I don't know. I'm gonna play devil's advocate here- why shouldnt your performance in undergrad matter as much or more than your performance on one test- a test that admittedly was never designed to be used to compare different students in terms of quality or future success? Can't you make the argument that a student at HMS who has always done well, who obviously once tested well enough to get into Harvard in the first place, but who bombs Step 1 should get more credit than someone who maybe just happened to do better on that one test? I just don't know that it's ever as simple as you guys make it out to be...
Instead of focusing on testing, I'd focus on clinical experience. A lot of the "best medical schools" have relatively weak clinical experience- in the sense that they don't tend to be very hands-on. Patients expect the great doctors, there's tons of residents who have to learn stuff, lots of pressure, and the med student gets shafted. Instead, at "lower tier" places they may have a more "see one, do one, teach one" attitude. The ugly truth of medical education is that for all that we're standardized- we have standardized testing, standardized information we all must learn- clinicals are remarkably not standardized at all. Grading is different among teams/ clerkships/ med schools. And a student at school X may have done 3 central lines while the student at school Y has sutured once ever.

And also this whole argument presupposes the fact that the "high ranked residency" is inherently better, and I still am not convinced by that. The truth is that most residents dont want to go into academics. Except for a chosen few fellowships, most of them are reachable from most residencies as long as you're competent. So what's left? Why is MGH surgery that much better? If anything you'll operate less there than a lot of other places, so why go there? The only way I can really see it mattering is if you're absolutely fascinated by a niche research topic that is only studied at MGH/ Hopkins at all. Otherwise I'd argue that most mid-range places will give you research opportunities as well if you're committed.

I also generally find it sort of frustrating that the same students who complain that HMS students get all the credit despite arguably not having miraculously brilliant students also complain that the big-named residencies won't take them as readily. So wait, should prestige matter at all? Why is residency ok but med school isn't?

No. The material from undergrad is almost completely irrelevant to the field of medicine. Step 1 material is all medical material covering the first 2 years of med school. Whether you like all the zebras on Step 1 or not, they are still real pathology in medicine. I'm about done with 3rd year and have seen quite a few "zebras" that I thought was just stupid Step 1 knowledge last year. For example, I just had a patient with combined variable immunodeficiency and I had to know which Ig's they are deficient in in order to choose the correct PPX treatment. It definitely matters. And Step 1 is not all zebras, it has tons of common medical pathology too that you definitely need to know on a regular basis.

While the residency admissions process is far from perfect, Step 1 is definitely the most objective and relevant way to compare applicants. To be fair, though, I'd argue that Step 2 should also be weighed a lot more since that tests more of your clinical application of your knowledge.

And there's no objective way to compare hundreds of applicants based on their clinical experience. You cannot compare grades from different schools, and arguably can't even compare grades within the same school since ppl have different attendings. That's why standardized tests exist.

 

[Dral]

I would rather gouge out my eye with a spoon than be a radiologist. If I wanted to sit in a dark room all day and not talk to anyone I'd shank a prisoner.

For real. I shadowed a radiologist at a community hospital for a day while on my med outpatient rotation during third year.

Most of what happened was sitting there and watching him look at films as they populated his list...press his dictate record button and say "dictaphone, normal bone" or talking about a clear CXR. Then about three times throughout the day a nurse came in and got him to go do some interventional thing that...I think mainly involved doing paracentesis as I remember it. I sensed he was annoyed at these and just wanted to get back and clear his list.

I left knowing 'hells no'. At least he was a cool guy...even bought me lunch...and we had a good convo or two.

 

[Anastomoses]

great thread! only thing it's made me want to do is work harder, learn more. As for the original question: You don't seem to be leaning to any particular field. The only thing I ask myself is - what do I want to be doing day in and day out?
If you really feel the same about both specialties go with the competitive program. Why wouldn't you want to be working at/with the top notch facility you can for that specific training? Seems common sense.

 

[imer]

For real. I shadowed a radiologist at a community hospital for a day while on my med outpatient rotation during third year.

Most of what happened was sitting there and watching him look at films as they populated his list...press his dictate record button and say "dictaphone, normal bone" or talking about a clear CXR. Then about three times throughout the day a nurse came in and got him to go do some interventional thing that...I think mainly involved doing paracentesis as I remember it. I sensed he was annoyed at these and just wanted to get back and clear his list.

I left knowing 'hells no'. At least he was a cool guy...even bought me lunch...and we had a good convo or two.

Oh look is that another bar of soap in the corner?