Competitiveness revisited.

[lejeunesage]

In a previous post, I pointed that, looking solely at board scores, we're tied for with Psych for the penultate spot, and barely above family medicine. The competitiveness of PM&R is real, though, but it's reflected in how much more desirable a physiatry position is than your average residency spot. This is best seen by looking at 2 figures:
1. Ratio of US seniors per spot*.
2. The percentage of matched US seniors.

So, here's how we compare to the other specialties when it comes to US grad applicants per spot.

Anesthesiology 0.7
Child Neurology 0.5
Dermatology 1.1
Diagnostic Radiology 0.7
Emergency Medicine 0.8
Family Medicine 0.4
General Surgery 0.8
Internal Medicine 0.5
Internal Medicine/Pediatrics 0.8
Neurological Surgery 1.2
Neurology 0.5
Obstetrics and Gynecology 1.2
Orthopaedic Surgery 1.2
Otolaryngology 1.3
Pathology 0.4
Pediatrics 0.7
Physical Medicine and Rehabilitation 0.6
Plastic Surgery 1.3
Psychiatry 0.5
Radiation Oncology 1.0
Vascular Surgery 0.7

For the most competitive specialties, the ratio of US grads to total spots is at least 1.0
By this metric, it's harder for a US grad to get a spot in physiatry than it is in child neurology, FM, IM, Neurology, Pathology, and psychiatry, which puts us as the top of the bottom third in terms of competitiveness.

2. Now let's look at the percentage of US grads who actually are able to match in PM&R. Arguably, this is the most important metric, since presumably, people worry more about matching than about competition in the abstract.

Anesthesiology 96%
Child Neurology 91%
Dermatology 76%
Diagnostic Radiology 99%!!! ...so, if you gave up your dream of being a radiologist because you didn't think you'd get in, you might want to rethink that. This is the easiest specialties for US grads to match into. Crazy! Don't people like money anymore?
Emergency Medicine 93%
Family Medicine 96%
General Surgery 85%
Internal Medicine 97%
Internal Medicine/Pediatrics 96%
Neurological Surgery 79%
Neurology 97%
Obstetrics and Gynecology 91%
Orthopaedic Surgery 77%
Otolaryngology 75%
Pathology 98%
Pediatrics 96%
Physical Medicine and Rehabilitation 89%
Plastic Surgery 71%
Psychiatry 96%
Radiation Oncology 89%
Vascular Surgery 89%

This is where the competitiveness of PM&R really shows.
For the most competitive specialties, fewer than 80% of applicants match.
Our 89% ties us with Rad Onc and Vascular surgery. We're only behind Derm, General Surgery, Neurosurgery, Ortho, ENT, and Plastic surgery.


*The problem with using the ratio of total applicants per spot is that it can be inflated if a specialty is desirable to independent applicants. If a huge number of foreign grads decide that it's easy to get into psych, resulting in 2/3 of applicants in that specialty being foreign grads, it pushes up the relative competitiveness of each spot, even though for a US grad, it doesn't change the competitiveness all that much.
Let's look at FM, IM, and Psych for a second. Looking at the ratio of independent applicants to total applicants, you get
FM: 69%
IM: 64%
Psych: 64%

PM&R? 67%...
Derm: 21%

This can make a specialty appear more competitive than it really is.

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[colourmebadd]

Your logic is flawed.

I don't doubt that PM&R is getting more competitive than in years prior, but comparatively it's still not that competitive.

 

[lejeunesage]

Aah? Well, enlighten us, then.
Interestingly, the people at Wash U seem to share my flawed logic in calling PM&R highly competitive.
http://residency.wustl.edu/Choosing/SpecDesc/Pages/PhysicalMedicine.aspx

 

[Missorleans]

I just can't wrap my head around it being that competitive when it has such a large percentage of IMGs matching.

 

[lejeunesage]

I guess I'm confused by what people are objecting to.
Competitive means that fully 89% of US grads who apply match. Why is that so hard to believe?

Also, only 53% of independent applicants matched in PM&R. I'm not sure that's such a particularly large percentage.
By comparison, the figure is
70% for anesthesiology
70% for radiology
59% for EM
54% for IM
60% for Neurology.

Also, the percentage of independent applicants is not such a great metric. Sometimes it's more of a reflection of how popular a specialty is among foreign grads than of its intrinsic competitiveness.
For Psych, for instance, only 49% of independent applicants matched.

 

[colourmebadd]

The flaw is that if there are only 0.6 US applicants per open position, and 11% of those applicants don't match, you can't just claim it's because PM&R is competitive. They fail to match for a multitude of other reasons. And WUSTL uses the exact same metric (% US grads who matched) as a surrogate for competitiveness. Flawed logic shared by others is still flawed... perhaps even Folie a Deux.

 

[colourmebadd]

Also, I just saw your comment about how radiology, with its 99% US grad match rate, is one of the easiest specialties to match into... and it became evident to me that it's not worth my time to explain things to you if you don't realize that med students are largely self-selecting in their specialty choices based largely on board scores.

Ok, now I'm done wasting my time on this.

 

[lejeunesage]

Didn't realize I was arguing against the SDN Chief of Psychiatry. Or do you prefer to go by Head Shrink?

1. I'm not arguing that PM&R is the most competitive specialty in the universe, merely that it's become one of the more competitive specialties, and that to see this you have to look beyond board scores.
2. Where there are very few US grad applicants per spot, you expected it to be easier for each of those applicants to land a spot, not harder, since they are competing against fewer US grads. Now, it's not a straight line, because there are undoubtedly many factors that influence people's chances of matching, but you can see broad trends.

At one extreme, you have the very most competitive specialties, where there is both a higher number of US applicants per spot and a low US grad match rate: for plastic surgery, those numbers are 1.3 and 71% respectively.
Other specialties in that bracket include
Derm: 1.1 and 76%
Neurosurgery: 1.2 and 79%
Ortho: 1.2 and 77%
Oto: 1.3 and 75%
I think without a doubt, these are the 5 most competitive NRMP specialties.

At the other extreme, you have the specialties where it's easiest to match: low number of US applicants and high US grad match rate. For pathology, the respective numbers are 0.4 and 98%.
In this group, I'd also include
FM: 0.4 and 96%
IM: 0.5 and 97%
Neuro: 0.5 and 97%
Psych: 0.5 and 96%

In between those two extremes there are programs that have a either a low US applicant rate or a low US grad match rate. I think the latter is more significant than the former, but that's just my judgment (or lack therefore, as you might think).
For PM&R, we're no have a low match rate (high competitiveness) and a low US applicant to available spot ratio (low competitiveness).
So we're neither among the most competitive or the least competitive.

 

[lejeunesage]

What's easier to match into: a specialty where the average step 1 score is high but every 99% of applicants match? or one where the average step 1 score is lower, but there are 5 applicants per spot and only 20% of people match?
Let's say you have a 215 on step 1, solidly below average.
Let's look at radiology:
For US applicants who have between a 211 and a 220, 2/44 failed to match. That's a 95% match rate. For US applicants who have between a 221 and a 230, 2/93 failed to matched. That's a 98% match rate.
For PM&R, the respective figures are: 5/37 in the 211-220 range: 86% match rate and 5/40 in the 221-230 range: 87.5% match rate.

If this were about self selection, you'd see huge numbers of people with low board scores fail to match in radiology.

Also, if I were you, I would learn to temper my arrogance and learn to address people with more respect.

 

[colourmebadd]

So you're saying an applicant with a 215 will more easily match in radiology than in PM&R?

Self selection means people with low scores don't attempt to match into 'more competitive' fields (i.e. those with higher avg. board scores).

I think we're seeing that PM&R is more competitive because the top programs can have their pick of applicants with great scores, excellent grades and a wealth of experience/research in the field. It's no longer a field that you fall back to if you didn't do too hot on boards.

 

[Dodgers75]

"Is an applicant with a 215 will more easily match in radiology than in PM&R?" According to data, YES.

But I do not believe it means PM&R is more competitive than radiology. I think it simply means that radiology has more low quality programs, which increases available # of spots = higher match rate. I think it has been confirmed that radiology just became one of the easier specialty to 'just match into' if an applicant truly wants to just match into ANY program.

However, for me, the real question should be "What are the chances of an average AMG MD with average STEP 1 score to match into mid tier (good quality) academic program in whatever specialty?"

Answer to this question should give you a true sense of 'competitiveness' nature and also the self selection factor for any given specialty. I think everyone could agree that if an average applicant with similar quality of CV applies to both radiology and PM&R, then the applicant will do much better in PM&R than radiology. No question.

So, I believe PM&R is a bit more competitive than the past, and radiology just became one of the easier specialty to just match into. But, to me, radiology is clearly still much more 'competitive' for an average applicant to match into a good quality program. In that sense, PM&R is still one of the less 'competitive' specialty to match into.

PM&R is gaining popularity and becoming more competitive for sure. But, I think it still has a long way to go if you want to compare PM&R with one of the 'competitive' specialties. And, it starts with higher step 1 average and lower IMG% match rate. The argument about 'competitiveness' becomes very weak when the specialty has one of the lowest average step 1 scores and filled with high % of IMGs.

 

[lejeunesage]

I'll take 2 issues with how you characterize things.

1. If your metric for competitiveness includes IMG match rate, then radiology is less competitive than PM&R. I think that's not the best metric to gauge competitiveness, but either way, it doesn't seem to support your argument.

2. I've seen many residency programs that weren't for me. Some programs make you work longer hours. Others make you do more scut. Some are in more desirable locations (which is highly subjective). But they all have to be able to train you to be a competent physician in their respective field. I don't think it's the case that there are vast numbers of "low-quality programs" in any specialty. Or they would promptly lose their accreditation.
I happen to have matched at a well-respected physiatry program. Do I think that if I'd matched at a less prestigious place I would have been less adequately trained? No way.
I'm not familiar with radiology programs, but I don't see any reason to perceive that a large number of them are "low-quality." But I may just be naive.

3. I guess I should clarify what I mean by competitiveness: among physiatry applicants, there is more competition for each residency slot than there is among radiology applicants.

 

[Dodgers75]

'Among physiatry applicants, there is more competition for each residency slot than there is among radiology applicants.' = True. But it really doesn't mean anything. I am not bashing on DO schools, but I am sure I could find some DO schools that receives more applicants per their spots every year than let's say Harvard, Stanford, or any other top medical schools. Does that mean those DO schools are more 'competitive' to get into? Nope. To me, it is more of some self selected lower quality applicants fighting each other for the lower quality spots (comparing to Harvard, Stanford, and etc.).

% IMGs were just generalization. Having high %IMGs for any specialty in general is a bad sign. You might be right. Radiology is maybe turning its corner. We may see ROADs becoming OADs sometime soon. Who knows?

Again, as for now, I think everyone could agree that if an average US AMG applicant with similar quality of CV applies to both radiology and PM&R, then the applicant will do much better in PM&R than radiology. No question.

It is just self selection at work. Perhaps, it may be easier for you to understand this by seeing stats for the people who were unmatched for radiology. Unmatched radiology applicants on average had Higher step 1, Higher step 2, More # AOA, and pretty much everything else comparing to 'matched' PM&R applicants. To me, this is what defines 'competitive specialty.' People who were unable to match into the specialty becomes about average or even above average applicants if they decide to apply for the less 'competitive' specialty. Most radiology programs were 'competitive' enough to afford 'unmatching' these applicants.

Another way to feel the general consensus is to just look around SDN. I think PM&R forum is about the only forum that compares radiology to PM&R. I just think that it is too early to say that PM&R is 'competitive.' That's all.

 

[RangerBob]

I agree that PM&R is more competitive than it would seem, but overall still not competitive. But I think it's becoming more competitive faster than most (maybe all?) other specialties (I think board scores went up for every specialty). What I'm curious to know is where that ceiling is--does it continue to the point that PM&R actually becomes a ROAD specialty? We have a great lifestyle, and while pay isn't great it's quite high considering the good lifestyle/hours. But if that was all it took to make a specialty a ROAD specialty then why isn't psych already one? And is all this PM&R interest just a temporary fad?

My impression is PM&R is finally becoming understood enough among medical students that most of them now actually hear about it/possibly consider it--in the past so many never heard of the field until residency (if ever). So I don't think it's true competitiveness was accurately reflected. I think we're seeing a sort of "equalization" now and the specialty's competitiveness will normalize sometime in the next few years. My guess is we'll end up with an average board score equal to the average for all specialties (we're not quite there), but that we'll still have a below average (ie, more competitive) match rate.

I also thought it's worth mentioning that according to the statistics in Charting Outcomes in the Match (which is where I assume these stats come from) US grad = MD. DO's are categorized as foreigns grads. I have no idea why they do it that way, but they do. The vast majority of PM&R "foreign grads" are actually DO's, as our specialty is incredibly popular with DO's (highest DO representation of any specialty by percentage). So I think it's misleading to say we're uncompetitive because of the number of foreign grads.

 

[Dodgers75]

I agree with most of what you said above.

Again, the IMG or I should say 'independent applicant' thing is just a generalization and if you need the proof to my point, then here it is.

The following data was directly from match data 2013, and I don't believe we will see any difference from this year's match result. You will see where my logic comes from:

Specialties with at least 10 positions in The Match and filled more than 90 percent by U.S. seniors:
Radiation Oncology (PGY-1): 100 percent
Radiation Oncology (PGY-2): 98.1 percent
Otolaryngology: 97.2 percent
Dermatology (PGY-1): 95.7 percent
Plastic Surgery (PGY-2): 95.0 percent
Thoracic Surgery: 95.0 percent
Orthopedic Surgery: 94.0 percent
Vascular Surgery: 92.7 percent

Top five specialties with at least 10 positions in The Match and filled with significant numbers of independent
applicants (calculated from table):
Pediatrics-Primary: 55.2 percent
Physical Medicine and Rehabilitation (PGY-2): 48.1 percent
Family Medicine: 46.4 percent
Internal Medicine (Categorical): 43.3 percent
Neurology (PGY-2): 41.9 percent

Not saying that it is a perfect measure. But, anyone can see the trend from the data above. DO included or not, it means something. Again, it is not perfect, but it seems like it goes well with the general consensus. Those with more US MDs are considered some of the 'competitive' specialties. Those with more independent applicants (including DOs) are considered some of the 'less competitive' specialties. Well... there you go.

 

[colourmebadd]

"Is an applicant with a 215 will more easily match in radiology than in PM&R?" According to data, YES.

I believe you mean to say, according to the data, a higher percentage of applicants with a 215-ish Step 1 matched in Radiology than in PM&R. Higher percentage matched does not connote easier to match into.

 

[lejeunesage]

Okay. Fair enough. This makes sense.
Looking at the percentage of total spots filled by US grads, physiatry definitely ranks with the low-competitiveness specialties.

 

[@JackShephard]

Is this a serious discussion?

• Charting the Outcomes shows the average PMR applicant that didn't match had a Step 1 of 211.
• 27/32 people matched that had Step 1 score of 191-200. Yes, that's awfully close to the % overall.
• It has the 2nd lowest % of AOA students in the match, with psychiatry last.

We've all had to study some amount of statistics - which means we've all heard of selection bias. The people who apply to Derm are completely different than those applying to PMR. You can't compare the %'s matched without taking that into consideration.

I think PMR is a great field and I have friends going into it. I considered going into it. But let's be honest, PMR isn't a top 5 or 10 specialty as far as competitiveness.

I'm not sure where this obsession to compare ourselves among our peers comes from. It's like we're trying to prove our worth by showing we are better than others. Why not just enjoy your specialty and be yourself?

Building elaborate arguments to show how you're gaining ground or moving up in the world is pretentious. PMR is probably moderately competitive like many other specialties - but does it matter? I don't think so.

 

[@JackShephard]

I agree with most of what you said above.

Again, the IMG or I should say 'independent applicant' thing is just a generalization and if you need the proof to my point, then here it is.

The following data was directly from match data 2013, and I don't believe we will see any difference from this year's match result. You will see where my logic comes from:

Specialties with at least 10 positions in The Match and filled more than 90 percent by U.S. seniors:
Radiation Oncology (PGY-1): 100 percent
Radiation Oncology (PGY-2): 98.1 percent
Otolaryngology: 97.2 percent
Dermatology (PGY-1): 95.7 percent
Plastic Surgery (PGY-2): 95.0 percent
Thoracic Surgery: 95.0 percent
Orthopedic Surgery: 94.0 percent
Vascular Surgery: 92.7 percent

Top five specialties with at least 10 positions in The Match and filled with significant numbers of independent
applicants (calculated from table):
Pediatrics-Primary: 55.2 percent
Physical Medicine and Rehabilitation (PGY-2): 48.1 percent
Family Medicine: 46.4 percent
Internal Medicine (Categorical): 43.3 percent
Neurology (PGY-2): 41.9 percent

Not saying that it is a perfect measure. But, anyone can see the trend from the data above. DO included or not, it means something. Again, it is not perfect, but it seems like it goes well with the general consensus. Those with more US MDs are considered some of the 'competitive' specialties. Those with more independent applicants (including DOs) are considered some of the 'less competitive' specialties. Well... there you go.

I agree and I think this is a good post.

With that said, who cares. Enjoy your specialty.

I think you could compare specialties with women. You can either enjoy your woman for who she is or constantly compare and assess her with others, showing you lack appreciation for what you have.

Good luck everyone.

 

[NightFury]

I think where a lot of the comparing comes from is that overall those of us who already have positions probably get excited about the concept of PM&R becoming competitive. When I told people what I was going into, I got a lot of reactions that basically made it sound like I picked it because I wanted to be lazy or not work, or because it was "easy." I'm not sure if this is because there wasn't a great understanding at my medical school of what a physiatrist really does. Although people might say the same about someone going into dermatology as far as not wanting to work much, they would never say they are lazy, because people know that getting a derm spot means you worked your butt off to get it.

Anyways, my point is, as someone who probably had the scores and resume to apply for just about any specialty, it was kind of frustrating for people to act like the one I chose was a joke. So I think maybe everyone gets excited about the idea of PM&R being more competitive and therefore, receiving more respect from colleagues as a specialty.

Good thing I don't really care what others think. 5 years from now I will be practicing in the specialty I enjoy!

 

[j4pac]

The answer to this question is simple: If I don't match...it's very competitive.