It's also a work:benefit issue. I'm sure that if each derm program ranks 40 people for each spot they are trying to fill, they will have no problem. But interviewing 40:1 is a huge pain, and expensive. So you interview a lower ratio -- less work, but more chance of ending up in SOAP. And guess what? If you end up as one of the 7 derm programs in SOAP, I expect you get lots of applications from people who didn't match into derm, you fill your spots, and life goes on. It's like finding out you have a cavity when you go to the dentist -- it's a pain, takes time out of your life, and is annoying. But you deal with it, and your life goes on just fine.