Have residency application trends changed over the past decades?

[drtribbiani]

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So we all know that getting into med school has gotten exponentially harder throughout the years. What about the difficulty of matching into certain residency programs (ei. surgery, derm, etc). Have those gotten harder too? Might be a naive question but I'm certainly curious.

 

[getdown]

fluctuates from year to year but in general the competitive specialties remain competitive until something else starts attracting students. But with more and more med students graduating everything will become more competitive as a whole.

 

[efle]

Depends on the metrics you look at. For example, the percent of MD applicants who get admitted hasn't changed that much. But, the average MCAT/GPA has steadily climbed, and shot up exponentially at the top programs to the point where a 3.95/top 1% MCAT is only at the average.

You can see similar data for some residency matches. Overall percent success is usually the same but the average stats have been climbing. As a random example here's the medians for Ophthalmology per SFMatch, showing a 10 pt increase in Step1 score in a decade

 

[907914]

Depends on the metrics you look at. For example, the percent of MD applicants who get admitted hasn't changed that much. But, the average MCAT/GPA has steadily climbed, and shot up exponentially at the top programs to the point where a 3.95/top 1% MCAT is only at the average.

You can see similar data for some residency matches. Overall percent success is usually the same but the average stats have been climbing. As a random example here's the medians for Ophthalmology per SFMatch, showing a 10 pt increase in Step1 score in a decade

For both Medical Schools and residencies, do you think this has to do with better students, better advising, better curriculum, or just students learning how to game these tests better (ie studying the test not the material)?

 

[deleted787552]

So we all know that getting into med school has gotten exponentially harder throughout the years. What about the difficulty of matching into certain residency programs (ei. surgery, derm, etc). Have those gotten harder too? Might be a naive question but I'm certainly curious.

I would say yes to a degree. A lot of those Uber competitive specialties (looking at you neurosurg) are self selecting so the level of competition may relatively stay the same. The issue we are gonna have to deal with is the fact that new med schools are opening like crazy, especially in the DO side with their large class sizes. The sheer number of people will likely make certain fields that weren’t competitive (FM/ IM) more competitive in the future due to residency caps

For both Medical Schools and residencies, do you think this has to do with better students, better advising, better curriculum, or just students learning how to game these tests better (ie studying the test not the material)?

I would argue it has to do with sheer number of applicants. With the large applicant pool, schools can be as choosy as they want. A lot of schools like boasting about their stats so it’s not too far off the mark to think they’d take people with higher stats. I’m sure better access to resources has a lot to do with it too. Back in the day, there was no online/prep material to use to study for step/mcat, so now that there is, it’s also helping to up the level of competition

 

[efle]

For both Medical Schools and residencies, do you think this has to do with better students, better advising, better curriculum, or just students learning how to game these tests better (ie studying the test not the material)?

Personally I think it's part of a global change in student selection processes, which has happened along the whole chain from competitive colleges, to med schools, to competitive residency.

It used to be that academic metrics were a check-box to make sure you had the necessary brainpower, and what really made people desirable was elsewhere in the app. For example, Yale college in the 1980s had median Math+Verbal SATs of 1340 (top 10% at the time). But, one generation later, shoots up to 1510 (top 0.5% now).

Similar happened with medical schools, with the top med schools holding MCAT medians of around 33 (top 10%) a decade ago, now up to 519+ (top 1%). Clearly, there's been a change in the zeitgeist of competitive student selection to very heavily emphasize standardized scores.

As to why this happened / continues to happen, I think it's due to the rise of the internet and "common application" systems. Gone are the days when you applied to college or med school based on what nearby options had solid reputations, and when each one had its own application limiting your numbers of apps. Instead you get today's system, where high achieving students strive for top 1% test scores and then all apply all over the country via common application to the same ~20-25 places that hold the highest score ranges and rankings.

With schools receiving a huge increase in application numbers, and suddenly fighting for elite status based on their test scores and rankings, it's no wonder that colleges and medical schools have started using absurdly high standardized score ranges as a filter and major criteria. Residency, I expect, is seeing some of the same phenomenon - a lot more applicants, and the use of test scores to decide who is the cream of the crop that deserves closer inspection.

The phenomenon also isn't restricted to scores and grades. Part of the NRMP data set is the number of "posters, publications and abstracts" on the residency application. In 2010, the mean number for a successful neurosurgery resident was 7.8. Eight years later it is now two-and-a-half times that, at 18.3! It's a positive feedback ratrace where every year the norm gets progressively more ridiculous, in extra curriculars as well as test scores.

Overall it's a very different world for students at all levels than it was a decade or two ago, and I certainly don't envy the hell that our children will have to go through if they want to be in the running for "top 20" or "competitive specialty" or whatever after another generation of this trend.

 

[drtribbiani]

Depends on the metrics you look at. For example, the percent of MD applicants who get admitted hasn't changed that much. But, the average MCAT/GPA has steadily climbed, and shot up exponentially at the top programs to the point where a 3.95/top 1% MCAT is only at the average.

You can see similar data for some residency matches. Overall percent success is usually the same but the average stats have been climbing. As a random example here's the medians for Ophthalmology per SFMatch, showing a 10 pt increase in Step1 score in a decade

When it says "Avg. applications per applicant", does that mean in, say, Jan 2018, the average applicant applied to 70 Ophthalmology programs?! That's a **** ton, is this normal?

 

[efle]

When it says "Avg. applications per applicant", does that mean in, say, Jan 2018, the average applicant applied to 70 Ophthalmology programs?! That's a **** ton, is this normal?

That's correct yep. It's a common application so you just go down the list and add dozens and dozens of programs. Big part of why standardized scores are becoming ever more front-and-center, I think. When you have a mountain of applicants to fill just a handful of residency seats, you have to start throwing up filters.

 

[Kingsmen2018]

EM is getting hot

 

[Master Thinker]

Hmm, I wonder if the quality of physicians has increased in correlation with the increased competitiveness. I do not envy being a med school applicants 10 years from now....at this rate, each person's AMCAS application would probably be a book with a table of content

 

[Lucca]

Hmm, I wonder if the quality of physicians has increased in correlation with the increased competitiveness. I do not envy being a med school applicants 10 years from now....at this rate, each person's AMCAS application would probably be a book with a table of content

Considering that the metrics we use for selecting both med students and residents are only loosely correlated with clinical performance and experience diminishing returns on providing valuable information, I actually doubt it

 

[efle]

I doubt the quality of care will be any better.

I predict having a gap year will become common, often multiple, and going straight through undergrad into MD will become extraordinary. It's already getting to the point where you have to realize you're premed early on to put together a high quality app in time.

 

[aldol16]

The phenomenon also isn't restricted to scores and grades. Part of the NRMP data set is the number of "posters, publications and abstracts" on the residency application. In 2010, the mean number for a successful neurosurgery resident was 7.8. Eight years later it is now two-and-a-half times that, at 18.3! It's a positive feedback ratrace where every year the norm gets progressively more ridiculous, in extra curriculars as well as test scores.

Neurosurgery especially has gotten very research-heavy in recent years - to the point where it's far outstripped other fields. Many neurosurgery residents now have MD/PhDs. Now, nobody should do an MD/PhD just because they're interested in neurosurgery but it's a marker for how research-heavy the field has become.

 

[aldol16]

Hmm, I wonder if the quality of physicians has increased in correlation with the increased competitiveness. I do not envy being a med school applicants 10 years from now....at this rate, each person's AMCAS application would probably be a book with a table of content

The only way quality would improve is if the graduating crop of physicians is somehow different as a population from the graduating crops of physicians in the past, which is most likely not true. Unless you believe that people in general are getting smarter as a whole and more compassionate, humane, etc. What's more likely is that the emphasis is simply shifting and people who are overachievers will continue to be overachievers in the new game. If the emphasis is on life experiences rather than test scores, then overachievers will seek to excel in the life experiences category. If the emphasis is instead placed on test scores, the same overachievers will work hard to excel in that category. Now, in an era when everything is emphasized/you can't be weak on anything, overachievers will work hard to excel in all categories. Only the game has changed - the players are still the same.

 

[deleted787552]

Neurosurgery especially has gotten very research-heavy in recent years - to the point where it's far outstripped other fields. Many neurosurgery residents now have MD/PhDs. Now, nobody should do an MD/PhD just because they're interested in neurosurgery but it's a marker for how research-heavy the field has become.

Neurosurgery Match has always been an interesting to me. I keep hearing that the applicant pool is very self selecting and this field highly prioritizes US MD applicants. Only 240 US seniors people applied to ~230 positions offered last year. I get that those 10ish US senior applicants are SOL but I don’t see why it’s becoming more competitive with more requirements when the ratio of the qualified applicant pool/spots isn’t as bad as it is for other specialties

 

[aldol16]

Neurosurgery Match has always been an interesting to me. I keep hearing that the applicant pool is very self selecting and this field highly prioritizes US MD applicants. Only 240 US seniors people applied to ~230 positions offered last year. I get that those 10ish US senior applicants are SOL but I don’t see why it’s becoming more competitive with more requirements when the ratio of the qualified applicant pool/spots isn’t as bad as it is for other specialties

Because it's a highly self-selected pool of people. Everybody I know who is set on going into neurosurgery (sans MS1s who are really still just exploring) is part of a self-selected group. They're all highly achieving and they all have those personal characteristics (i.e. gunner) that make it a good fit for them. Then there's also the Step 1 screen. If you have a **** Step 1 score with no research, you're not applying into neurosurgery. If you are, you're just misinformed and it's not going to turn out well.