How competitive is psychiatry becoming? Advice

[brdlh_15]

I've been interested in psychiatry ever since I can remember. Currently, I'm a second year MD student (class of 2021) from a mid tier medical school preparing for the Step 1. I failed two basic science courses and successfully remediated (one in M1 and another at the end of M2). As all of that was happening, I was seeing a therapist/psychiatrist that determined I have ADHD-Inattentive type and was told my poor academic performance in medical school was likely related to my "inability to compensate". Currently, I am in the lower half of my class for all my classes except my clinical prep/skills course where I typically perform above average on patient encounter OSCEs. As for extracurriculars, I have held leadership positions in many organizations, should have two basic science publications by the end of this year (still waiting for them to get accepted), and have been involved in policy writing. However, none of my extracurriculars are directly related to psychiatry.

I'm concerned whether I should realistically look into pursuing other residency options that interest me (neurology/lifestyle medicine) given the red flags described above if I do not score highly on the step exam considering my overall application. When I spoke to the student affairs at my school, they told me that since psychiatry is becoming highly competitive and that I would need to score 230-240+ if I chose to pursue psychiatry.

I wanted to be proactive and ask for realistic feedback regarding if there is room for me to recover (and how I could attempt do so) from the red flags and someday become a psychiatrist or if I should look into other options.

Thanks.

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[TexasPhysician]

I would ignore the comments about Step 1 and just do the best you can.

Consider applying to lower tier psych programs, lower tier neuro, and maybe some FM as well. 2 remediations are two big red flags that can’t be hidden. Hopefully you receive plenty of interviews and can start cancelling them.

 

[Stagg737]

If you're worried about matching psych but still really want to do it, then just apply to FM programs as back-ups. You'll have to spend more time and money during the interview season, but that's a lot better than not matching or not trying for your top field (which is still not that competitive compared to many others).

 

[brdlh_15]

I would ignore the comments about Step 1 and just do the best you can.

Consider applying to lower tier psych programs, lower tier neuro, and maybe some FM as well. 2 remediations are two big red flags that can’t be hidden. Hopefully you receive plenty of interviews and can start cancelling them.

Thank you. Is there anything I could do during my third/fourth years to improve my application and possibly increase my chances for psych?

If you're worried about matching psych but still really want to do it, then just apply to FM programs as back-ups. You'll have to spend more time and money during the interview season, but that's a lot better than not matching or not trying for your top field (which is still not that competitive compared to many others).

Everyone I have spoken to has been saying psych is extremely competitive now, and I do not really know what that means, so I have been nervous about that.. thank you for your suggestion! I will consider doing the psych/FM route when I prepare for ERAS because I am really interested in a career related to mental health (unless that changes because of an awful clinical experience, which is highly unlikely) because of how much it has influenced my life in recent years and because I find the theories/concepts/recent movements in psychiatry extremely fascinating. My biggest worry is that I ruined my chances to obtain a residency placement with my preclinical academic performance, but I do want to at least try.

 

[Stagg737]

Everyone I have spoken to has been saying psych is extremely competitive now

Psych is certainly more competitive than it was even 5 years ago, but to say it is "extremely competitive" is very hyperbolic. I matched last year with no Step scores, terrible Level 1 scores, and poor class rank. The things I had going for me were strong LORs and attending comments on my MSPE, applying broadly, and knocking audition rotations out of the park. It seems more competitive now because there is a much higher volume of students applying to the field in the past, but the average stats for applicants are still far lower than the traditionally competitive fields (partially because psych doesn't emphasize stats as much).

Try and network and get to know some PDs and attendings at various programs during 3rd year and early 4th year. People may tell you audition rotations are a waste, but if you do really well and people like you it will only help your chances. Also, since you have red flags I'd apply broadly. It's frustrating that people have to apply to so many programs now (I applied to ~75 and got 9 interviews), but I'd rather have over-applied and matched than not applied to enough/too competitively and not matched.

 

[MacDonaldTriad]

Anyone who says psych is extremely competitive now hasn't looked at any data. We were second from the bottom and are now fourth or fifth from the bottom depending upon what measures you believe. You might have a slightly higher chance of matching into family medicine, neurology, or Peds, but only slightly. Half of psych slots were IMG filled 5 years ago, now it is about 40%. This is hardly a massive sea change. I am over the moon glad that it is getting better, but we are still far below average in competitiveness.

 

[GEToutLADYits6AM]

Dude psych is the new derm, where is your head at?

 

[brdlh_15]

Psych is certainly more competitive than it was even 5 years ago, but to say it is "extremely competitive" is very hyperbolic. I matched last year with no Step scores, terrible Level 1 scores, and poor class rank. The things I had going for me were strong LORs and attending comments on my MSPE, applying broadly, and knocking audition rotations out of the park. It seems more competitive now because there is a much higher volume of students applying to the field in the past, but the average stats for applicants are still far lower than the traditionally competitive fields (partially because psych doesn't emphasize stats as much).

Try and network and get to know some PDs and attendings at various programs during 3rd year and early 4th year. People may tell you audition rotations are a waste, but if you do really well and people like you it will only help your chances. Also, since you have red flags I'd apply broadly. It's frustrating that people have to apply to so many programs now (I applied to ~75 and got 9 interviews), but I'd rather have over-applied and matched than not applied to enough/too competitively and not matched.

Thank you, that's extremely helpful advice! Definitely makes me feel like I still have a chance, I appreciate it.

Anyone who says psych is extremely competitive now hasn't looked at any data. We were second from the bottom and are now fourth or fifth from the bottom depending upon what measures you believe. You might have a slightly higher chance of matching into family medicine, neurology, or Peds, but only slightly. Half of psych slots were IMG filled 5 years ago, now it is about 40%. This is hardly a massive sea change. I am over the moon glad that it is getting better, but we are still far below average in competitiveness.

I thought that when I looked at data a few months back, and made the decision to work on my focus/attention issues (which has yielded a major difference in my grades, but too late to benefit my app). So, I expect my clinical performance/shelf grades to be much better than preclinical. But, my worries stem from student support recently telling me it's highly competitive now and Psych lecturers telling my class that it's "the new derm" as @GEToutLADYits6AM commented.. which made me question the data and post on here to see how valid that statement was, so I could have a better idea of how realistic pursuing psych would be for me with red flags. Thank you for the feedback!

 

[MacDonaldTriad]

I saw the psych is the new derm data. It was based on what percentage of applicants failed to match into psych. There is a flood of very weak applicants applying to psych and now it is somewhat less, but the derm percentage that fail to get in are probably not very similar to the psych ones. It is a silly comparison. Just do your best, kill your steps and talk about your breakthrough on your attentional issues in your PS. If all goes well in the second half of med school, that will be infinitely better than killing the first half and slipping the second. The top psych programs are getting some richer cream of the crop, but there is still a lot of room at some very good places.

 

[BiscoDisco]

I had a couple classmates in my cohort match with <205 step1 scores this year. Be passionate, be personable, be positive. You'll match.

 

[Shufflin]

...But, my worries stem from student support recently telling me it's highly competitive now and Psych lecturers telling my class that it's "the new derm" ...

It's heading, gradually, in that direction. With the rise of more interventions in Psych, and the cooling off of Derm salaries, the ship will probably continue on that course.

 

[brdlh_15]

I saw the psych is the new derm data. It was based on what percentage of applicants failed to match into psych. There is a flood of very weak applicants applying to psych and now it is somewhat less, but the derm percentage that fail to get in are probably not very similar to the psych ones. It is a silly comparison. Just do your best, kill your steps and talk about your breakthrough on your attentional issues in your PS. If all goes well in the second half of med school, that will be infinitely better than killing the first half and slipping the second. The top psych programs are getting some richer cream of the crop, but there is still a lot of room at some very good places.

If all goes well in the second half, would it be a good idea for me to mention my issues in my PS? My concern with that is that it would make me come off as irresponsible / liability or that PDs would be biased against me due to that?

I had a couple classmates in my cohort match with <205 step1 scores this year. Be passionate, be personable, be positive. You'll match.

Thank you, that makes me feel much more optimistic about my chances!

 

[brdlh_15]

It's heading, gradually, in that direction. With the rise of more interventions in Psych, and the cooling off of Derm salaries, the ship will probably continue on that course.

How do you feel this will impact the applicant pool in the next year?

 

[MacDonaldTriad]

How do you feel this will impact the applicant pool in the next year?

It will become more essential that applicants get into a real medical school. That is about it. You decide if this is offensive to you and then reflect on its validity without elaboration from me. Reality hits sooner than later even if you find alternatives to not being accepted. No means no more and more.

 

[GEToutLADYits6AM]

It will become more essential that applicants get into a real medical school. That is about it. You decide if this is offensive to you and then reflect on its validity without elaboration from me. Reality hits sooner than later even if you find alternatives to not being accepted. No means no more and more.

What is considered a real medical school? Please tell me what these unreal/fake schools are?

 

[Shufflin]

How do you feel this will impact the applicant pool in the next year?

The bell curve will have stronger applicants at the upper end, shifting the average stats upward.

 

[MacDonaldTriad]

What is considered a real medical school? Please tell me what these unreal/fake schools are?

There could be a gradation of definitions, but being associated with a university and operating your training hospital and being domestic would be a good start. If you have to find your own clinical rotations and your school is for profit, be wary.

 

[GEToutLADYits6AM]

There could be a gradation of definitions, but being associated with a university and operating your training hospital and being domestic would be a good start. If you have to find your own clinical rotations and your school is for profit, be wary.

Lol im at a school which forces us to find our own rotations and robs us for profit and raises tuition every 2 years. My only is escape is killing boards

 

[BiscoDisco]

There could be a gradation of definitions, but being associated with a university and operating your training hospital and being domestic would be a good start. If you have to find your own clinical rotations and your school is for profit, be wary.

Sounds like most DO schools.

 

[MacDonaldTriad]

Most DO schools, and a few new MD schools. Do you think it isn't clear to us when we see Dean's letters? What kind of inter-rater reliability can you have when no one who grades you works for you in any way? Kind of hard to make a curriculum when no one is in charge. Does your school pay hospitals in NYC for rotations there? Does your school in NYC have a shortage of rotations because they are selling rotations to over seas medical schools? Most students are happy just to be accepted, but be ware.

 

[BiscoDisco]

Most DO schools, and a few new MD schools. Do you think it isn't clear to us when we see Dean's letters? What kind of inter-rater reliability can you have when no one who grades you works for you in any way? Kind of hard to make a curriculum when no one is in charge. Does your school pay hospitals in NYC for rotations there? Does your school in NYC have a shortage of rotations because they are selling rotations to over seas medical schools? Most students are happy just to be accepted, but be ware.

Don't disagree with any of this. But do you really believe DO schools are not real medical schools? Would it follow that DO students are not real medical students/eventual doctors?

 

[MacDonaldTriad]

There are poor MD graduates and excellent DO graduates for sure, but the quality of one vs the other does depend on the quality of the schools they graduate from. A student can overcome a weak education, or they can fail to take advantage of a good education, but these are still exceptions. By the way, I wasn't starting an MD vs DO discussion, I was talking about educational resources and clinical rotations. If your education fits into one or the other description, that isn't because the nature of the degree itself.

 

[Sir James Bond]

I think the field is becoming more difficult to enter. Programs can select more from the cream of the crop than before.

 

[ridethecliche]

Honestly, my biggest regret this year was not doing any away rotations. I think that really hurt me at the end of the day.

Doing a few aways and having letters from outside my school would have allowed me to match far better imho especially if the sites had been well picked. I think I'll be fine for matching as far down as I did this cycle, but the thought never crossed my mind that I'd match below my home program. Match day kinda sucked even though I'm mostly less bitter about it now haha.

For reference:

Step 1: 210-220
Step 2: 230-240
Step 2CS: pass first try

MSPE was okay with two grades on the lower end of the spectrum one of which hurt because it was family. No red flags on applications. I did mention a health issue that was very well controlled and hadn't been an issue in years.

Letters were good. I had folks reading me excerpts at interviews which basically felt like a pep talk over an interview. Lots of research in a seemingly unrelated field but I made the connection to psych in both my interviews and in my personal statement.

I very nearly could have not matched. It was pretty terrifying to see how far I'd dropped down in my last on match day and it really made me question a lot of what I thought going into the program including what it means for a home program to support you.

 

[MacDonaldTriad]

There can be a lot of selection bias on these forums so medical students shouldn't be complacent, nor should they be scared away from applying to psychiatry. It is still true the vast majority of applicants match in their first 3 or 4 choices, but exceptions can happen. For those of you who are disappointed, I get it. It is hard to relate kindly to the weatherman who reported a mild to moderate chance of tornados when you lose your house. Most people spend a couple of hours eating canned food in the basement and that is about it. When these things have your number, it is hard not to feel singled out.

 

[dl2dp2]

There can be a lot of selection bias on these forums so medical students shouldn't be complacent, nor should they be scared away from applying to psychiatry. It is still true the vast majority of applicants match in their first 3 or 4 choices, but exceptions can happen. For those of you who are disappointed, I get it. It is hard to relate kindly to the weatherman who reported a mild to moderate chance of tornados when you lose your house. Most people spend a couple of hours eating canned food in the basement and that is about it. When these things have your number, it is hard not to feel singled out.

Agree 100%. I'd say psych now is middle of the pack in terms of competitiveness, but the field is large enough that if you really want a spot you'll get a spot in general, if you apply widely. Psych programs at public facilities or out in the boonies still have problems attracting non-DO AMGs. I think psych will eventually approach middle of the pack large specialties like EM and rads and stablize there. Due the the large number of programs and size of the work force it'll never be like derm or ortho.

That said, within psych, top 5-10% programs within top markets for top (most competitive) jobs (i.e. fancy cash, top academic etc) are already comparably competitive as a top lifestyle track like derm/GI etc. The competitiveness is mainly limited at that level due to self-selection. People who go into neurosurgery are very different from the starting point.

 

[SDunkey]

Apply widely and really show a dedication to the field with your application. It really is getting competitive, but I feel like my PS and extracurricular helped a lot.

 

[dl2dp2]

Yeah: check the data in this. Looks like psych this year is sort of similar (slight less competitive) to anesthesia/OBGYN. 60%ish US seniors. Number needed to rank per spot is low (<4). This means people are complacent and not applying to enough spots. The 10%ish US seniors not matching (on par with derm) is also strange and concerning (am I reading the figure right??--guess some of the above posters referenced this).

IMG proportions are also dropping quickly: 10%+ in 4 years.

Match Data

Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…

www.nrmp.org

 

[MacDonaldTriad]

Medical schools are opening and expanding much faster than post graduate programs. This puts the squeeze on IMGs for sure. Psychiatry has drifted from roughly 50% IMG to 40% IMG, but if you look at the % of US grads going into psych, it is flat. There are just more of them. The take home message is don't buy stock in Caribbean Medical Schools. It is going to get much tougher for their graduates.

 

[billybb]

Medical schools are opening and expanding much faster than post graduate programs. This puts the squeeze on IMGs for sure. Psychiatry has drifted from roughly 50% IMG to 40% IMG, but if you look at the % of US grads going into psych, it is flat. There are just more of them. The take home message is don't buy stock in Caribbean Medical Schools. It is going to get much tougher for their graduates.

You are actually incorrect. 60.6% US seniors are ONLY allopathic seniors. Osteopathic seniors are not included there. In last years match, IMG accounted for only 16.4% (half of them US IMGs, look at page 3 for ref: https://mk0nrmpcikgb8jxyd19h.kinsta.../Charting-Outcomes-in-the-Match-2018-IMGs.pdf). I don't know the specifics of this year's match, but the drop in IMG is from 50 to roughly 15-20%, not 40%.

 

[MacDonaldTriad]

Thank you for the correction. If you are right, then I made the same error with the 50% and maybe this is more 30% to 20%. At any rate, IMG rates are down and US grads are up, but only in proportion to school expansion.

 

[puahate]

projected pseudo-Derm tier competitiveness in 5 to 10 years

 

[NontradCA]

It doesn’t matter how competitive it is. It’s not derm or ortho. There are a ton of spots. Just do the best you can to become the most competitive candidate because it’s going to put you in the best possible position for your career. And it’s also good for patients for you to do the best you can. Especially in a phase where, as a student, it’s going to be the foundation for the doctor you’re going to be.

 

[ridethecliche]

Yeah: check the data in this. Looks like psych this year is sort of similar (slight less competitive) to anesthesia/OBGYN. 60%ish US seniors. Number needed to rank per spot is low (<4). This means people are complacent and not applying to enough spots. The 10%ish US seniors not matching (on par with derm) is also strange and concerning (am I reading the figure right??--guess some of the above posters referenced this).

IMG proportions are also dropping quickly: 10%+ in 4 years.

Match Data

Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…

www.nrmp.org

Number needed to rank per spot is applicants ranked for programs to fill a spot?

 

[deleted736562]

The most striking thing about those stats is that the number of non-US IMG matched applicants has gone up and so has % matched, hitting almost record levels at 60%. I remember a few years ago when everyone was predicting that IMGs will be squeezed out. Never happened but in fact the opposite has occurred. Just sayin.

 

[Dharma]

Ahhhh... reminds me of the pre-med and med students forums. Good times.

 

[MacDonaldTriad]

The most striking thing about those stats is that the number of non-US IMG applicants has gone up and so has % matched, hitting almost record levels at 60%. I remember a few years ago when everyone was predicting that IMGs will be squeezed out. Never happened but in fact the opposite has occurred. Just sayin.

If 16% of matches were IMG and roughly half were US-IMG, how can US grads go up, non-US-IMGs go up without US-IMG tanking? Are we sure the number of non-US IMGs were up as well as the %? This would have to come out of somewhere. I know the 2017 data showed both categories of IMGs dropping. What I haven't found is the table that shows multiple years.

 

[billybb]

The most striking thing about those stats is that the number of non-US IMG applicants has gone up and so has % matched, hitting almost record levels at 60%. I remember a few years ago when everyone was predicting that IMGs will be squeezed out. Never happened but in fact the opposite has occurred. Just sayin.

That is also not true. Look at the link I referenced above. Only 131 out of 370 total non-US IMGs matched which translates to roughly 30-40% match rate.

 

[deleted736562]

If 16% of matches were IMG and roughly half were US-IMG, how can US grads go up, non-US-IMGs go up without US-IMG tanking? Are we sure the number of non-US IMGs were up as well as the %? This would have to come out of somewhere. I know the 2017 data showed both categories of IMGs dropping. What I haven't found is the table that shows multiple years.

The number of matched non-US IMGs has gone up and so the %, but not the total number. However it's clear the doomsday prediction given 5-6 years ago never materialized. There are more matched non-US IMGs in 2019 than in any of the past 5 years. To clarify, this includes all specialties, and not just psych.

 

[GEToutLADYits6AM]

The number of matched non-US IMGs has gone up and so the %, but not the total number. However it's clear the doomsday prediction given 5-6 years ago never materialized. There are more matched non-US IMGs in 2019 than in any of the past 5 years.

How is this even possible with so many us grads not even being able to get placed anywhere?

 

[deleted736562]

That is also not true. Look at the link I referenced above. Only 131 out of 370 total non-US IMGs matched which translates to roughly 30-40% match rate.

How is this even possible with so many us grads not even being able to get placed anywhere?

This is not for psychiatry only but for all specialties.

https://mk0nrmpcikgb8jxyd19h.kinsta...oads/2019/03/Advance-Data-Tables-2019_WWW.pdf Table 4.

 

[MacDonaldTriad]

Ok, so this whole discussion has been apples and oranges.

 

[deleted736562]

Ok, so this whole discussion has been apples and oranges.

Sorry I strayed out of topic but wanted to point this out as I remember significant gloom for IMGs at the time I was in med school that never materialized.

 

[MacDonaldTriad]

So I found my hard copy of the results from 2017. So the total # of positions was 1495 in 2017 and was 1556 this year. The number of applicants was 2614 and this dropped to 2383 this year. The number of IMGs getting into psych regardless of citizenship starting in 2013 was 394, 387, 342, 294, 303, and this year 255. So there was a blip up in 2017, but this year was the lowest in 6 years. The % that get in is too much of a function of how many try. As #getting in drops, probably more will try other specialties and the % may even go up.

 

[GEToutLADYits6AM]

we need trump to ban IMGs from applying. If they want to become a physician in the united states, then they must go to an umerican school!!

 

[MacDonaldTriad]

Oh my

 

[BiscoDisco]

Yeehaw get em cowboy

 

[Espadaleader]

Field is competitive. It is as not as USMLE driven as Ortho/Derm etc. (i.e. you can get by with a 230+ at an elite level), but I think these program put emphasis on real accomplishments. MPA/MPP/MBA/MPH, research, advocacy. This stuff is valued at the top in this field in a way that other fields don't care about because the practice of psychiatry is related to it. I would say getting into a top 10 Psych spot is like getting into a rando Derm spot.

 

[FlowRate]

most programs give zero weight to having an MPH/MBA etc in itself

And some places (faculty dependent) may even have a bias against it (especially MBA).

 

[MacDonaldTriad]

"I wanted to be extra prepared for medical school so I got my master's in science after my BS before I went to medical school".
Translation: "I didn't get in the first time so I had some time to kill".

There are legitimate MD/MPH programs, but often MBAs and such can be a way of distracting programs from noticing there was a break in education for some reason. PhDs are a completely different and pass the "really and why" test rather automatically.

If given the choice, wouldn't you take the guy who spent a few years developing a company that designed roller coasters over an MBA who studied with an emphasis on Venn diagrams? It is easy to hate MBAs. They are always hired to come in and tell you they know how to run your operation better than you when they have little to no experience. "I think we can identify some useful quick wins". (Me)