How has the relative competitiveness of specialties changed over time?

[Euxox]

I was reading this article and this sentence got me thinking:

Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.

But IM and general surgery have so many positions compared to other specialties! I just can't wrap my head around this, but it does really spark my curiosity.

Do any of the older forum members care to share what the landscape looked like in the past? How has the relative prestige of different specialties changed over time? How was the match different back in the days where there were more positions than applicants? What were the years in and around the dot-com bubble like? Were there any specialties that didn't exist thirty years ago? Specialties that once existed but no longer do?

And what about the future? I would guess that changing reimbursement rates will reduce the number of applicants for ROAD specialties. That and telemedicine and increasing scope of practice for optometrists and nurse anesthetists. Any other guesses? (Just for fun. Hopefully no one will read this thread and try use it to pick a specialty.)

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[Ace-Co-A]

Looks like this has come up a time or two:

(1) http://forums.studentdoctor.net/threads/most-competitive-fields-of-medicine-30-years-ago.921535/

(2) http://forums.studentdoctor.net/thr...ecialties-also-competive-20-years-ago.861145/

Interesting stuff, tho, @Euxox ...

 

[Cyberdyne 101]

Somewhere in this thread, an ortho candidate mentioned how a 240 USMLE used to be a "golden ticket" into orthopedics, but that it's now fairly pedestrian (he may have been quoting Dr. William Levine, who's at Columbia and is actively involved in the orthogate site). Anyway, here's the link:
http://www.orthogate.org/forums/viewtopic.php?f=1&t=8824
So it looks like orthopedics has gotten more competitive.

 

[Fabio Lanzoni]

Somewhere in this thread, an ortho candidate mentioned how a 240 USMLE used to be a "golden ticket" into orthopedics, but that it's now fairly pedestrian (he may have been quoting Dr. William Levine, who's at Columbia and is actively involved in the orthogate site). Anyway, here's the link:
http://www.orthogate.org/forums/viewtopic.php?f=1&t=8824
So it looks like orthopedics has gotten more competitive.

A lot of very unimpressive scores used to be "golden tickets" to a lot of things going back a couple of decades.

 

[Cyberdyne 101]

A lot of very unimpressive scores used to be "golden tickets" to a lot of things going back a couple of decades.

That doesn't surprise me. I just pay more attention to ortho.

 

[GoPelicans]

Competitiveness has always correlated to salary.

 

[Cyberdyne 101]

According to this thread
http://forums.studentdoctor.net/threads/lifestyle-of-a-vascular-surgeon.449862/
vascular surgery has changed (seemingly for the better) due to the newer endovascular techniques. Also, more ppl are doing integrated programs rather than taking the traditional (gen surg + fellowship), which makes for a more expeditious path. But I really have no idea how this correlates with competitiveness vs other surgical specialties.

 

[DermViser]

Competitiveness has always correlated to salary.

Uh, no. Try again. In the modern match era, it's more correlated with lifestyle. Millenial medical students are more willing to trade higher income for a specialty that has either a good lifestyle or a controlled lifestyle, both in residency and beyond.

Hence popularity of specialties such as Radiology, Ophthalmology, Anesthesiology, Dermatology, PM&R, EM, Psych, Path, Rad Onc, etc. as well as subspecialties that are lifestyle friendly.

 

[Kaputt]

Competitiveness has always correlated to salary.

Which is why everyone is clawing to get into neurosurgery.

I am joking if you can't tell.

DermViser is right. Lifestyle > money. Because some specialties will destroy your personal life to get you that money.

 

[Fabio Lanzoni]

That doesn't surprise me. I just pay more attention to ortho.

I was shadowing some docs and they thought my scores (LizzyM ~72) were Ivy shoo-in material and were shocked I didn't bother applying

 

[Cyberdyne 101]

Which is why everyone is clawing to get into neurosurgery.

I am joking if you can't tell.

DermViser is right. Lifestyle > money. Because some specialties will destroy
your personal life to get you that money.

So working 85+ hrs a week as an attending spine surgeon isn't "the life" then. Learn something new everyday lol.

 

[Cyberdyne 101]

I was shadowing some docs and they thought my scores (LizzyM ~72) were Ivy shoo-in material and were shocked I didn't bother applying

Not long ago I met a Cornell Med alum who told me she paid $5000 a year for tuition when she was a student there.

 

[Kaputt]

So working 85+ hrs a week as an attending spine surgeon isn't "the life" then. Learn something new everyday lol.

Shocking, isn't it? And yet all the time on sdn we have 17 year olds wondering about how their AP test scores will affect their chances of getting into neurosurgery residency.

 

[Cyberdyne 101]

Shocking, isn't it? And yet all the time on sdn we have 17 year olds wondering about how their AP test scores will affect their chances of getting into neurosurgery residency.

In all fairness, there are neurosurgeons that do not work insane hours as attendings:
http://www.neurosurgic.com/index.ph...how-many-hours-do-you-spend-on-work-each-week
And some residency programs seem to be friendlier than others. For example, I think Vanderbilt gives junior residents weekends off.
But yeah, you don't want that AP chem score to ruin your chances for matching at Hopkins. Also, you can't go to med school unless you attend an Ivy League undergrad so those AP scores can't be subpar.

 

[Kaputt]

In all fairness, there are neurosurgeons that do not work insane hours as attendings:
http://www.neurosurgic.com/index.ph...how-many-hours-do-you-spend-on-work-each-week
And some residency programs seem to be friendlier than others. For example, I think Vanderbilt gives junior residents weekends off.
But yeah, you don't want that AP chem score to ruin your chances for matching at Hopkins. Also, you can't go to med school unless you attend an Ivy League undergrad so those AP scores can't be subpar.

As a soon-to-be radiology resident, the idea that a program has to brag about giving junior residents weekends off disturbs me. The moment a radiology resident has to stay past 5pm on a regular day, it's like the world is crashing down.

 

[D4C]

Not long ago I met a Cornell Med alum who told me she paid $5000 a year for tuition when she was a student there.

Must have been nice!

 

[Cyberdyne 101]

Must have been nice!

Too bad it's probably over $60K now.

 

[Winged Scapula]

Somewhere in this thread, an ortho candidate mentioned how a 240 USMLE used to be a "golden ticket" into orthopedics, but that it's now fairly pedestrian (he may have been quoting Dr. William Levine, who's at Columbia and is actively involved in the orthogate site). Anyway, here's the link:
http://www.orthogate.org/forums/viewtopic.php?f=1&t=8824
So it looks like orthopedics has gotten more competitive.

Its not that Ortho has gotten that much more competitive recently, its just that the average USMLE Step 1 score has increased (teaching to the exam, score inflation, what have you). 20 years ago the average Step 1 score was around 200-210, so 240 was phenomenal. However, most specialties have waxed and waned in popularity; GS certainly experienced an uptick with work hour restrictions, Anesthesia and Rads have decreased in popularity.

In all fairness, there are neurosurgeons that do not work insane hours as attendings:
http://www.neurosurgic.com/index.ph...how-many-hours-do-you-spend-on-work-each-week
And some residency programs seem to be friendlier than others. For example, I think Vanderbilt gives junior residents weekends off.

While Vandy has not applied for the 88 hour work week extension, I can see no evidence that they "give junior residents weekends off". It appears to me that they follow the standard rules, which is 1 day in 7 off for all their residents.

 

[GoPelicans]

Which is why everyone is clawing to get into neurosurgery.

I am joking if you can't tell.

Last I checked, neurosurgery is extremely competitive.

And I don't disagree that lifestyle plays a huge role in people's specialty decisions, I was just trying to give OP a simple albeit incomplete means to gauge competitiveness of different things.

 

[Cyberdyne 101]

Its not that Ortho has gotten that much more competitive recently, its just that the average USMLE Step 1 score has increased (teaching to the exam, score inflation, what have you). 20 years ago the average Step 1 score was around 200-210, so 240 was phenomenal. However, most specialties have waxed and waned in popularity; GS certainly experienced an uptick with work hour restrictions, Anesthesia and Rads have decreased in popularity.



While Vandy has not applied for the 88 hour work week extension, I can see no evidence that they "give junior residents weekends off". It appears to me that they follow the standard rules, which is 1 day in 7 off for all their residents.

My source for this was Uncle Harvey, which is now MIA
On the other hand, maybe it evens out with a night float set-up. But there are some programs that seem to be more "insane" than others in terms of work hours.

 

[Winged Scapula]

Last I checked, neurosurgery is extremely competitive.

No, its competitive; there are many specialties which are more competitive. Nsgy has a self-selected population to be sure but it is not considered "extremely" competitive.

My source for this was Uncle Harvey, which is now MIA
On the other hand, maybe it evens out with a night float set-up. But there are some programs that seem to be more "insane" than others in terms of work hours.

RE: Uncle Harvey - SDN will be working with them to take over their forums, so it may resurface at some point

What you heard may be true, an "unofficial" policy although it would be unusual as much of Nsgy trauma tends to come in on the weekends so having the junior residents on call during the weekend is not only fair but educationally advantageous. Its also hard to develop a call schedule if interns, PGY2-4 are not taking call on weekends. Perhaps what they meant was that if you aren't on call, you don't have to come in on the weekends which is not unusual. My GS program did that as well *on some rotations* where the Chief residents and attendings were more work hour/lifestyle understanding.

There are definitely programs with worse hours, which is why I posted the factoid about them not applying for the 88 hour exception.

 

[SouthernSurgeon]

As a soon-to-be radiology resident, the idea that a program has to brag about giving junior residents weekends off disturbs me. The moment a radiology resident has to stay past 5pm on a regular day, it's like the world is crashing down.

I got way more weekend off my intern year (general surgery) than did my medicine colleagues. Due to the way their call system was set up, they got their one day off in seven - but it was always just one day at a time, and was mostly on a random weekday. Our call system was set up so that we got usually two weekends off per month, including one "golden" weekend (i.e. post-call Friday morning, off Sat/Sun).

 

[Cyberdyne 101]

As a soon-to-be radiology resident, the idea that a program has to brag about giving junior residents weekends off disturbs me. The moment a radiology resident has to stay past 5pm on a regular day, it's like the world is crashing down.

Do you plan on doing an IR fellowship after residency?

 

[Kaputt]

Last I checked, neurosurgery is extremely competitive.

And I don't disagree that lifestyle plays a huge role in people's specialty decisions, I was just trying to give OP a simple albeit incomplete means to gauge competitiveness of different things.

You're wrong, neurosurgery is not "extremely" competitive. Like WS said, there are massive amounts of self-selection in neurosurgery. It does not have broad appeal and is not one of the fields that the undecided 260+ folks end up going into. And the reason is largely lifestyle. The folks who love surgery and want a decent post-residency lifestyle pick stuff like ENT and uro because they have lots of outpatient procedures that tend to make their lifestyles better. Neurosurgery isn't like that. The only people who ever go into it will be people who are gluttons for punishment.

 

[Kaputt]

Do you plan on doing an IR fellowship after residency?

no, I don't mind doing basic IR but I have no interest in the meaty endovascular stuff. Too much like surgery for me. I'll be going into DR for sure.

 

[deanthedream17]

My father a general surgeon told me general surgery and neurosurgery used to be very highly requested, but is nowhere near as competitive since it comes with a lot of headaches and medical malpractice problems.

 

[shiftingmirage]

How has the relative prestige of different specialties changed over time?

I think there is a distinction to be made between prestige and competitiveness. Derm is very competitive, but if physicians were asked to rank the prestige of different specialties, excluding their own, I doubt derm would be #1. Plastics, again competitive. Had a really smart friend doing medicine at BID. I joked about her going into plastics and she said she couldn't really see herself doing boob jobs for a living.

It seems like the lifestyle specialties are becoming more popular and therefore competitive and things like ortho are deemed macho making them more attractive.

 

[shiftingmirage]

.

 

[DermViser]

Last I checked, neurosurgery is extremely competitive.

And I don't disagree that lifestyle plays a huge role in people's specialty decisions, I was just trying to give OP a simple albeit incomplete means to gauge competitiveness of different things.

Your statement on this thread read, "Competitiveness has always correlated to salary."

That is absolutely wrong. Your "simple albeit incomplete means to gauge competitiveness" is also wrong.

https://www.aamc.org/newsroom/reporter/336402/work-life.html

 

[Winged Scapula]

Plastics, again competitive. Had a really smart friend doing medicine at BID. I joked about her going into plastics and she said she couldn't really see herself doing boob jobs for a living.

Your friend is then woefully under informed about PRS. Ask the surgeon who reconstructs the breast of someone who has been affected by cancer, who treats a 7 yo burned in a house fire, who repairs the face of a syndromic child or replants a hand lost in an industrial accident if they feel like they're "doing boob jobs for a living". Aesthetic plastics is a very small part of the field and to assume otherwise is insulting to our colleagues who work hard at providing some normalcy for patients with congenital, traumatic and other acquired abnormalities.

 

[Cyberdyne 101]

You're wrong, neurosurgery is not "extremely" competitive. Like WS said, there are massive amounts of self-selection in neurosurgery. It does not have broad appeal and is not one of the fields that the undecided 260+ folks end up going into. And the reason is largely lifestyle. The folks who love surgery and want a decent post-residency lifestyle pick stuff like ENT and uro because they have lots of outpatient procedures that tend to make their lifestyles better. Neurosurgery isn't like that. The only people who ever go into it will be people who are gluttons for punishment.

Or ppl who simply think a 12 hr aneurysm surgery and/or 10 hr chordoma resection is the best way to spend their time. I've met a couple of med students who said they wouldn't want to do anything else. But then again, this was prior to actually doing a NS rotation.

 

[Winged Scapula]

Or ppl who simply think a 12 hr aneurysm surgery and/or 10 hr chordoma resection is the best way to spend their time. I've met a couple of med students who said they wouldn't want to do anything else. But then again, this was prior to actually doing a NS rotation.

Exactly. It isn't punishment if you enjoy doing it.

 

[type12]

Your statement on this thread read, "Competitiveness has always correlated to salary."

That is absolutely wrong. Your "simple albeit incomplete means to gauge competitiveness" is also wrong.

https://www.aamc.org/newsroom/reporter/336402/work-life.html

Wouldn't this just increase demand since the normal numbers of hours are being lost, which in turn would increase the hourly rate?

Example: Anesthesiologist wants to work 10 hours less. Those 10 hours are filled by a part-time anesthesiologist for 1.5x the pay.

 

[Kaputt]

Or ppl who simply think a 12 hr aneurysm surgery and/or 10 hr chordoma resection is the best way to spend their time. I've met a couple of med students who said they wouldn't want to do anything else. But then again, this was prior to actually doing a NS rotation.

In my experience, these are typically very naive and insecure students who think their self-worth should be defined by their job. When they're on their 3rd divorce I think they might be wishing they chose something else. Different strokes for different folks, but some specialties lend themselves to horrible personal lives. If you don't want a personal life, go for it. But as someone who does not want their life defined by their job, I'll never fully understand it.

 

[mrh125]

Probably all minus primary care type specialities: more competitive and harder to get into. admissions standards are having to be raised due to the competitive nature of <insert discipline here>.

 

[Cyberdyne 101]

In my experience, these are typically very naive and insecure students who think their self-worth should be defined by their job. When they're on their 3rd divorce I think they might be wishing they chose something else. Different strokes for different folks, but some specialties lend themselves to horrible personal lives. If you don't want a personal life, go for it. But as someone who does not want their life defined by their job, I'll never fully understand it.

There has to be the possibility for some sort of balance though. The free time won't be as abundant as in other fields, but I'd like to think that some neurosurgeons do have time for other things.

 

[DermViser]

I think there is a distinction to be made between prestige and competitiveness. Derm is very competitive, but if physicians were asked to rank the prestige of different specialties, excluding their own, I doubt derm would be #1. Plastics, again competitive. Had a really smart friend doing medicine at BID. I joked about her going into plastics and she said she couldn't really see herself doing boob jobs for a living.

It seems like the lifestyle specialties are becoming more popular and therefore competitive and things like ortho are deemed macho making them more attractive.

You asked someone doing Internal Medicine at BIDMC about Plastics? Your comment regarding Ortho shows you know nothing about what constitutes something being competitive for the millenial medical student.

 

[waiting too long]

Life decisions for some people will always be more attuned to money while others choose lifestyle and/or job satisfaction. It's a no-win arguement. Life is rarely black and white; for example why are all these threads posted about "help me choose: I really want to go to X medical school but Y gave me a bigger scholarship!" Let's face it, many people are attracted to medicine because of the income. Each person gives more weight to different factors. Personally, I don't think money buys life satisfaction, happiness or a marriage that lasts.

 

[womp]

Percent of Unmatched US Seniors in 2014 (from NRMP):

Neurosurg: 17.7%
ENT: 17.6%
Plastics: 17.3%
Ortho: 17.1%
Derm: 9.1%
Gen Surg: 8.7%
OBGYN: 7.1%
Rad Onc: 6.0%
Psych: 3.6%
EM: 3.4%
Family Med: 3.1%
Peds: 3.0%
Neurology: 2.6%
IM: 2.0%
Anesthesia: 2.0%
Radiology: 1.0%

I don't think it's a stretch to say neurosurgery is still very competitive.

Note, this is only part of the equation of competiveness (the supply and demand). You will also need to incorporate average Step 1 scores or AOA to get the full picture. Unfortunately, we do not have average Step 1 scores since 2011 Charting Outcomes, although the surgical subspecialties are likely to remain in 240+ range.

 

[womp]

Which is why everyone is clawing to get into neurosurgery.

I am joking if you can't tell.

DermViser is right. Lifestyle > money. Because some specialties will destroy your personal life to get you that money.

Lifestyles of specialties also change. Radiologists now work much longer hours than they used to for less pay. That's like a double whammy.

When picking a specialty, you should look at a whole host of issues from the content of the specialty (as in, can you spend hours reading about the specialty in your "free time"), to fit or personality (can you get along with your colleagues in this field), to how well the specialty molds to your natural talents (if you like physics and comp sci, and hate talking to patients, then maybe radiology is a natural extension, or if you enjoyed your carpentry work for Habitat for Humanity then you might also think about ortho). And you will also need to decide if you want to have your own patients (PCP, psych, derm, ortho/ENT/uro/GS, IM specialists etc) or be primarily a consultant for other physicians (OR anesthesia, radiology, pathology etc).

Lots to think about than just lifestyle and money, both of which are subject to change. You couldn't pay me enough money to sit in a dark room for 10 hours reading to a speech recognition machine day in and day out. It's like being assigned to the hatch in Lost. To each his own, and that's what third or fourth year is for, to see that there's a lot more to this than money and lifestyle.

 

[Kaputt]

Lifestyles of specialties also change. Radiologists now work much longer hours than they used to for less pay. That's like a double whammy.

When picking a specialty, you should look at a whole host of issues from the content of the specialty (as in, can you spend hours reading about the specialty in your "free time"), to fit or personality (can you get along with your colleagues in this field), to how well the specialty molds to your natural talents (if you like physics and comp sci then maybe radiology or rad onc is a natural extension, or if you enjoyed your work for Habitat for Humanity then you might also think about ortho).

I also hear there are no radiology jobs, even in rural Idaho, unless you want to make $1 an hour. On the flip side, I hear there are hospitalist gigs where they give you free mansions in San Francisco to work 1 week on, 10 weeks off and pull $500k per year.

I hear even part-time PCPs make more than radiologists, in desirable locales, whereas all radiology jobs (even though there aren't any) are not even within 5 hours of major cities.

For more of this, please come to the troll infested radiology board.

 

[Amba]

Percent of Unmatched US Seniors in 2014 (from NRMP):

Neurosurg: 17.7%
ENT: 17.6%
Plastics: 17.3%
Ortho: 17.1%
Derm: 9.1%
Gen Surg: 8.7%
OBGYN: 7.1%
Rad Onc: 6.0%
Psych: 3.6%
EM: 3.4%
Family Med: 3.1%
Peds: 3.0%
Neurology: 2.6%
IM: 2.0%
Anesthesia: 2.0%
Radiology: 1.0%

I don't think it's a stretch to say neurosurgery is still very competitive.

Note, this is only part of the equation of competiveness (the supply and demand). You will also need to incorporate average Step 1 scores or AOA to get the full picture. Unfortunately, we do not have average Step 1 scores since 2011 Charting Outcomes, although the surgical subspecialties are likely to remain in 240+ range.

Percentage of unmatched US Seniors (2014) for Urology: 32%. Up from only 12% a couple years ago.

(source: http://www.auanet.org/education/urology-and-specialty-matches.cfm)

 

[womp]

I also hear there are no radiology jobs, even in rural Idaho, unless you want to make $1 an hour. On the flip side, I hear there are hospitalist gigs where they give you free mansions in San Francisco to work 1 week on, 10 weeks off and pull $500k per year.

I hear even part-time PCPs make more than radiologists, in desirable locales, whereas all radiology jobs (even though there aren't any) are not even within 5 hours of major cities.

For more of this, please come to the troll infested radiology board.

You got problems, bro.

 

[Kaputt]

You got problems, bro.

You must be fun at parties. A rock has a better sense of humor than you. Oh I forgot, you think all tongue-in-cheek forum posts are a sign of mental illness.

Why'd you even quote me if you didn't want me to respond? You know I like yanking your chain.

 

[circulus vitios]

I think there is a distinction to be made between prestige and competitiveness. Derm is very competitive, but if physicians were asked to rank the prestige of different specialties, excluding their own, I doubt derm would be #1. Plastics, again competitive. Had a really smart friend doing medicine at BID. I joked about her going into plastics and she said she couldn't really see herself doing boob jobs for a living.

It seems like the lifestyle specialties are becoming more popular and therefore competitive and things like ortho are deemed macho making them more attractive.

Funny, I bet the plastic surgeons couldn't see themselves groveling for collections on a $60 Medicare office visit.

 

[circulus vitios]

Wouldn't this just increase demand since the normal numbers of hours are being lost, which in turn would increase the hourly rate?

Example: Anesthesiologist wants to work 10 hours less. Those 10 hours are filled by a part-time anesthesiologist for 1.5x the pay.

What, no.

 

[type12]

What, no.

I know a handful of ER doctors at Northshore that do this, so you're going to have to do better than that (i.e., explain why not).

 

[Peskywabbit505]

I'm genuinely curious, friends: on a scale of 1 to 10, how competitive is neurosurgery? 1 being completely uncompetitive and 10 being you have to up the ladder and lick some boots for even a SLIVER of a chance to get matched. I'm in High School and it's my eventual goal and ambition to enter Neuro, so I'd really like someone educated on the subject to answer, not someone talking out of their anus on the matter. I've heard one of two things whilst talking to doctors about it:
1. neurosurgery is EXTREMELY competitive and it's in the same league as Derm and Plastics
2. neurosurgery is above average in competitiveness, but not as some other specialties because of the lifestyle and because they torture you in residency
I don't know what to believe and I need some good, honest feedback on this. Thanks in advance!!!

 

[DermViser]

I'm genuinely curious, friends: on a scale of 1 to 10, how competitive is neurosurgery? 1 being completely uncompetitive and 10 being you have to up the ladder and lick some boots for even a SLIVER of a chance to get matched. I'm in High School and it's my eventual goal and ambition to enter Neuro, so I'd really like someone educated on the subject to answer, not someone talking out of their anus on the matter. I've heard one of two things whilst talking to doctors about it:
1. neurosurgery is EXTREMELY competitive and it's in the same league as Derm and Plastics
2. neurosurgery is above average in competitiveness, but not as some other specialties because of the lifestyle and because they torture you in residency
I don't know what to believe and I need some good, honest feedback on this. Thanks in advance!!!

 

[Peskywabbit505]

Well, I'm incredibly fascinated by the brain, spine, and the peripheral nervous system, and I couldn't imagine doing anything else, really!