How will I ever know if I am competitive enough for a "competitive specialty"? I am considering doing a "less competitive" specialty.

[CuriousMDStudent]

Title sums it up. Urology matched 65% last year. I'm looking at the optho and the uro match threads on reddit and I am hearing about these amazing applicants not getting in because they got unlucky. Whether or not these people are lying or not I don't know. I know I don't have the full story. However, it's still a very scary thought.

For me, I'm interested in ortho but there's a 80% match rate. I also attend a T15 but last year out of the 4 that applied, only 2 matched. I know one of the two who didn't match and he was an average applicant according to nrmp statistics. I find the prospect of not being able to get a job after working so hard to get into medical school really scary. Especially with the loans I have accrued.

Currently, I have 6 ortho projects that have been written up and submitted to journals and conferences. None of them have been published yet. One of them was accepted to a conference but I won't be presenting since I am second author.

I have 2 issues/questions.
1. I never feel like I have enough. Like do I have enough research to get into ortho? Do I need more? I feel like it's so competitive to get in that I feel like I always need more. I feel that since STEP 1 is P/F for me, I keep feeling inadequate and wondering how many more publications other people have. Do I need more? Do I need a research year?
2. I keep thinking about other less competitive specialties. Specifically anesthesiology and internal medicine. More anesthesiology right now. I really like that there's still a procedural aspect to it (intubation + putting in lines). I like that the lifestyle is good as well. Also, I talked to people in my school's anesthesiology department and how everyone who applies anesthesia at my school matches and get one of their top 3 choices mostly and how I won't need to do more research if I didn't want to and that is such a major relief. I am not a big fan of research and I like the idea of applying into a specialty with a pretty safe match rate. However, do I really want to give up my aspiration of becoming an ortho surgeon for a "safer career". I keep wondering if I will regret it down the road and ask myself "what if I did try". Or what if my ego gets bruised as I work with other surgeons and keep wondering "Man, I could've been a surgeon". I have heard that no anesthesiologist has ever wished to be a surgeon and surgical residents have switched to becoming anesthesiologists.

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[mrbreakfast]

I find the prospect of not being able to get a job after working so hard to get into medical school really scary.

Not matching into specialty X =/= not getting a job. People dual apply, scramble, or reapply. I personally know a single MD (out of hundreds) who didn't match either initially or on on reapplication. If you graduate from medical school in good standing and are able to hold a normal conversation for 3 minutes, you'll get a residency spot. It might not necessarily be in your top choice of specialty, but you'll get one.

Like do I have enough research to get into ortho?

Well, you have zero publications, so probably not. That could change, but you should never assume a submitted paper will be published.

2. I keep thinking about other less competitive specialties.

No one can answer this for you. This is what clinicals are for. Cool, you're interested in surgery; so is a third of your class. 75% of them will change their minds by the end of their first week on their surgical rotation.

You need to decide if you want to be a surgeon (of any kind) or not first. If you're set on surgery, you can always dual apply ortho-gen surg. If not, you've got plenty of options. You don't have to decide today; you don't even have to decide in the next 12 months.

 

[Aurarice]

Imo the fact that you already have 6 projects submitted is a big step in the right direction and says that you're putting in the work. Considering your other posts that I've seen, it looks like you're an MS2, which means you still have a full year to get a whole lot of work done.

- Keep working on research. Worst case scenario, you can try the paper in a different journal or a different conference. Definitely keep in touch with your mentor/PI's, though. (As an aside, not EVERY project needs to be ortho, so that may be just a helpful side route)
- Do well in your classes, rotations, and STEP2.
- Network. Going to a T15 school helps loads with that aspect, especially if you have a home program you're interested in.
- Make sure you're actually interested in ortho via surgical selective rotations. Keep your mind open throughout rotations. You may fall in love with an entirely different specialty, which would make your last point negligible because it's what you want to do.

As an added note, what you aspire for within medicine as a whole can change over time.
I've heard plenty of attendings, both in and out of the academic setting, who would have done something more lifestyle-centric because of family, friends, hobbies, etc. (Granted, they still absolutely LOVED what they do and don't particularly regret it.)

 

[calivianya]

You've posted a ton on this topic and I really think you're overthinking it. It's really simple - go for whatever you want to. If you're applying to a competitive specialty, also apply to your second favorite, less competitive specialty, and do this regardless of how good your app is. There is no limit on the number of programs or specialties you can apply to on ERAS.

But more importantly, you're legit questioning whether you should give up trying for a future career that you want and settle for something easier to match because you're worried about matching, and you have done so over and over in multiple threads. This behavior pattern makes me a little concerned about where you're at with managing your stress. Obviously I don't know you, but if you're talking about not even trying for a potentially 30+ year future career because of temporary stress, I would consider trying counseling first to see if you can learn some healthier coping mechanisms. Obviously if you do rotations in both anesthesia and ortho and like anesthesia better, you'll be happy in anesthesia. But if you let your stress and anxiety get the better of you and skip applying ortho just because of anxiety, which is very treatable, I think you may regret it later.

 

[Med Ed]

How do you know you're competitive enough?

You don't. You just do your best, apply smartly, hope things go well, and have a backup plan ready to engage. At the end of the day, what else can you do?

 

[Browns99]

How do you know you're competitive enough?

You don't. You just do your best, apply smartly, hope things go well, and have a backup plan ready to engage. At the end of the day, what else can you do?

Title sums it up. Urology matched 65% last year. I'm looking at the optho and the uro match threads on reddit and I am hearing about these amazing applicants not getting in because they got unlucky. Whether or not these people are lying or not I don't know. I know I don't have the full story. However, it's still a very scary thought.

For me, I'm interested in ortho but there's a 80% match rate. I also attend a T15 but last year out of the 4 that applied, only 2 matched. I know one of the two who didn't match and he was an average applicant according to nrmp statistics. I find the prospect of not being able to get a job after working so hard to get into medical school really scary. Especially with the loans I have accrued.

Currently, I have 6 ortho projects that have been written up and submitted to journals and conferences. None of them have been published yet. One of them was accepted to a conference but I won't be presenting since I am second author.

I have 2 issues/questions.
1. I never feel like I have enough. Like do I have enough research to get into ortho? Do I need more? I feel like it's so competitive to get in that I feel like I always need more. I feel that since STEP 1 is P/F for me, I keep feeling inadequate and wondering how many more publications other people have. Do I need more? Do I need a research year?
2. I keep thinking about other less competitive specialties. Specifically anesthesiology and internal medicine. More anesthesiology right now. I really like that there's still a procedural aspect to it (intubation + putting in lines). I like that the lifestyle is good as well. Also, I talked to people in my school's anesthesiology department and how everyone who applies anesthesia at my school matches and get one of their top 3 choices mostly and how I won't need to do more research if I didn't want to and that is such a major relief. I am not a big fan of research and I like the idea of applying into a specialty with a pretty safe match rate. However, do I really want to give up my aspiration of becoming an ortho surgeon for a "safer career". I keep wondering if I will regret it down the road and ask myself "what if I did try". Or what if my ego gets bruised as I work with other surgeons and keep wondering "Man, I could've been a surgeon". I have heard that no anesthesiologist has ever wished to be a surgeon and surgical residents have switched to becoming anesthesiologists.

Seriously, have some damn confidence. Make yourself competitive for the field you want and go after it. You should go into a field you find interesting and can see doing the rest of your professional career. If that field is competitive, then go look at the data for accepted applicants and follow. Grades, Step II, research and one of the most important....get outstanding letters of rec if you can.

Lastly, some will say apply to less competitive as a back-up, I say this advice applies to those that know deep inside they are not competitive enough, so to avoid that, work hard, try to seek out mentors that are well-known in the speciality field you want, be likable on your rotations and the rest will follow.

 

[DOVinciRobot]

I can promise you 100% that if your heart is set on a surgical field and you don’t apply simply because you’re worried about competition you will be miserable the rest of your career wondering “what if.”

If you apply and don’t match that’s one thing, because you tried and you can know you gave it your best effort, but don’t just not try because things are competitive.

 

[efle]

Shoot your shot with a safety net. Dual apply

 

[aldol16]

For me, I'm interested in ortho but there's a 80% match rate

Match rate is likely to go down this year and in the coming years due to the massive numbers not matching last year, which produces a cascade effect. Check on the match rate after Match Day and see where things lie.

Currently, I have 6 ortho projects that have been written up and submitted to journals and conferences. None of them have been published yet. One of them was accepted to a conference but I won't be presenting since I am second author.

Worry less about the number but more about who you did those projects with (PI) and whether they got to know you well enough to vouch for you. You never know who knows who and they could end up making the critical call for you. In small fields, who you know matters. The rest is out of your hands - it's factors you can't necessarily control (i.e., not your scores, research, letters, etc.).

1. I never feel like I have enough. Like do I have enough research to get into ortho? Do I need more? I feel like it's so competitive to get in that I feel like I always need more. I feel that since STEP 1 is P/F for me, I keep feeling inadequate and wondering how many more publications other people have. Do I need more? Do I need a research year?

It's not all about research. Yes, research numbers are high for competitive specialties. But they're not everything - people with very little research (relatively speaking) match. You have to think about what your strengths are that set you apart from everyone else. When everyone is doing research, it's hard for a program to justify interviewing someone just because they had 20 publications rather than 10. They might very well interview the person with 10 interviews if they're interesting in another way. So you need to convey those other attributes on your application.

 

[homunculusus]

Not matching into specialty X =/= not getting a job. People dual apply, scramble, or reapply. I personally know a single MD (out of hundreds) who didn't match either initially or on on reapplication. If you graduate from medical school in good standing and are able to hold a normal conversation for 3 minutes, you'll get a residency spot. It might not necessarily be in your top choice of specialty, but you'll get one.

Heck, I know IMGs who failed Step 1 the first time and still matched IM then PCCM and H/O. Also seen a few FMGs who can barely put together two sentences. US MDs are always freaking out over nothing

 

[Chelsea FC]

Why do you care about a competitive specialty?? Like try and free yourself from the med school/ pre-med rat race of going for the shiny object and chase prestige etc. life is a lot more than that.

 

[efle]

Why do you care about a competitive specialty?? Like try and free yourself from the med school/ pre-med rat race of going for the shiny object and chase prestige etc. life is a lot more than that.

I too fell into the trap of the undifferentiated student and assumed competitive things were competitive for a reason.

What I didnt realize was the reason is mostly being small fields with few spots, and not that most high performers like the field better.

 

[Hzreio]

Why do you care about a competitive specialty?? Like try and free yourself from the med school/ pre-med rat race of going for the shiny object and chase prestige etc. life is a lot more than that.

Lol acting like there are no financial or lifestyle incentives to a lot of the competitive specialties…

 

[Chelsea FC]

Minus Derm not a lot of these highly competitive fields are lifestyle specialties. If money is what OP is after then fine, but alot of people just chase competitive specialties because they think that's what they should be doing. And people who are making 500K in derm, ENT and optho??? are def working hard, and even though there are setups where you can make good money working fewer hours. The most common theme are these highly competitive specialties that you work hard in, the additional hours don't stop after becoming attendings. At the end of the day all im saying is just dont run after the shiny objects because thats what everyone else is doing. Tons of avenues in medicine and ways to make money that doesn't involve chasing after a competitive specialty

 

[voxveritatisetlucis]

Would a red flag that kept one out of top schools keep one out of competitive specialties. I talked to a prosecutor today and she assented to my motion to seal past record, so I don’t think it will have to go on ERAS?

In the state, sealing is equivalent to it never happening. I know for licensure and such, it will have to be disclosed but not for residency apps.

 

[Lawpy]

Would a red flag that kept one out of top schools keep one out of competitive specialties. I talked to a prosecutor today and she assented to my motion to seal past record, so I don’t think it will have to go on ERAS?

In the state, sealing is equivalent to it never happening. I know for licensure and such, it will have to be disclosed but not for residency apps.

The expunge vs exonerate situation is problematic so i’m just going to tag @NotAProgDirector for insights

 

[odyssey2]

This. Anyone average can do anesthesia and make $500k, but making $500k in ophtho, derm or ENT is a heck lot less stressful - hence they're more competitive

Lol acting like there are no financial or lifestyle incentives to a lot of the competitive specialties…

As it relates to OP, anesthesia would absolutely have an easier residency than ortho, and possibly a better lifestyle as an attending if not necessarily as lucrative.
Most of the ultra-competitive fields are not "lifestyle" fields with the exception of derm and ophtho. Neurosurgery and IR have terrible lifestyles and the other surgical subspecialties still require a brutal residency. The only thing they have in common is high compensation. Path and psych have some of the best lifestyles in medicine and are still on the lower end of competitiveness.

 

[efle]

Here's a plot I threw together to ask "Do higher scoring medical students choose better compensated fields?"

Percent of 250+ from an old thread of mine and salary data from MGMA 2018. Note this is not the percent of the specialty with a 250+ score, which is obviously very different by the size of each field. Instead, it's what fraction of the 250+ crowd is choosing each field. IM is excluded because of the wide fellowship variety for both axes.

Answer: Nope, no relationship between typical specialty compensation and percent of high scorers matching it.

 

[Hzreio]

As it relates to OP, anesthesia would absolutely have an easier residency than ortho, and possibly a better lifestyle as an attending if not necessarily as lucrative.
Most of the ultra-competitive fields are not "lifestyle" fields with the exception of derm and ophtho. Neurosurgery and IR have terrible lifestyles and the other surgical subspecialties still require a brutal residency. The only thing they have in common is high compensation. Path and psych have some of the best lifestyles in medicine and are still on the lower end of competitiveness.

I’m speaking from an hourly compensation perspective. Psych is rising is competitiveness and not everyone wants to spend the rest of their careers doing microscope stuff.

No surgical subs (maybe except for ENT/uro partially) are conducive to lifestyle, but it is on the higher end of compensation. I don’t need to talk about the lifestyle benefits of derm/ophtho. Generally speaking, more competitive specialities provide more lucrative options. As a plastic surgeon for example you don’t have to bust your ass working 60 hrs per week and still clear over 500k easily.

People say gas is lifestyle but idk so many early mornings + the average hours worked per week is rising to 50-55+. Compensation is getting pretty nuts though from what I’ve heard anecdotally.

 

[voxveritatisetlucis]

I’m speaking from an hourly compensation perspective. Psych is rising is competitiveness and not everyone wants to spend the rest of their careers doing microscope stuff.

No surgical subs (maybe except for ENT/uro partially) are conducive to lifestyle, but it is on the higher end of compensation. I don’t need to talk about the lifestyle benefits of derm/ophtho. Generally speaking, more competitive specialities provide more lucrative options. As a plastic surgeon for example you don’t have to bust your ass working 60 hrs per week and still clear over 500k easily.

People say gas is lifestyle but idk so many early mornings + the average hours worked per week is rising to 50-55+. Compensation is getting pretty nuts though from what I’ve heard anecdotally.

Don’t you also have to factor in mental exhaustion/exertion when considering hourly pay of doctors in surgical specialties like plastics. I know the technology has come along way, but I imagine that the work of a plastic surgeon is much more stressful than say a psychiatrist, on average of course. There is probably a lot of stress involved with inpatient psych and such.

 

[NotAProgDirector]

Would a red flag that kept one out of top schools keep one out of competitive specialties. I talked to a prosecutor today and she assented to my motion to seal past record, so I don’t think it will have to go on ERAS?

In the state, sealing is equivalent to it never happening. I know for licensure and such, it will have to be disclosed but not for residency apps.

This is one of the most asked questions here. The rules for sealing / expunging / etc are different for every state, so no broad statements can be made. However, let's assume that in your state you legally can answer "no" to "were you ever convicted of a misdemeanor?". Theoretically you can simply answer no to the question in ERAS. But then if you're planning on disclosing it when you apply for a license, in many states you complete your licensing paperwork and send it to the program for submission and processing. So now the program is going to hear about it. Or, maybe it comes back on their background check. Or, maybe your program is affiliated with a VA and they do an FBI background check and it shows up. In all of those cases, you may now have an unhappy program. At best you can argue that you followed the letter of the law, but programs may not see it that way. It could impact your program's assessment of your professionalism. Or not.

Or, you could list it anyway. Then, some programs might pass you by because of it. But at least you'd know that any program that is interviewing you doesn't care. If the issue was in the distant past and not that serious, no one is going to care in any case.

As you can see, both paths may cause you some worry. You would need to pick the one that you can live with.

 

[voxveritatisetlucis]

This is one of the most asked questions here. The rules for sealing / expunging / etc are different for every state, so no broad statements can be made. However, let's assume that in your state you legally can answer "no" to "were you ever convicted of a misdemeanor?". Theoretically you can simply answer no to the question in ERAS. But then if you're planning on disclosing it when you apply for a license, in many states you complete your licensing paperwork and send it to the program for submission and processing. So now the program is going to hear about it. Or, maybe it comes back on their background check. Or, maybe your program is affiliated with a VA and they do an FBI background check and it shows up. In all of those cases, you may now have an unhappy program. At best you can argue that you followed the letter of the law, but programs may not see it that way. It could impact your program's assessment of your professionalism. Or not.

Or, you could list it anyway. Then, some programs might pass you by because of it. But at least you'd know that any program that is interviewing you doesn't care. If the issue was in the distant past and not that serious, no one is going to care in any case.

As you can see, both paths may cause you some worry. You would need to pick the one that you can live with.

Thank you! I think I will just disclose to eras even if it gets sealed

Is 7+ years with no new infractions and demonstrated commitment to addressing root causes and helping others in similar circumstances usually long enough for PDs to give another chance? I’m not even dead set on doing a competitive speciality but I don’t want to go unmatched or anything.

 

[srirachamayonnaise]

Thank you! I think I will just disclose to eras even if it gets sealed

Is 7+ years with no new infractions and demonstrated commitment to addressing root causes and helping others in similar circumstances usually long enough for PDs to give another chance? I’m not even dead set on doing a competitive speciality but I don’t want to go unmatched or anything.

If you are not legally bound to disclose, just don’t, even if they will know later through an unofficial way. Who cares if the program is happy or not. They want you licensed, period and end of sentence. Don’t listen to people here who have no legal background. As a lawyer, I can tell you definitively that if not obligated, you don’t need to disclose and there will be absolutely no negative consequence if you don’t disclose.

 

[Med Ed]

In the state, sealing is equivalent to it never happening. I know for licensure and such, it will have to be disclosed but not for residency apps.

Depending on the state, the licensing boards ask wildly different questions about criminal history. Some require disclosure of arrests and convictions regardless of outcome, others ask only about convictions. A couple don't ask about anything older than 7 years other than felony convictions. Unless it has changed, the VA has is like this. Spend a weekend sifting through licensing applications in different states and you'll see what I mean.

 

[Hzreio]

Don’t you also have to factor in mental exhaustion/exertion when considering hourly pay of doctors in surgical specialties like plastics. I know the technology has come along way, but I imagine that the work of a plastic surgeon is much more stressful than say a psychiatrist, on average of course. There is probably a lot of stress involved with inpatient psych and such.

Look at the burnout/happiness data for that question. AFAIK psych is pretty good for that, which is why I thinking it’s growing in competitiveness. If reimbursements for psych we’re as high as ophtho, it would probably be top tier competitive

Competitiveness is related to too many applicants to too few positions… but you gotta think about why all these ppl want to do these fields to begin with

 

[odyssey2]

Look at the burnout/happiness data for that question. AFAIK psych is pretty good for that, which is why I thinking it’s growing in competitiveness. If reimbursements for psych we’re as high as ophtho, it would probably be top tier competitive

Competitiveness is related to too many applicants to too few positions… but you gotta think about why all these ppl want to do these fields to begin with

Do you have good burnout/happiness data outside of the medscape reports?

 

[Chelsea FC]

All I’m going to say is tons of med students chase these fields simply because it’s the thing to do. Okay Ben though lifestyle to pay isn’t always a reasonable payoff.

 

[NotAProgDirector]

If you are not legally bound to disclose, just don’t, even if they will know later through an unofficial way. Who cares if the program is happy or not. They want you licensed, period and end of sentence. Don’t listen to people here who have no legal background. As a lawyer, I can tell you definitively that if not obligated, you don’t need to disclose and there will be absolutely no negative consequence if you don’t disclose.

I think we disagree on how important having a good relationship with your new employer may be, and how if they are unhappy with you on day 0 how that might cause negative consequences.

In this case, I don't think it will matter at all what choice is made. It's far in the past, non-recurrent, and if it's just MJ possession / use no one is likely to care.

 

[voxveritatisetlucis]

I think we disagree on how important having a good relationship with your new employer may be, and how if they are unhappy with you on day 0 how that might cause negative consequences.

In this case, I don't think it will matter at all what choice is made. It's far in the past, non-recurrent, and if it's just MJ possession / use no one is likely to care.

Well it was a bit worse than that..bad enough to keep me out of top schools (got into multiple T20s year it happened..rescinded..then took some time off before applying again) but I guess not bad enough to shut me out completely?

There will be 7 years vs like 3.5 right now. Hopefully that will be long enough to at least match something

 

[Ho0v-man]

OP, just do what you want to do. Go for a backup if it makes you feel safer.

Maybe I’m just talking out of my butt here; but if someone with a solid app for the field from a top school doesn’t match their desired field, they either exclusively ranked top programs or they’re just a tool and that came out in evals/interviews, etc.

 

[collegestud2013]

As it relates to OP, anesthesia would absolutely have an easier residency than ortho, and possibly a better lifestyle as an attending if not necessarily as lucrative.
Most of the ultra-competitive fields are not "lifestyle" fields with the exception of derm and ophtho. Neurosurgery and IR have terrible lifestyles and the other surgical subspecialties still require a brutal residency. The only thing they have in common is high compensation. Path and psych have some of the best lifestyles in medicine and are still on the lower end of competitiveness.

Don't forget about the job market. The CURRENT job market, especially for new grads straight out of residency/fellowship, often plays a role in determining how competitive a specialty is by shifting the amount of interest and thus applicants in that specialty (in addition to the usual factors like pay or lifestyle). A few examples:

Pathology has one of the best lifestyles (and consistently lowest burnout rates among surveys) and decent pay (median probably in low $300k, though will most likely be lower for new grads) but the main reason there's not much interest is because the job market has been consistently in the dumpster, with new grads often having to do at least a fellowship after a 4-year residency and having to be geographically VERY flexible afterwards just to get a job at all. And the demand for the number of pathologists across the board isn't really rising since jobs are being consolidated so less positions are needed, and because of the lower burnout rate there's probably less job turnover and hence less new positions opening.

Rad onc also has a pretty good lifestyle and if you look at compensation data it' still up there overall (median near $500k) but there's been very little interest in going into it since it's hard to find a job out of residency at all unless you're geographically VERY flexible (eg have to move across the country and to undesirable rural areas), and even then the pay for new grads is much lower nowadays as the market is saturated with grads (probably in $200ks at a lot of places and for a working an insane amount). And the older rad oncs probably have pretty cush and profitable practice set-ups so they are less likely to retire.

EM is getting saturated due to the combination of rapid residency expansion and more reliance on NP/PAs to staff EDs, and that's surprising since burnout rates in EM have historically and remain near the top (and with high burnout rates you would expect more physicians to leave clinical practice or at least go part time which would open up more positions). And that's also going to drive pay down and limit jobs to the less desirable locations.

Psych has a decent job market now and lifestyle can be considered good, which has made it more competitive. But overall pay isn't at the top, and besides the patient population you have to deal with isn't for a lot of physicians.

 

[Redpancreas]

Title sums it up. Urology matched 65% last year. I'm looking at the optho and the uro match threads on reddit and I am hearing about these amazing applicants not getting in because they got unlucky. Whether or not these people are lying or not I don't know. I know I don't have the full story. However, it's still a very scary thought.

For me, I'm interested in ortho but there's a 80% match rate. I also attend a T15 but last year out of the 4 that applied, only 2 matched. I know one of the two who didn't match and he was an average applicant according to nrmp statistics. I find the prospect of not being able to get a job after working so hard to get into medical school really scary. Especially with the loans I have accrued.

Currently, I have 6 ortho projects that have been written up and submitted to journals and conferences. None of them have been published yet. One of them was accepted to a conference but I won't be presenting since I am second author.

I have 2 issues/questions.
1. I never feel like I have enough. Like do I have enough research to get into ortho? Do I need more? I feel like it's so competitive to get in that I feel like I always need more. I feel that since STEP 1 is P/F for me, I keep feeling inadequate and wondering how many more publications other people have. Do I need more? Do I need a research year?
2. I keep thinking about other less competitive specialties. Specifically anesthesiology and internal medicine. More anesthesiology right now. I really like that there's still a procedural aspect to it (intubation + putting in lines). I like that the lifestyle is good as well. Also, I talked to people in my school's anesthesiology department and how everyone who applies anesthesia at my school matches and get one of their top 3 choices mostly and how I won't need to do more research if I didn't want to and that is such a major relief. I am not a big fan of research and I like the idea of applying into a specialty with a pretty safe match rate. However, do I really want to give up my aspiration of becoming an ortho surgeon for a "safer career". I keep wondering if I will regret it down the road and ask myself "what if I did try". Or what if my ego gets bruised as I work with other surgeons and keep wondering "Man, I could've been a surgeon". I have heard that no anesthesiologist has ever wished to be a surgeon and surgical residents have switched to becoming anesthesiologists.

Forget about the match lists. If you want more useful information, compare yourself to people with similar demographics, count their pubs by stalking their google scholar profiles, and assess their metrics on an individual basis and that is usually a better indicator than X number of people matched last year, etc. .

Just apply to Orthopedic Surgery. Publications are important, but the process is important and I'm sure those six things will convert to some meaningful items on your CV which may count as publications. I'm not going to say you're competitive or not for Orthopedic Surgery but you've done enough to warrant buckling down, maybe getting a few more things submitted, and applying for it. Do dual apply to Anesthesia/IM if you only want to do this only once. You will match the latter for sure. If you plan to practice anesthesia, you do not need to train in the ivory towers. Many of latter (Anesthesia/IM PDs) will know full well of your intentions, but would be thrilled to have a categorical from a T15 school on their resident roster if you fall to them no matter what facade they display.

If you want to do Orthopedic surgery, plan on a research year (ask others who struggled but matched ortho if it's better to apply twice or not). You're going to be doing this career for 30+ years. If you want Ortho, make an investment and get it done. Orthopedic Surgery residents are well-published and the field is competitive, but it's attainable for people of normal ability if you are willing to put in the honest work in which it seems like you're doing! The issue is most people aren't willing to try putting that effort in. The fact that you have already differentiates you to some degree.