I don’t do anything outside of school really, am I screwed when it’s time to apply for residencies?

[Latteandaprayer]

TL;DR—end of M2 (core clinical year) at a T20 without much productivity outside of the classroom. Interested in Neuro or IM or FM.

I’m most interested in Neuro, IM, FM, or MAYBE anesthesia but I’ve only spent 4 days on that so idk. Anyway, outside of school, I generally just go home and chill. I don’t mean to make this too personal, but at the end of M1 I came out to my mom as gay and it caused a huge stir. She threatened suicide, told me I am a disgrace, and I had to move out pretty quickly (lived with parents to save money). That was right before starting core clerkships (1 year preclinical program, so M1 is didactics, 2 is clinicals, 3/4 are Step 1 and 2, sub-Is, aways, etc). I had a hard time adjusting to clerkships, and I let clubs and research fall to the side.

Since all that, I’ve started investing more into what I want and what makes me happy. So I started working out, learned to cook, got a boyfriend, bought movie theater memberships for local theaters, and now just do what makes me happy. However, it seems everyone around me is super involved in research or clubs. I’m too lazy I think. I know none of the fields require heavy research or leadership, but I guess I don’t have much to show for commitment. I don’t want to end up in the middle of nowhere for 3-4 years, especially because I don’t want to drag my boyfriend to the boonies lol.

For more context, I have 2 first author papers from undergrad and my gap year, and one middle author manuscript that’s been in the works since last year. Otherwise, nothing.

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[djiboutiman]

I’m sorry for what you’ve had to go through with your mom. It’s awesome though that you have been able to find happiness. Coming from a top 20 alone will take you pretty far. IM, FM, and Neuro are not competitive at all and you’ll be able to match no problem, probably at some really good programs, as long as you don’t have any serious red flags in your application.

 

[Mr.Smile12]

Since you are at a T20, have you talked with your student dean? Come up with a workable plan to get reacclimated to other parts of academic culture that you will be expected to participate in once you graduate.

 

[esob]

Based on the specialties that you are interested in, I think you will be fine for everything but anesthesia. You might not have your pick of programs but there are enough PD's that would take you based solely on the fact you attended a top school and don't have any red flags.

 

[mrbreakfast]

You are probably not going to match top-tier IM or neuro without research/extracurriculars, but if you don't care as much about "prestige" you will otherwise be OK.

 

[Latteandaprayer]

You are probably not going to match top-tier IM or neuro without research/extracurriculars, but if you don't care as much about "prestige" you will otherwise be OK.

if I have 2 first-authorships from undergrad/gap year, a poster from M1, and a middle authorship from M2, do you think it’s a “waste” to try and apply for top tier programs? I guess it’s not like I don’t have any research at all, just not a bunch of papers and conferences. Not to be defensive, I appreciate the feedback!!

 

[ChordaEpiphany]

Based on the specialties that you are interested in, I think you will be fine for everything but anesthesia. You might not have your pick of programs but there are enough PD's that would take you based solely on the fact you attended a top school and don't have any red flags.

Has anesthesia gotten more competitive in recent years? When I started med school (...back in 2017) anesthesiology was maybe a bit harder to match, but easier to score a top residency compared to IM. If you came from a T50, where most specialties aside from surgical subs/derm are within reach without red flags, anesthesiology was considered an easier match from the perspective of location/prestige.

In terms of competitiveness at academic programs, I always thought of it as derm/surgical subs > gen surg/OBGYN/rads > IM > neuro/gas/psych > path/peds/EM/PM&R/FM.

At least at my program it seems like people tend to match "up" in anesthesiology while they match "neutral" in IM.

if I have 2 first-authorships from undergrad/gap year, a poster from M1, and a middle authorship from M2, do you think it’s a “waste” to try and apply for top tier programs? I guess it’s not like I don’t have any research at all, just not a bunch of papers and conferences. Not to be defensive, I appreciate the feedback!!

Probably still worth it if that's your goal. The question is, will you be happy surrounded by go-getters if you have taken on a new, relaxed frame of mind that is actually working for you? Personally, being in a T5 environment just became absurdly unhealthy for me once I crossed 30 and started having priorities other than gathering academic accolades.

So much is expected of you in those environments with very little reward. Advisors will start to brush you off if you aren't producing for them at a rapid clip. You'll get very little extrinsic validation unless you are keeping up with people at the top. The constant jockeying for position, opportunity, authorship, etc. is really tiresome after a while.

Not saying to go to a community program, but unless you plan on being a super specialist at a national powerhouse, you will get the best possible training at a solid academic program where you fit with the culture and your goals align with your mentors' vision of their graduates. If you do nothing else, you'd likely be competitive at places in the T50-T15 range, depending on how clinical rotations go. You could train at hospitals all over the country like Yale, BIDMC, BUMC, UPMC, UVA, UNC, UAB, Baylor, U Chicago, UCSD, USC, OHSU, etc... and you'd get very similar training with a little more enthusiasm for a trainee that is interested in having work life balance.

 

[operaman]

Dude. You are doing just fine. You have a full year of essentially bulls--t rotations that you can probably also pack with research electives and easy clinical rotations such as the "radiation vacation" or the beloved "dermaholiday." You may have a little bit of catching up to do, but you have plenty of time and likely have plenty of resources at your school to get some things cooking.

I had a buddy who fell in love with ENT in March of M3 and had zero research at the time. He was able to bang out 5 first author papers by September when ERAS went in, so it can be done. You have oodles more time than that and are aiming at fields far less competitive. You can join a club or two today and add that to your ERAS as well.

Outside of research, most other ECs don't really matter much. You just want a few things so those sections aren't completely empty, but it's not like pre-med where fluffing the CV is the whole game. So join a student interest group or two for the fields you're considering and enjoy some free pizza and learn about the field. Volunteer a day or two next year in a student free clinic. Get some clinical research going that will lead to pubs. Do well on your step exams. If you want to go overboard, just start your own student group that watches great cinema and then discusses afterward over drinks once a month. Bam, you've got plenty of stuff to look interesting on paper!

For research, here's the low hanging fruit to consider:

1) Case reports and review of lit. Can write a rough draft of one of these in an afternoon. Try and title it so it doesn't sound like a case report if the journal will let you, though many crack down on this practice. Either way, easy research pub and you can usually be first author.

2) Finish someone elses unfinished pub. Odds are good that senior residents at your program have a handful of posters or presentations that they never turned into an actual manuscript because that's the part that sucks. And especially if they aren't going into academics, they may not even care. These are basically finished projects that just need to be converted into a manuscript. As you get to know residents, reach out and ask if they have anything like this lying around and whether they'd be willing to mentor you writing it up for them in exchange for being second author to their first. Win-win for everyone.

3) Systematic review and meta analysis. Need a mentor who does these, but if there's one around these are super easy to bang out once you know the methods and are comfortable with the software. For ideas, either ask faculty or do a pubmed search in your desired field for these sorts of papers and set the date range to 15 years ago or more. Updating an old meta analysis is a stupidly easy way to land a pub, especially if it's for a clinical question where treatments have changed a lot in 20 years and outcomes may be different now.

4) Chart reviews. The bread and butter of med student research. Find faculty who publish a lot and they will usually have a few possible projects lying around. They're usually IRB expedited as well so quick to get approved and get cooking compared to a more involved project.

So yeah, no reason to wind up in BFE. Use this next year to beef up the CV and do well on steps and no doors should be closed to you.

 

[solitarius]

Hey man, the specialties you are interested are less competitive and have plenty of spots. I don't think you'll end up in the boonies.

 

[ChordaEpiphany]

Dude. You are doing just fine. You have a full year of essentially bulls--t rotations that you can probably also pack with research electives and easy clinical rotations such as the "radiation vacation" or the beloved "dermaholiday." You may have a little bit of catching up to do, but you have plenty of time and likely have plenty of resources at your school to get some things cooking.

I had a buddy who fell in love with ENT in March of M3 and had zero research at the time. He was able to bang out 5 first author papers by September when ERAS went in, so it can be done. You have oodles more time than that and are aiming at fields far less competitive. You can join a club or two today and add that to your ERAS as well.

Outside of research, most other ECs don't really matter much. You just want a few things so those sections aren't completely empty, but it's not like pre-med where fluffing the CV is the whole game. So join a student interest group or two for the fields you're considering and enjoy some free pizza and learn about the field. Volunteer a day or two next year in a student free clinic. Get some clinical research going that will lead to pubs. Do well on your step exams. If you want to go overboard, just start your own student group that watches great cinema and then discusses afterward over drinks once a month. Bam, you've got plenty of stuff to look interesting on paper!

For research, here's the low hanging fruit to consider:

1) Case reports and review of lit. Can write a rough draft of one of these in an afternoon. Try and title it so it doesn't sound like a case report if the journal will let you, though many crack down on this practice. Either way, easy research pub and you can usually be first author.

2) Finish someone elses unfinished pub. Odds are good that senior residents at your program have a handful of posters or presentations that they never turned into an actual manuscript because that's the part that sucks. And especially if they aren't going into academics, they may not even care. These are basically finished projects that just need to be converted into a manuscript. As you get to know residents, reach out and ask if they have anything like this lying around and whether they'd be willing to mentor you writing it up for them in exchange for being second author to their first. Win-win for everyone.

3) Systematic review and meta analysis. Need a mentor who does these, but if there's one around these are super easy to bang out once you know the methods and are comfortable with the software. For ideas, either ask faculty or do a pubmed search in your desired field for these sorts of papers and set the date range to 15 years ago or more. Updating an old meta analysis is a stupidly easy way to land a pub, especially if it's for a clinical question where treatments have changed a lot in 20 years and outcomes may be different now.

4) Chart reviews. The bread and butter of med student research. Find faculty who publish a lot and they will usually have a few possible projects lying around. They're usually IRB expedited as well so quick to get approved and get cooking compared to a more involved project.

So yeah, no reason to wind up in BFE. Use this next year to beef up the CV and do well on steps and no doors should be closed to you.

I think the bigger consideration is OP's mindset (which needs no correction, btw). OP doesn't want to hustle, bang out 5 pubs, and rub elbows with the department chair so he can match MGH for IM. He's already found a formula for happiness that works for him, and it's at least a little bit incompatible with further beefing up the CV.

OP is at a T20 and wants IM, FM, neuro, or maybe gas. He already has 3 pubs, including one from med school and multiple 1st author. Outside of the top 10-15 programs in IM/neuro/gas, OP will have his pick of programs assuming they have no red flags and aren't at the absolute bottom of the class.

Unless your goal is to be a super academic publishing 20+ papers/year at a T10, my advice is "have your cake and eat it too." You've already put in a ton of work that put you in the fortunate position of being competitive for a residency in those specialties regardless of how the rest of the year turns out. Make sure to do decently on step. Be a positive person who adds value to whatever team you're on. You'll land somewhere great and likely be much happier than others in your cohort.

 

[Latteandaprayer]

Has anesthesia gotten more competitive in recent years? When I started med school (...back in 2017) anesthesiology was maybe a bit harder to match, but easier to score a top residency compared to IM. If you came from a T50, where most specialties aside from surgical subs/derm are within reach without red flags, anesthesiology was considered an easier match from the perspective of location/prestige.

In terms of competitiveness at academic programs, I always thought of it as derm/surgical subs > gen surg/OBGYN/rads > IM > neuro/gas/psych > path/peds/EM/PM&R/FM.

At least at my program it seems like people tend to match "up" in anesthesiology while they match "neutral" in IM.

Probably still worth it if that's your goal. The question is, will you be happy surrounded by go-getters if you have taken on a new, relaxed frame of mind that is actually working for you? Personally, being in a T5 environment just became absurdly unhealthy for me once I crossed 30 and started having priorities other than gathering academic accolades.

So much is expected of you in those environments with very little reward. Advisors will start to brush you off if you aren't producing for them at a rapid clip. You'll get very little extrinsic validation unless you are keeping up with people at the top. The constant jockeying for position, opportunity, authorship, etc. is really tiresome after a while.

Not saying to go to a community program, but unless you plan on being a super specialist at a national powerhouse, you will get the best possible training at a solid academic program where you fit with the culture and your goals align with your mentors' vision of their graduates. If you do nothing else, you'd likely be competitive at places in the T50-T15 range, depending on how clinical rotations go. You could train at hospitals all over the country like Yale, BIDMC, BUMC, UPMC, UVA, UNC, UAB, Baylor, U Chicago, UCSD, USC, OHSU, etc... and you'd get very similar training with a little more enthusiasm for a trainee that is interested in having work life balance.

I guess my definition of “top” was like T50. Yeah no interest in going to a residency that more or less REQUIRES you to do research.

 

[esob]

Has anesthesia gotten more competitive in recent years?

U.S. MD senior match rate was 68% last cycle, with an overall match rate of just 54%.

 

[Dantes]

U.S. MD senior match rate was 68% last cycle, with an overall match rate of just 54%.

? Anesthesia had an 83% match rate among US MDs who ranked it first, according to NRMP:

OP you're not screwed, especially for IM, FM, or neuro. If anesthesia maybe try to get involved in a couple projects or something else as that is moderately competitive now. Focus on crushing Step 2 and if interested in more competitive locations/residencies start getting more involved. There's still plenty of time.

 

[DOVinciRobot]

if I have 2 first-authorships from undergrad/gap year, a poster from M1, and a middle authorship from M2, do you think it’s a “waste” to try and apply for top tier programs? I guess it’s not like I don’t have any research at all, just not a bunch of papers and conferences. Not to be defensive, I appreciate the feedback!!

I guess my definition of “top” was like T50. Yeah no interest in going to a residency that more or less REQUIRES you to do research.

You’ll be perfectly fine. The constant rat race of academia whoring is absolutely not worth it. Find a residency program that fits your career AND life goals, and don’t look back.

 

[mrbreakfast]

do you think it’s a “waste” to try and apply for top tier programs?

I guess my definition of “top” was like T50. Yeah no interest in going to a residency that more or less REQUIRES you to do research.

You're be fine. The top (not top-50, more like top-20) neuro programs may want to see a little research, but there are plenty of places that won't require it, including as a resident. If your goal is to become a physician-scientist or to be able to say "well, I trained at X University under Dr. Y" as if to imply that makes you a better physician, then you probably need to step it up. But you can still match well without research.

U.S. MD senior match rate was 68% last cycle,

Not sure where you got this number, but as noted above, this number is significantly different from the official NRMP statistics, and would imply anesthesia is more competitive than ortho and neurosurg, for example.

 

[esob]

? Anesthesia had an 83% match rate among US MDs who ranked it first, according to NRMP:

I think the NRMP massages the number published by listing 83% "for those who ranked it first." However, from my perspective, # of applicants / # of matches is a better metric to consider as it presents a worst-case scenario for the match. Those numbers are 1199 matches out of 1741 applicants (68.8%). The difference in those two numbers, of course results from applicants ranking multiple specialities. I feel like people who rank anesthesia second are more often surgery candidates who rank it as a backup, and hence are likely to have stronger applications than the average anesthesia applicant. Hence, the worst-case scenario is a better measure in my personal opinion, but YMMV.

 

[Dantes]

I think the NRMP massages the number published by listing 83% "for those who ranked it first." However, from my perspective, # of applicants / # of matches is a better metric to consider as it presents a worst-case scenario for the match. Those numbers are 1199 matches out of 1741 applicants (68.8%). The difference in those two numbers, of course results from applicants ranking multiple specialities. I feel like people who rank anesthesia second are more often surgery candidates who rank it as a backup, and hence are likely to have stronger applications than the average anesthesia applicant. Hence, the worst-case scenario is a better measure in my personal opinion, but YMMV.

Maybe, but I think that's a little confusing to list that without specifying, because traditionally when discussing match rates and statistics the NRMP data and charting outcomes are based around applicants who ranked the specialty first. We don't have any information to my knowledge about how competitive backup applicants are, including step scores, research experiences, AOA etc.