IM Subspecialty Competitiveness (2022 appt year)

[CCM-MD]

1. Gastroenterology - 970 applicants, 614 matched (63.3%)
2. Critical Care Medicine - 204 applicants, 133 matched (65.2%)
3. Pulmonary & Critical Care Medicine - 1022 applicants, 693 matched (67.8%)
4. Cardiovascular Disease - 1598 applicants, 1114 matched (69.7%)
5. Rheumatology - 357 applicants, 264 matched (73.9%)
6. Hematology & Oncology - 860 applicants, 649 matched (75.5%)
7. Endocrinology - 421 applicants, 330 matched (78.4%)
8. Allergy & Immunology - 174 applicants, 144 matched (82.8%)
9. Sleep Medicine - 198 applicants, 170 matched (85.9%)
10. Geriatrics - 190 applicants, 166 matched (87.4%)
11. Hospice & Palliative Medicine - 394 applicants, 359 matched (91.1%)
12. Nephrology - 337 applicants, 315 matched (93.5%)
13. Infectious Disease - 364 applicants, 352 matched (96.7%)

https://www.nrmp.org/wp-content/uploads/2021/12/MSMP-2022-Appt-Year_Match-Results-Stats.pdf

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[DrMetal]

1. Nephrology - 337 applicants, 315 matched (93.5%)
2. Infectious Disease - 364 applicants, 352 matched (96.7%)

Wow, so basically if you can fog up a mirror . . .I thought ID would be more competitive via the Fauci effect

 

[aafisahar]

Wow, so basically if you can fog up a mirror . . .I thought ID would be more competitive via the Fauci effect

No resident gives a **** about Fauci. ID pays less for more training and for the majority of us l, clinical ID is 99% boring. For everyone cool case, you have a 100 dumb cases like "bilateral cellulitis what abx do we need?" and it just turns out the patient is in heart failure. Or it's all setting up OPAT for osteo.

 

[NITRAS]

No resident gives a **** about Fauci. ID pays less for more training and for the majority of us l, clinical ID is 99% boring. For everyone cool case, you have a 100 dumb cases like "bilateral cellulitis what abx do we need?" and it just turns out the patient is in heart failure. Or it's all setting up OPAT for osteo.

HIV clinic was by far the most fun I had in an outpatient clinic. The eccentric patient population, the pictures on the wall of the medications (they were all brand name at the time). Lots of “goody bags.”

Just a lot of fun.

 

[DrSnips]

Percent matched into specialty is not a great marker of competitiveness. For example, crit care is "more competitive" than cardiology above, yet it could be possible the average person matching cards has a more impressive application than the average person matching crit care, so in effect it would still be more challenging for an individual to apply to cards because you'd be compared against higher caliber applicants. If applicants weren't self-sorting into specialties then it would make sense to look at percent matched as a marker of competitiveness.

 

[grt398]

Percent matched into specialty is not a great marker of competitiveness. For example, crit care is "more competitive" than cardiology above, yet it could be possible the average person matching cards has a more impressive application than the average person matching crit care, so in effect it would still be more challenging for an individual to apply to cards because you'd be compared against higher caliber applicants. If applicants weren't self-sorting into specialties then it would make sense to look at percent matched as a marker of competitiveness.

There's a lot of truth to your point...but I would just be cautious for future CCM applicants as I reviewed applications for my program this year and due to the fact that there are 1 & 2 year positions, and applicants from IM, EM, and IM subspecialities (multiple people who had completed/were completing cardiology fellowships in addition to the usual ID/nephro), the applicant pool is actually pretty competitive. And places definitely like taking their own for the 1 year spots. Cards-CCM (sometimes with interventional cards as a 3rd fellowship), despite the long training path, seems to be becoming a thing for academic CVICU director type positions.

 

[bronx43]

Percent matched into specialty is not a great marker of competitiveness. For example, crit care is "more competitive" than cardiology above, yet it could be possible the average person matching cards has a more impressive application than the average person matching crit care, so in effect it would still be more challenging for an individual to apply to cards because you'd be compared against higher caliber applicants. If applicants weren't self-sorting into specialties then it would make sense to look at percent matched as a marker of competitiveness.

There's no perfect marker of competitiveness - unless someone has access to literally every statistic for every applicant and creates a logistic regression model. Even then, it can only be retrospective, and cannot account for external factors (covid anyone?) which may influence specialty choices.

Percent matched into each specialty isn't a bad marker on its own. We can all agree that the top 4 (GI, cards, pulm/CC) are palpably more competitive than the middle 4 (rheum, endo, A/I, and heme onc) and significantly more competitive than the bottom 5 (sleep, geri, ID, neph, palliative). The fact that CC had higher non-match rate this year than cards is probably more a reflection of intensive care being en vogue than anything else.

 

[bronx43]

Wow, so basically if you can fog up a mirror . . .I thought ID would be more competitive via the Fauci effect

Does ID even have a big role in COVID? I would think most COVID related treatment decisions are up to IM and pulm/CC. I'm outpt so I actually don't know...

 

[CCM-MD]

Percent matched into specialty is not a great marker of competitiveness. For example, crit care is "more competitive" than cardiology above, yet it could be possible the average person matching cards has a more impressive application than the average person matching crit care, so in effect it would still be more challenging for an individual to apply to cards because you'd be compared against higher caliber applicants. If applicants weren't self-sorting into specialties then it would make sense to look at percent matched as a marker of competitiveness.

In my experience, the most impressive applicants are the ones applying to pulm crit and critical care. And I’m obviously not biased at all.

 

[NITRAS]

Does ID even have a big role in COVID? I would think most COVID related treatment decisions are up to IM and pulm/CC. I'm outpt so I actually don't know...

During different parts of the pandemic, remdesivir, Toci, and baricitanib were restricted and required ID consult. As we got busy, they loosened that up.

I would say the ID and pathology docs made the biggest impact on our overall policy. Our pathologist, who developed our own PCR test before there were available From outside our system, really helped us out a bunch.

 

[aafisahar]

During different parts of the pandemic, remdesivir, Toci, and baricitanib were restricted and required ID consult. As we got busy, they loosened that up.

That consult went like this "this guy has bad covid, can we give him the drug of the month".

"ok sure".

 

[thecalccobra]

In my experience, the most impressive applicants are the ones applying to pulm crit and critical care. And I’m obviously not biased at all.

Impressive in terms of?

If overall academic excellence/research/etc, I would disagree.

 

[CCM-MD]

Impressive in terms of?

If overall academic excellence/research/etc, I would disagree.

All of it.

/sarcasm . Don’t get your ego bruised.

 

[collegestud2013]

If you use percent matched as a marker for competitiveness, it looks like people are still primary chasing for the money, and somewhat for lifestyle. If ID and Nephro paid as much as GI on average (and their fellowships are 2 yrs instead of 3 years) I'm sure they would be similarly competitive with more applicants. Besides the money you get from scoping nonstop all day, there's not much else going for GI - lifestyle is mixed at best with a good amount of call, and you literally have to deal with poop all time. And the money is far from guaranteed for the long run for GI or any specialty. All it takes is for CMS to decide to steeply cut reimbursements for GI procedures a few years down the line since they think GI is getting paid too much (and this will also drive down reimbursements from private insurers), and the money factor for GI can quickly go away.

A bit surprised that endocrine match rate was that low. Good lifestyle but but essential pays the same as just being a PCP. Rheum pay isn't super high either but I guess people are going after the lifestyle.

 

[bronx43]

If you use percent matched as a marker for competitiveness, it looks like people are still primary chasing for the money, and somewhat for lifestyle. If ID and Nephro paid as much as GI on average (and their fellowships are 2 yrs instead of 3 years) I'm sure they would be similarly competitive with more applicants. Besides the money you get from scoping nonstop all day, there's not much else going for GI - lifestyle is mixed at best with a good amount of call, and you literally have to deal with poop all time. And the money is far from guaranteed for the long run for GI or any specialty. All it takes is for CMS to decide to steeply cut reimbursements for GI procedures a few years down the line since they think GI is getting paid too much (and this will also drive down reimbursements from private insurers), and the money factor for GI can quickly go away.

A bit surprised that endocrine match rate was that low. Good lifestyle but but essential pays the same as just being a PCP. Rheum pay isn't super high either but I guess people are going after the lifestyle.

It's all about the money... always has been. If you plot competitiveness of all specialties with income, it would have a R value of 0.95. It's funny how people find their "calling" to be whatever CMS decides to pay a lot of $ for.

"I like to use my hands, so GI was a great fit."
"I have always dreamed of being a dermatologist."
"I can't see myself doing anything other than orthopedic surgery."

 

[Loog567]

Percent matched isn't a good marker for competitiveness, because physicians are generally smart enough to self-select.

For example, I don't believe for 1 second that radiation oncology (99.1% match rate) is way less competitive than psychiatry (89.6%) or gen surg (83%). The average Rad onc resident has a 243 step 1, the average psychiatry resident has an average 227 step 1, and the gen surg has a 237 step 1.

pg.10 of pdf for match percentages

https://www.nrmp.org/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

Rather, applicant characteristics is the best measure (e.g. average step score of matched applicants, # of pubs, AOA, etc.)

Ideally we'd probably just sort by step 1, but based on the data above, we only have US MD (more competitive) vs IMG/FMG which are less competitive.

Fellowships ranked by the % of new fellows who are US MD

1. Allergy/Immunology 70.1%
2. Gastroenterology 60.4%
3. Heme/Onc 53.6%
4. Cardiology 50.8%
5. Pulm/CC 48.9%
6. ID 46.1%
7. Sleep 43.6%
8. Rheum 42.1%
9. Geri 40.2%
10. Endocrine 32.2%
11. Nephrology 28.7%

 

[CCM-MD]

Percent matched isn't a good marker for competitiveness, because physicians are generally smart enough to self-select.

For example, I don't believe for 1 second that radiation oncology (99.1% match rate) is way less competitive than psychiatry (89.6%) or gen surg (83%). The average Rad onc resident has a 243 step 1, the average psychiatry resident has an average 227 step 1, and the gen surg has a 237 step 1.

pg.10 of pdf for match percentages

https://www.nrmp.org/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

Rather, applicant characteristics is a best measure (e.g. average step score of matched applicants, # of pubs, AOA, etc.)

Ideally we'd probably just sort by step 1, but based on the data above, we only have US MD (more competitive) vs IMG/FMG which are less competitive.

Fellowships ranked by the % of new fellows who are US MD

1. Allergy/Immunology 70.1%
2. Gastroenterology 60.4%
3. Heme/Onc 53.6%
4. Cardiology 50.8%
5. Pulm/CC 48.9%
6. ID 46.1%
7. Sleep 43.6%
8. Rheum 42.1%
9. Geri 40.2%
10. Endocrine 32.2%
11. Nephrology 28.7%

Have you visited the rad onc section of this website recently? If you had, you would know why it has become so undesirable.

 

[cardsperson]

Percent matched isn't a good marker for competitiveness, because physicians are generally smart enough to self-select.

For example, I don't believe for 1 second that radiation oncology (99.1% match rate) is way less competitive than psychiatry (89.6%) or gen surg (83%). The average Rad onc resident has a 243 step 1, the average psychiatry resident has an average 227 step 1, and the gen surg has a 237 step 1.

pg.10 of pdf for match percentages

https://www.nrmp.org/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

Rather, applicant characteristics is the best measure (e.g. average step score of matched applicants, # of pubs, AOA, etc.)

Ideally we'd probably just sort by step 1, but based on the data above, we only have US MD (more competitive) vs IMG/FMG which are less competitive.

Fellowships ranked by the % of new fellows who are US MD

1. Allergy/Immunology 70.1%
2. Gastroenterology 60.4%
3. Heme/Onc 53.6%
4. Cardiology 50.8%
5. Pulm/CC 48.9%
6. ID 46.1%
7. Sleep 43.6%
8. Rheum 42.1%
9. Geri 40.2%
10. Endocrine 32.2%
11. Nephrology 28.7%

Lol this is also a dumb way of ranking specialties, there's no way a physician from Germany or India is moving to the US to restart their whole career just to be an allergist and make as much money as they could by being a regular internist.

We have actual objective criteria for comparing competitiveness specialties, and cards/heme-onc on average have the highest step scores and % of fellows who are AOA members, with GI a very close second:

https://www.nrmp.org/wp-content/uploads/2018/10/2018-Charting-Outcomes-SMS.pdf

Granted, the rankings above don't include A/I, but if you look at the grads of the "top" residency programs eg BWH, Hopkins, MGH, UCSF... they overwhelmingly go on to specialize in cards, heme/onc, and GI. That's the kind of pool that applicants in these fields have to compete against.

Pulm/CCM is having a bit of a moment right now, the same way that hospital medicine had a moment ten years ago, but the reality of shift work for large corporate entities that treat you as an interchangeable cog will hit these grads in a few years and the market will realign.

 

[Loog567]

Have you visited the rad onc section of this website recently? If you had, you would know why it has become so undesirable.

That's an even worse methodolgy because sdn is filled with neurotic overachievers. The average SDN poster is NOT the average med student/resident. The avg rad onc candidate scored a 243 while there are tons of peeople who go unmatched every year. Regardless, the methodology is seriously flawed. I don't believe for a second that psych (89%) is much more competitive than neurology (97%). 227 step 1 vs 232 step 1.

 

[Loog567]

Lol this is also a dumb way of ranking specialties, there's no way a physician from Germany or India is moving to the US to restart their whole career just to be an allergist and make as much money as they could by being a regular internist.

We have actual objective criteria for comparing competitiveness specialties, and cards/heme-onc on average have the highest step scores and % of fellows who are AOA members, with GI a very close second:

https://www.nrmp.org/wp-content/uploads/2018/10/2018-Charting-Outcomes-SMS.pdf

Granted, the rankings above don't include A/I, but if you look at the grads of the "top" residency programs eg BWH, Hopkins, MGH, UCSF... they overwhelmingly go on to specialize in cards, heme/onc, and GI. That's the kind of pool that applicants in these fields have to compete against.

Pulm/CCM is having a bit of a moment right now, the same way that hospital medicine had a moment ten years ago, but the reality of shift work for large corporate entities that treat you as an interchangeable cog will hit these grads in a few years and the market will realign.

How is it dumb? It literally supports what you say about GI/Heme Onc/Cards being near the top. It matches your perception that Cards is more competitive than PCC. You also have an availability bias. There are less allergy spots in general. There are over 1k cards spots. By this logic IM is the most competitive specialty (it's not) because that's the biggest specialty of Harvard med students.

"We have actual objective criteria ... highest step scores and % of fellows who are AOA member"

I mean if you read what I wrote, that's literally what I wrote.

Here's what I wrote: "Ideally we'd probably just sort by step 1, but based on the data above, we only have US MD (more competitive) vs IMG/FMG which are less competitive."

 

[bronx43]

Percent matched isn't a good marker for competitiveness, because physicians are generally smart enough to self-select.

For example, I don't believe for 1 second that radiation oncology (99.1% match rate) is way less competitive than psychiatry (89.6%) or gen surg (83%). The average Rad onc resident has a 243 step 1, the average psychiatry resident has an average 227 step 1, and the gen surg has a 237 step 1.

pg.10 of pdf for match percentages

https://www.nrmp.org/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

Rather, applicant characteristics is the best measure (e.g. average step score of matched applicants, # of pubs, AOA, etc.)

Ideally we'd probably just sort by step 1, but based on the data above, we only have US MD (more competitive) vs IMG/FMG which are less competitive.

Fellowships ranked by the % of new fellows who are US MD

1. Allergy/Immunology 70.1%
2. Gastroenterology 60.4%
3. Heme/Onc 53.6%
4. Cardiology 50.8%
5. Pulm/CC 48.9%
6. ID 46.1%
7. Sleep 43.6%
8. Rheum 42.1%
9. Geri 40.2%
10. Endocrine 32.2%
11. Nephrology 28.7%

I mean, sure- taking MULTIPLE variables would give you a better regression model (though have to be careful not to overfit). Even then, you'll likely have different models perform the "best" at different points in time, as model selection will change every year as the dataset is updated with new fellows.

But without breaking out the machine learning textbooks, I think we can all agree that GI, cards, pulm, and heme onc are competitive, while neph, ID, geri, and palliative are not competitive...

 

[CCM-MD]

That's an even worse methodolgy because sdn is filled with neurotic overachievers. The avg rad onc candidate scored a 243 while there are tons of peeople who go unmatched every year. Regardless, the methodology is seriously flawed. I don't believe for a second that psych (89%) is much more competitive than neurology (97%). 227 step 1 vs 232 step 1.

Well if you had visited the forum, you would know how difficult it is to get a job in rad onc these days. And you know, most people actually want to have a job after all this extensive training…

You are also out of touch if you don’t know how competitive psychiatry has become in recent years.

Don’t understand your fixation on step 1 scores. Supply/demand as evidenced by the applicants to positions ratio is a much better marker of true competitiveness - not just when it comes to this, but most other things in life also.

 

[Bobblehead]

Another recent example of how reimbursement patterns alter specialties is sleep. Look at the sleep medicine sub-forum (and the above matching percentage, and the percentage of US grads matching to sleep). The only people left doing sleep are the ones that actually like doing it.

 

[Loog567]

Well if you had visited the forum, you would know how difficult it is to get a job in rad onc these days. And you know, most people actually want to have a job after all this extensive training…

You are also out of touch if you don’t know how competitive psychiatry has become in recent years.

Don’t understand your fixation on step 1 scores. Supply/demand as evidenced by the applicants to positions ratio is a much better marker of true competitiveness - not just when it comes to this, but most other things in life also.

Supply demand is basically proxied by how competitive the applicants are. Psychiatry being lower in match is due to it typically being a safety or a target for those who can’t match/at risk for not matching. Again, you miss the phenomenon of self-selection.

Tens of thousands of applicants CANNOT EVEN MATCH INTO ANY residency. You think FMGs are too stupid to know about the fact that they can apply rad onc or something? No matter how bad the job market is, it’s way better than being an unmatched fmg. They don’t apply because they don’t have any reason to waste their money. They all talk about applying FM or psych a 2nd go around, they never talk about applying rad onc. Just like how tons of people don’t apply Harvard, they know it’s a waste of time/money. Physicians at this point have enough self awareness to self select.

 

[bronx43]

Supply demand is basically proxied by how competitive the applicants are. Psychiatry being lower in match is due to it typically being a safety or a target for those who can’t match/at risk for not matching. Again, you miss the phenomenon of self-selection.

Tens of thousands of applicants CANNOT EVEN MATCH INTO ANY residency. You think FMGs are too stupid to know about the fact that they can apply rad onc or something? No matter how bad the job market is, it’s way better than being an unmatched fmg. They don’t apply because they don’t have any reason to waste their money. They all talk about applying FM or psych a 2nd go around, they never talk about applying rad onc. Just like how tons of people don’t apply Harvard, they know it’s a waste of time/money. Physicians at this point have enough self awareness to self select.

Please define "competitiveness" of a specialty. Before discussing something, I think it's best to define the term.

 

[chessknt]

Did you know this thread would turn a full bore dicks out for Harambe battle royale? Do you just want to watch the world burn?

 

[Loog567]

Please define "competitiveness" of a specialty. Before discussing something, I think it's best to define the term.

I'm defining competitiveness as if you took a random med student/resident, how easy it is for them to match into that specialty.

If you look at surveys and general experience you'll see that factors that determine how good/likely an applicant can match are somewhat subjective, but there are several objective factors that are predictive, like Step score, AOA, top 40 NIH funding institution, # of research experiences, US MD (vs DO vs IMG/FMG).

The easiest way is to just sort by step score, especially given a large enough sample. Since we don't have that data, I just sorted by US MDs (who are much more competitive as a group than FMGs).

 

[DrMetal]

Have you visited the rad onc section of this website recently? If you had, you would know why it has become so undesirable.

Why I think Rad/Onc has a secure career and bright future

You ain't kidding. I was curious . . .now I wanna drink.

 

[Splenda88]

That's an even worse methodolgy because sdn is filled with neurotic overachievers. The average SDN poster is NOT the average med student/resident. The avg rad onc candidate scored a 243 while there are tons of peeople who go unmatched every year. Regardless, the methodology is seriously flawed. I don't believe for a second that psych (89%) is much more competitive than neurology (97%). 227 step 1 vs 232 step 1.

Psych is indeed more competitive than neurology. I think neurology is at the level of IM/FM competitiveness.

 

[I-dont-do-source-control]

No resident gives a **** about Fauci. ID pays less for more training and for the majority of us l, clinical ID is 99% boring. For everyone cool case, you have a 100 dumb cases like "bilateral cellulitis what abx do we need?" and it just turns out the patient is in heart failure. Or it's all setting up OPAT for osteo.

Anecdotally, my ID program had more applications and got significantly more "competitive" applicants this year. My home IM program also had a spike in people who applied and macthed.

Wonder if there is some selection bias, as in some people only apply to 1-2 HPM programs and also look for hospitalist jobs so the match rate is lower, but for ID this is less prevalent? Also the starting rate for ID jobs in my city is very close to on par with hospitalist starting (if not 10-20k more) with no nights, and ~1:6 weekends 8-4(or 5) M-F (and include admin FTE for time for stewardship, infection control or other area of your choice) so some could say a better lifestyle.

 

[Loog567]

Psych is indeed more competitive than neurology. I think neurology is at the level of IM/FM competitiveness.

Lol, that’s a classic SDN meme driven by people who are desperate to match at all but reality doesn’t bear out.

The average neuro resident has a higher step score, has more research, is more likely to be in AOA, and is more likely to be is a top 40 med school based on charting outcomes. The average neuro resident is objectively more competitive than the psych resident.

 

[DrMetal]

The average neuro resident has a higher step score, has more research, is more likely to be in AOA, and is more likely to be is a top 40 med school based on charting outcomes. The average neuro resident is objectively more competitive than the psych resident.

yeah, so they can 'advise' us to get the MRI, then start ASA/statin.

 

[Loog567]

yeah, so they can 'advise' us to get the MRI, then start ASA/statin.

I mean derm advises me to use topical steroids while I let out a big yawn but they're obviously more competitive as a group than IM lol. But I digress. At least neuro's consults to IM are a lot less frivolous to psych's consult to IM!

 

[Splenda88]

Lol, that’s a classic SDN meme driven by people who are desperate to match at all but reality doesn’t bear out.

The average neuro resident has a higher step score, has more research, is more likely to be in AOA, and is more likely to be is a top 40 med school based on charting outcomes. The average neuro resident is objectively more competitive than the psych resident.

You also have to look at the # of applicants vs the # of spots.

 

[bochaw]

wow rheum and endo competitiveness has been increasing every year

 

[Loog567]

You also have to look at the # of applicants vs the # of spots.

That’s what I’ve been saying, the # of applicants is driven by heavy self selection. Tons of people I know in IM would have loved to been dermatologists instead, but didn’t apply. The “real” match percentage is much lower.

Step scores are interchangeable, high step scores make a generic med student more competitive in any specialty they apply to. Their odds of matching are high when they score higher than their peers and low when they score lower than their peers. If the hypothetical general student applied psych, he would have a higher chance of matching because he is likely the higher scoring of his peers vs if he had applied neurology.

Step score of residents already account for the number of spots. If there are 3 spots and 3 applicants with scores of 230, 240, and 250, the average would be 240. If there was only one spot with 3 applicants, the average step score would be 250 (hypothetically assuming other attributes are equal).

Psych and FM are known to be easy and thus are the target for a lot of IMGs who can’t otherwise match. If you look at the unmatched step scores from charting outcomes you’ll see very low step scores for that reason. Match % is very misleading this way.

 

[rokshana]

If you use percent matched as a marker for competitiveness, it looks like people are still primary chasing for the money, and somewhat for lifestyle. If ID and Nephro paid as much as GI on average (and their fellowships are 2 yrs instead of 3 years) I'm sure they would be similarly competitive with more applicants. Besides the money you get from scoping nonstop all day, there's not much else going for GI - lifestyle is mixed at best with a good amount of call, and you literally have to deal with poop all time. And the money is far from guaranteed for the long run for GI or any specialty. All it takes is for CMS to decide to steeply cut reimbursements for GI procedures a few years down the line since they think GI is getting paid too much (and this will also drive down reimbursements from private insurers), and the money factor for GI can quickly go away.

A bit surprised that endocrine match rate was that low. Good lifestyle but but essential pays the same as just being a PCP. Rheum pay isn't super high either but I guess people are going after the lifestyle.

Fyi… there were 6 unfilled endocrine spots this year.

 

[Splenda88]

i was told there were a lot of nephrology and ID spots.

 

[rokshana]

i was told there were a lot of nephrology and ID spots.

167 unfilled spots in nephrology

 

[Splenda88]

167 unfilled spots in nephrology

That is a lot. So even IMG/FMG dont want to be specialists

 

[Chemist0157]

i was told there were a lot of nephrology and ID spots.

Nephrology interest fellow off around 2013, but programs increased spots anyway starting in 2016. There's still only so many spots at the better programs, but there has been just a surplus of spots for years that have not been eliminated.

 

[PamBeesly]

That is a lot. So even IMG/FMG dont want to be specialists

IMG/FMG are often smarter and tougher than US graduates. It's not like we take the rejected stuff US MDs don't want. Jeez. I know more IMG cardiology fellows than US ones.

 

[Loog567]

IMG/FMG are often smarter and tougher than US graduates. It's not like we take the rejected stuff US MDs don't want. Jeez. I know more IMG cardiology fellows than US ones.

This isn’t really about intelligence or “toughness”. They are objectively less competitive overall.

Sure, some FMGs are the genius of their country and match MGH. But overall their stats are worse per charting outcomes and there is a bias against them.

I will usually say that IMGs are usually less competitive, rarely would a US citizen go abroad to the Carribean to attend med school if given the choice to attend a US med school.

 

[bronx43]

That’s what I’ve been saying, the # of applicants is driven by heavy self selection. Tons of people I know in IM would have loved to been dermatologists instead, but didn’t apply. The “real” match percentage is much lower.

Step scores are interchangeable, high step scores make a generic med student more competitive in any specialty they apply to. Their odds of matching are high when they score higher than their peers and low when they score lower than their peers. If the hypothetical general student applied psych, he would have a higher chance of matching because he is likely the higher scoring of his peers vs if he had applied neurology.

Step score of residents already account for the number of spots. If there are 3 spots and 3 applicants with scores of 230, 240, and 250, the average would be 240. If there was only one spot with 3 applicants, the average step score would be 250 (hypothetically assuming other attributes are equal).

Psych and FM are known to be easy and thus are the target for a lot of IMGs who can’t otherwise match. If you look at the unmatched step scores from charting outcomes you’ll see very low step scores for that reason. Match % is very misleading this way.

I get what you're saying about self selection, and I agree to an extent. However, you don't have statistical evidence that step scores are the biggest factor for fellowship matching (which is VERY different from residency matching). The statistical models for each type of match is likely radically different. I'm not saying you're wrong about step scores, but at this point it's mainly your subjective feelings towards the process.

I would argue that medical school ranking is likely just as important in determining residency and fellowship match as step scores. A Harvard grad with mediocre scores would likely out-match an unranked medical school candidate with a better score. At my institution, there has literally been a spoken agenda amongst GME leaders that medical school and residency ranking needs to be heavily considered. Everybody wants their website to show a bunch of trainees from top 40. Do I agree? No, but it is what it is.

 

[aafisahar]

IMG/FMG are often smarter and tougher than US graduates. It's not like we take the rejected stuff US MDs don't want. Jeez. I know more IMG cardiology fellows than US ones.

And I know more AMg cardiology fellows than IMGs. Anecdotes aren't data.

 

[Renal_Prometheus]

Nephrology interest fellow off around 2013, but programs increased spots anyway starting in 2016. There's still only so many spots at the better programs, but there has been just a surplus of spots for years that have not been eliminated.

And the fellowship programs will never eliminate those spots because they can always fill with someone in the scramble. They need the bodies for scut work and taking their night calls. Meanwhile the specialty desperately needs a decrease in number of graduates for supply and demand to self correct. Many graduates, who were unable to find a lucrative practices post-graduation, end up just taking a hospitalist/IM position. It's the reality we live in and nothing will change.

 

[collegestud2013]

IMG/FMG are often smarter and tougher than US graduates. It's not like we take the rejected stuff US MDs don't want. Jeez. I know more IMG cardiology fellows than US ones.

Only for the non-US citizen IMGs/IMGs that's the case. Not really true for most Caribbean IMGs, which are primarily US citizens who couldn't get into USMD schools.

 

[collegestud2013]

And the fellowship programs will never eliminate those spots because they can always fill with someone in the scramble. They need the bodies for scut work and taking their night calls. Meanwhile the specialty desperately needs a decrease in number of graduates for supply and demand to self correct. Many graduates, who were unable to find a lucrative practices post-graduation, end up just taking a hospitalist/IM position. It's the reality we live in and nothing will change.

Apparently, interest for Nephro is so low that some programs can't even find someone to scramble into. Nephro can be lucrative, but only for those with some ownership (eg partner and owns dialysis centers) which tends to be limited to those who are more established. Overall the job market is saturated, especially for new grads. In the Nephro forums, they were saying that about 30-40% of Nephro grads will stop practicing Nephro within 5 years post-fellowship. Right now the pay per hour for hospitalist is the same or often slightly higher (and with 2 less years of training), and Nephro tends to have a very busy call schedule. Also, unless you're at a larger hospital with good volume and not too much competition, it's common to have to travel between multiple sites in a single work day which can significantly cut down on your efficiency.

Rad onc and EM are already in a similar boat as well. However, the difference here is even after Nephro fellowship, if you can't find a decent job as a Nephrologist you can still work as general IM. For rad onc, there doesn't seem to be much of an alternative unless you go back re-do another residency (but the older and more established rad oncs are still killing it).

 

[Loog567]

I get what you're saying about self selection, and I agree to an extent. However, you don't have statistical evidence that step scores are the biggest factor for fellowship matching (which is VERY different from residency matching). The statistical models for each type of match is likely radically different. I'm not saying you're wrong about step scores, but at this point it's mainly your subjective feelings towards the process.

I would argue that medical school ranking is likely just as important in determining residency and fellowship match as step scores. A Harvard grad with mediocre scores would likely out-match an unranked medical school candidate with a better score. At my institution, there has literally been a spoken agenda amongst GME leaders that medical school and residency ranking needs to be heavily considered. Everybody wants their website to show a bunch of trainees from top 40. Do I agree? No, but it is what it is.

But I never claimed step was the end all.

I wrote “average neuro resident has a higher step score, has more research, is more likely to be in AOA, and is more likely to be is a top 40 med school than psych”.

I clearly stated that being from a top 40 med school is also a factor.

Applicant characteristics determine how competitive a specialty is, because if a hypothetical generic person wanted to match into that specialty, their applicant characteristics will compared with the other applicants. Match rate % isn’t important.

 

[bronx43]

But I never claimed step was the end all.

I wrote “average neuro resident has a higher step score, has more research, is more likely to be in AOA, and is more likely to be is a top 40 med school than psych”.

I clearly stated that being from a top 40 med school is also a factor.

Applicant characteristics determine how competitive a specialty is, because if a hypothetical generic person wanted to match into that specialty, their applicant characteristics will compared with the other applicants. Match rate % isn’t important.

You previously stated: "I'm defining competitiveness as if you took a random med student/resident, how easy it is for them to match into that specialty." I interpret that to be the probability of a candidate with randomly generated metrics (step scores, AOA, research etc) to match into each specialty.

You haven't shown that the match rate isn't important. I would argue that it would be almost impossible for the match rate to NOT affect the model itself. In fact, it IS the outcome - the dependent variable - the DATA. How can the data itself not affect the likelihood?

Take this simplified example with only one variable (step score) in a normal distribution. Specialty A has applicants with mean step 1 score of 240 with standard deviation of 10, and specialty B has an mean step 1 score of 230 with SD of 12. If match rate for specialty A is 99.99% and match rate for specialty B is 50%, then a randomly generated step score would have a higher probability of matching A than B, even though the mean score is higher in the former.