Interesting notes on 2019 THE MATCH

[DrFortiusNatando]

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Obviously the premeds on SDN have 4 years until they match, but it does not hurt to know the landscape and follow it over the next three years until they apply. Today was the day that all medical students who applied in the NRMP match found out if they did NOT match and the unfilled spots at US residencies were released. As more and more medical schools sprout up and others expand their class size, while residencies fail to grow at the same pace, there are more US medical students who fail to match, even from very good schools. Though I am not a big fan of using the USMLE licensing exams for a purpose for which they were not devised, it was clear that students with low Step 1 scores continue to encounter disproportionate difficulty especially in surgical specialties, even at T20 schools. This is not overwhelmingly true for T20 students applying in less competitive fields, even IM, EM, Med-Peds, Peds, Psych, Neuro.

As for the specialties that did not fill, surprisingly there were relatively a lot of spots in Radiation Oncology, compared to years past. There were a few spots in Derm and ORTHO too, as well as EM. There were no ENT spots. Only 2 programs in OB/GYN and Vascular Surgery failed to fill. Anesthesia and Radiology had fewer spots open than they had in the past. There were some open spots in IM, Neurology, Pediatrics and a good number in Family Medicine. Not surprisingly, as always, there were a lot of prelim spots in General Surgery and some in prelim IM, but these can be dead end jobs.

The lesson is to have a good idea of your competitiveness for your residency specialty when you apply, and make sure to apply to, interview at, and rank ANYPLACE you would consider going, as opposed to going unmatched. For students who do not match, all is not lost, bc there is a SOAP process to offer the leftover residency spots, but it is a tough game. Very few spots, if any, especially in surgery and surgical subspecialties.

 

[puahate]

Obviously the premeds on SDN have 4 years until they match, but it does not hurt to know the landscape and follow it over the next three years until they apply. Today was the day that all medical students who applied in the NRMP match found out if they did NOT match and the unfilled spots at US residencies were released. As more and more medical schools sprout up and others expand their class size, while residencies fail to grow at the same pace, there are more US medical students who fail to match, even from very good schools. Though I am not a big fan of using the USMLE licensing exams for a purpose for which they were not devised, it was clear that students with low Step 1 scores continue to encounter disproportionate difficulty especially in surgical specialties, even at T20 schools. This is not overwhelmingly true for T20 students applying in less competitive fields, even IM, EM, Med-Peds, Peds, Psych, Neuro.

As for the specialties that did not fill, surprisingly there were relatively a lot of spots in Radiation Oncology, compared to years past. There were a few spots in Derm and ORTHO too, as well as EM. There were no ENT spots. Only 2 programs in OB/GYN and Vascular Surgery failed to fill. Anesthesia and Radiology had fewer spots open than they had in the past. There were some open spots in IM, Neurology, Pediatrics and a good number in Family Medicine. Not surprisingly, as always, there were a lot of prelim spots in General Surgery and some in prelim IM, but these can be dead end jobs.

The lesson is to have a good idea of your competitiveness for your residency specialty when you apply, and make sure to apply to, interview at, and rank ANYPLACE you would consider going, as opposed to going unmatched. For students who do not match, all is not lost, bc there is a SOAP process to offer the leftover residency spots, but it is a tough game. Very few spots, if any, especially in surgery and surgical subspecialties.

A resident told me to not do RadOnc because of the job market. I been on the RadOnc sub and it seems like it isnt a good specialty anymore due to bad leadership

 

[Lawpy]

As for the specialties that did not fill, surprisingly there were relatively a lot of spots in Radiation Oncology, compared to years past.

For anyone interested: Guessing # unmatched spots

 

[scrapy]

Overall, did more US students fail to match this year?

 

[907914]

I am curious, when there are only an annual number of medical graduates somewhere around 25,000 when you combine US MD and DO, but somewhere around 30,000 residency slots, who else is filling those remaining slots? Also, if residency Slots are federally funded why do they accept any foreign medical graduate if we still have US MD and DO students not matching?

 

[givesumacceptpls]

How does the ranking work? Because, it is my belief that if I apply to 50 programs, and get invited to interview at 15, I would rank those 15 regardless of how I feel I did. Is this how it works?

 

[WedgeDawg]

How does the ranking work? Because, it is my belief that if I apply to 50 programs, and get invited to interview at 15, I would rank those 15 regardless of how I feel I did. Is this how it works?

You rank every program you interview at that you would be happier at than not matching at all.

 

[givesumacceptpls]

You rank every program you interview at that you would be happier at than not matching at all.

so people really choose to not rank over going to a place they wouldn't be super comfortable?

 

[WedgeDawg]

so people really choose to not rank over going to a place they wouldn't be super comfortable?

Some programs are terrible fits for some people. It is up to them to decide what choice is right for them.

 

[getdown]

Some programs are terrible fits for some people. It is up to them to decide what choice is right for them.

I would rather eat a whole steaming pile of elephant doodoo than soap into a prelim gen surgery program.

 

[sloppypapi]

I haven't even started med school yet, and the mere thought of not matching made my heart rate spike.

 

[WedgeDawg]

I haven't even started med school yet, and the mere thought of not matching made my heart rate spike.

I am not someone who gets anxious easily but dammit if Monday morning wasn’t the most anxious I’ve been in recent memory

 

[965978]

I am not someone who gets anxious easily but dammit if Monday morning wasn’t the most anxious I’ve been in recent memory

In your opinion, what’s more emotionally and mentally taxing? The med school admission process or the match?

 

[Naruhodo]

In your opinion, what’s more emotionally and mentally taxing? The med school admission process or the match?

If I'd interpreting the data correctly odds of matching are still better than the odds of being accepted to medical school. But by the time the match comes along you've invested a whole lot into the process of becoming a doctor...

 

[WedgeDawg]

In your opinion, what’s more emotionally and mentally taxing? The med school admission process or the match?

I think this is an unfair question for me to try to answer objectively today 😛

I think overall the residency process is more taxing because interviews are more numerous, more important, more stressful, and more expensive, and the consequences of not matching are far greater than not getting into med school. And enough people don’t match that it’s scary. SOAP is literal hell. If you don’t get into med school, you can try again next year and there’s no urgency or time limit. You can retake your MCAT but step 1 is forever.

 

[965978]

I think this is an unfair question for me to try to answer objectively today 😛

I think overall the residency process is more taxing because interviews are more numerous, more important, more stressful, and more expensive, and the consequences of not matching are far greater than not getting into med school. And enough people don’t match that it’s scary. SOAP is literal hell. If you don’t get into med school, you can try again next year and there’s no urgency or time limit. You can retake your MCAT but step 1 is forever.

Would you say it also depends on specialty? I think there are some specialties like FM and Neuro where everyone matches barring a significant red flag (failing Step 1, getting a criminal record in med school, only ranking a couple programs etc)

 

[WedgeDawg]

Would you say it also depends on specialty? I think there are some specialties like FM and Neuro where everyone matches barring a significant red flag (failing Step 1, getting a criminal record in med school, only ranking a couple programs etc)

The degree may vary somewhat based on specialty, but everyone is stressed and under a good degree of pressure.

 

[DrFortiusNatando]

I am curious, when there are only an annual number of medical graduates somewhere around 25,000 when you combine US MD and DO, but somewhere around 30,000 residency slots, who else is filling those remaining slots? Also, if residency Slots are federally funded why do they accept any foreign medical graduate if we still have US MD and DO students not matching?

There are a good number of students from International medical schools, including many US citizens who have done medical school in the Caribbean, Ireland/rest of Europe, Australia, Japan, South America, etc. (Not to mention non-US citizen IMGs) And keep in mind some of the unfilled spots are for prelim programs in surgery, IM, Fam Med, Transition year - and these can be dead end jobs.

Or the unfilled spots are for very specialized research tracks for which there are not necessarily enough qualified students to take the spots. Or they are for poorly compensated specialties and/or in areas of the country that are not particularly desirable due to lack of opportunities for partners to find jobs, lack of opportunity to find partners, culture shock, etc. But trust me, there are no unfilled categorical spots in a major academic medical center after SOAP in most fields. Nothing left in ortho, general surgery, CT surgery, Plastic surgery, Dermatology, Vascular surgery, internal medicine, neurosurgery, radiology, Obstetrics-gynecology, ENT, anesthesia, pediatrics etc after SOAP. After SOAP, there were still some spots, mostly all prelim surgery. So, it is not just about the total numbers when we speak about number of medical students and residency spots.

 

[907914]

There are a good number of students from International medical schools, including many US citizens who have done medical school in the Caribbean, Ireland/rest of Europe, Australia, Japan, South America, etc. (Not to mention non-US citizen IMGs) And keep in mind some of the unfilled spots are for prelim programs in surgery, IM, Fam Med, Transition year - and these can be dead end jobs.

Or the unfilled spots are for very specialized research tracks for which there are not necessarily enough qualified students to take the spots. Or they are for poorly compensated specialties and/or in areas of the country that are not particularly desirable due to lack of opportunities for partners to find jobs, lack of opportunity to find partners, culture shock, etc. But trust me, there are no unfilled categorical spots in a major academic medical center after SOAP in most fields. Nothing left in ortho, general surgery, CT surgery, Plastic surgery, Dermatology, Vascular surgery, internal medicine, neurosurgery, radiology, Obstetrics-gynecology, ENT, anesthesia, pediatrics etc after SOAP. After SOAP, there were still some spots, mostly all prelim surgery. So, it is not just about the total numbers when we speak about number of medical students and residency spots.

Why is a transitional year dead end? Aren’t there some programs that require transitional intern years (most physiatrist residencies come to mind)

 

[meronebib]

A transitional year or prelim year without a PGY-2 placement (e.g. a PM&R or rads or urology spot held for you after you finish) is a dead end. It's fine and normal for certain specialties to do a prelim/transitional year, then go on to your specialized training.

But sometimes people either SOAP into or match to only a prelim/TY, which will not prepare you to be board certified in any specialty. So you would need to reapply for residency at the end of that year, and hope to get a spot in whatever specialty to finish your training.

Does that essentially give you 2 opportunities to match into your field though? For example, someone doesn’t match into derm, but they match into a prelim. Can they try again for derm at the end of that prelim and essentially lose no time?

 

[ciestar]

I haven't even started med school yet, and the mere thought of not matching made my heart rate spike.

I am an MS3 and I already am stressed about next year

In your opinion, what’s more emotionally and mentally taxing? The med school admission process or the match?

Definitely the match. Think of it this way, not matching means you spent four years in med school and have all that debt and nowhere to go. At least with not getting into med school you’re not stuck paying back all that debt.

 

[meronebib]

I am an MS3 and I already am stressed about next year



Definitely the match. Think of it this way, not matching means you spent four years in med school and have all that debt and nowhere to go. At least with not getting into med school you’re not stuck paying back all that debt.

But isn’t the match statistically more likely to work in your favor than med school?

 

[WedgeDawg]

But isn’t the match statistically more likely to work in your favor than med school?

Depends on the specialty. It breaks down for smaller specialties with not very many spots per program.

 

[965978]

Depends on the specialty. It breaks down for smaller specialties with not very many spots per program.

Quick question. Columbia, at one point, had an administrative error in which their cardiothoracic surgery program wasn’t included in the Match. They then decided not to get anyone in from SOAP. Why do you think they did that?

 

[WedgeDawg]

Quick question. Columbia, at one point, had an administrative error in which their cardiothoracic surgery program wasn’t included in the Match. They then decided not to get anyone in from SOAP. Why do you think they did that?

Honestly I have no idea ... don't really have any insight unfortunately... sorry I don't have a more satisfying answer 😛

 

[965978]

Honestly I have no idea ... don't really have any insight unfortunately... sorry I don't have a more satisfying answer 😛

Oh no don’t worry haha. I was just extremely curious as to why a program would leave a seat vacant on purpose.

 

[Ms Procrastinator]

I would rather eat a whole steaming pile of elephant doodoo than soap into a prelim gen surgery program.

What's wrong with a prelim general surgery program?

 

[ciestar]

What's wrong with a prelim general surgery program?

Well.. it is general surgery lol

And im on my surgery rotation now and one of the PGY-1 prelims failed to match.

 

[WedgeDawg]

Oh no don’t worry haha. I was just extremely curious as to why a program would leave a seat vacant on purpose.

It looks like they're at their full compliment of 12 residents right now (per google search) so I think the ended up filling somehow

 

[WedgeDawg]

What's wrong with a prelim general surgery program?

No guarantee of a PGY-2 year, you're essentially free floor labor for the gen surg service, categorical residents given priority in the OR, have to work really hard to try to make a good impression to hopefully try to land a PGY-2 position somewhere in something... just a lot of uncertainty and pain for no guaranteed outcome.

 

[DrFortiusNatando]

What's wrong with a prelim general surgery program?

A long time ago, a lot of surgery programs USED to be pyramid programs. They needed a lot more worker bees, so they accepted 8 interns, but after 2-3 years of residency simply told the "bottom" 3 residents that they were dismissed, out of a job. Nothing good happened to these partly-trained residents. (Programs often only had enough "good" surgical cases to support a small number of senior residents, per the residency review committees, so were limited to a much smaller number of senior residents. But they needed lots of interns to hold retractors and cover the post op patients who were admitted and to cover clinic.)

Then, in part due to a backlash, programs went to offering designated preliminary spots that had a defined end at the end of one year to solve their problem of needing more worker bees. This was not a problem for people who were matching at the same time into a PGY 2 spot in optho or derm - they would get their match results in the same year (PGY 2 spots in the match are for the following year). However, without a designated place to go after the prelim surgery, many people have no place to go. Occasionally, a star prelim intern can get a PGY 2 spot out of the match for general surgery if someone drops out, but there are very few of these opportunities. So that is why a prelim surgery spot is often a dead end. In some states, one can get a license after a one year of internship, but some states, you can not even get a license.

 

[965978]

Same way reapplicants are less competitive for med school.

Defiantly not true if the reapplicant has fixed their deficiencies.

 

[Faha]

I am curious, when there are only an annual number of medical graduates somewhere around 25,000 when you combine US MD and DO, but somewhere around 30,000 residency slots, who else is filling those remaining slots? Also, if residency Slots are federally funded why do they accept any foreign medical graduate if we still have US MD and DO students not matching?

There are actually over 30,000 residency slots when you add in the DO residency programs. Almost 3,000 US IMG graduates and almost 4,000 non US IMG matched in 2018. Over 5,000 of those IMG end up in Family Practice, Internal Medicine or Pediatrics. With the increasing number of DO and MD schools opening up, in another 10 years the non US IMG will disappear from the match and most of the US IMG will going to US DO or MD schools.

 

[Goro]

There are actually over 30,000 residency slots when you add in the DO residency programs. Almost 3,000 US IMG graduates and almost 4,000 non US IMG matched in 2018. Over 5,000 of those IMG end up in Family Practice, Internal Medicine or Pediatrics. With the increasing number of DO and MD schools opening up, in another 10 years the non US IMG will disappear from the match and most of the US IMG will going to US DO or MD schools.

As an aside, does anyone note the irony that many IMGs go for the offshore MD, only to end up in, wait for it, Family Practice, Internal Medicine or Pediatrics?

 

[965978]

As an aside, does anyone note the irony that many IMGs go for the offshore MD, only to end up in, wait for it, Family Practice, Internal Medicine or Pediatrics?

Logic and common sense are like finding the strawberry cremé in a box of chocolates. Some people don’t find it until later in life when they are at an overcrowded lecture hall in the Caribbean 😛

 

[Master Thinker]

Logic and common sense are like finding the strawberry cremé in a box of chocolates. Some people don’t find it until later in life when they are at an overcrowded lecture hall in the Caribbean 😛

Jokes on you, they are actually in a overcrowded room on a cruise ship

 

[The Knife & Gun Club]

There are actually over 30,000 residency slots when you add in the DO residency programs. Almost 3,000 US IMG graduates and almost 4,000 non US IMG matched in 2018. Over 5,000 of those IMG end up in Family Practice, Internal Medicine or Pediatrics. With the increasing number of DO and MD schools opening up, in another 10 years the non US IMG will disappear from the match and most of the US IMG will going to US DO or MD schools.

I disagree - there will always be space for some non-US IMGs. Often these non-US students are rock stars from their home countries and there’s always going to be residencies willing to take them.

US IMGs on the other hand are often damaged goods students from questionable degree mill schools. We’ll see them lose out long before their non-US counterparts

 

[907914]

I disagree - there will always be space for some non-US IMGs. Often these non-US students are rock stars from their home countries and there’s always going to be residencies willing to take them.

US IMGs on the other hand are often damaged goods students from questionable degree mill schools. We’ll see them lose out long before their non-US counterparts

That is where the ugliness of the politics comes in to play - do we want meh US citizens becoming US doctors or do we want awesome non-US citizens to become US trained, potentially serve their home country doctors?

Anyone have statistics on the number of IMGs who continue to work in the US after residency? The only one I know is a urologist that practices 2 weeks in the US followed by 2 weeks in Romania. Sweet gig.

 

[The Knife & Gun Club]

That is where the ugliness of the politics comes in to play - do we want meh US citizens becoming US doctors or do we want awesome non-US citizens to become US trained, potentially serve their home country doctors?

Anyone have statistics on the number of IMGs who continue to work in the US after residency? The only one I know is a urologist that practices 2 weeks in the US followed by 2 weeks in Romania. Sweet gig.

I don’t have any stats to support this - but I haven’t/don’t work with any residents who’ve gone back to their home country after training here.

Why would they? What do you get from doing a US residency if you don’t plan to practice here?

 

[Faha]

I don’t have any stats to support this - but I haven’t/don’t work with any residents who’ve gone back to their home country after training here.

Why would they? What do you get from doing a US residency if you don’t plan to practice here?

Most of the non US IMG residents stay in this country. Is it ethical though to take 4,000 physicians from their native countries, many 3rd world countries with a major shortage of physicians? Lack of access to health care and higher death rates from preventable diseases is the end result. This has also been noted in the UK where they import physicians from Commonwealth nations and former colonies.

 

[The Knife & Gun Club]

Most of the non US IMG residents stay in this country. Is it ethical though to take 4,000 physicians from their native countries, many 3rd world countries with a major shortage of physicians? Lack of access to health care and higher death rates from preventable diseases is the end result. This has also been noted in the UK where they import physicians from Commonwealth nations and former colonies.

I mean that’s a tough question.

While not ideal I think it’s fine. Considering we’re talking about the entire world, I doubt a few thousand doctors makes a measurable difference on that scale.

Also I think you’ve gotta respect the autonomy of the physicians trying to come here. People have the free will to do whatever they think is best for them, and if they’re willing to put in the work it’s not our place to force them to stay in their home country.

That’s just my opinions though.

 

[LukaDoncicLuk]

Most of the non US IMG residents stay in this country. Is it ethical though to take 4,000 physicians from their native countries, many 3rd world countries with a major shortage of physicians? Lack of access to health care and higher death rates from preventable diseases is the end result. This has also been noted in the UK where they import physicians from Commonwealth nations and former colonies.

Physicians shouldn't be punished because they were unfortunate enough to be born in a country with a terrible government.

 

[Faha]

Physicians shouldn't be punished because they were unfortunate enough to be born in a country with a terrible government.

And neither should the other 99.9% of citizens of those countries who are not physicians. Perhaps they should also be treated on an equal basis with physicians when deciding who is allowed to immigrate to this country ?

 

[LukaDoncicLuk]

And neither should the other 99.9% of citizens of those countries who are not physicians. Perhaps they should also be treated on an equal basis with physicians when deciding who is allowed to immigrate to this country ?

Yeah this is why I'm for open borders, free trade, and minimal government interference. We are in agreement.

 

[WedgeDawg]

Heyyyyyy remember what thread we’re in 😀

 

[puahate]

It is so sad what happened to rad onc.

 

[Master Thinker]

It is so sad what happened to rad onc.

What happened to Rad Onc?

 

[puahate]

What happened to Rad Onc?

People are referring to this recent match as a wake up call. I would have thought that the ABR screwing over an entire class of residents on their physics and rad bio exams would have been a wake up call but our leadership did absolutely nothing and the ABR won. What makes us think this is any different? People taking to twitter won’t solve the problem and we are doing this to ourselves.

Just in case anyone wants a refresher on the ludicrous events of the ABR Rad Bio/Physics fiasco here as a brief summary:

• Dr. Amdur/Lee write an article in PRO noting that residents are spending an inordinate amount of time studying for Rad Bio and Physics minutiae rather than focusing on clinically relevant training
• The ABR (Dr. Wallner and Kachnic) write a reply--which can be found on this thread several pages back-- in which they state with no supporting evidence that residents aren’t getting smarter, they are actually getting dumber. They blame small programs for this.. Again, with no supporting evidence.
• Rad Bio/Physics Exam 2018: 3 months later current PGY-5’s take the Rad Bio and Physics exam. Scores come out with a Physics pass rate of 70% and Rad Bio Pass rate of 74%. These scores are 3-5 standard deviations off of what they have been in the past 15 years for Rad Bio and Physics.
• The ABR accepts no responsibility that the exam they administered may have been at fault. They instead shift the blame claiming that is multifactorial. They blame worse teaching as a cause (Worse teaching which occurred in ONE YEAR and would have to occur in nearly ALL the programs in the country?) and say the angoff scoring method is flawless and could not have played a role. They additionally do analysis to look at ‘small programs’ to show that they performed worse (albeit with some likely twisting of the numbers, and it was only programs of 4 or less, which make up 6% of the resident pool). This ignores the fact that large programs have question banks, but that is a conversation for another day. Resident programs with 6 or more did not do worse to any statistically significant degree yet are being lumped in as ‘small programs are worse’.
• The end result of this debacle: no resolution, no changes are made. The ABR publishes what they refer to as a ‘new Study Guide’ for Rad Bio and physics in March of 2019 which is simply nothing more than a list of all the major textbooks and topics in the field (McDermott, Hall, Kahn, etc).
• Match Day 2019: we have the worst match in recent memory. The most obvious thing that has happened in the last year is the ABR Rad Bio and Physics exam and the pathetic handling of it. But rather than crediting medical students for recognizing a sinking ship we blame SDN for our woes as a field. Med students likely said, ‘I’m smart and have great scores, why would I bust my butt for 5 years in Rad Onc and only be guaranteed a 70% pass rate on TWO of the qualifying exams.. only to have to then take a written AND oral board exam? I can just go into another specialty…’. On Twitter our leaders are again refusing to acknowledge the source of the problem. They instead blame a lack of exposure to our field (something that hasn’t changed in decades.. it didn’t change all of a sudden) and that SDN was the culprits.
• Currently:
  • This has sparked some good debate as to the issues in our field. Residency expansion is certainly one. However, small programs are not the only ones to blame for the excessive numbers of residents. Some small programs may need to be shut down— but others are high quality programs and these are the institutions that train our Rad Oncs taking jobs in rural and undesirable locations (how many MSKCC, MD Anderson, UCSF grads end up in small town Missisippi, Kansas or West Virginia?). Large programs should also be trimming the fat and potentially reducing their numbers of residents.
  • Our Leadership: Our ABR leadership has already hurt our field. They have caused serious damage to our current PGY-5’s and now it is reflected in our incoming residents at this last match. Maybe it is time for a change.
  • Our Qualifying Exams: Maybe now is the time to reassess our qualifying exams. Should they be consolidated? Medical oncology only has 1 written exam (after passing Internal Medicine), do we really need 4 including oral boards?

This explains it well

 

[getdown]

Does that essentially give you 2 opportunities to match into your field though? For example, someone doesn’t match into derm, but they match into a prelim. Can they try again for derm at the end of that prelim and essentially lose no time?

Unlike applying to med school, a residency applicant who is 1,2,3 years out of being a med student is considered damaged goods. "Why didn't this person match the first, second, third time?", "what red flags are in this person's file that prevented him/her matching x number of times?". Think about it from a residency program's perspective. The point of the program is to graduate residents. Too high a failure rate gets them on probation and even shut down by the ACGME. The number 1 reason a program will not take a student is because their STEP scores are poor, failed STEP multiple times which all points to failing their board certification exams. There's no reason for a program to take a chance on someone like this when they can choose from a perfectly fine group of NEW graduating medical students. This is why failing to match the first time around is devastating and causes extreme anxiety in a lot of MS4s. And to your "lose no time" you actually are losing a whole year of potential attending income. More if you fail to match multiple years. Not to mention your loans come due and are accruing interest the entire time you're not doing anything.

 

[DokterMom]

Quick question. Columbia, at one point, had an administrative error in which their cardiothoracic surgery program wasn’t included in the Match. They then decided not to get anyone in from SOAP. Why do you think they did that?

My guess is that they knew they'd be able to cherry-pick some outstanding candidates through other channels outside the match and SOAP. I read later on that the program filled but didn't see who those residents are and where they went to school. Very curious...