People talk about how one should "choose" or "pursue" a specialty that they have "an interest in"- but from what I've seen in my research, MUCH of what it takes to match into a specialty is objective- and based mostly on your Steps, Grades, and research. So in the end, you don't so much as choose your specialty- but rather- are assigned one- based on what specialty you CAN match into- after competing with other applicants. If this is the case, what happens if someone wants to match into, say, Neurosurgery, but due to inadequate grades/scores can only be competitive enough to match into Pediatrics or some other specialty? Does that person become a disgruntled, dispassionate pediatrician? I'd imagine that would be a HORRIBLE scenario to be in. I mean not everyone can match into their preferred specialty right?
Is choosing a specialty mostly dependent on your Step Scores/grades?
- Thread starter HriRish
- Start date
- Joined
- Oct 18, 2008
- Messages
- 1,106
- Reaction score
- 1,413
It depends. There are a very few specialties that require stellar everything, and a few that you just need to pass step 1 and you're in. Everything else is flexible.
- Joined
- Jan 8, 2013
- Messages
- 1,136
- Reaction score
- 91
Hopefully not. Once they accept the fact that they are not going to be a neurosurgeon, they will find reasons that they are glad they didn't become a NS, and they will find reasons to be happy they matched peds.
- Joined
- Aug 1, 2005
- Messages
- 61,070
- Reaction score
- 13,937
The scenario you just described happens. I mean we all cant get top scores, etc.
That is why I say you cant really decide on what specialty you want to do until you take Step 1. Then, you can talk about it.........
Unless, you want to do something that is not competitive like myself.
I believe in many specialities you will find some physicians unhappy for the reasons you described. It was all they could get. But, in the same manner, there are other physicians that get what they want and find out they hate it. And on top of that, there are others that went into medicine for what I consider to be wrong reasons........family pressure, prestige, etc. and soon learn that this **** is hard. And you have to really love it to be happy. Some docs I know dont like the job but like the money and lifestyle it brings so the ends justify means for those folks.
But, yeah you cant really be a derm unless you got the means.
All of this is based on averages. I know there are those cases that still get in. I am talking more than likely.......not the long shots.
That is why I say you cant really decide on what specialty you want to do until you take Step 1. Then, you can talk about it.........
Unless, you want to do something that is not competitive like myself.
I believe in many specialities you will find some physicians unhappy for the reasons you described. It was all they could get. But, in the same manner, there are other physicians that get what they want and find out they hate it. And on top of that, there are others that went into medicine for what I consider to be wrong reasons........family pressure, prestige, etc. and soon learn that this **** is hard. And you have to really love it to be happy. Some docs I know dont like the job but like the money and lifestyle it brings so the ends justify means for those folks.
But, yeah you cant really be a derm unless you got the means.
All of this is based on averages. I know there are those cases that still get in. I am talking more than likely.......not the long shots.
- Joined
- Mar 3, 2013
- Messages
- 239
- Reaction score
- 6
My mentors are encouraging me to decide not just a specialty, but a specialty for every single STEP score that will change as the hypothetical STEP score goes up or down. I guess they think that STEP score/grades are the primary factors in deciding a specialty.
- Joined
- Mar 31, 2013
- Messages
- 4
- Reaction score
- 0
This aspect of medicine has always kind of bothered me; your potential step score(s) limiting what field you can go into. There just seems to be something wrong with that
- Joined
- May 20, 2010
- Messages
- 5,602
- Reaction score
- 7,681
I mean it's not ideal but if we didn't have some kind of filter a quarter of every medical school class would be trying to match derm and plastics which would mean a lot more people would just not match. It would actually probably make certain specialties even more competitive (in terms of applicants per seat) than they are right now since there would be no "self filter" with step scores.
Your step score does not tell you which specialties you are interested in, but it certainly helps determine if you will match into a specific competitive specialty.
We all have a span of interests and there is a range of specialties with similar characteristics that might fit various parts of those interests. It's a matter of balancing your interests to your qualifications (in this case your step score and the rest of your application).
That's how it is for any job search, not just in medicine.
We all have a span of interests and there is a range of specialties with similar characteristics that might fit various parts of those interests. It's a matter of balancing your interests to your qualifications (in this case your step score and the rest of your application).
That's how it is for any job search, not just in medicine.
- Joined
- Feb 24, 2005
- Messages
- 15,463
- Reaction score
- 1,908
Step score rules out specialties. Your interests rule in.
- Joined
- Mar 23, 2008
- Messages
- 12,111
- Reaction score
- 250
It's not any different than what happens in many other fields. There are always some sort of exclusion criteria within the profession. Went to a mediocre law school? You probably won't be doing patent law for big pharma. Okay-ish business school? Wall Street is a long shot. Etc. At least you have a large amount of control over your career trajectory once you're in the midst of your professional education, unlike those examples.
- Joined
- Nov 8, 2009
- Messages
- 1,333
- Reaction score
- 24
What's the alternative?
I think it's far superior to a prestige based system where Ivy League brats would get what they want and us state schoolers would get the leftovers. I appreciate a system where we generally start with a blank slate with respect to college GPAs and MCAT scores. If a person decides to work their ass off for 2 years after being medicore in college then they still have the ability to get into the specialty of their choice.
- Joined
- Mar 3, 2013
- Messages
- 239
- Reaction score
- 6
It's a good thing to have test scores determine your life rather than who your Dad knows or what school you're from.
- Joined
- Apr 16, 2008
- Messages
- 1,584
- Reaction score
- 1,401
Anything is "possible" with poor board scores; just the road is much tougher and back-up plans are a wise decision. Do individuals with <200 get ortho..sure, but it's a lot easier to get it with 260; but at the same time a 260 doesn't guarantee you a spot.
As has been said, you can get to pretty much what you want eventually, just going to take awhile. I have a good friend who wanted a radiology residency the way that my dog wants a bacon-covered bone. Alas, he had pretty mediocre board scores. So he hustled, did tons of research, got mentors. And he got one. It wasn't the most prestigious one, but hell he got it.
For neurosurgery, probably have to do gen surgery first. But can get there.
For neurosurgery, probably have to do gen surgery first. But can get there.
- Joined
- Dec 21, 2007
- Messages
- 2,085
- Reaction score
- 2,947
- Joined
- Aug 13, 2010
- Messages
- 161
- Reaction score
- 9
Neurosurg. is one of the only, if not the only, field where you have to match straight into. There is no backdoor according to an attending who lectured us a while back.
- Joined
- Aug 6, 2010
- Messages
- 1,920
- Reaction score
- 15
It's because unfortunately medicine is a business and the most competitive specialties happen to be the ones that pay the best/have the nicest lifestyle. It doesn't make that much sense, I agree. The very idea that derm requires the best of the best students is utter nonsense, for example, but that's unfortunately just the way it is.
- Joined
- Aug 6, 2010
- Messages
- 1,920
- Reaction score
- 15
You can actually match and apply for interventional neurology (which is essentially minimally invasive neurosurgery) through a neurology residency so even that's not entirely true.
Didn't know that (I'm a total non-surgical type)....learn something new everyday. Especially since I'll be associated with neurosurgeons (start my neuro residency in a couple of months).
Was actually thinking would do a gen surf residency first, then go for neurosurgery.
Was actually thinking would do a gen surf residency first, then go for neurosurgery.
- Joined
- Aug 6, 2010
- Messages
- 1,920
- Reaction score
- 15
While I totally agree with the sentiment coming from a state med school myself (and undergrad) it's actually not true that prestige has no effect on residency application. I saw for myself that at the top tier programs on interviews, they tended to favor top tier applicants from top tier med schools. I probably had more research and better scores than some of the people who were selected for those programs but unfortunately being from a non-top 20 school still hurt my chances. Doesn't mean it's impossible of course to match those, but you have to work harder and look even better than someone from a Hopkins or Harvard tier school may have to.
- Joined
- Aug 6, 2010
- Messages
- 1,920
- Reaction score
- 15
Congrats on matching! I recently matched IM residency. I only knew about it because I have a friend going into neurology who is thinking of doing that himself.
- Joined
- Apr 5, 2010
- Messages
- 185
- Reaction score
- 1
It's multifactorial.
AAMC has a careers in medicine thing that some people like. It's supposed to tell you where you fit better. However, everyone I've talked to says that 3rd year is really when you figure out what you're gonna do. Mostly because of exposure combined with the knowledge of what your boards score can get you.
Also, some specialties love things that others don't so it really all depends. I've heard the important things to focus on are clerkship grades, step scores, LORs, MSPE letter, and research. AOA and good preclinical grades are also supposed to help to varying degrees.
I've also heard that the whole prestige thing isn't gone for the match process. Just to echo what ArcGuren said.
AAMC has a careers in medicine thing that some people like. It's supposed to tell you where you fit better. However, everyone I've talked to says that 3rd year is really when you figure out what you're gonna do. Mostly because of exposure combined with the knowledge of what your boards score can get you.
Also, some specialties love things that others don't so it really all depends. I've heard the important things to focus on are clerkship grades, step scores, LORs, MSPE letter, and research. AOA and good preclinical grades are also supposed to help to varying degrees.
I've also heard that the whole prestige thing isn't gone for the match process. Just to echo what ArcGuren said.
- Joined
- Feb 13, 2012
- Messages
- 1,694
- Reaction score
- 1,948
Not even close to the same.
On another note. Interventional neurology and neurointerventional radiology are going by the wayside because neurosurgeons do it too. Most patients, and referring physicians, prefer a one-stop-shop kind of doctor as opposed to multiple doctors.
- Joined
- Dec 14, 2009
- Messages
- 1,132
- Reaction score
- 736
How so? Neurologists have to carry the stroke pager, too. I imagine they will have more referring power than neurosurgeons, which is 99% of the turf battle if we consider the analogous rise of interventional cardiology in lieu of interventions performed by vascular/CT surgery/IR. Curious for your thoughts, not trying to be contrarian here.
being completely honest, yes. But being a DO applying to MD residencies is a big reason why. I knew that if I did below average, the door would be shut on basically everything but primary care. So I did my best not to get my hopes up about what specialty I wanted. Once I found out I did well on step 1, I began exploring some of the easier to match specialties. It sucks that so much of your life is determined by 1 test, but I'm happy with how it worked out for me.
- Joined
- Apr 4, 2013
- Messages
- 417
- Reaction score
- 2
Actually those still matter.
- Joined
- Dec 21, 2007
- Messages
- 2,085
- Reaction score
- 2,947
Those matter more than they should and 1000% more than SDN seems to want to admit.
- Joined
- Sep 30, 2008
- Messages
- 40,985
- Reaction score
- 24,987
No, of course not everyone can match into their preferred specialty. However, for most, there isn't "one true specialty" that they love, and then they hate absolutely everything else; most fields have at least some overlap with something else. People who want to do neurosurg can be happy with gen surg or neurology, people who want ortho could do PM&R, people who want derm (aka mostly wanting a certain lifestyle... not always true, but often) can settle for path or psych, etc. I can imagine that would be disappointing, but you find things you like about the specialty that you wind up being competitive for and you move on with your life.
Moving to pre-allo.
- Joined
- Mar 3, 2013
- Messages
- 239
- Reaction score
- 6
But they matter less than they do in law or banking.
- Joined
- Feb 13, 2012
- Messages
- 1,694
- Reaction score
- 1,948
I see what you're saying, and clot busting may be one thing that neurointerventionalists hold on to since, as you mentioned, neurologists are on call for strokes and may be more inclined to refer them to an interventional neurologist. That being said, getting a hospital to hire you and privileges to perform procedures is a different story. I'd suspect when given the choice between a neurosurgeon who does interventional or a neurologist who does interventional, a hospital would pick the neurosurgeon every time. The neurosurgeon scope of practice is larger and billing is higher.
Say for example a stroke patient comes in and goes for IA tPA or thrombectomy by the neurointerventionalist. Post-procedure the interventionalist washes his hands and the patient goes to the neuro-ICU (or MICU or wherever) and the intensivist manages the patient. Now the patient has a hemorrhagic conversion, neurosurgery is consulted for an evacuation or DECRO and the patient is on the neurosurgery service. In an alternative scenario, the neurosurgeon does the thrombectomy, admits the patient to his service in the ICU, then takes the patient to the OR to evacuate/decompress. Continuity of care. It's harder to sell your services if you're just a piece of a puzzle rather than the whole picture.
- Joined
- Apr 6, 2013
- Messages
- 265
- Reaction score
- 2
Is pathology one of those specialties?
- Joined
- May 20, 2010
- Messages
- 5,602
- Reaction score
- 7,681
Which one....pathology is generally not a very competitive specialty.
- Joined
- Apr 6, 2013
- Messages
- 265
- Reaction score
- 2
A competitive specialty; thanks for the answer. 🙂 Very interested in pursuing this specialty (though I know there's a good chance I'll have changed my mind when it's actually time to choose).
- Joined
- Mar 21, 2013
- Messages
- 467
- Reaction score
- 141
I have a total noob question regarding competitive residencies (so not 100% off-topic)
If you feel like you're interested in a few different specialties, can you try to match into a variety of types of residencies? So like if you are interested in neurosurgery, ortho, and derm, can you apply to residencies in each and hope you get one? Or do you have to pick one specialty and apply only to residencies in that specialty?
If you feel like you're interested in a few different specialties, can you try to match into a variety of types of residencies? So like if you are interested in neurosurgery, ortho, and derm, can you apply to residencies in each and hope you get one? Or do you have to pick one specialty and apply only to residencies in that specialty?
- Joined
- May 3, 2006
- Messages
- 4,698
- Reaction score
- 1,675
You can apply to all three technically. Of course, you'd have to schedule your electives so you'll have rotations in all 3 and get LORs from each place, apply broadly to all 3(applying to the same place in two specialties can raise eyebrows, especially since people talk). Not to mention, costly 😱
You very rarely(almost never) see someone do this. I suppose someone could apply for both neurosurgery and ortho as two choices, but most people dont apply to 3 different specialties.
- Joined
- Mar 21, 2013
- Messages
- 467
- Reaction score
- 141
thx!
haha yeah it doesn't seem like the brightest idea, I just didn't know if it was even allowed/possible.
haha yeah it doesn't seem like the brightest idea, I just didn't know if it was even allowed/possible.
- Joined
- Sep 30, 2008
- Messages
- 40,985
- Reaction score
- 24,987
It's not uncommon to see someone apply for a competitive specialty and then a less competitive backup (ie ortho and gen surg, derm and path, IM and FM, etc)--in fact, if you know that you are kind of reaching out of your league on your competitive dream specialty, it's probably a good idea.
You could, theoretically, apply to multiple competitive specialties, but I don't know why you would--there isn't much in common between the three specialties you named (ortho is surgical and derm isn't, and neurosurg has a horrible lifestyle unlike either of the other two), so you'd be basically going for something competitive just for the point of proving how much you hate yourself. If you're competitive numbers-wise, you need to pick something eventually, and you might as well go all-out on your favorite specialty to get the best program you can. If you're NOT competitive numbers-wise, you STILL might as well go all-out on your favorite specialty, get as much research and make as many connections as you possibly can within your field, and put all your eggs in one basket rather than make a half-assed attempt at multiple specialties (though as I said above, you can probably swing applying to a backup, less-competitive specialty, if there is some overlap between the two).
- Joined
- Mar 21, 2013
- Messages
- 467
- Reaction score
- 141
There was someone on another thread yesterday talking about how important the "prestige" of the specialty is. I figure there are probably a handful of people who care more about matching into a competitive specialty than what exactly they'll be doing.
But yeah, I see what you mean about having a backup for a competitive specialty. That definitely makes more sense and is surely more common than what I was talking about.
- Joined
- Jul 18, 2008
- Messages
- 6,234
- Reaction score
- 1,658
It's no different than the MCAT.
- Joined
- Sep 18, 2012
- Messages
- 340
- Reaction score
- 21
Nm already addressed b4 finishing post
Last edited:
My default was to find the "like" button. Oh facebook...
Totally agree with this. My approach to Step 1 was to do decent enough to leave doors open for myself so I could decide completely based off of my interests.
- Joined
- Apr 2, 2013
- Messages
- 2,992
- Reaction score
- 1,898
Agreed. 👍
- Joined
- Feb 27, 2010
- Messages
- 916
- Reaction score
- 28
Except it seems that you can prepare more for the boards and its more effort based. MCAT screws a lot of people over for not having built an inherent skill with verbal or intro science knowledge. Tough to do. People who fix their approach in med school can succeed.
So basically, aim to get the highest grades and Step Scores you can, so the door is wide open for any specialty you want. In addition, make an effort to do research with reputed faculty in the specialty of interest to curry favor and get a few publications and stellar letters of recommendation from them in the process. Also, do rotations in the specialty of interest and excel at them. Not too bad. Easy-peasy, right?
