Is Psych EM/Anesthesia/Surgery Level Competitiveness?

[yanks26dmb]

Trying to make sense of the data that's coming in (and of course the anecdotal 250 applicant who is now SOAPING) and not sure what to think.

Everyone is saying the sky is falling and psych is now a tough match. Can anyone who is more familiar with what the data means comment? Third year DO student with a low 240 now worrying about my odds next year...

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[deleted407021]

Omg, the news flying about is making me nervous too.

 

[Tastycakes]

There were 16 open spots this year (1%.)

 

[908377]

A PD on this subforum posted the stats and it showed that just shy of 18% of General Surgery spots went unfilled this year. Psychiatry had 1% of spots unfilled.

 

[TexasPhysician]

Trying to make sense of the data that's coming in (and of course the anecdotal 250 applicant who is now SOAPING) and not sure what to think.

Everyone is saying the sky is falling and psych is now a tough match. Can anyone who is more familiar with what the data means comment? Third year DO student with a low 240 now worrying about my odds next year...

Take a deep breath. With increasing med school enrollments, all fields are getting a bit tougher. Advisors need to do a better job of providing realistic programs to apply toward. I’ve seen 250+ boarded AOA applicants with research fail to match and applicants who failed an entire year match #1 on their rank list. Being realistic about where you apply is important.

 

[yanks26dmb]

Take a deep breath. With increasing med school enrollments, all fields are getting a bit tougher. Advisors need to do a better job of providing realistic programs to apply toward. I’ve seen 250+ boarded AOA applicants with research fail to match and applicants who failed an entire year match #1 on their rank list. Being realistic about where you apply is important.

Thanks for the insight. If be lying if I said I wasn't nervous for next year. I feel like my scores are good and I've been a solid student, but feeling like I need to send out 100+ apps to avoid a potential disaster.

 

[NontradCA]

A PD on this subforum posted the stats and it showed that just shy of 18% of General Surgery spots went unfilled this year. Psychiatry had 1% of spots unfilled.

Those are mostly prelim spots, not categorical spots. I wish he would’ve noted that so it wouldn’t be taken out of context. I shudder at the thought of doing a year of that. It’d be like being on a gen surg audition rotation for a year.

That being said, it looks like every field is becoming more competitive just because of the increased number of students applying. Well see more when the data comes out. I don’t think you’d have to worry much with a 240 step 1, other than poor interviewing.

 

[Evidence Based]

That being said, it looks like every field is becoming more competitive just because of the increased number of students applying. Well see more when the data comes out. I don’t think you’d have to worry much with a 240 step 1, other than poor interviewing.

I would also just caution about taking a few internet anecdotes out of context. Psych is definitely getting more competitive, but the reason those stories stick out is because they're outliers. We'll have more data coming out with the new charting outcomes, so I would hold off on panicking until then. The mean Step 1 score was 220 last edition, and I have a hard time believing it's going to jump 20 or 30 points.

 

[yanks26dmb]

I would also just caution about taking a few internet anecdotes out of context. Psych is definitely getting more competitive, but the reason those stories stick out is because they're outliers. We'll have more data coming out with the new charting outcomes, so I would hold off on panicking until then. The mean Step 1 score was 220 last edition, and I have a hard time believing it's going to jump 20 or 30 points.

Any idea when this is coming out?

 

[908377]

I think defaulting to analyzing Step 1 as the main predictor of specialty competitiveness is misleading. Psychiatry has so many applicants who look like rockstars because they are able to passionately articulate why Psychiatry is a great career fit for them, given some unique experiences and rotations which they demonstratively cite. This makes somebody with a 225 but ample experience really stand out on interview day.

 

[yanks26dmb]

I think defaulting to analyzing Step 1 as the main predictor of specialty competitiveness is misleading. Psychiatry has so many applicants who look like rockstars because they are able to passionately articulate why Psychiatry is a great career fit for them, given some unique experiences and rotations which they demonstratively cite. This makes somebody with a 225 but ample experience really stand out on interview day.

Are there just not many of these all-star applicants though? psych has a ton of spots filled by IMGs still - any idea why?

 

[clausewitz2]

Interesting anecdata: the medical school that my residency is attached to had a greater proportion of candidates fail to match in psychiatry this year than in ortho.

 

[Evidence Based]

Any idea when this is coming out?

Later this summer/early this fall I believe? They come out every two years, and last one was September 2016.

 

[908377]

Are there just not many of these all-star applicants though? psych has a ton of spots filled by IMGs still - any idea why?

What do you mean? My point is that Psychiatry ubiquitously has all-star applicants, just not in the sense that all of us have incredible board scores. What makes Psych applicants so excellent is that we are sincerely dedicated to Psychiatry and our experiences/CV reflect that. Long gone are the days where you just apply with a high Step 1 score and write your ticket to a lifetime of good hours and good pay.

 

[yanks26dmb]

What do you mean? My point is that Psychiatry ubiquitously has all-star applicants, just not in the sense that all of us have incredible board scores. What makes Psych applicants so excellent is that we are sincerely dedicated to Psychiatry and our experiences/CV reflect that. Long gone are the days where you just apply with a high Step 1 score and write your ticket to a lifetime of good hours and good pay.

I was making the assumption that IMG/FMG would not qualify for all-star candidates. It seems more competitive specialties have higher percentage of USMDs. The fact psych is 60% makes me wonder if they don't have enough of those super passionate all-stars to fill their spots still.

 

[yanks26dmb]

Interesting anecdata: the medical school that my residency is attached to had a greater proportion of candidates fail to match in psychiatry this year than in ortho.

This is terrifying.

 

[deleted407021]

Who told all the Miami-kid gunners who went to med school to afford Maseratis that Psych was a lifestyle specialty??

 

[DisorderedDoc417]

This is terrifying.

This is a good example of an anecdote with high likelihood for falsehood or misinformation... can the neuroticism stop?

 

[clausewitz2]

This is a good example of an anecdote with high likelihood for falsehood or misinformation... can the neuroticism stop?

I agree with you that it doesn't actually prove anything and that the objective data that will land in September is going to actually show us what is happening, but it is a true thing about one particular medical school class.

 

[Amygdarya]

What do you mean? My point is that Psychiatry ubiquitously has all-star applicants, just not in the sense that all of us have incredible board scores. What makes Psych applicants so excellent is that we are sincerely dedicated to Psychiatry and our experiences/CV reflect that. Long gone are the days where you just apply with a high Step 1 score and write your ticket to a lifetime of good hours and good pay.

I don't necessarily agree with it. Everyone professes their love to psychiatry on the interview day. But I know that at least from more than 10 applicants from my school this year almost half were late deciders. People can tell you more about their doubts, choices and decision making one on one in low pressure environments.

 

[WingedOx]

I would also just caution about taking a few internet anecdotes out of context. Psych is definitely getting more competitive, but the reason those stories stick out is because they're outliers. We'll have more data coming out with the new charting outcomes, so I would hold off on panicking until then. The mean Step 1 score was 220 last edition, and I have a hard time believing it's going to jump 20 or 30 points.

Plus, step scores seem to be going up across medical education nowadays too. The study materials that students are using are better and more efficient, for one thing. Like, I have no idea what "Pathoma" is, but all the students in the allo board bring it up constantly.

 

[clausewitz2]

Plus, step scores seem to be going up across medical education nowadays too. The study materials that students are using are better and more efficient, for one thing. Like, I have no idea what "Pathoma" is, but all the students in the allo board bring it up constantly.

The state of commercial study materials geared hyper-specifically at Boards is such that I was effectively homeschooled during my preclinical years. I really think there is perhaps some wisdom in moving towards a model of medical education per se being clinical experience (with didactics) that one is eligible for after successfully challenging, say Step 1.

 

[billybb]

Are there just not many of these all-star applicants though? psych has a ton of spots filled by IMGs still - any idea why?

It’s not “tons”. It was 8 point something percent last year. Let’s see how much it dropped this year.

 

[Amygdarya]

It's actually my pet peeve when people discuss their chances of matching solely based on their Step scores. Sure, having failed Steps and/or very low scores will hurt you. But having 250+ doesn't guarantee a great match, just as lower scores don't mean you're out of luck. Other parts of the application matter, especially in psychiatry.

 

[Mad Jack]

It's actually my pet peeve when people discuss their chances of matching solely based on their Step scores. Sure, having failed Steps and/or very low scores will hurt you. But having 250+ doesn't guarantee a great match, just as lower scores don't mean you're out of luck. Other parts of the application matter, especially in psychiatry.

A very good friend of mine matched with COMLEX only and scores in the 30th percentile. She had more interviews than me because of her unique application, despite my much higher scores. Psych seems more flexible with numbers than other fields when the rest of the application is solid.

 

[WingedOx]

It's actually my pet peeve when people discuss their chances of matching solely based on their Step scores. Sure, having failed Steps and/or very low scores will hurt you. But having 250+ doesn't guarantee a great match, just as lower scores don't mean you're out of luck. Other parts of the application matter, especially in psychiatry.

Still I think there's a "wow" factor that goes into seeing all these ridiculous scores come across your desk when you're scanning applications.

 

[Amygdarya]

Still I think there's a "wow" factor that goes into seeing all these ridiculous scores come across your desk when you're scanning applications.

Sure, it's something that catches one's eye. But there must be more than ridiculously high scores to be ranked high enough to match well.

 

[clausewitz2]

Still I think there's a "wow" factor that goes into seeing all these ridiculous scores come across your desk when you're scanning applications.

If you're me there is also just a faint, passing jealousy/sense of inferiority when interviewing someone with step scores 30 points higher than mine. Then I remember I won the matching game and nobody cares anymore.

...I still round up by a point when people ask me my Step 2, though.

 

[WingedOx]

If you're me there is also just a faint, passing jealousy/sense of inferiority when interviewing someone with step scores 30 points higher than mine. Then I remember I won the matching game and nobody cares anymore.

...I still round up by a point when people ask me my Step 2, though.

"well clearly if this guy is scoring in the 250s, it must be because he's compensating for other deep personality flaws. I shall spend this 40 minute interview attempting to find said flaws."


/I only remember my Step 2 because it was the exact national average that year.
//My step 3 was basically just "Pass" for all I gave a crap

 

[uhmocksuhsillen]

It’s not “tons”. It was 8 point something percent last year. Let’s see how much it dropped this year.

Who's making up that 39% that isn't falling into US seniors? Either way they're matching a lot of non USMD applicants right?

 

[Amygdarya]

Who's making up that 39% that isn't falling into US seniors? Either way they're matching a lot of non USMD applicants right?

Mainly DOs.

 

[uhmocksuhsillen]

Mainly DOs.

No disrespect to DOs ( I'm a DO) but isn't that a sign of a not very competitive field?

 

[DisorderedDoc417]

I agree with you that it doesn't actually prove anything and that the objective data that will land in September is going to actually show us what is happening, but it is a true thing about one particular medical school class.

Can we prove it? What if all the psych grads failed step 1? What if they missed particular cues during their interview which made them all appear “off kilter”. I don’t know. Pretending psych is on any level of competitive with ortho is a joke. They apply to hundreds of programs. The above med students had red flags or applied/interviewed poorly.

 

[clausewitz2]

Can we prove it? What if all the psych grads failed step 1? What if they missed particular cues during their interview which made them all appear “off kilter”. I don’t know. Pretending psych is on any level of competitive with ortho is a joke. They apply to hundreds of programs. The above med students had red flags or applied/interviewed poorly.

Again, may well be true. This is a fairly fancy brand name medical school so there may have been some complacency. I suspect the psych folks here were mostly not failing Step 1 (I interviewed a good number of them) but many of the other failure modes you identify may be relevant. In no sense is Psych the same as Ortho, and I think you'll find that my post history has pushed back against competitiveness hysteria for literally years.

What does seem to be increasingly different is that what used to be, if not the modal applicant, at the very least a not unusual applicant, the poor scores, not great ECs, but earnest applicant, is no longer guaranteed a spot in the way it seems like they used to be. This is on balance probably good for the field though we probably so lose something by rewarding box-checking aptitude more heavily. Rather like the idea that we still collect misfits, though I would prefer capable and smart misfits.

 

[DisorderedDoc417]

Again, may well be true. This is a fairly fancy brand name medical school so there may have been some complacency. I suspect the psych folks here were mostly not failing Step 1 (I interviewed a good number of them) but many of the other failure modes you identify may be relevant. In no sense is Psych the same as Ortho, and I think you'll find that my post history has pushed back against competitiveness hysteria for literally years.

What does seem to be increasingly different is that what used to be, if not the modal applicant, at the very least a not unusual applicant, the poor scores, not great ECs, but earnest applicant, is no longer guaranteed a spot in the way it seems like they used to be. This is on balance probably good for the field though we probably so lose something by rewarding box-checking aptitude more heavily. Rather like the idea that we still collect misfits, though I would prefer capable and smart misfits.

I agree on many accounts! I think pushing forward with strong medical students will bring about a transformation from the age of “personal eclectic art of medicine” to a more standardized method of continually seeing the most evidence based practices at work. Of course where there is little or poor evidence base we must substitute with what clinical judgement we do have... which will hopefully be improved as a result of the higher tier candidate. I’m an intern about to finish his first year, so I speak mostly from ignorance and meant no disrespect. I just find myself regularly bothered by the status quo psychiatry I see out in the community by NPs and “the usual candidates” that have apparently not opened a book since it was thought that titrating up until you saw the shuffle was a good idea. Here’s to a great 2018 for psychiatry!!

 

[Mad Jack]

Can we prove it? What if all the psych grads failed step 1? What if they missed particular cues during their interview which made them all appear “off kilter”. I don’t know. Pretending psych is on any level of competitive with ortho is a joke. They apply to hundreds of programs. The above med students had red flags or applied/interviewed poorly.

I mean, many psych applicants are applying to 60+ programs these days, which is roughly a quarter of all programs, just to get that magic number of interviews that will statistically equal a match. It's much more competitive than it used to be and rapidly approaching the middle of the pack with regard to competitiveness. My bet is it'll overtake EM within four years as the "hot new thing." Where it goes from there, who knows. It's always been pretty cyclical.

 

[Stagg737]

Thanks for the insight. If be lying if I said I wasn't nervous for next year. I feel like my scores are good and I've been a solid student, but feeling like I need to send out 100+ apps to avoid a potential disaster.

You don't need to send 100+ apps unless you're a mediocre IMG/FMG. You will likely need to send out more than was previously recommended though. My adviser recommended I send out ~50 applications based on my stats. I applied to 75 because I was worried wouldn't get enough interviews. Was it overkill? Maybe, but the extra ~$600 or so I spent on those extra 25 programs was well worth the comfort of knowing I'll be a psychiatry resident next year.

Are there just not many of these all-star applicants though? psych has a ton of spots filled by IMGs still - any idea why?

Could be several things. Some US grads may not have realized that psych has gotten so much more competitive (it seems to have happened pretty quickly) and may not have applied to enough "safety" programs. In the past, even the middle-of-the-pack US applicants could land spots at strong programs and didn't need to apply to weaker programs. That no longer seems to be the case, and applicants as a whole may be catching up to that trend. Combine that with the fact that IMGs and FMGs have been shot-gunning the app for years already (several PGY-2 residents I talked to applied to 150+ psych programs), and it make sense that the weaker programs that USMDs don't typically apply to would fill up with non-USMDs.

A very good friend of mine matched with COMLEX only and scores in the 30th percentile. She had more interviews than me because of her unique application, despite my much higher scores. Psych seems more flexible with numbers than other fields when the rest of the application is solid.

I'll give myself away a bit, but my Level 1 was around the 15th percentile and my Level 2 was even lower than that. Didn't take either USMLE exam. I had 9 interviews (mostly academic) and matched. Meanwhile, I found out today that I have classmates with far better apps statistically, including USMLE scores above the national average, who didn't match. A board score is 1 number, there is no field where that alone gives an accurate picture of an applicant, certainly not in psychiatry.

 

[DisorderedDoc417]

I mean, many psych applicants are applying to 60+ programs these days, which is roughly a quarter of all programs, just to get that magic number of interviews that will statistically equal a match. It's much more competitive than it used to be and rapidly approaching the middle of the pack with regard to competitiveness. My bet is it'll overtake EM within four years as the "hot new thing." Where it goes from there, who knows. It's always been pretty cyclical.

What is many? I didn’t meet a single person who applied to 60 last year. I applied to 20 and had 15 interviews, went to 9 of them, and I felt I spent a little too much money wasting my time in hindsight. Reimbursements in EM are much higher, we will see.

 

[Mad Jack]

What is many? I didn’t meet a single person who applied to 60 last year. I applied to 20 and had 15 interviews, went to 9 of them, and I felt I spent a little too much money wasting my time in hindsight. Reimbursements in EM are much higher, we will see.

Eh, I'm a DO student, applied 58 for 9 interviews with very mediocre USMLE and high COMLEX with no red flags. All in the Northeast, which might make a difference.

Everyone I know from my school that successfully matched had similar application/interview numbers.

 

[uhmocksuhsillen]

Eh, I'm a DO student, applied 58 for 9 interviews with very mediocre USMLE and high COMLEX with no red flags. All in the Northeast, which might make a difference.

Everyone I know from my school that successfully matched had similar application/interview numbers.

In your experience should a DO with ~242/670 who applied to 60 programs expect more than 10 interviews?

 

[NontradCA]

In your experience should a DO with ~242/670 who applied to 60 programs expect more than 10 interviews?

Yes. In general. You could probably get away with less if you research your programs beforehand, and apply smartly. 10 reach, 15 solid, 10 safety. And most of these should be in your schools region.

 

[Mad Jack]

In your experience should a DO with ~242/670 who applied to 60 programs expect more than 10 interviews?

I'm not a magic 8 ball, couldn't tell you. You'd probably get 15+ interviews with those stats. You'll definitely be fine, in any case

 

[Mad Jack]

Yes. In general. You could probably get away with less if you research your programs beforehand, and apply smartly. 10 reach, 15 solid, 10 safety. And most of these should be in your schools region.

I figured that was about what I was looking at but applied to far more safeties- literally applied to every program within 6 hours of home that had ever taken a DO. 225-230 USMLE, 550-600 COMLEX 1, 675-725 COMLEX 2. 9 interviews total in the NE

 

[Mad Jack]

Lessons I'd give anyone for the future: take Step 2/COMLEX 2 early and have CS/PE results as early as possible. The biggest difference in who seemed to get interviews and who didn't with relatively similar psych apps was whose application had more exams filed as passed and scores in at the time interviews were extended

 

[zyxab]

Lessons I'd give anyone for the future: take Step 2/COMLEX 2 early and have CS/PE results as early as possible. The biggest difference in who seemed to get interviews and who didn't with relatively similar psych apps was whose application had more exams filed as passed and scores in at the time interviews were extended

When did you have your Step2/COMLEX 2 and CS/PE in by? Would Step 2 CK results received by early September and CS pass received by mid-October be considered relatively early?

 

[Mad Jack]

When did you have your Step2/COMLEX 2 and CS/PE in by? Would Step 2 CK results received by early September and CS pass received by mid-October be considered relatively early?

Had my COMLEX 2 in before apps even opened, didn't have PE until after interviews were completed but prior to ranking. Try to have at least the written done when you're sending your app in, and the sooner the better for your CS/PE. Most interviews go out early, so keep that in mind.

 

[zyxab]

Had my COMLEX 2 in before apps even opened, didn't have PE until after interviews were completed but prior to ranking. Try to have at least the written done when you're sending your app in, and the sooner the better for your CS/PE. Most interviews go out early, so keep that in mind.

Do you feel that you would have gotten more interviews if you had gotten CS/PE results earlier or you think it didn't make much of a difference?

 

[DisorderedDoc417]

Eh, I'm a DO student, applied 58 for 9 interviews with very mediocre USMLE and high COMLEX with no red flags. All in the Northeast, which might make a difference.

Everyone I know from my school that successfully matched had similar application/interview numbers.

Thats fair. Coming from an MD program with competitive but not stellar Steps. Of course, for DO students the rules for playing the game are different.

 

[FlowRate]

As psych has been for several years now, it's between the traditional easy matches (ANY IM program, ANY peds, ANY FM) and true mid tier (EM/Gas). And I think it might actually be easier to get ANY EM/Gas position than ANY psych position, but not because of step scores. Psychiatry is uniquely focused on non-numbers qualities. Step scores get you in the door but, at least at my program, they don't play a huge role in determining rank position. They also aren't the only way in the door.

If you're me there is also just a faint, passing jealousy/sense of inferiority when interviewing someone with step scores 30 points higher than mine. Then I remember I won the matching game and nobody cares anymore.

...I still round up by a point when people ask me my Step 2, though.

And despite all that I said above... I interviewed a very nice person who I hope we matched with a 27x step 1 and >265 step 2ck. I won't mention the magnitude of difference between our step 1 scores... That's in addition to what seemed like at least 50 people with >250 step 1. I think that we also interviewed at least 10 AOA at our program this year, if not more. The charting outcomes data this year will be very interesting.

My only worry with psych is whether moderately competitive people are thinking of it as a "no work" specialty. We need people who want to work in psych. It's too easy to do a mediocre job.

 

[D.O.noHarm]

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