It's OFFICIAL....Most Competitive Specialties by Step 1 and Step 2 Scores...

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The average clinician really has no idea about the nuances and the subtleties that go into interpretting a study. There's a reason why it takes 4 years and 3 board exams to become certified to practice. My own experience is replete with examples where the relevant subspecialist was way, way off. This says nothing of understanding the physics involved, which test to order, how to protocol the examination, or how best to follow it up. That's not a knock; that's how it's supposed to be. That's why we exist. Sure, in theory, you could tack a year or two onto everyone's residency training so that they could be profficient in their commonly ordered studies. But you could also say that we should get rid of urology and add 2 years onto a general surgery residency??

I'm going to jump in here also. Now while we're taught to interpret our own BASIC images for rapid diagnosis and intervention (especially CXRs for pneumothoraces, line placement, pleural effusions, pneumonia, pulmonary contusion, ETT placement, NGT/feeding tube placement, chest tube placement; or CT abdomen for SBO, obvious vascular pathology, etc.)...there are a TON of other diagnostic tests that you need Rads for. I've often felt bad for the one radiology resident working in the ER who has to diagnosis bad head traumas/abdominal traumas one after another on a busy call night at our county hospital.

Pretty crucial adjunct to the H&P, if you ask me.

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I try not to be too much of a specialty homer, and I have a lot of respect for clinicians. But this part of your post is pretty ignorant. I know you tempered your comments somewhat, but still.

The average clinician really has no idea about the nuances and the subtleties that go into interpretting a study. There's a reason why it takes 4 years and 3 board exams to become certified to practice. My own experience is replete with examples where the relevant subspecialist was way, way off. This says nothing of understanding the physics involved, which test to order, how to protocol the examination, or how best to follow it up. That's not a knock; that's how it's supposed to be. That's why we exist. Sure, in theory, you could tack a year or two onto everyone's residency training so that they could be proficient in their commonly ordered studies. But you could also say that we should get rid of urology and add 2 years onto a general surgery residency??

I'm sorry for getting kinda riled up about this, but I think that radiology is incredibly misunderstood. And I think it's silly to think that you could get rid of radiologists and expect the system to function anywhere near it currently does.

No apology necessary, anyone's gonna feel defensive if perceiving a slight professional or otherwise. No slight intended however. I have zero intention of demeaning any specialty, nor is there any benefit in doing so. For sure any specialty could be expanded to cover this or that aspect of any other specialty to varying degrees of effectiveness. All I'm saying is that right now this minute, without a radiologist, most clinicians can interpret the relevant critical findings of the vast majority of scans to the degree that they can treat their patient effectively. That's part of their job description and it would be negligent for a clinician to not to interpret the image. If you are a board certified specialist, you are expected to be able to interpret all scans related to pathologies under your treatment skill set. You are also expected to listen to the radiologist if they point out something else important. A clinician is also allowed to treat based on their interpretation prior to rad interpretation and that happens commonly (for example the internist will act on the CXR prior to, or indeed without ever talking to a radiologist or reading a report).

Putting myself in the shoes of the surgeon I greatly value my access to radiology, would never want to give it up, and would fight to remain close to the best radiologists. I would however give it up before I would give up my access to an internist to consult. I believe not having an internist to help me with complicated patients would produce more worse outcomes than not having a radiologist to read my images, if I ever found myself having to make such an odd decision. Regardless of what the scan showed, I would have a workably reliable idea of cut vs minimally invade vs medicate vs wait. That's part of the definition of being competent in one's field right? But plenty of systemic co morbidities would keep me up at night not managing very well. I would not be expected to know how to optimize COPD or complex diabetes.

I'll probably do a rad elective later on this academic year because I know a good read is vital.

As clinicians who have not been in the role of a radiologist, you do not see how often this really happens. Maybe for each of you it happens once in a while and the remainder of the time you the rad doesn't effect your treatment.

Agreed. Its not that anyone thinks the rad has low value, just the opposite they are extremely valuable. Its simply that the impact gets diluted in the sheer number of cases that present in a radiologically straightforward manner.
 
I would however give it up before I would give up my access to an internist to consult.

Well, sure, if we're going to reduce it to this level, then I agree with you. If we could only have one, I'd rather have internists than radiologists, too.

Regardless of what the scan showed, I would have a workably reliable idea of cut vs minimally invade vs medicate vs wait. That's part of the definition of being competent in one's field right?

See, I think this is where our viewpoints differ. Even a general surgeon's proverbial bread & butter, appendicitis, is vastly more radiographically complex than most people realize. So, yeah, if there's a big, blind-ending, tubular structure in the RLQ with an appendicolith and surrounding fat stranding, then I have no doubt that you can look at the CT and decide the proper course of action. We call that the janitor diagnosis. Fortunately for us radiologists, it's seldom that straightforward. What about when you can't find the appendix? Plus, there's a whole slew of secondary signs; the list of appendicitis mimics is pretty darn long; the sensitivity of US vs. CT, yada yada yada. Oh, and throw in the big liver met you missed while you were concentrating on the RLQ. Anyway, that's just a really long way of saying that even with straightforward findings, there are dozens of little subtleties and nuances that we've considered that never make it into our reports.

I'm not trying to imply that it's voodoo that only a select few can grasp. If surgeons spent enough time and went to the same degree of detail, then they could interpret their own studies. Just like if internists learned about kids then they could be pediatricians, too.

Anyway, I think we agree more than we disagree. I like radiology both because of its breadth and its depth (vis-a-vis radiographic findings), and I don't think many people recognize how much a good radiologist can glean from even a simple chest film.
 
I've noticed that there are two types of residents in derm: hot blond chicks and skinny asian dudes.

How else is a skinny asian guy like myself gonna get a chance to hang out with some hot blonds. They won't give me the time of day anywhere else.:hungover:
 
Back to the original post-
Radiology is a very competitive specialty - no argument there. Many people have posted implying that it is practically irrelevant. If so, then why do you think so many of the top students go into it? I am asking because I am curious, not to cause more argument. I would like to know what the non-radiologists think the motivation is for going into rads.

By the way, this (below) is inaccurate and insulting to many....

From p53
What does the new AAMC data suggest?

1. Applicants want lifestyle. The four most competitive specialties are Plastic Surgery, Derm, ENT, and Radiology. They are outpatient based with minimal overnight emergencies.

2. Applicants want $$$$. Radiologists start out at $420,000+ a year after residency. Surgeons start out at $250,000. Why would you want $170,000 less AND be on overnight call after residency?
 
This will finally shut up the people that claim General Surgery, Anesthesiology, and Ob/Gyn are competitive.....LOL.....

Step 1 averages of those that matched (based on March 15, 2007 Match)

1. Plastic Surgery, Step 1= 243 Step 2= 246
2. Dermatology, Step 1= 240 Step 2= 240
3. ENT, Step 1= 239 Step 2=240
4. Diagnostic Radiology, Step 1 = 235 Step 2= 238
5. Radiation Oncology, Step 1 = 235 Step 2=237
6. Orthopedic Surgery, Step 1 = 234 Step 2= 236
7. Transitional Year, Step 1 = 233 Step 2=231
8. Internal Medicine, Step 1=222 Step 2=228
8. General Surgery, Step 1=222 Step 2=228
8. Pathology, Step 1=222 Step 2=226
11. Medicine-Pediatrics Combined, Step 1=221 Step 2=233
11. Emergency Medicine, Step 1=221 Step 2=228
13. Anesthesiology, Step 1=220 Step 2=224
14. Neurology, Step 1=218 Step 2=226
15. Pediatrics, Step 1=217 Step 2=226
16. Ob/Gyn, Step 1=213 Step 2= 224
17. Family Medicine, Step 1=209 Step 2=219
18. PM&R, Step 1=208 Step 2=214
19. Psychiatry, Step 1=208, Step 2=213

As I mentioned many, many times. ENT and Diagnostic Radiology is more competitive than Orthopedic Surgery.

Also, the competition for the cush transitional year is getting increasing competitive. Step 1 average for the Transitional year is 10+ points higher than General Surgery, Anesthesiology, and ER.

What does the new AAMC data suggest?

1. Applicants want lifestyle. The four most competitive specialties are Plastic Surgery, Derm, ENT, and Radiology. They are outpatient based with minimal overnight emergencies.

2. Applicants want $$$$. Radiologists start out at $420,000+ a year after residency. Surgeons start out at $250,000. Why would you want $170,000 less AND be on overnight call after residency?

Where are Ophthalmology, Urology and Neurosurgery on this list?
 
It is great the rads makes all that money now. But in the future you are going to see all the xrays, cts etc etc be done by techs and out sourced to india or china because the hospitals are going to find a cheap contract. A radiologist can't do anything other than read a scan. You can always find someone that will do that cheaper. You can't outsource going to the OR!

God bless clinical medicine
 
You can't outsource going to the OR!

God bless clinical medicine

If you do your research, there is talk of (or there already is) insurance companies who mandate that the surgery be done by a foreign surgeon (in a foreign country) because it is cheaper for them to fly the patient there, pay for the hotel, and pay for the entire procedure than it is to just pay for the procedure in the US.

I'm not sure reading xrays/MRIs/ultrasounds/etc is all that easy. Why would the training entail a 4 years of residency? I would say the threat is no diff than the threat there is in every other field of medicine of CRNAs, NPs, PAs, RNs, etc taking over.
 
If you do your research, there is talk of (or there already is) insurance companies who mandate that the surgery be done by a foreign surgeon (in a foreign country) because it is cheaper for them to fly the patient there, pay for the hotel, and pay for the entire procedure than it is to just pay for the procedure in the US.

I'm not sure reading xrays/MRIs/ultrasounds/etc is all that easy. Why would the training entail a 4 years of residency? I would say the threat is no diff than the threat there is in every other field of medicine of CRNAs, NPs, PAs, RNs, etc taking over.

It's not the surgeon that's costing the insurance so much money... it's the hospital practice... But convincing someone to go to another country to get operated on...lets just say good luck with that and I hope you can still maintain your customers with that sort of insurance policy.
 
It is great the rads makes all that money now. But in the future you are going to see all the xrays, cts etc etc be done by techs and out sourced to india or china because the hospitals are going to find a cheap contract. A radiologist can't do anything other than read a scan. You can always find someone that will do that cheaper. You can't outsource going to the OR!

God bless clinical medicine

I can't believe someone is this IGNORANT. Radiologists do more different procedures than almost any other specialty. This is DURING general radiology training.


---------------------------------------------------------
General radiologists perform a wide variety of procedures:


Biopsies - Biopsies are performed with image guidance (usually CT, ultrasound, or fluoroscopy). Common biopsy sites include the neck, lung, breast, mediastinum, liver, kidney, adrenal glands, chest or abdominal masses, or other soft tissue masses.

Angiograms - Angiography is a specialized field within radiology. Angiography is performed for a variety of indications including trauma, atherosclerotic disease, planned surgery (i.e., free flap planning), as well as the diagnosis and treatment of pulmonary embolic disease.

Arthrograms - Arthrograms are commonly performed on the knee, shoulder, and hip. Virtually any joint is accessible to the radiologist.

Interventions and Drainage - Interventional radiology involves using catheters and drains to treat obstructions (i.e., biliary system, urinary system, GI tract) and drain abscesses. Also interventionalists create and maintain vascular fistulae and other types of venous and arterial accesses (PICC lines, central venous catheters, Groshongs, etc.). Insertion of IVC filters and vascular stents and grafts is also routinely performed. Treatment of atherosclerotic disease is a routine part of interventional procedures. Endovascular interventional techniques and materials are rapidly developing, and abdominal aortic aneurysm repair is beginning to be the domain of the interventional radiologist.

Other miscellaneous procedures that radiologists perform include GU studies (cystograms, IVPs, retrograde urethrograms, hysterosalpingograms, etc.) and GI studies (barium and Hypaque enemas, upper GI, esophagography, fistula and sinograms, etc.).


Depending on the practice mix, the procedures can range from plain film x-rays (a large proportion of which will be chest x-rays and bone films) to MRI, CAT scan, ultrasound, nuclear medicine, and vascular and nonvascular interventional procedures. The time spent on various procedures varies widely, with plain film readings taking anywhere from thirty seconds to five or ten minutes depending on the complexity of the plain film study and the number of prior studies necessary to compare, to more complex procedures that can take up to four to six hours. Fortunately, the radiologist's satisfaction can be great when reading both the routine plain film or performing the most technically challenging vascular and nonvascular interventional procedures.
 
Ask and you shall recieve.

Optho last year had an average of 231 and Nuero Surge had an average of 236.


It's because optho and NS are sfmatch (early match) and you have to go there for the match stats. This charting match outcomes report is for NRMP (regular match).

Courtesy of Long....

231 Optho
236 Neuro

Optho is NOT as competitive as people think.
 
It's not the surgeon that's costing the insurance so much money... it's the hospital practice... But convincing someone to go to another country to get operated on...lets just say good luck with that and I hope you can still maintain your customers with that sort of insurance policy.

Actually a little company that you may have heard of called General Motors has such a policy. Many of these big operations can cost tens of thousands of dollars. If you agree to get a surgery in India (at one of the top hospitals there, which still costs about a quarter of what it does here), they split half the difference with you. A lot of their retirees are going overseas to get surgery, and are pocketing thousands of dollars in the process. Sometimes they even throw in a free holiday or at least a stay in resort like settings. It's called "medical tourism" and it's a booming business, one that you'll only hear more of in the future.

http://www.time.com/time/magazine/article/0,9171,1196429-1,00.html
 
But in the future you are going to see all the xrays, cts etc etc be done by techs and out sourced to india or china because the hospitals are going to find a cheap contract. A radiologist can't do anything other than read a scan.

Way to fire from the hip and come up totally empty. You're wrong on both accounts.
 
Courtesy of Long....

231 Optho
236 Neuro

Optho is NOT as competitive as people think.

The lesson, for those not yet in residency who see threads like this and freak out is that board scores are NOT the sole arbiter of candidate competitiveness, NOR are they independent variables from the rest of the parts of the application.

To look at board scores and make sweeping conclusions about the competitiveness of fields is one thing, but to somehow make the ill-advised leap to conclude that this has any significant relevance on the individual candidate is asinine. There are many candidates with high boards scores who are rejected every year from the residency of their choice, in part because they presume that the high board score would cancel out deficiencies in the rest of their application. Conversely, there are candidates every year with lower board scores who beat out these candidates because they have other things to recommend them.

I think every resident candidate knows that a high board score is better than a lower board score, and will improve their candidacy. That is basically the only relevant part. Within all of these numbers are ranges and standard deviations which would probably overlap and make the actual differences nearly insignificant.

I know med students like to have numbers to compare and like to fight over levels of competitiveness, but it's really silly and juvenile. It's not as juvenile as slamming other specialties because you want to prove yours is "better" but it's pretty close.
 
If you do your research, there is talk of (or there already is) insurance companies who mandate that the surgery be done by a foreign surgeon (in a foreign country) because it is cheaper for them to fly the patient there, pay for the hotel, and pay for the entire procedure than it is to just pay for the procedure in the US.

I'm not sure reading xrays/MRIs/ultrasounds/etc is all that easy. Why would the training entail a 4 years of residency? I would say the threat is no diff than the threat there is in every other field of medicine of CRNAs, NPs, PAs, RNs, etc taking over.

Even if the preliminary reading for CT scans and MRI are done outsourced they still need to be certified and finalised by a US certified Radiologist ......
it would be nearly impossible to sue those doctors and hospitals if anything goes wrong .....
 
I'm not really trying to defend p53 here, and I don't know what this "us" stuff is (see above). As I recall, he just started his internship, so no one is giving him any clinical data. But at least one point he makes isn't all together without merit...

The vast majority of clinical histories provided leave something to be desired. Some are woefully inadequate, like "follow-up", "pain", or "needs head CT". Garbage in, garbage out.

Research has shown (so far) that the clnical information really doesn't alter a diagnoses much. Supposed to be trained to look at the image unbiasedly, whether that happens is another story. I've always seen radiology as a tool to measure twice, and cut once. The true, straightup, diagnostic nobody knew what it was stuff came from symptoms that were a shotgun blast of crap information, and not the symptoms that follow the trends. No, I have no idea what I mean by that. There are plenty of docs that use radiology as a crutch, much to the dismay of the radiologist. Many don't go "Yey! More money". They actually get irritated when a head CT is ordered with no clinical information to support it. A radiologist that is efficient, personable, and can dictate GOOD reports is very valuable. The introduction of the dictation software shows that a writing background can be helpful for those guys now. Some of them just paste masses of worthless information on the page, while others meticulously divide it between the requested information and the extra, with nice bold summaries and whatnot. Yes, I am a premed. I'm sure someone will use the "You don't know ****" argument with me....and I am pretty stupid so I'll go along with it.

Now, to those numbers. Many of those numbers are statistically tied. I hardly consider 1 point definitive evidence that the one speciality is more difficult to get into. There does appear to be a few clusters. A 4 point jump or greater seems to be pretty big with many specialities being virtually tied. I don't know what to take from it other than integrated plastics being really really hard to get into. I suspected that before, we just sent it to radiology now.
 
You are such an easy target I will refrain from the obvious counterargument. Since you are likely preparing to take the MCAT, I suggest you brush up on your verbal reasoning skills of this thread.

The argument is that radiologists do not make diagnosis rather they offer another test and/or say to the clinician that they should correlate with clinical date. The point is that clinicians should give clinical data therefore the radiologists would not say "correlate with clinical data" after the fact.

Secondly, ignorance is actually a virtue. Only if it is recognized and kept to yourself. It allows you to realize that you are incompetent hence you can improve your knowledge with due diligence. However, when someone speaks(types) ignorance it is a character flaw. The fact is that clinical correlation helps diagnose diseases. So please don't speak from your hip.

My point is this. If you want to order a $1K CT or $2K MRI wouldn't you want to provide as much information as possible to the radiologists to make the diagnosis easier to decipher? We all hear about clinicians say they care alot about their patients. Well prove it. Provide as much clinical correlation as possible so it minimizes the chance that you wasted $2K of the patient's and/or tax payers money.

Back to the guy that has unwarranted confidence to actually speak. You should do a search on pubmed on what you are talking about. Here is one piece of advice. If you are fortunate to get into medical school, just remember during 3rd year of medical school to keep your mouth shut. Only talk when you are asked. In medical school, most of the time people will think you are very bright. Once you open your mouth that's when people will realize that you have very little knowledge.


Research has shown (so far) that the clnical information really doesn't alter a diagnoses much. Supposed to be trained to look at the image unbiasedly, whether that happens is another story. I've always seen radiology as a tool to measure twice, and cut once. The true, straightup, diagnostic nobody knew what it was stuff came from symptoms that were a shotgun blast of crap information, and not the symptoms that follow the trends. No, I have no idea what I mean by that. There are plenty of docs that use radiology as a crutch, much to the dismay of the radiologist. Many don't go "Yey! More money". They actually get irritated when a head CT is ordered with no clinical information to support it. A radiologist that is efficient, personable, and can dictate GOOD reports is very valuable. The introduction of the dictation software shows that a writing background can be helpful for those guys now. Some of them just paste masses of worthless information on the page, while others meticulously divide it between the requested information and the extra, with nice bold summaries and whatnot. Yes, I am a premed. I'm sure someone will use the "You don't know ****" argument with me....and I am pretty stupid so I'll go along with it.

Now, to those numbers. Many of those numbers are statistically tied. I hardly consider 1 point definitive evidence that the one speciality is more difficult to get into. There does appear to be a few clusters. A 4 point jump or greater seems to be pretty big with many specialities being virtually tied. I don't know what to take from it other than integrated plastics being really really hard to get into. I suspected that before, we just sent it to radiology now.
 
The fact is that anyone that diagnoses PE or DVT clinically is the dumbest physician on the planet. NO ONE IS THAT STUPID.

What is the sensitivitiy of the Homan's Sign? What is the sensitivity of pleuritic chest pain?

Let's not BS the medical students on here.

PE and DVT is a radiological diagnosis. Hemmoragic Strokes are also a radiological diagnosis. There is no way you can suspect hemmoragic vs ischemic stroke upon physical diagnosis and/or history. Feed me some more lies guyes.

You may not like me, or my style. However, the fact is that medical imaging DIAGNOSES diseases. You may have a clinical suspicion of a certain disease but please don't try to dupe people on here by saying that you already know when someone has a PE by physical diagnosis. You are full of Shizznit.

Oh come on now... you are fooling yourself. How can you call those a radiologic diagnosis when prior to doing your radiologic test the patient is pre-screened by clinical diagnosis from the clinical assessment. You wanna call a PE a true radiologic diagnosis? Fine, CTA every single possible PE out there and without clinical screens and watch your specificity hit rock bottom.

Apply the same concept to Appendicitis... lets just CT scan all possible acute abdomen.

Having said that, I dont think anyone here denies that scans are critical in the confirmation. It's like a western blot confirming a positive elisa. It was not the western blot that got the HIV diagnosis.
 
Oh come on now... you are fooling yourself. How can you call those a radiologic diagnosis when prior to doing your radiologic test the patient is pre-screened by clinical diagnosis from the clinical assessment. You wanna call a PE a true radiologic diagnosis? Fine, CTA every single possible PE out there and without clinical screens and watch your specificity hit rock bottom.

Apply the same concept to Appendicitis... lets just CT scan all possible acute abdomen.

Having said that, I dont think anyone here denies that scans are critical in the confirmation. It's like a western blot confirming a positive elisa. It was not the western blot that got the HIV diagnosis.

In a perfect world, this is what would happen. In the real world, our positive rate for PE studies is about 5%. Appy scans are much higher, but probably over half the time they are negative or we can give an alternate diagnosis (colitis, epiploic appendigitis, large ovarian dermoid or cyst, etc etc). DVT ultrasound positive rate is also pretty damn low in my experience (I have never seen a positive DVT exam on a patient who has BILATERAL ultrasounds requested). So while I'm sure there is some pre-screening, I'm not so sure its at all accurate in many common situations.

While p53 has an overinflated ego (especially for an intern you hasn't yet even practiced radiology), the insult fest against radiologists in this thread is very disturbing and the little digs many of you put in your posts are completely uncalled for (Western Blot? Are you kidding me?).
 
Fine, CTA every single possible PE out there and without clinical screens and watch your specificity hit rock bottom.

Apply the same concept to Appendicitis... lets just CT scan all possible acute abdomen.

Of course, I have to concede that you may work in a hospital with much better clinicians than I do. But what you wrote above is exactly what already happens at my hospital.
 
The transitional year has inflated scores because people going Derm, radiology, rad onc want a less strenuous intern year than doing a prelim medicine/surgery year.

Doing an easy transitional year is one of the biggest kept secrets in medical school. Since everyone now knows about them because of the ultra high Step 1 scores.

Can someone please list some Cush Transitionals for those going into derm, radiology, rad-onc, neurology. It would be deeply appreciated by this year's applicants.

Thank you very much for your help.
 
While p53 has an overinflated ego (especially for an intern you hasn't yet even practiced radiology), the insult fest against radiologists in this thread is very disturbing and the little digs many of you put in your posts are completely uncalled for (Western Blot? Are you kidding me?).

I agree that I may have an ego but it is par for the course among physicians. If you want to talk about big egos. Let me direct your attention to exhibit A and exhibit b, BigFrank and Jalby.
 
I agree that I may have an ego but it is par for the course among physicians. If you want to talk about big egos. Let me direct your attention to exhibit A and exhibit b, BigFrank and Jalby.

I see a common denominator with you and the people you talk about, radiology.;)
 
Does anyone have any idea about an average score for urology??
 
Is PM&R really that low?? That's pretty damn non-competitive. I like :thumbup:
 
Is PM&R really that low?? That's pretty damn non-competitive. I like :thumbup:

PMR will never be that uncompetitive because it requires that prelim year and that makes the field a notch harder than FM/Psych/Peds.
 
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