M3 wanting to do anesthesia. What are my chances if I get high passes/some honors during third year and good STEP 2 score? Is my decision correct?

[CuriousMDStudent]

Hello everyone!

M3 at a T15 medical school on his second rotation. I am still learning how to break the high pass/ honors threshold. However, I am getting a lot more interested in anesthesiology and I think it's my top choice right now. My first question is: If I were to get high passes and some honors during third year with a good STEP 2 score (240-250), can I match well in anesthesiology? I aim to match in NYC as that's where I'm from and where me and my partner want to end up, Cleveland because that's why my partner lives currently, and any big city. I've made connections with the anesthesia people at my medical school and talked to the program directors and they stated that as long as I get a good STEP 2 score and have a solid app, I should be set for anesthesia. What do you all think?

My second question is whether you all think I'm choosing the specialty for the right reasons/am a good fit? When I started medical school, I wanted to do ortho, but during my second year, I was intrigued by anesthesiology after a workshop. For me, anesthesia beat ortho in that I felt pharmacology and physiology were more interesting to me than MSK, the lifestyle is better as it's shiftwork and more vacation, the residency match is much less of a worry, I would still get to do procedures, but they're much less intense and stressful compared to that of ortho, and I felt I fit in with the anesthesiology people more than the ortho people.

One of the reasons I held back on anesthesia was I wanted to be in a specialty where I got to talk and get to know patients. But after being on FM and IM, I am realizing that I'm not that into it anymore. Yes, I am an extrovert, but I am realizing that I am so busy that I am aiming to get the pertinent info and move on so I can finish my day at a reasonable time. I'm noticing this too with interns, residents, and attendings as they do small talk but are trying to move on with patients ASAP as they're so busy. I saw it in ortho too while shadowing so I realized that is no longer as important to me and not something I really want. I also like that in anesthesia, note writing is minimal as I've realized how annoying it is to write notes.

Second reason was ego but I now realize that in anesthesia, you're really doing your own thing where you put the patient down, keep them stable, and wake them up. Surgeons might ask me to increase certain doses during the surgery. But overall, I'm in charge of the anesthesia/drug aspect of the procedure and the surgeon is in charge of the operating. We work hand in hand and generally don't interfere with each other.

Finally, I'm really considering pain medicine if I really do end up wanting autonomy. I aim to do some research projects in pain medicine in my spare time in my fourth year to get ready for the fellowship match. So that's a backup.

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[BLADEMDA]

Match results signaled strong demand for anesthesiology residency programs. Key metrics include growth in the number of applicants and positions offered, increase in the percentages of positions filled, and applicants not matched. In 2022, a total of 4,861 candidates applied to 1,980 anesthesiology positions and filled all but seven available positions. The number of anesthesiology positions offered increased 7% between 2018 and 2022.

2022 marked a 36% decline in matched candidates who graduated from non-U.S. medical schools, compared to 2018, and was the lowest reported to date. 162 (8%) matched candidates graduated from non-U.S. medical schools in 2022,

Less than 42% of all candidates who applied to an anesthesiology program matched in 2022

This report shows that the overall total number of matched candidates continues to grow, with the percentage of matched U.S. allopathic seniors and osteopathic students or graduates (84%) increasing by 5 percentage points in 2022 compared to 2018 (79%).

2022 Anesthesiology Residency Matches Hit Another Record | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

__________________________________

What does this mean? It is now harder to match anesthesiology as a non US M.D./D.O. and with lower Step Scores. The OP needs to get that Step 2 score of 240 or higher, decent third year grades and good letters of recommendation in order to secure a match at a decent program. Of course, it is possible to Match into Anesthesiology with low Step scores but then the odds begin to diminish as well. When you break down the numbers of the unmatched applicants, you will see a pattern of non US med school applicants and/or low Step scores as the main reasons.

 

[CuriousMDStudent]

Match results signaled strong demand for anesthesiology residency programs. Key metrics include growth in the number of applicants and positions offered, increase in the percentages of positions filled, and applicants not matched. In 2022, a total of 4,861 candidates applied to 1,980 anesthesiology positions and filled all but seven available positions. The number of anesthesiology positions offered increased 7% between 2018 and 2022.

2022 marked a 36% decline in matched candidates who graduated from non-U.S. medical schools, compared to 2018, and was the lowest reported to date. 162 (8%) matched candidates graduated from non-U.S. medical schools in 2022,

Less than 42% of all candidates who applied to an anesthesiology program matched in 2022

This report shows that the overall total number of matched candidates continues to grow, with the percentage of matched U.S. allopathic seniors and osteopathic students or graduates (84%) increasing by 5 percentage points in 2022 compared to 2018 (79%).

2022 Anesthesiology Residency Matches Hit Another Record | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

__________________________________

What does this mean? It is now much harder to match anesthesiology as a non US M.D./D.O. and with lower Step Scores. The OP needs to get that Step 2 score of 240 or higher, decent third year grades and good letters of recommendation in order to secure a match at a decent program.

Oh this is interesting. Well I'm not a non US MD/DO and I don't have a STEP 2 score yet. So I guess I'll just keep grinding away for STEP 2 and hope I do well and hopefully coming from a T15 MD helps.

 

[nimbus]

Oh this is interesting. Well I'm not a non US MD/DO and I don't have a STEP 2 score yet. So I guess I'll just keep grinding away for STEP 2 and hope I do well and hopefully coming from a T15 MD helps.

I think T15 helps a lot. Anesthesia competitiveness has waxed and waned over the decades. Even during times when anesthesia has been competitive, below average students from T10-T15 schools have been able to match at excellent anesthesia programs, often into top anesthesia programs. It’s rare to see a student from a top medical school match into a less desirable anesthesia program. That may happen more often as anesthesia becomes more competitive but it has not happened yet. If you’re an average student at a top medical school, you can expect to match at a top anesthesia program.

 

[BLADEMDA]

https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-MD-Seniors-2022_Final.pdf

Go to page 15. I have to slightly disagree with my learned colleague Nimbus on the 2023 Match. My best guess is that a 240 is the Minimum Step 2 score for a successful Match in Anesthesiology at a mid tier program. The specialty has gotten more competitive and as a result, those US MDs who don't rank/interview lower tier programs when their scores are below 240, may not Match at all.

Med Students need to use the data and be realistic about their chances of matching into a specialty/program. If you are aiming for a top tier program then your application should reflect it vs your peers for that same program. For example, in 2023 I expect the Top 10 programs in Anesthesiology to have mean Step 2 scores over 250 with plenty of students from top 30 med schools applying for those spots. I wouldn't want to be in the position of trying to land a top 10 residency with a Step 2 of 240- it may not happen. Instead, focus on mid tier programs where your status from a top 15 school combined with your less than average Step 2 score of 240 will fit in better with those trying to get a spot at that program.

 

[BLADEMDA]

Look at pages 24 and 27. Med Students are excellent at applying to programs, and matching, which reflect their overall application.

Mean USMLE Step 2 score 248= Anesthesiology

https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-MD-Seniors-2022_Final.pdf

 

[BLADEMDA]

More US MD senior med students failed to MATCH with Step 2 scores over 231 than those with Step 2 scores less than 231. Why is that? What happened to cause such an occurrence? Could it be those students didn't apply or interview to the correct tier of programs?

 

[nimbus]

https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-MD-Seniors-2022_Final.pdf

Go to page 15. I have to slightly disagree with my learned colleague Nimbus on the 2023 Match. My best guess is that a 240 is the Minimum Step 2 score for a successful Match in Anesthesiology at a mid tier program. The specialty has gotten more competitive and as a result, those US MDs who don't rank/interview lower tier programs when their scores are below 240, may not Match at all.

Med Students need to use the data and be realistic about their chances of matching into a specialty/program. If you are aiming for a top tier program then your application should reflect it vs your peers for that same program. For example, in 2023 I expect the Top 10 programs in Anesthesiology to have mean Step 2 scores over 250 with plenty of students from top 30 med schools applying for those spots. I wouldn't want to be in the position of trying to land a top 10 residency with a Step 2 of 240- it may not happen. Instead, focus on mid tier programs where your status from a top 15 school combined with your less than average Step 2 score of 240 will fit in better with those trying to get a spot at that program.

Of the 5.6% of USMD seniors who failed to match in anesthesia, 21% of came from a school that was in the top 40 for NIH research funding. So about 1% (5.6%x21%) of USMD seniors from a top 40 school failed to match. I agree it is possible for students from those schools to fail to match. However, it is quite rare.

If you look at the match lists of the so-called top 15 schools (eg, Michigan, U of Chicago, UCLA, UCSF, Northwestern, Cornell, WashU , CWRU, Duke, Baylor, Vanderbilt, etc) most of the anesthesia matches are at top programs.

 

[BLADEMDA]

Of the 5.6% of USMD seniors who failed to match in anesthesia, 21% of came from a school that was in the top 40 for NIH research funding. So about 1% (5.6%x21%) of USMD seniors from a top 40 school failed to match. I agree it is possible for students from those schools to fail to match. However, it is quite rare.

If you look at the match lists of the so-called top 15 schools (eg, Michigan, U of Chicago, UCLA, UCSF, Northwestern, Cornell, WashU , CWRU, Duke, Baylor, Vanderbilt, etc) most of the anesthesia matches are at top programs.

This is a circular argument. The vast majority of students at the top schools are likely to score above 250 on Step 2. Those scoring lower than 240 on Step 2 are probably happy matching at a midtier program. The OP needs to understand that step scores do matter as he/she is competing for a spot at a Top 10 anesthesiology program not just any program. My comments towards the OP are about where he/she can Match with a Step 2 of 240 not WHETHER he/she can match at all. With a lower than median Step 2 score like 240 the goal is to aim high but be realistic about programs.

 

[TeslaCoil]

Be careful with the line of thinking that anesthesia necessarily has a better lifestyle. If you go to any kind of reputable program, your life will likely not be peaches and cream during training. My residency was pretty damn tough. 24 hour calls frequently. High acuity cases including OB, trauma, cardiac, transplants (lungs, hearts, livers), codes, ICU crashes that go at any moment of the night or day. I rarely slept on my calls. When I was a PGY-4 I carried 4 pagers on call. By the end I could handle anything, but they had beat the i$h outta me to the point that it pushed me into pain mgmt or I would have left anesthesia altogether.

Do not make the mistake of thinking anesthesia is a "cushy" field overall. Anesthesiologists are the quintessential intensivists. If you go to any kind of decent program, you will be doing a lot of just that. Intensivism. If thats what you love, then go for it. Its true that once out of training the lifestyle is controllable. Meaning that you can choose to make less money and take less call, and work in a setting where high acuity cases are less frequent. Now, if you really want a "cushy" life, check out PM&R. Great field.

 

[kidthor]

Do not make the mistake of thinking anesthesia is a "cushy" field overall. Anesthesiologists are the quintessential intensivists. If you go to any kind of decent program, you will be doing a lot of just that. Intensivism. If thats what you love, then go for it. Its true that once out of training the lifestyle is controllable. Meaning that you can choose to make less money and take less call, and work in a setting where high acuity cases are less frequent. Now, if you really want a "cushy" life, check out PM&R. Great field.

Spot on. PM&R is totally underrated. Nobody really seems to know what they do fully, and nobody seems to want to tell them what to do either. Also likely few emergencies or need for brutal call. Perfect!

 

[TeslaCoil]

Also, the last number I saw for avg hours/wk an anesthesiologist works was 65.

Pain mgmt has an excellent lifestyle. Its also the most competitive anesthesia subspecialty with a relatively low match rate. Your step scores and even ITE’s will come back to haunt you. If you go into anesthesia with the intent of ending up in pain, I suggest busting your @zz in residency. Get at least a paper or two published in pain. Show interest and be active in pain early. Join societies and go to conferences. Make contacts. And definitely dont show disinterest in the rest of anesthesia, because earning that sort of rep will also earn you an uphill battle. Keep in mind you can also get to pain from PM&R, psych, neurology, and EM.