Match Mishaps

[Arkangeloid]

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So I'm at a mid-tier US Allo school. This year, we had 11 people out of about 145 go unmatched. I thought this was rather high. I asked some of my fourth year friends why this happened. I thought it was because we had a lot of failing or marginal students.

But my fourth year friends said that wasn't the case. They said that a lot of the people going unmatched had poorly constructed their lists, putting too many high-tier hospitals. Others tried to aim for specialties their scores/grades weren't competitive for. The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Are my friends right? Why are so many people going unmatched?

 

[Frazier]

So I'm at a mid-tier US Allo school. This year, we had 11 people out of about 145 go unmatched. I thought this was rather high. I asked some of my fourth year friends why this happened. I thought it was because we had a lot of failing or marginal students.

But my fourth year friends said that wasn't the case. They said that a lot of the people going unmatched had poorly constructed their lists, putting too many high-tier hospitals. Others tried to aim for specialties their scores/grades weren't competitive for. The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Are my friends right? Why are so many people going unmatched?

Your friends are not trying to trick you.

 

[SouthernSurgeon]

So I'm at a mid-tier US Allo school. This year, we had 11 people out of about 145 go unmatched. I thought this was rather high. I asked some of my fourth year friends why this happened. I thought it was because we had a lot of failing or marginal students.

But my fourth year friends said that wasn't the case. They said that a lot of the people going unmatched had poorly constructed their lists, putting too many high-tier hospitals. Others tried to aim for specialties their scores/grades weren't competitive for. The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Are my friends right? Why are so many people going unmatched?

At US MD schools, the VAST majority of the time when someone goes unmatched it is due to poor match strategy. The reasons you listed in your second paragraph capture a majority of those reasons.
-Aiming for a specialty you are uncompetitive or marginally competitive for with no backup
-Aiming for too prestigious of programs in any field without appropriate backup
-Not interviewing at enough programs
-Not ranking enough programs
-Etc Etc

 

[Kaputt]

You need to worry about M1, OP. The nuances of applying to and ranking programs is above your current paygrade.

 

[KinasePro]

The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Is this even true? First the first year in a while, there were unfilled programs in Ortho (2 total, both in the northeast, no less). By contrast, ENT/nsurg/plastics had no vacancies. I think that signifies a less-competitive year, but maybe people in the match can correct me if I'm wrong.

 

[SouthernSurgeon]

Is this even true? First the first year in a while, there were unfilled programs in Ortho (2 total, both in the northeast, no less). By contrast, ENT/nsurg/plastics had no vacancies. I think that signifies a less-competitive year, but maybe people in the match can correct me if I'm wrong.

It's such a small number that it more likely reflects a fluke than any variation in the competitiveness of the field

 

[Dumpstarrian]

-

 

[SouthernSurgeon]

There always seems to be conflicting opinions on this. I feel like I consistently heard from my school and advisers that one should rank depending on their desirability to match at that program, not based on the applicant's competitiveness. I have also frequently heard that the match process is "in favor of the applicant," and to shoot for the stars when ranking.

Admittedly, my knowledge and understanding of the match algorithm is limited at best, but there must be an adverse effect of ranking multiple highly tiered hospitals over hospitals that one is competitive at.

No, what your school has told you is correct. There is no disadvantage to ranking by your preference.

The issue is when students ONLY apply to/rank highly competitive programs without a backup of some less competitive programs.

For an extreme example, if my top 1-10 are all reach programs that I do not match at, am I less likely to match to (hospital Z) rank #11 than if I ranked that same Hospital Z as #1? From what I've heard from my school, no, but I would suspect this is not entirely the case

Your odds are the same.

 

[MSTPlease]

There always seems to be conflicting opinions on this. I feel like I consistently heard from my school and advisers that one should rank depending on their desirability to match at that program, not based on the applicant's competitiveness. I have also frequently heard that the match process is "in favor of the applicant," and to shoot for the stars when ranking.

Admittedly, my knowledge and understanding of the match algorithm is limited at best, but there must be an adverse effect to ranking multiple highly tiered hospitals over hospitals that one is competitive at. For an extreme example, if my top 1-10 are all reach programs that I do not match at, am I less likely to match to (hospital Z) rank #11 than if I ranked that same Hospital Z as #1? From what I've heard from my school, no, but I would suspect this is not entirely correct.

Yeah, as stated above, what people mean by "too many high tier hospitals" is someone who doesn't rank hospital Z at all despite interviewing there and only ranks the 10 reach hospitals. Or similarly the person who doesn't' even bother applying to hospital Z in the first place.

 

[Dumpstarrian]

-

 

[DermViser]

So I'm at a mid-tier US Allo school. This year, we had 11 people out of about 145 go unmatched. I thought this was rather high. I asked some of my fourth year friends why this happened. I thought it was because we had a lot of failing or marginal students.

But my fourth year friends said that wasn't the case. They said that a lot of the people going unmatched had poorly constructed their lists, putting too many high-tier hospitals. Others tried to aim for specialties their scores/grades weren't competitive for. The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Are my friends right? Why are so many people going unmatched?

A while back, Radiology and Radiology Oncology were one of the least competitive specialties, filled with IMGs. This is definitely no longer the case.

Orthopedic Surgery has always been competitive in recent times. That being said a few decades back, Orthopedic Surgery was for people at the bottom of the class.

 

[DermViser]

Is this even true? First the first year in a while, there were unfilled programs in Ortho (2 total, both in the northeast, no less). By contrast, ENT/nsurg/plastics had no vacancies. I think that signifies a less-competitive year, but maybe people in the match can correct me if I'm wrong.

By that logic, Dermatology is getting LESS competitive because there were 9 spots unfilled in the match this year. Here's a hint: It's not.
It's called a fluke, where the program was overconfident.

 

[DermViser]

There always seems to be conflicting opinions on this. I feel like I consistently heard from my school and advisers that one should rank depending on their desirability to match at that program, not based on the applicant's competitiveness. I have also frequently heard that the match process is "in favor of the applicant," and to shoot for the stars when ranking.

Admittedly, my knowledge and understanding of the match algorithm is limited at best, but there must be an adverse effect to ranking multiple highly tiered hospitals over hospitals that one is competitive at. For an extreme example, if my top 1-10 are all reach programs that I do not match at, am I less likely to match to (hospital Z) rank #11 than if I ranked that same Hospital Z as #1? From what I've heard from my school, no, but I would suspect this is not entirely correct.

The order of ranking is not the issue. It's how wide you cast the net, which is the issue.

 

[DermViser]

So I'm at a mid-tier US Allo school. This year, we had 11 people out of about 145 go unmatched. I thought this was rather high. I asked some of my fourth year friends why this happened. I thought it was because we had a lot of failing or marginal students.

But my fourth year friends said that wasn't the case. They said that a lot of the people going unmatched had poorly constructed their lists, putting too many high-tier hospitals. Others tried to aim for specialties their scores/grades weren't competitive for. The fourth years also said Orthopaedic Surgery was abnormally competitive this year.

Are my friends right? Why are so many people going unmatched?

Here is one reason (see the powerpoint): http://www.docstoc.com/docs/1512467...ve-Specialty-and-the-Less-Competitive----AAMC

 

[Arkangeloid]

You need to worry about M1, OP. The nuances of applying to and ranking programs is above your current paygrade.

Agreed. But at the rate I'm going, I'll be an MS-2 very soon, and then it's only a couple years until I'm an MS-4. I was just wondering why so many people are going unmatched, because it's a pretty big concern.




On another note, what exactly makes a "high tier" or "reach" hospital as far as residencies go? Is it the big name? Links to good fellowships? Less work hours? Research opportunities? Location?

 

[Kaputt]

Agreed. But at the rate I'm going, I'll be an MS-2 very soon, and then it's only a couple years until I'm an MS-4. I was just wondering why so many people are going unmatched, because it's a pretty big concern.

People go unmatched every year. Is the 11 unmatched students unusual for your school? Were they all applying to competitive residencies and/or programs? If suddenly 30 people in your class all want to do ENT, yeah, there's going to be some SOAPers in that crowd.

On another note, what exactly makes a "high tier" or "reach" hospital as far as residencies go? Is it the big name? Links to good fellowships? Less work hours? Research opportunities? Location?

It's completely specialty-dependent as to which programs are considered the "best" or most "desirable". In general, academic university programs >>>> community programs. Reputation is big and specialty-dependent. Location plays a major role. Any major academic institution in a big exciting city is going to be very competitive (like the programs in Boston, NYC, Chicago, San Francisco, LA, etc.)

When you end up picking a specialty, you'll figure out from your peers, your upperclassmen, and sdn goons as to what the really competitive/top tier places are and what places are solid mid-tiers and what places to avoid. At this point, without picking a specialty, you're just day-dreaming out loud.

 

[mvenus929]

11 people going unmatched does seem a little high, but the things already mentioned in this thread are valid reasons for people not matching. As far as I know, we have 3 people in my class of 146 SOAPing. One already knew in advance, because he didn't get an early match position, so got a prelim year at our institution and then was soaping for another specialty. There may have been one who intentionally designed his list to not match (couples match), but I haven't verified this so I'm not sure how true it is.

For you, personally, the key thing to keep in mind when you're an MS4 is how competitive you are as an applicant. If your Step 1 score isn't go great for the specialty you're going into, if you don't have enough research for that specialty, etc, etc, you need to apply more broadly. Be honest with yourself and with your adviser, choose an adviser who will be honest with you, and do your best to go on as many interviews as you can stand.

 

[DermViser]

For you, personally, the key thing to keep in mind when you're an MS4 is how competitive you are as an applicant. If your Step 1 score isn't go great for the specialty you're going into, if you don't have enough research for that specialty, etc, etc, you need to apply more broadly. Be honest with yourself and with your adviser, choose an adviser who will be honest with you, and do your best to go on as many interviews as you can stand.

THIS.

I think it's hard for many to find an "honest" adviser due to the inevitable hurt feelings that it engenders. Definitely not jealous of that position. No one likes to be seen as the one crushing someone's dream career. I'd say more than anything choose the advisor in the specialty you're going for to give you the low down, not some student affairs dean or an attending in another specialty.

 

[@JackShephard]

11 is really high.

The match landscape may be changing.

 

[KinasePro]

By that logic, Dermatology is getting LESS competitive because there were 9 spots unfilled in the match this year. Here's a hint: It's not.
It's called a fluke, where the program was overconfident.

Not so sure about the bolded point. Recent data from last 4 matches suggest derm is actually getting less competitive. Increasing % seniors matched, decreasing # seniors unmatched.(http://residency.wustl.edu/Choosing/SpecDesc/Pages/Dermatology.aspx). It could be selection bias, but I'd like to see the evidence for that if that's whats being argued. Otherwise, Occam's razor.

I can see how people would like to chalk up unfilled residency spots to "flukes," but the bottom line is that # unfilled is a proxy for competitiveness, albeit an imperfect one. Out of all the surgical sub-specialties (ortho/plastics/ neuro/thoracic/nsurg/ent/urology/vascular), only ortho and vascular had unfilled spots. Based on my gestallt from speaking to current/future applicants of the different surgical specialties, ortho and vascular are probably the least competitive of those subspecialties. So chalking this up to "flukes" makes less sense to me. Just my $0.02 though.

 

[DermViser]

Not so sure about the bolded point. Recent data from last 4 matches suggest derm is actually getting less competitive. Increasing % seniors matched, decreasing # seniors unmatched.(http://residency.wustl.edu/Choosing/SpecDesc/Pages/Dermatology.aspx). It could be selection bias, but I'd like to see the evidence for that if that's whats being argued. Otherwise, Occam's razor.

I can see how people would like to chalk up unfilled residency spots to "flukes," but the bottom line is that # unfilled is a proxy for competitiveness, albeit an imperfect one. Out of all the surgical sub-specialties (ortho/plastics/ neuro/thoracic/nsurg/ent/urology/vascular), only ortho and vascular had unfilled spots. Based on my gestallt from speaking to current/future applicants of the different surgical specialties, ortho and vascular are probably the least competitive of those subspecialties. So chalking this up to "flukes" makes less sense to me. Just my $0.02 though.

Application to derm is highly a self-selected process. With proper advising, there are many people who objectively look at their board scores and grades and realize that they aren't competitive for derm and thus self-select out and don't apply. There are others who will apply regardless of what they are told by advisors.

Now the years in which more people apply, the unmatch rate will undoubtedly be higher. The # unfilled as a marker for competitiveness is over several years not based on 1-2 years. It's the trend that matters. Also I wouldn't trust WashU's website completely regarding the labeling of competitiveness, as they label Radiology as "Low in competitiveness when the mean Step 1 score of matched U.S. seniors is 240. That being said, Ortho is labeled as "High" in competitiveness on the WUSTL website and is hardly "the least competitive" as you say it is.

 

[username456789]

Not so sure about the bolded point. Recent data from last 4 matches suggest derm is actually getting less competitive. Increasing % seniors matched, decreasing # seniors unmatched.(http://residency.wustl.edu/Choosing/SpecDesc/Pages/Dermatology.aspx). It could be selection bias, but I'd like to see the evidence for that if that's whats being argued. Otherwise, Occam's razor.

I can see how people would like to chalk up unfilled residency spots to "flukes," but the bottom line is that # unfilled is a proxy for competitiveness, albeit an imperfect one. Out of all the surgical sub-specialties (ortho/plastics/ neuro/thoracic/nsurg/ent/urology/vascular), only ortho and vascular had unfilled spots. Based on my gestallt from speaking to current/future applicants of the different surgical specialties, ortho and vascular are probably the least competitive of those subspecialties. So chalking this up to "flukes" makes less sense to me. Just my $0.02 though.

Much of it depends on how you define "competitive", and at what point. By the time people are getting ready to apply to specialties, much of the discussion on "competitiveness" has already been drastically altered by self selection.

One of my classmates was interested in Derm for a while, but was devastated by "only" hitting 238 on Step I. So he gave up the ghost and switched to Neurosurgery (and matched at a great program). Is he an idiot for abandoning his initial goal? In my opinion, yes (a 238 certainly doesn't put the kaibosh on a derm application). But that's the kind of mentality a lot of people have. "I'm nowhere near good enough, so why bother trying?"

If you take all comers on day one of medical school, they are likely going to have to achieve more to match into Derm or Plastics than for any other field. The increased "competitiveness" of these fields begins the first day of medical school and continues for all 4 years. Once ERAS opens, the majority of the people even thinking of applying have already played King of the Mountain and succeeded.

Additionally, over the past couple years most of the spots that have gone unfilled in the match are either dedicated research tracks or, in one instance, a single program that probably miscalculated grossly and only matched 1 of 4 spots. I know my program specifically would prefer to leave a spot open than to match someone they didn't think fit in well. Derm programs tend to interview ~6-10 people per spot, and often have 2-4 spots available. It's a small applicant pool, and a lot of the same people are interviewing at a lot of the same programs together. Inevitably there are some very strong candidates that feel the squeeze.

As I said in the beginning, competitiveness is difficult to purely define and utilize as some sort of metric. You and I may have differing opinions of what makes a given field more or less so.

 

[DoctwoB]

Not so sure about the bolded point. Recent data from last 4 matches suggest derm is actually getting less competitive. Increasing % seniors matched, decreasing # seniors unmatched.(http://residency.wustl.edu/Choosing/SpecDesc/Pages/Dermatology.aspx). It could be selection bias, but I'd like to see the evidence for that if that's whats being argued. Otherwise, Occam's razor.

I can see how people would like to chalk up unfilled residency spots to "flukes," but the bottom line is that # unfilled is a proxy for competitiveness, albeit an imperfect one. Out of all the surgical sub-specialties (ortho/plastics/ neuro/thoracic/nsurg/ent/urology/vascular), only ortho and vascular had unfilled spots. Based on my gestallt from speaking to current/future applicants of the different surgical specialties, ortho and vascular are probably the least competitive of those subspecialties. So chalking this up to "flukes" makes less sense to me. Just my $0.02 though.

Interesting. If you look at that data it makes it seem like Urology is the most competetive specialty with US Senior match rate of 67% for two straight years compared to ~80s for ortho, plastics, ent, and derm.

 

[Anonymous99]

Not so sure about the bolded point. Recent data from last 4 matches suggest derm is actually getting less competitive. Increasing % seniors matched, decreasing # seniors unmatched.(http://residency.wustl.edu/Choosing/SpecDesc/Pages/Dermatology.aspx). It could be selection bias, but I'd like to see the evidence for that if that's whats being argued. Otherwise, Occam's razor.

Maybe it is but I (thought I) had a pretty solid app. US Senior, I & II: just shy of 260, top 1/3rd, pub/presentations/posters, 8 int/ranks, excellent LoRs. No match. No SOAP.

n=1 of course, however.

 

[DermViser]

Much of it depends on how you define "competitive", and at what point. By the time people are getting ready to apply to specialties, much of the discussion on "competitiveness" has already been drastically altered by self selection.

One of my classmates was interested in Derm for a while, but was devastated by "only" hitting 238 on Step I. So he gave up the ghost and switched to Neurosurgery (and matched at a great program). Is he an idiot for abandoning his initial goal? In my opinion, yes (a 238 certainly doesn't put the kaibosh on a derm application). But that's the kind of mentality a lot of people have. "I'm nowhere near good enough, so why bother trying?"

If you take all comers on day one of medical school, they are likely going to have to achieve more to match into Derm or Plastics than for any other field. The increased "competitiveness" of these fields begins the first day of medical school and continues for all 4 years. Once ERAS opens, the majority of the people even thinking of applying have already played King of the Mountain and succeeded.

Additionally, over the past couple years most of the spots that have gone unfilled in the match are either dedicated research tracks or, in one instance, a single program that probably miscalculated grossly and only matched 1 of 4 spots. I know my program specifically would prefer to leave a spot open than to match someone they didn't think fit in well. Derm programs tend to interview ~6-10 people per spot, and often have 2-4 spots available. It's a small applicant pool, and a lot of the same people are interviewing at a lot of the same programs together. Inevitably there are some very strong candidates that feel the squeeze.

As I said in the beginning, competitiveness is difficult to purely define and utilize as some sort of metric. You and I may have differing opinions of what makes a given field more or less so.

As smart as medical students are, it amazes me those who don't understand basic statistics. He was nowhere near out of the running for Derm.

A lot of the time the scramble (or SOAP now) highly works in the Derm program's favor as they get to capture the applicant who fell through the cracks.

 

[DermViser]

Maybe it is but I (thought I) had a pretty solid app. US Senior, I:258, II: 259, top 1/3rd, pub/presentations/posters, 8 int/ranks, excellent LoRs. No match. No SOAP.

n=1 of course, however.

What tier is your medical school in? With your board scores and research in derm, you should have gotten a LOT more interviews. You may have gotten less invites, if you went to a low tier, unranked medical school. I'm assuming of course, that you interview well (no reason to believe that you don't).

 

[Daodejing]

Maybe it is but I (thought I) had a pretty solid app. US Senior, I:258, II: 259, top 1/3rd, pub/presentations/posters, 8 int/ranks, excellent LoRs. No match. No SOAP.

n=1 of course, however.

Brutal. Hope things begin to look up sooner rather than later

 

[badnewstime1]

One of my classmates was interested in Derm for a while, but was devastated by "only" hitting 238 on Step I. So he gave up the ghost and switched to Neurosurgery (and matched at a great program). Is he an idiot for abandoning his initial goal? In my opinion, yes (a 238 certainly doesn't put the kaibosh on a derm application). But that's the kind of mentality a lot of people have. "I'm nowhere near good enough, so why bother trying?"

As someone who thought he would be ok applying to a super competitive specialty with a 220 step 1, looking back I was a bit delusional. Yes, I did get interviews because of the work I did to show interest in the field. A lot actually. But I was interviewing alongside 250 and up. I have learned the hard way that the number of interviews doesn't matter that much for applicants with low usmle scores. You need to absolutely blow the interviews away, and you need probably twice as many as better applicants (which you won't get).

People always say, 'once you get an interview, everybody is on a level playing field.' I couldn't disagree more. When a program interviews 10 people and are looking through their packets when making the list they see 262, 258, 244, 249, 217, 258, 236, 271, 238, 248. It doesn't really matter how solid the rest of the 217 applicant's application is (and with a lower step 1 it will inevitably have more holes in it), what matters is that score stands out. Unless you do something phenomenal and blow the interview away, you are going to the bottom or not getting ranked. It's like trying out for the basketball team and they line you up on the wall to give you your number and you are 5'5" and everyone else is 6'4". Yeah, you can still make the team if you sit there and drain threes all day, but you are judged even before you get a chance to open your mouth.

Programs have gotten super snobby about step scores (I have heard the behind the scenes chatter) and the scores in the past 5 years have just gotten to be stratospheric. We have pre-meds already reading first aid these days. I didn't even know what first aid was until the end of first year. We have people taking 3-4 months of dedicated study time. We have all sorts of training programs and tools I didn't know about. It's gotten insane. I wouldn't recommend this profession to anyone I cared about unless they are 100% sure they want to do primary care lest you fall in love with a great specialty and never get to do it.

 

[badnewstime1]

Here is one reason (see the powerpoint): http://www.docstoc.com/docs/1512467...ve-Specialty-and-the-Less-Competitive----AAMC

This website indicates that if you match into a prelim med position you only get a 3 year GME ceiling. If this is the case, matching a prelim only for, oh lets say a rads applicant, would be disastrous because that applicant would be reapplying during intern year for a specialty that requires 4 additional years of pgy training when you've only got 2 years of training. Or am I missing something? Is there any option for those who match prelim only to get out of the match commitment? I.e., delay graduation so the program requests a waiver and doesn't take you? Or is this not allowed/will flag you as a match violator?

 

[DermViser]

This website indicates that if you match into a prelim med position you only get a 3 year GME ceiling. If this is the case, matching a prelim only for, oh lets say a rads applicant, would be disastrous because that applicant would be reapplying during intern year for a specialty that requires 4 additional years of pgy training when you've only got 2 years of training. Or am I missing something? Is there any option for those who match prelim only to get out of the match commitment? I.e., delay graduation so the program requests a waiver and doesn't take you? Or is this not allowed/will flag you as a match violator?

I really believe that part is incorrect. The ceiling starts when you enter a categorical residency not a prelim which by definition is only 1 year.

My understanding was that the number of years ceiling is based on the specialty in question. So since by defintion a prelim year is only 1 year it wouldn't affect Radiology bc it's needed in order to do Radiology.

 

[Mad Jack]

Is this even true? First the first year in a while, there were unfilled programs in Ortho (2 total, both in the northeast, no less). By contrast, ENT/nsurg/plastics had no vacancies. I think that signifies a less-competitive year, but maybe people in the match can correct me if I'm wrong.

Those two programs only went unfilled because the otherwise competitive people that applied for them failed to meet the 400 lb deadlift+300 lb squat+200 lb bench minimum of the programs. Trying to match ortho without being able to lift, not even once.

 

[Winged Scapula]

I really believe that part is incorrect. The ceiling starts when you enter a categorical residency not a prelim which by definition is only 1 year.

My understanding was that the number of years ceiling is based on the specialty in question. So since by defintion a prelim year is only 1 year it wouldn't affect Radiology bc it's needed in order to do Radiology.

The "ceiling" or funding time clock starts when the resident enters a training scheme defined as a terminal pathway; this would typically be defined as a categorical position.

 

[Trogghunter]

Those two programs only went unfilled because the otherwise competitive people that applied for them failed to meet the 400 lb deadlift+300 lb squat+200 lb bench minimum of the programs. Trying to match ortho without being able to lift, not even once.

Not always true. My home program(B1G) matched 2 that probably can't even bench 185 last yr. Must've been a fluke cycle. The pgy2 are solid, I'd say they rep 200 between them. The 3rds rep 225 easy, probably 10x at least, including a former d1 NCAA football player. 4ths are on rotations, but the seniors.....they're are on call for reductions at SeaWorld, the local farms, and the local zoo. I heard that the incoming class was in 300 AND the sequel, though. Rumor has it that the top match was a stand in for Optimus Prime.

 

[caffeinemia]

Honestly, after going through the match process, I think delusions of grandeur can often explain why people don't match. Ie... if >50% of people think the are better than average drivers, then >90% of med students think they are better than the average med student. I have met a number of present and previous classmates who who ranked a small handful (ie 5) programs and thought they would get lucky. That unbridled optimism is cute when you're a kid, not when you're planning your career. If there is any universally true advice that can be given about matching -- it's that greater number of ranked programs leads to greater chance of success. That should be the main goal when applying -- a realistic self assessment and making choices that will lead to as many interviews as possible, even if it means doing a different specialty or applying to ridiculous number of programs.

 

[DermViser]

We have pre-meds already reading first aid these days. I didn't even know what first aid was until the end of first year.

Good grief.

 

[DermViser]

As someone who thought he would be ok applying to a super competitive specialty with a 220 step 1, looking back I was a bit delusional. Yes, I did get interviews because of the work I did to show interest in the field. A lot actually. But I was interviewing alongside 250 and up. I have learned the hard way that the number of interviews doesn't matter that much for applicants with low usmle scores. You need to absolutely blow the interviews away, and you need probably twice as many as better applicants (which you won't get).

People always say, 'once you get an interview, everybody is on a level playing field.' I couldn't disagree more. When a program interviews 10 people and are looking through their packets when making the list they see 262, 258, 244, 249, 217, 258, 236, 271, 238, 248. It doesn't really matter how solid the rest of the 217 applicant's application is (and with a lower step 1 it will inevitably have more holes in it), what matters is that score stands out. Unless you do something phenomenal and blow the interview away, you are going to the bottom or not getting ranked. It's like trying out for the basketball team and they line you up on the wall to give you your number and you are 5'5" and everyone else is 6'4". Yeah, you can still make the team if you sit there and drain threes all day, but you are judged even before you get a chance to open your mouth.

Programs have gotten super snobby about step scores (I have heard the behind the scenes chatter) and the scores in the past 5 years have just gotten to be stratospheric. We have pre-meds already reading first aid these days. I didn't even know what first aid was until the end of first year. We have people taking 3-4 months of dedicated study time. We have all sorts of training programs and tools I didn't know about. It's gotten insane. I wouldn't recommend this profession to anyone I cared about unless they are 100% sure they want to do primary care lest you fall in love with a great specialty and never get to do it.

Hence why in these cases, a research year is usually necessary.

 

[badnewstime1]

I really believe that part is incorrect. The ceiling starts when you enter a categorical residency not a prelim which by definition is only 1 year.

My understanding was that the number of years ceiling is based on the specialty in question. So since by defintion a prelim year is only 1 year it wouldn't affect Radiology bc it's needed in order to do Radiology.

The "ceiling" or funding time clock starts when the resident enters a training scheme defined as a terminal pathway; this would typically be defined as a categorical position.

Ok, then that website is blatantly wrong. That scared me because if it were true, I would be totally screwed if reapplying during an internal med prelim. Nobody would want an applicant with only 2 years of funding left.

Hence why in these cases, a research year is usually necessary.

I was advised by everybody not to do a pre-emptive research year and try the match first. I actually wanted to do a research year, but literally everybody said not to and were not willing to help place me in a research position. Now I am committed to a prelim med program. Not much time to do research during that. Which means I would need to do a research year afterwards? I have heard about people not matching and delaying graduation to do research instead and reapply as a senior again. This sounds like a good idea, but again I was advised by everyone to put a prelim on my primary rank list. If I just didn't show up to my last rotation or something to delay graduation and get some publications by next September, what would happen given that I am matched to a prelim? Would this be a match violation?

 

[DermViser]

Ok, then that website is blatantly wrong. That scared me because if it were true, I would be totally screwed if reapplying during an internal med prelim. Nobody would want an applicant with only 2 years of funding left.



I was advised by everybody not to do a pre-emptive research year and try the match first. I actually wanted to do a research year, but literally everybody said not to and were not willing to help place me in a research position. Now I am committed to a prelim med program. Not much time to do research during that. Which means I would need to do a research year afterwards? I have heard about people not matching and delaying graduation to do research instead and reapply as a senior again. This sounds like a good idea, but again I was advised by everyone to put a prelim on my primary rank list. If I just didn't show up to my last rotation or something to delay graduation and get some publications by next September, what would happen given that I am matched to a prelim? Would this be a match violation?

You would also fail the rotation thus affecting your good standing as a medical student. Likely a research year after internship, is bc you then have a medical license, and can do a lot more than as a student. This is very common in derm, for example.

 

[badnewstime1]

The advising I am getting on this is driving me mad (not from you, from everyone at my school and home program). They were pretty much not willing to discuss research years as a medical student. On the other hand, match rates are abysmal for US MD grads vs senior medical students. Am I missing something? You are saying post-MD research years are common in derm, but other fields like ortho and ent virtually never take anyone other than senior med students (luckily I am not doing these). What it sounds like is that I have no choice but to do the internship (I'm actually kind of surprised I matched there -- it's a solid academic program). I am trying to figure out if it was a good thing that I put it on my primary ROL or if I should have just gone unmatched and done a research year. Basically, am I hurting my chances at matching next year or the year after by doing the prelim?

 

[Frazier]

The advising I am getting on this is driving me mad (not from you, from everyone at my school and home program). They were pretty much not willing to discuss research years as a medical student. On the other hand, match rates are abysmal for US MD grads vs senior medical students. Am I missing something? You are saying post-MD research years are common in derm, but other fields like ortho and ent virtually never take anyone other than senior med students (luckily I am not doing these). What it sounds like is that I have no choice but to do the internship (I'm actually kind of surprised I matched there -- it's a solid academic program). I am trying to figure out if it was a good thing that I put it on my primary ROL or if I should have just gone unmatched and done a research year. Basically, am I hurting my chances at matching next year or the year after by doing the prelim?

A lot of people do the "research year" before graduating... for example, between Ms2 and Ms3 (at my school). When they graduate, they are still a "US senior", iirc.

 

[Arkangeloid]

So I went to Match Day, but I left early because seeing happy and successful people depresses me, and I felt bad for those who didn't match.

Even if they were deluded enough to think they could get into Derm when they clearly couldn't.

 

[Frazier]

So I went to Match Day, but I left early because seeing happy and successful people depresses me, and I felt bad for those who didn't match.

Even if they were deluded enough to think they could get into Derm when they clearly couldn't.

Well, that is unfortunate.

 

[SouthernSurgeon]

So I went to Match Day, but I left early because seeing happy and successful people depresses me

You might want to see someone about that...

 

[Arkangeloid]

You might want to see someone about that...

I'm already on SSRIs, don't worry. It's just that medicine and med school damage some of us more than others.

 

[Wordead]

I'm already on SSRIs, don't worry. It's just that medicine and med school damage some of us more than others.

How would SSRIs help you need some serious CBT for that

 

[Arkangeloid]

How would SSRIs help you need some serious CBT for that

We don't offer CBT at my medical school, only Psychiatric assistance and medication.

 

[bakedbeans18]

There always seems to be conflicting opinions on this. I feel like I consistently heard from my school and advisers that one should rank depending on their desirability to match at that program, not based on the applicant's competitiveness. I have also frequently heard that the match process is "in favor of the applicant," and to shoot for the stars when ranking.

Admittedly, my knowledge and understanding of the match algorithm is limited at best, but there must be an adverse effect to ranking multiple highly tiered hospitals over hospitals that one is competitive at. For an extreme example, if my top 1-10 are all reach programs that I do not match at, am I less likely to match to (hospital Z) rank #11 than if I ranked that same Hospital Z as #1? From what I've heard from my school, no, but I would suspect this is not entirely correct.

This is true. However, if you are aiming for IM, for example, and you have a ~240/240 for your USMLE, and you interview with:

Hopkins, Penn, UChicago, Cook County Hospital, UCLA-Harbor, Lenox Hill Hosp, MassGen, Loyola University Medical Ctr, Stanford University Hosp, Stamford (CT) Hospital, North Shore University Hospital, UTSW, Brown/Rhode Island Hospital, Vanderbilt, University of Florida, Washington Hospital Center, and WashU, but then your ROL looks like this:

1. MassGen
2. Stanford
3. Hopkins
4. Penn
5. UTSW
6. UChicago
7. WashU
8. Vanderbilt
9. Brown/RI Hospital

but you don't include the community programs like Loyola, UCLA-Harbor, Lenox Hill, NorthShore, even at the bottom of your ROL, then you aren't doing yourself any favors at all. You're being over-confident with the ROL, and the match can only be done "in favor of the applicant" to the extent to the total # of programs that will rank the applicant. "In favor of the applicant" just means that you will get placed to the highest priority program on your ROL that has also ranked you. So, if, according to the above sample ROL, at the very least Brown has not ranked you, then the other programs won't even be able to recruit you because of their exclusion from your ROL, even if they were your last choice programs.

 

[Arkangeloid]

Oh, and some good news, I heard that some of the people who didn't match "soaped" successfully, though I'm not quite sure what a "soap" is.

 

[DermViser]

So I went to Match Day, but I left early because seeing happy and successful people depresses me, and I felt bad for those who didn't match. Even if they were deluded enough to think they could get into Derm when they clearly couldn't.

Why would people excited to match in their chosen specialty depress you?!?

 

[Arkangeloid]

Why would people excited to match in their chosen specialty depress you?!?

Well I had to wake up early for some mandatory bull and I hate waking up early, so I was tired and mad about that. I pumped a lot of caffeine into my system, which makes you irritable and has anxiogenic properties.

Then I see all these amazingly successful and happy people, and contrast that with my past failures and my anger at waking up early, and I feel terrible. 🙁

The Redbulls are wearing off now so I'll probably sleep soon.

But I'm afraid I won't survive residency, I hate the morning too much...