Matching Gen Surg with low scores vs not matching with high scores

[GuzzyRon]

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I was looking at the 2009 charting outcomes for gen surg and was wondering:

1. What could the 78 US seniors with Step 1 scores ranging from 181 - 200 possibly had going on that made them match? and
2. What could possibly be lacking in the applications of the high-scoring seniors (scores 241 - 260) that failed to match?

Just curious.

 

[SouthernSurgeon]

2. What could possibly be lacking in the applications of the high-scoring seniors (scores 241 - 260) that failed to match?

This one is easy - a high score is hardly a guarantee. They may have had poor grades, or just been unpleasant people on their interview day. The board score only gets you so far.

 

[Doctor Bagel]

This one is easy - a high score is hardly a guarantee. They may have had poor grades, or just been unpleasant people on their interview day. The board score only gets you so far.

They also might have applied to, interviewed at or ranked too few programs.

 

[Thanatos]

They also might have applied to, interviewed at or ranked too few programs.

This is key. People I know that didn't match or weren't happy where they matched did not apply to very many places. I had several friends that failed to match, they applied to like 7 programs. Why would anyone do that....I still don't know.

 

[JackADeli]

This one is easy - a high score is hardly a guarantee. They may have had poor grades, or just been unpleasant people on their interview day. The board score only gets you so far.

Hard to believe, but, I knew programs that actually want the folks in the middle-range of the bell curve. GSurgeons don't want the extremes in their trainees. They want a solid foundation but room to learn. You come into a program with a extraterrestial board score you need to make sure you normalize who you are. They will be very nervous of you being cocky/arrogant and or dysfunctional. They want some confidence with humility and a board score off the charts can often overshadow some of the characteristics programs look for....

JAD

 

[Dokcn]

a board score off the charts can often overshadow some of the characteristics programs look for....

JAD

Sorry, I am confused. When I looked at the charting result, 125 out of 130 US seniors with step 1 score ranging from 240 to 260 landed a GS program last year. It seems scoring high is not a bad thing at all.

 

[Doctor Bagel]

Hard to believe, but, I knew programs that actually want the folks in the middle-range of the bell curve. GSurgeons don't want the extremes in their trainees. They want a solid foundation but room to learn. You come into a program with a extraterrestial board score you need to make sure you normalize who you are. They will be very nervous of you being cocky/arrogant and or dysfunctional. They want some confidence with humility and a board score off the charts can often overshadow some of the characteristics programs look for....

JAD

This is kinda of an amazing post in that it implies that you should actually be worried because you did well on Step 1. It seems a little disturbing that you have to be extra cool to make up for that 260. 🙄 Why can't we be glad that others are capable to doing well instead of worrying about false arrogance?

 

[Doctor Bagel]

Sorry, I am confused. When I looked at the charting result, 125 out of 130 US seniors with step 1 score ranging from 240 to 260 landed a GS program last year. It seems scoring high is not a bad thing at all.

Because scoring well is not a bad thing. How could it be?

 

[JackADeli]

Because scoring well is not a bad thing. How could it be?

Score well. You should strive to do the best you can. I do not think anyone is suggesting you do otherwise.

This is kinda of an amazing post in that it implies that you should actually be worried because you did well on Step 1. ...

No, it implies that there may be reasons why some high scoring individuals do not match.

...Why can't we be glad that others are capable to doing well instead of worrying about false arrogance?

You can try to read into my post and find any twist you want. In the end, most folks understand the concept of bell curves... I'm not sure of who "we" are... I'm not a PD, nor you. But, PDs (I have seen) do have to worry about assuring teamwork and what not. It is quite common for programs to look for "well rounded" applicants. A score in and of itself does not guarantee entry (low or high). You can be well rounded and have a 260... but programs are concerned with extremes. That is just reality. As a resident, I have seen numerous folks with spectacular scores and their presence suggested to all in the room that maybe they should never have come out of the lab...

...People I know that didn't match or weren't happy where they matched did not apply to very many places. I had several friends that failed to match, they applied to like 7 programs. Why would anyone do that...

There can be numerous reasons. Some folks I knew had significant others that said their loved one could only apply in certain areas. Some applicants only applied in certain areas because they "couldn't live in x, y, z...". In most cases folks were quite sure they were "guaranteed" to get into one of their limited number of places. They looked at program composition, saw where the current residents came from, looked at their own scores, and knew they were at least as good as those guys.... So, they logically chose not to apply beyond. All these reasonings and "absolutely never go here or there" seems to melt away after match day.

JAD

 

[Doctor Bagel]

I just don't get why anyone would assume that someone who did well on a Step 1 is less well-rounded than someone who didn't. Most everyone I know studied the same amount for Step 1 and some did better than others -- that's just how it goes. I think the real key is that doing well on Step 1 in and of itself is not enough to get you in if the rest of your application sucks.

And as was mentioned above, very few high scores actually did not match.

But maybe surgery is some weird Harrison Bergeronesq world ... 😉

 

[JackADeli]

...Most everyone I know studied the same amount for Step 1 and some did better than others -- that's just how it goes...

Maybe the exception, but my experience has been that the majority of cases one does better if one prepares/studies more. Those I knew that scored higher the vast majority of the time studied more/prepared more/took extra courses/etc.... It would be nice to say everyone studied the same and those that scored higher were just lucky or better test takers.... I think those exceptions exist but do not represent the norm. Sorry to burst anyones bubble or ruin one's consoling rationalizations....

JAD

 

[Doctor Bagel]

Maybe the exception, but my experience has been that the majority of cases one does better if one prepares/studies more. Those I knew that scored higher the vast majority of the time studied more/prepared more/took extra courses/etc.... It would be nice to say everyone studied the same and those that scored higher were just lucky or better test takers.... I think those exceptions exist but do not represent the norm. Sorry to burst anyones bubble or ruin one's consoling rationalizations....

JAD

Lol, I'm a sea of self-hatred about that high step 1 score I got. Gee, my life's so hard -- if only I had scored 20 points lower. 🙄

I still don't buy what you're saying, and it doesn't seem to be backed up by the facts either. Maybe you have some feelings of inadequacy about not doing as well on step 1 as you wished. I love how people on SDN can turn good things into bad things. Next you'll be telling me that programs don't like AOA applicants.

 

[SocialistMD]

Lol, I'm a sea of self-hatred about that high step 1 score I got. Gee, my life's so hard -- if only I had scored 20 points lower. 🙄

I still don't buy what you're saying, and it doesn't seem to be backed up by the facts either. Maybe you have some feelings of inadequacy about not doing as well on step 1 as you wished. I love how people on SDN can turn good things into bad things. Next you'll be telling me that programs don't like AOA applicants.

I think the point of not expecting to ride one's elevated USMLE score into a top GS residency is valid, even if you don't think the numbers support it. What you don't know is how often those people with upper eschelon Step 1 scores matched at their first choice, which is really the goal when you have a score above 250. If you come off as arrogant, you do make people think you will be difficult to train or that you won't be a team player. This is true if you have a 202 or a 272. A high Step 1 score won't make up for your attitude at the top programs, as there are a lot of 270s interviewing who don't think they are God's gift to surgery, even if they are. As a result, those who have an air about them will still match because they are strong on paper and some programs are willing to look past personality deficiencies; it just might not be where they wanted or where an outside observer would have guessed they would be based simply on their scores.

 

[Doctor Bagel]

I think the point of not expecting to ride one's elevated USMLE score into a top GS residency is valid, even if you don't think the numbers support it. What you don't know is how often those people with upper eschelon Step 1 scores matched at their first choice, which is really the goal when you have a score above 250. If you come off as arrogant, you do make people think you will be difficult to train or that you won't be a team player. This is true if you have a 202 or a 272. A high Step 1 score won't make up for your attitude at the top programs, as there are a lot of 270s interviewing who don't think they are God's gift to surgery, even if they are. As a result, those who have an air about them will still match because they are strong on paper and some programs are willing to look past personality deficiencies; it just might not be where they wanted or where an outside observer would have guessed they would be based simply on their scores.

I agree 100% with this and even stated something similar above about how a high step 1 score won't make up for other deficiencies. I'm just questioning the notion that programs prefer applicants with scores closer to the norm, which JackADeli seems to be advocating, which implies that a high score can actually be a detriment to an application.

 

[JackADeli]

...I'm just questioning the notion that programs prefer applicants with scores closer to the norm, which JackADeli seems to be advocating, which implies that a high score can actually be a detriment to an application.

If you read what I posted.... No, I never advocated scoring lower. But, you can read it as you wish.

...No, it implies that there may be reasons why some high scoring individuals do not match...

Score well. You should strive to do the best you can. I do not think anyone is suggesting you do otherwise...

...my experience has been that the majority of cases one does better if one prepares/studies more. Those I knew that scored higher the vast majority of the time studied more/prepared more/took extra courses/etc.... It would be nice to say everyone studied the same and those that scored higher were just lucky or better test takers.... I think those exceptions exist but do not represent the norm...

...It is quite common for programs to look for "well rounded" applicants. A score in and of itself does not guarantee entry (low or high). You can be well rounded and have a 260... but programs are concerned with extremes. That is just reality...

...Maybe you have some feelings of inadequacy about not doing as well on step 1 as you wished. I love how people on SDN can turn good things into bad things...

I actually find it interesting how some folks on SDN, particularly students try to complicate and psycho-analyze someone's post.... As I stated, most people that score higher did in fact study more. There is no feelings of innadequacy in that. I have in no way made a "good thing" into a bad thing. I encourage everyone to study hard and earn as high a score on your exams as possible. But, everyone should appreciate PDs are looking for normal/well rounded folks. It has been stated numerous times on this thread that a score in and of itself does not guarantee admission.....

JAD

 

[GuzzyRon]

I was looking at the 2009 charting outcomes for gen surg and was wondering:

1. What could the 78 US seniors with Step 1 scores ranging from 181 - 200 possibly had going on that made them match? and
2. What could possibly be lacking in the applications of the high-scoring seniors (scores 241 - 260) that failed to match?

Just curious.

OK, so it appears question 2 has been answered. But there still isn't a single explanation as to how question 1 happens. I'm thinking great LORs and tons of published research among other unquantifiable qualities can help. But I still don't see how these overcome or negate a low, barely-passing board score. I guess my basic question is:

Besides published research and great LORs, what are some of the things that these low-scoring seniors do to earn themselves a spot that candidates with far superior academic records didn't do? Where/how did some in this group excel where more competitive applicants fail?

 

[DoctaJay]

I would think that these seniors who scored in that low range had 2 things going for them in addition to good LORs and research:

1) An attending at their institution who was calling program directors / chairmans at other programs to vouch for them (which I believe is gold for matching at institutions)

2) Stellar performance at away rotations. Once the programs saw in person what it was like to work with the student and how the student fit in with the residents, it was probably alot easier to overlook the test scores.

I can't think of anything else that would push people to the top than that. But heck, even people with good step 1 scores could benefit tremendously from 1 and 2 above so how really knows.

 

[surg]

As someone who reads apps, here are my thoughts for those with low scores. (BTW, to the OP, I don't consider a 240-260 so extraordinary that it would catch my attention and make me think that the applicant will definitely match. There are a LOT of applicants with those scores now in surgery)

1) Scores are important, but not even close to the only thing. They are, for me, just one part of the whole academic picture, so long as you pass the basic screens for the program I'm at. I've seen people with high grades with low scores, mediocre grades with high scores and everything in between. A high score with low grades, makes me wonder about motivation. Great grades with a low score tends to make me think the person just had a bad day, and if they can give me a decent explanation (and show via their LORs, etc) that the score is the anomaly, I'll tend to blow it off. Similarly, a single fail or a basic science course that you give me great insight as to why it happened and what you've done to remedy the situation isn't an application killer (it's not a good thing though) so long as it doesn't appear to be a trend

2) Personality matters and personal experience with that person matters. The more I think you will be easy to work with, the more likely I'm going to break ties towards you. There are a TON of people that look similar on paper when you get right down to it. It is often a gut feeling as to who amongst these similar people to put at the top of their group or to jump up a group or two, or drop down a group or two. I'm not hesitant to not rank applicants or rank them quite low that give evidence that they won't make good residents personality wide. Fine examples of that, people who treat my staff poorly on the phone or in person. People who seem totally disinterested in the interview. Warning signs in their LOR. The worse you look on paper, the better you'll have to be in person. Personal experience with your working style such as you having rotated here and doing well, is a significant leg up. You rotating here and doing not well, is a quick way to the not ranked list. Keep that in mind when deciding to take an away rotation. The better you look on paper, the less time you want me to see you probably and vice versa. Similarly, substituted experience matters too. In this case, that means someone I know or respect vouching for you helps a lot.

3) finally, something to remember that I'm paraphrasing from the former Stanford Undergrad admission instructions: Sometimes people ask whether it is better to get an A in a standard class or a B in an honors class. We would remind you that most of our successful applicants are able to achieve an A in an honors level class.
Doing well in school won't hurt you. A good personality goes a long way. Having a pleasant personality and doing well in school is the best way to go. Don't forget to apply wide enough to match your paper profile.

 

[Biscuit799]

OK, so it appears question 2 has been answered. But there still isn't a single explanation as to how question 1 happens. I'm thinking great LORs and tons of published research among other unquantifiable qualities can help. But I still don't see how these overcome or negate a low, barely-passing board score. I guess my basic question is:

Besides published research and great LORs, what are some of the things that these low-scoring seniors do to earn themselves a spot that candidates with far superior academic records didn't do? Where/how did some in this group excel where more competitive applicants fail?

A good portion of this phenomenon that has yet to be suggested is basically the exact opposite of the "high score/no match" problem.

Basically the individual with a low step 1 score wants to do General Surgery, but has a realistic understanding of their status as an applicant. Thus, they apply to 100 programs, do 20 interviews, and rank all 20 programs. They shotgun the whole application process because they know that there's safety in numbers. There are plenty of middle to low tier programs out there that will take an applicant with a sub par step 1 score. Frankly, Gen Surg isn't the most competitive specialty, and there's a wide range of programs, some of which require perfect applications and others which require the individual to merely be a U.S. grad (if that).

 

[thedrjojo]

Many programs, for better or worse, prefer US grads over DO/IMG's regardless of scores, so when you look at many of the community hospitals out there, the low tier schools, these are primarily where the weaker applicants end up. There isn't any data out there, but if you were to somehow be able to look at the numbers for University programs, I am pretty sure that almost none of those 78 people ended up in one of those programs, and if they did, they had some sort of "IN" at that program (ie, home program, superb away, research with faculty, a relative on the selection committee, a picture of the PD with a dead hooker)

And as for the people 240-260 that didn't match (which I think some other poster said was 5 people), the reasons have already been well discussed: too few programs, too few interviews, too few ranks, or too few interpersonal skills.

 

[docmartin252]

Now I haven't gone through the match and I am just speculating here, but I think that another possiblity is that those with high Step I scores may have ranked gen surg, but didn't go into the field. Meaning, those five or so applicants that didn't match may have also ranked a subspecialty higher on their ROL and were accepted to one of those programs, while ranking gen surg lower as sort of a safety net. Or, instead of a surgical subspecialty maybe they ranked another competitive field like hem/onc or something along those lines....just my .02

 

[Doctor]

Many programs, for better or worse, prefer US grads over DO/IMG's regardless of scores

Not saying it isn't true, but this is such poor judgment. This unwritten policy basically serves to weigh what the applicant learned in undergrad (nothing at all that is related to medicine!) over what the applicant learned in medical school (knowledge demonstrated on these scores is implicitly related to the practice of medicine), wherever that med school was.

 

[SLUser11]

Not saying it isn't true, but this is such poor judgment. This unwritten policy basically serves to weigh what the applicant learned in undergrad (nothing at all that is related to medicine!) over what the applicant learned in medical school (knowledge demonstrated on these scores is implicitly related to the practice of medicine), wherever that med school was.

:::::::::

😴

 

[JackADeli]

Many programs, for better or worse, prefer US grads over DO/IMG's regardless of scores, so when you look at many of the community hospitals out there, the low tier schools, these are primarily where the weaker applicants end up...

Not saying it isn't true, but this is such poor judgment. This ...basically serves to weigh what the applicant learned in undergrad ...over what the applicant learned in medical school...

I will take this bate....

There are definately exceptions.... But, for most, what medical school you get into (i.e. MD vs Do, US vs Foreign) represents a culmination of your efforts and achievements (or failures) up to that point. This can go from how you did in high school to improve your college application to your actual college performance. This includes what choices you make during college.... party animal, having fun? vs numerous sacrifices and setting goals and activities geared toward a course into medical school.

Then you have your MCAT. Yes, not everyone is a great test taker. Yet, you have what, at least 2-4 years to work at improving your performance on this standardized test. Again, showing the inititiative and efforts to recognize the obstacles and plan to overcome them.

By the time you have completed undergrad to start medical school, you have produced a "track record". What medical school you get into is incorporated into that track record. What caliber undergrad, to what caliber medical school should not be taken lightly. By your own response you suggest/imply folks in non-US medical schools have a track record of not being the top picks. Thus, yes, residencies would be foolish to not take into consideration and weigh heavily the caliber of medical school training one received and what the caliber of students in said medical school have traditionally been.... IF, the students in an island medical school or other international medical school have traditionally been those whose applications were just not strong enough to compete in a US medical school, why should any residency presume your score of honors on the island is equivalent to a score of honors at Duke? Because you scored well on the USMLE???? If you were unable to learn the materials in undergrad to put yourself ahead, you will not remediate and learn that while at the same time trying to learn what must be learned in medical school. It is as they say in surgery residency.... you know the most basic science you are going to ever know after you complete your second year of medical school. By the time you are a resident, you are forgetting more basic science then you will likely learn.... So to is it if your undergrad pre-reqs were sub-par....

JAD

PS: I know there are plenty of folks that study abroad for reasons of adventure or reasons other then innadequate applications, my reply is a generalization focused the others....

 

[Doctor]

I will take this bate....

There are definately exceptions.... But, for most, what medical school you get into (i.e. MD vs Do, US vs Foreign) represents a culmination of your efforts and achievements (or failures) up to that point. This can go from how you did in high school to improve your college application to your actual college performance. This includes what choices you make during college.... party animal, having fun? vs numerous sacrifices and setting goals and activities geared toward a course into medical school.

Then you have your MCAT. Yes, not everyone is a great test taker. Yet, you have what, at least 2-4 years to work at improving your performance on this standardized test. Again, showing the inititiative and efforts to recognize the obstacles and plan to overcome them.

By the time you have completed undergrad to start medical school, you have produced a "track record". What medical school you get into is incorporated into that track record. What caliber undergrad, to what caliber medical school should not be taken lightly. By your own response you suggest/imply folks in non-US medical schools have a track record of not being the top picks. Thus, yes, residencies would be foolish to not take into consideration and weigh heavily the caliber of medical school training one received and what the caliber of students in said medical school have traditionally been.... IF, the students in an island medical school or other international medical school have traditionally been those whose applications were just not strong enough to compete in a US medical school, why should any residency presume your score of honors on the island is equivalent to a score of honors at Duke? Because you scored well on the USMLE???? If you were unable to learn the materials in undergrad to put yourself ahead, you will not remediate and learn that while at the same time trying to learn what must be learned in medical school. It is as they say in surgery residency.... you know the most basic science you are going to ever know after you complete your second year of medical school. By the time you are a resident, you are forgetting more basic science then you will likely learn.... So to is it if your undergrad pre-reqs were sub-par....

JAD

PS: I know there are plenty of folks that study abroad for reasons of adventure or reasons other then innadequate applications, my reply is a generalization focused the others....

My basic point is that performance on the USMLE is a better barometer of being a good doctor than performance on the MCAT. Also, in a world of $30,000 in-state tuitions in the U.S., I can't blame even top students for going wherever the tuition is cheapest!

 

[JackADeli]

My basic point is that performance on the USMLE is a better barometer of being a good doctor than performance on the MCAT. Also, in a world of $30,000 in-state tuitions in the U.S., I can't blame even top students for going wherever the tuition is cheapest!

I understand what you said and are saying....

However, Numerous programs do NOT rank the highest USMLE scoring applicants after the interview. As most if not all residency directors will tell you, USMLE is only one component they consider.

I believe that when there is significant data to show the highest performing undergrads, at the highest performing universities are choosing to go abroad.... then DO/IMG programs will be viewed in a different light. The truth as I understand it is that the current students in DO & foreign programs do not in any majority represent the top applicants. In fact, EVERY DO & FMG (except maybe one) that I have ever encountered have spoken to their med-school representing a back-up plan/second choice. If you spend four years in a program in which you are competing with a lower tier caliber of peers for the test curve, yes, it does impact the over all perception of your training.

If your school of training (i.e. medical school), represents your second choice or last resort.... why should any rational residency program director not view it in the same manner. If a program director did NOT take that into consideration, I would say that represents poor judgement. A residencies' success or failure greatly depends on the successful completion of the program by their residents and ultimately board passage rate. You must take into account all factors that may support the belief in a potential resident's ability to succeed.

I have upwards of 200k tuition debt for out of state tuition costs. I chose to accept that debt in exchange for a top tier medical school education. I don't regret that choice. Each adult must make their choice. If your choice is a discounted medical education.... you should be prepared to take all that comes with that choice.

Yes, I know it is all unfair....

JAD

PS: The economy sucks, I do not see a mass exodus of top tier applicants fleeing the USA for discounted tuition. I have never known ANY "top" student select a foreign program because of the tuition cost. Though I hear plenty (not top) now claiming it later after they go abroad. It's nice for folks to try and rationalize things later.

 

[Doctor Bagel]

Hard to believe, but, I knew programs that actually want the folks in the middle-range of the bell curve.

Quoting for posterity. I'm seeing JAD trying to backtrack from this statement, but here it is.

 

[SouthernSurgeon]

Quoting for posterity. I'm seeing JAD trying to backtrack from this statement, but here it is.

He's made the same claim before

 

[JackADeli]

Quoting for posterity. I'm seeing JAD trying to backtrack from this statement, but here it is.

Not sure I follow your point. I have been on admissions/interview committees. PDs say they look for a minimum USMLE score. They have also low ranked or not ranked at all folks with very high scores based on numerous other factors. A very common comment I have heard from numerous PDs is that a minimum USMLE may score may (or may not) open the door to an interview but it is NOT the only factor... I don't see anything I have said to be a back tracking.... please show me otherwise. Maybe there is some sort of an interpretation or context error.

I stand by the previous statement:

...I knew programs that actually want the folks in the middle-range of the bell curve. GSurgeons don't want the extremes in their trainees. They want a solid foundation but room to learn. You come into a program with a extraterrestial board score you need to make sure you normalize who you are. They will be very nervous of you being cocky/arrogant and or dysfunctional. They want some confidence with humility and a board score off the charts can often overshadow some of the characteristics programs look for....

JAD

 

[Doctor]

I understand what you said and are saying....

However, Numerous programs do NOT rank the highest USMLE scoring applicants after the interview. As most if not all residency directors will tell you, USMLE is only one component they consider.

I believe that when there is significant data to show the highest performing undergrads, at the highest performing universities are choosing to go abroad.... then DO/IMG programs will be viewed in a different light. The truth as I understand it is that the current students in DO & foreign programs do not in any majority represent the top applicants. In fact, EVERY DO & FMG (except maybe one) that I have ever encountered have spoken to their med-school representing a back-up plan/second choice. If you spend four years in a program in which you are competing with a lower tier caliber of peers for the test curve, yes, it does impact the over all perception of your training.

If your school of training (i.e. medical school), represents your second choice or last resort.... why should any rational residency program director not view it in the same manner. If a program director did NOT take that into consideration, I would say that represents poor judgement. A residencies' success or failure greatly depends on the successful completion of the program by their residents and ultimately board passage rate. You must take into account all factors that may support the belief in a potential resident's ability to succeed.

I have upwards of 200k tuition debt for out of state tuition costs. I chose to accept that debt in exchange for a top tier medical school education. I don't regret that choice. Each adult must make their choice. If your choice is a discounted medical education.... you should be prepared to take all that comes with that choice.

Yes, I know it is all unfair....

JAD

PS: The economy sucks, I do not see a mass exodus of top tier applicants fleeing the USA for discounted tuition. I have never known ANY "top" student select a foreign program because of the tuition cost. Though I hear plenty (not top) now claiming it later after they go abroad. It's nice for folks to try and rationalize things later.

Is it unfair? To you, yes.

If someone wants to do General Surgery, Family Practice, Internal Medicine, etc. I would absolutely advise them to go for the lowest tuition possible in medical school. If they are talented enough to go to any med school they want (let's assume a 40 MCAT), they are talented enough to get a 240 USMLE no matter where they go to med school... and they will easily get into these less competitive fields.

The difference at the end of the day is that you have $250,000 in debt and the Caribbean guy with the 240+ USMLE beside you has $100,000 in debt. Who's better off?

Now if the student is truly viewing the Caribbean as a last resort, he probably isn't a good test taker and that's why he has to resort to it. Then he probably won't get the top USMLE and might not make it back to the US for residency. In that case, it's a bad idea (but what else is he going to do devoid of options).

This argument is null and void if they want to go into a more competitive specialty like neurosurgery, plastic surgery, etc.

 

[Winged Scapula]

The difference at the end of the day is that you have $250,000 in debt and the Caribbean guy with the 240+ USMLE beside you has $100,000 in debt. Who's better off?

Hmmm....given that the current tuition at St. George's is $39K per year which doesn't include living expenses and the fact that other Caribbean schools are not far behind in terms of tuition, most Caribbean grads are not better off in terms of savings.

As a matter of fact, with the exception of schools in India, Manila, Mexico and perhaps Eastern Europe, all the "big" foreign schools are pretty pricey and students are NOT going there to save money, IMHO.

 

[Doctor]

Hmmm....given that the current tuition at St. George's is $39K per year which doesn't include living expenses and the fact that other Caribbean schools are not far behind in terms of tuition, most Caribbean grads are not better off in terms of savings.

As a matter of fact, with the exception of schools in India, Manila, Mexico and perhaps Eastern Europe, all the "big" foreign schools are pretty pricey and students are NOT going there to save money, IMHO.

Saba (basically on a deserted island) is the $13000 a year one I was thinking of... friend just graduated there and glided right into General Surgery to get me on this idea (she was not someone who had her choice of schools, but she did have the astronomically high MCAT and USMLE scores... previously had a 2.4 GPA from UC Berkeley to limit her U.S. med school options). There are some even less in the Caribbean but I don't recall which ones.

The price of St. George's puzzles me. I can't think of a good reason to go there unless there is no other option.

EDIT: By this link, it looks like Saba is now $17000 a year and rising. Eventually there may be no med school bargains left. But for now, that's about $100k in debt to get into surgery, versus the $225k or so of debt at U.S. schools (or St. George's).

 

[JackADeli]

Saba (basically on a deserted island) is the $13000 a year one I was thinking of... friend just graduated there and glided right into General Surgery to get me on this idea (she was not someone who had her choice of schools, but she did have the astronomically high MCAT and USMLE scores... previously had a 2.4 GPA from UC Berkeley to limit her U.S. med school options). There are some even less in the Caribbean but I don't recall which ones.

The price of St. George's puzzles me. I can't think of a good reason to go there unless there is no other option.

EDIT: By this link, it looks like Saba is now $17000 a year and rising. Eventually there may be no med school bargains left. But for now, that's about $100k in debt to get into surgery, versus the $225k or so of debt at U.S. schools (or St. George's).

All that you say about Saba may be true.... but, I still do not see a mass exodus of top notch & competitive undergrads rushing for the discount.

Your friends example again proves the point, she had a good MCAT score but not a competitive GPA. Thus, I don't believe she went to Saba for the discount. I think it is great she made the best of her circumstances and was able to match back into the USA. Nobody said you can not get into a USA residency from school abroad. I am certain your friend is NOT at the Brighm as a categorical GSurgery resident.

 

[Winged Scapula]

Just as there are expensive Caribbean schools (and it may be worth $39K to go to the school that is widely considered to be the "best" choice in the Caribbean), there are expensive US medical schools. I'm glad to hear that your friend succeeded in proving herself despite her education at Saba.

Conversely, just as Saba may be a relative bargain, there are US schools with tuition far below what you are quoting. Many in state US schools have tuition nowhere near these.

 

[Doctor]

All that you say about Saba may be true.... but, I still do not see a mass exodus of top notch & competitive undergrads rushing for the discount.

Your friends example again proves the point, she had a good MCAT score but not a competitive GPA. Thus, I don't believe she went to Saba for the discount. I think it is great she made the best of her circumstances and was able to match back into the USA. Nobody said you can not get into a USA residency from school abroad. I am certain your friend is NOT at the Brighm as a categorical GSurgery resident.

We're talking across each other. Your point is that you don't currently see people going to the Caribbean unless they couldn't get into U.S. schools. Duly noted.

My point is that while that may be, the reason for this is probably asymmetric information (i.e. thinking they couldn't get into their chosen field from the Caribbean when, in actuality, if they are top talents they will get into General Surgery quite easily)... and thus, they would probably be best served taking the lowest tuition available whether it is in the U.S., or on a remote island, or in Poland.

 

[Doctor]

just as Saba may be a relative bargain, there are US schools with tuition far below what you are quoting. Many in state US schools have tuition nowhere near these.

I would certainly recommend they go to the school with the lowest tuition, especially if it were based in the U.S. But many (most?) experiences with in-state tuition look something like this. Twice the price for the same result.

 

[SouthernSurgeon]

We're talking across each other. Your point is that you don't currently see people going to the Caribbean unless they couldn't get into U.S. schools. Duly noted.

My point is that while that may be, the reason for this is probably asymmetric information (i.e. thinking they couldn't get into their chosen field from the Caribbean when, in actuality, if they are top talents they will get into General Surgery quite easily)... and thus, they would probably be best served taking the lowest tuition available whether it is in the U.S., or on a remote island, or in Poland.

I like my chances at matching in g-surg a lot better coming from my american MD school.

And of course we're not even talking about the fact that not all general surgery residencies are created equal. You may be able to "glide" right into a general surgery residency coming from the carib, but you won't be gliding into one of the top programs. This also ignores the many previously posted pitfalls of caribbean schools (i.e. the pyramidal structure, the lack of well-coordinated clinical experiences, etc)

 

[SLUser11]

The difference at the end of the day is that you have $250,000 in debt and the Caribbean guy with the 240+ USMLE beside you has $100,000 in debt. Who's better off?

The US grad by far. Not even close.

If you really want someone to agree with you and support your delusions, then go to the Caribbean forum.....they've all got the winning lottery ticket in their hand.

Absolutely nobody goes to the Caribbean by choice. It is everyone's last resort. Cost of education is a ridiculous red herring and lets me know that you have absolutely no idea what you are talking about.

As for DO School, we all know that the majority of students are there because they couldn't get into a US allopathic school. The exceptions are infrequent, but still frequently quoted.

There's going to be a hierarchy at all levels of medical education. Harvard grads probably view my med school the way State University grads view DOs. Is this hierarchy fair? Sometimes. Should a Harvard grad with identical scores to State U. grads be given preferential treatment? Probably.

Don't get me wrong. I am all for people from offshore med schools busting their butts on Step 1 and trying to improve their position. But, a single test of basic medical knowledge doesn't make them equal with US grads, and it never will. You can call me elitist or snobbish, but we can argue about the reasons all day. Of course, no dead horse has ever been beaten so hard in the history of the Student Doctor Network.



Most of us on this forum are generation Y, and we are an entire generation of "overachievers," who have been told since birth that we are special, unique little snowflakes. Since mommy and daddy have told us for years that we are super-duper smart, none of us can accept for a second that we're not capable of something, so when things don't go our way, we try to manipulate things to make it seem to us like a choice. What happens as a result is that we all make ourselves out to be mad geniuses, who only fail because of some tragic flaw or family mishap, never due to lack of ability.

How many times have we all heard these things:

"I could do really well in school, but I just don't try very hard."
"Dude, he's really smart. I know his GPA is 2.0, but he scored well on a test once."
"I was going to go to med school, but then I had some personal issues."

etc. etc.

My freshman year of college, there were 660 students in Pre-med chemistry. By second semester, that number was about 350. By the end of organic chemistry, it was less than 100. Do you think these students dropping out all admitted to themselves that they didn't have what it took to get into med school? Of course not! They all made "choices" to do something else. Sometimes it may have been true, but a lot of times it was an excuse.

What makes us think that these excuse-generating snowflakes don't exist at the med school and resident level? Lord knows I've met a few in my humble experience.

 

[JackADeli]

We're talking across each other. Your point is that you don't currently see people going to the Caribbean unless they couldn't get into U.S. schools. Duly noted.

My point is that while that may be, ...if they are top talents they will get into General Surgery quite easily... and thus, they would probably be best served taking the lowest tuition available whether it is in the U.S., or on a remote island, or in Poland.

I don't know if you are even a medical student.... You are talking out your rump. I appreciate your promotion of social justice and all. But, in the end, I am pleased to know that with few exceptions, motivated, bright, qualified, and competitive medical school propsects are choosing their education based more on quality/caliber/reputation then on discount prices. I would also point out... again... that education is quite influenced by those that surround you during the education process. Your peers motivate you and stimulate you to not just succeed, but go beyond. If you are at a medical school predominantly occupied by the lower tier/under achievers, your bar of achievement is set pretty low... as is the test curve.

I would certainly recommend they go to the school with the lowest tuition...

I would certainly recommend nobody go to you for career and education guidance counseling.

...If you really want someone to agree with you and support your delusions, then go to the Caribbean forum.....they've all got the winning lottery ticket in their hand.

Absolutely nobody goes to the Caribbean by choice. It is everyone's last resort. Cost of education is a ridiculous red herring and lets me know that you have absolutely no idea what you are talking about.

As for DO School, we all know that the majority of students are there because they couldn't get into a US allopathic school. The exceptions are infrequent, but still frequently quoted...

Agreed. In the end, one gets what they pay for, some may make more out of it, but you are making a decision. A discounted medical education will limit your subsequent residency options. Furthermore, while in practice, I have seen colleagues receive less referrals and/or community prestige/reespect because.... the public views an island education or Mexican education or etc.... in a certain manner.

If someone wants to make it their mission in life to create social justice and equalize island schools... best of luck.

JAD

 

[Doctor]

I don't know if you are even a medical student.... You are talking out your rump. I appreciate your promotion of social justice and all. But, in the end, I am pleased to know that with few exceptions, motivated, bright, qualified, and competitive medical school propsects are choosing their education based more on quality/caliber/reputation then on discount prices. I would also point out... again... that education is quite influenced by those that surround you during the education process. Your peers motivate you and stimulate you to not just succeed, but go beyond. If you are at a medical school predominantly occupied by the lower tier/under achievers, your bar of achievement is set pretty low... as is the test curve.I would certainly recommend nobody go to you for career and education guidance counseling.
Agreed. In the end, one gets what they pay for, some may make more out of it, but you are making a decision. A discounted medical education will limit your subsequent residency options. Furthermore, while in practice, I have seen colleagues receive less referrals and/or community prestige/reespect because.... the public views an island education or Mexican education or etc.... in a certain manner.

If someone wants to make it their mission in life to create social justice and equalize island schools... best of luck.

JAD

Wow. Sounds like someone is trying desperately hard to justify paying more than he had to. This isn't law school, it's certainly not business school. General surgeons make the same salary whatever med school and residency they went to. (This couldn't be further from the truth when comparing b-schools.)

You are free to ask the insurance company for a larger reimbursement because you went to X medical school or Y residency. Good luck!

I'm not promoting social justice, although I hear that's nice. I'm promoting sound economics and personal finance. Topics that so many (most!) doctors know absolutely nothing about.

 

[SouthernSurgeon]

Wow. Sounds like someone is trying desperately hard to justify paying more than he had to. This isn't law school, it's certainly not business school. General surgeons make the same salary whatever med school and residency they went to. (This couldn't be further from the truth when comparing b-schools.)

You are free to ask the insurance company for a larger reimbursement because you went to XY medical school. Good luck!

I'm not promoting social justice, although I hear that's nice. I'm promoting sound economics and personal finance. Topics that so many (most!) doctors know absolutely nothing about.

Keep talking out your rear...it's quite entertaining. You have no clue, and it is increasingly obvious.

 

[Doctor]

Keep talking out your rear...it's quite entertaining. You have no clue, and it is increasingly obvious.

If you can't make a point to stand on, I recommend just remaining silent.

You are free to ask the insurance company for a larger reimbursement because you went to X medical school or Y residency. Good luck!

If a Poland-trained doctor gets reimbursed at a lower rate than a Harvard-trained one, please let me know. I'll be waiting for your response. 😉

I agree that this just isn't fair... but that's the reality of modern medicine. It's a bizarre one-size-fits-all system that isn't like any other industry... where "name brand" schools and such would actually matter (or, if you feel that they do matter in medicine, they would matter 100000x more in any other industry to put it in perspective).

 

[Winged Scapula]

I recommend that users treat each other professionally and civilly or the thread will be closed.

FWIW, we aren't talking about whether a Poland trained physician makes more or less than a Harvard trained physician in terms of insurance reimbursement. We are talking about the very real differential in practice opportunities and referrals from PCPs and practices who do care where you went (fair or not, its real). The more prestigious your program, the more offers you generally have and the higher salary/benes/incentives to join the practice. Same goes for having a "niche" practice.

 

[SouthernSurgeon]

If you can't make a point to stand on, I recommend just remaining silent.

Fine. Here's my point (same as all the others in this thread):

For anyone with the option of doing so, attending an American medical school is by far the safest and financially sound decision that they can make.

If you attend medical school overseas/offshore, you face a tremendous series of obstacles to successfully graduating and gaining a residency slot in the US.

These obstacles are both internal (pyramidal structure, requiring students to pass internal exams before allowing them to sit for the USMLE, kicking students out for failing USMLE, poor access to clinical rotations, the list goes on and on and on) and external.

You seem to be making the argument that if all you want to do is a "non-competitive" specialty such as general surgery that you should go to the cheapest option out there including offshore schools. This is ignorant of the fact that general surgery is actually becoming more competitive by the year, and that the US medical schools are increasing their enrollment by ~15-20% at the behest of the AAMC; the end result of this will be that more and more IMGs get "boxed out."

Also, as we advise any pre-med, it is foolish to pick a medical school with an eye towards a specific residency field. The majority of medical students change their mind about residency multiple times during their four years. What if your friend had changed their mind and decided they really wanted an ortho slot? All of a sudden the Carib looks like a worse and worse decision.

In short - US medical students may pay more for tuition (and in general they don't - most of the caribbean schools are quite expensive), but what they get out of it (vastly higher odds of graduating, vastly higher odds of obtaining the residency of their choice) is more than worth the investment.

 

[JackADeli]

...In short - US medical students may pay more for tuition (and in general they don't - most of the caribbean schools are quite expensive), but what they get out of it (vastly higher odds of graduating, vastly higher odds of obtaining the residency of their choice) is more than worth the investment.

I will again reafirm my point.... can someone get a basic science medical school education abroad on a nice island? Yes. Nobody has stated otherwise. However, it is unlikely to expose you to all the state of the art and high end opportunities. I doubt Saba is a leading center of advanced research in a far reaching diverse areas of sciences from basic science, medical science, to you name it..... You get what you pay for and sometimes less then what you pay for. I have watched numerous folks look up doctors on "vitals.com" to find what their "ranking" is. It's not fair but even US medical schools are ranked differently... I think vitals.com uses a 1-4 star ranking. Patients do use these pieces of information.

Insurances reimburse for services by qualified physicians. Nobody said a surgeon with a foreign medical school background will be reimbursed less. To make that argument or infer that argument (you did) from the discussion to this point shows a significant lack of understanding.

I have seen partners review job apps and place FMG & DOs at the bottom of the choice list. I know of numerous programs that will not hire FMG or DOs. There are plenty that will not refer patients to FMG or DOs. These are all facts that are tangible and real. They are experiences one chooses to purchase when they purchase an island education.

I am very happy with my medical school education. It continues to open doors and opportunities.... and it has a 4 star rating online👍 A concept of "pedigree" does actually exist in the medical arena. A high caliber, USA, MD medical school education combined with GSurgery residency at a well respected program and ABS certification all go far. The more pieces you have in this puzzle, the more opportunities.

JAD

PS: you can have your opinion. If you ever go to medical school, you can choose a discounted medical education. I am not mad and what you do for yourself truely is of no consequence to me. However, you are talking to surgeons on this board with real life experience and first hand knowledge. We want to help folks and try to provide the best possible advise. At best, what you are selling is silly and misinformed. At worst, it is deceptive and/or dishonest.

 

[JackADeli]

...General surgeons make the same salary whatever med school and residency they went to...

As noted by WS, others, and I; this statement is innaccurate.

...Furthermore, while in practice, I have seen colleagues receive less referrals and/or community prestige/reespect because.... the public views an island education or Mexican education or etc.... in a certain manner...

....we aren't talking about whether a Poland trained physician makes more or less than a Harvard trained physician in terms of insurance reimbursement. We are talking about the very real differential in practice opportunities and referrals from PCPs and practices who do care where you went (fair or not, its real). The more prestigious your program, the more offers you generally have and the higher salary/benes/incentives to join the practice. Same goes for having a "niche" practice.

while re-imbursement may be equal from insurance, what groups will offer you a job and/or partnership and what hiring salaries and benefits may look like do very much differ based on the names/institutional seals on your certificates. Again, those within the field and having some experience understand this reality.

Final comment as this line of discussion is dead and trolled out...
If you look at physician salary surveys i.e. Cejka/etc... there is an average starting salary and a range of listed income. There are numerous factors that contribute not the least of which might be how you set up your practice. But, every physician surgeon or otherwise will tell you a referral base is critical. A physicians willingness to refer to you can be very much influenced by how well they perceive you to be trained. Salaries vary widely and to say all GSurgeons make the same regardless is quite naive and innaccurate.:troll:

 

[Doctor]

A physicians willingness to refer to you can be very much influenced by how well they perceive you to be trained. Salaries vary widely and to say all GSurgeons make the same regardless is quite naive and innaccurate.

They make the same for the same procedure. An economist might assume that's what I meant, but I have to remind myself that most doctors haven't taken anything past Econ 101.

So, before you pat yourself on the back for "making more" than the island grad, remind yourself that A) you're starting out at a point where you have an additional $100,000+ plus interest in debt, compared to the guy who took the island vacation, and that has to be paid out of this additional work you see yourself getting; and B) you're getting paid more only because you are doing more procedures... meaning you are working more hours, and still getting paid the same reimbursement rates.

Time is money, friend!

However, I think you have a point about the Vitals.com ratings... more referrals won't change your hourly wage or reimbursement rate, but high ratings for your medical school may increase your sense of self-worth, especially if your patient and hospital ratings on that site are not good.

:troll:

Well I never!

The more prestigious your program, the more offers you generally have and the higher salary/benes/incentives to join the practice. Same goes for having a "niche" practice.

Fair point. If, through a higher offer, you could (post-tax, not pre-tax) make up the $100,000+ plus interest hole in the few years it takes to become a partner in the practice, then it could be as good or better to attend the more expensive school.

 

[SouthernSurgeon]

So, before you pat yourself on the back for "making more" than the island grad, remind yourself that A) you're starting out at a point where you have an additional $100,000+ plus interest in debt, compared to the guy who took the island vacation,

You keep throwing this strawman out there - the average debt of a caribbean grad is as high or higher than that of a US MD grad; Saba notwithstanding. The caribbean is not a "money-saving" option. It is the last resort for any sensible applicant; at this point you are either completely ignorant or disingenuous to assert otherwise.

 

[Doctor]

You keep throwing this strawman out there - the average debt of a caribbean grad is as high or higher than that of a US MD grad; Saba notwithstanding. The caribbean is not a "money-saving" option. It is the last resort for any sensible applicant; at this point you are either completely ignorant or disingenuous to assert otherwise.

I'd recommend they go to the school with the lowest tuition, especially if it were based in the U.S.

I think it's obvious I'm talking about the least expensive schools, be they in Poland, the Caribbean, or the USA. I've even said this above. (Thus, I'm not talking about the Caribbean schools "in general".) Saba is a "money-saving" option, absolutely... whereas by the same token St. George's would be a "money-wasting" option.

PS - I will do you a favor and leave this particular discussion now! Since pre-meds probably aren't in the Surgery forums, and everyone reading this has already paid or is paying their tuition however low or high it is or was... I can't help but feel that maybe I am trolling everyone maybe just a little bit. And it feels like my time would be better spend elsewhere. 😳

 

[SouthernSurgeon]

I think it's obvious I'm talking about the least expensive schools, be they in Poland, the Caribbean, or the USA. I've even said this above. (Thus, I'm not talking about the Caribbean schools "in general".) Saba is a "money-saving" option, absolutely... whereas by the same token St. George's would be a "money-wasting" option.

Your advice is still poor. It doesn't particularly matter if the med school you attend costs less money if it doesn't get you where you need to be.

Look at the NRMP data on general surgery: http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

You keep throwing out "240" as your benchmark for Step 1 scores - well amongst IMGs with 240 or greater on their Step 1 - 32 matched and 64 did not match. So even if you achieve that admirable score, you are still looking at basically a 1/3 shot. Whereas US MDs with >240 have >95% odds of matching.

Going to the caribbean or to another non-american school jeopardizes your chances of matching at a US surgical residency; it is a foolish decision. There is a reason that virtually no one turns down a US med school for the carib or another non-US school.

You are tilting at windmills for unknown reasons here.