Most competitive residencies?

[Plue00]

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What would you say the top 5-10 are?

How about radiology, otolaryngology, and ophthalmology?

 

[PeepshowJohnny]

Top 2 are undisputably Dermatology and Integrated Plastics surgery. After that, ranking them leads to arguing which leads to hurt feelings and e-peen measuring. But to list a few (not ranked) Radiation Oncology, all surgical subspecialties, Radiology, and Ophthalmology are all competitive.

Radiology is competitive, but very doable. They like a high Step 1 and you to be in the upper tier of the class, but they're not impossible.

Oncology is a fellowship of Internal Medicine (often paired with Hematology). Internal Medicine is prettty much "average" in competitiveness, but going to a more competitive place makes you much more likely to be able to secure a fellowship.

 

[vtucci]

Competitiveness depends on a number of factors: specialty and also LOCATION. It can be analyzed by scores, AOA status, number of programs available and number of slots for students.

Trying to get a psych residency at Bellevue might be just as competitive as trying to match into derm.

Just do what you find most interesting and competitiveness is a secondary consideration.

 

[Law2Doc]

What would you say the top 5-10 are?

How about radiology and oncology?

I would say derm, plastics, rad onc, radiology, optho.

By oncology if you meant rad onc, it is very competitive, if you meant heme-onc (an IM subspecialty) not the same at all.

 

[turkeyjerky]

Is heme-onc a tough fellowiship to land, by the way? I mean is it in cards and GI territory, or less competitive?

 

[TexasPhysician]

Is heme-onc a tough fellowiship to land, by the way? I mean is it in cards and GI territory, or less competitive?

I am speeking only from word-of-mouth. I have no interest in the field. Rumor has it that heme-onc is becoming more competitive because salaries are on the rise and recruiting is up. Still, it is not yet as competitive as cards and GI.

 

[TexasPhysician]

I would say derm, plastics, rad onc, radiology, optho.

By oncology if you meant rad onc, it is very competitive, if you meant heme-onc (an IM subspecialty) not the same at all.

I don't see why general rads is in the same category as these others. Sure the average Step scores are up, but because there are over 1000 spots, it isn't that hard to get into (U.S. acceptance rate is 90%). According to the NRMP, over 70% of applicants with a 202 Step 1 score get into rads.

Because of numbers and demand, I'd say derm, plastics, rad-onc, and surgical subspecialties (ophtho, ENT, uro, etc.) are easily the hardest to get into.

Did you know that the average accepted rad-onc student has 6 research presentations/publications?

 

[badasshairday]

Agree with the abovea bout rads. It is competitive but not like rad-onc, derm, plastics, optho.

Rads has gone down just a little bit in competition. There are definitely a good number of spots.

http://residency.wustl.edu/medadmin/resweb.nsf/f7d261b19325755a86256f900062b64f/b1a2b4ee4af135b386256f8f0072972a?OpenDocument

^^^ If you look at the category of competitiveness it shows the past 4 years. 2005 high. 2006 high. 2007 intermediate. 2008 intermediate.

 

[Law2Doc]

I don't see why general rads is in the same category as these others. Sure the average Step scores are up, but because there are over 1000 spots, it isn't that hard to get into (U.S. acceptance rate is 90%). According to the NRMP, over 70% of applicants with a 202 Step 1 score get into rads.

Because of numbers and demand, I'd say derm, plastics, rad-onc, and surgical subspecialties (ophtho, ENT, uro, etc.) are easily the hardest to get into.

Did you know that the average accepted rad-onc student has 6 research presentations/publications?

Fair enough, but I wouldn't elevate all the surgical subspecialties to the level of derm, plastics or rad onc either. Optho sure, uro maybe (although it's hard to tell with those non-ERAS-match things).

But I think your statistics are misleading because of the self and school imposed selection that goes into these specialties. Most schools won't "let" you apply to any of these if your stats aren't up to par. You will have an uncomfortable sit down with the dean where he basically tells you to "pick again". A lot of places aren't shy about heavy-handed advising in this manner. So you would expect a very high percentage acceptance at the most competitive fields, because at most schools, it's only competitive people applying. I also would note that for the competitive fields people are advised to apply to many more places, so the odds of getting in will be higher notwithstanding the level of competitiveness. So yeah, you do have to look at things like average board scores and publications and ignore the percentages. They are misleading because it's a self selected group applying to a vastly different number of programs and these two things MAKE it more competitive, not less.

 

[howelljolly]

Competitiveness depends on a number of factors: specialty and also LOCATION. It can be analyzed by scores, AOA status, number of programs available and number of slots for students.

Trying to get a psych residency at Bellevue might be just as competitive as trying to match into derm.

Just do what you find most interesting and competitiveness is a secondary consideration.

Very true. Psych residencies like Belevue and Duke are that competetive. Top 15%, AOA, publications... etc.

 

[howelljolly]

I am speeking only from word-of-mouth. I have no interest in the field. Rumor has it that heme-onc is becoming more competitive because salaries are on the rise and recruiting is up. Still, it is not yet as competitive as cards and GI.

Yup, compensation is going up. Scientific advances in the field are exponential. Mortality is decreasing, and so the field is less depressing. Its getting uber competitive.

 

[howelljolly]

There are also factors of self selection related to the particular field. Pathology is getting more competetive every year, and recieves a big portion of their recruits from the MD PhD pool. This is even more true with Rad-Onc. A lot of MD PhD applicants go for fields that MDs tend not to go for, and so these fields become particularly competetive. (rad-onc. AI, pediatric-genetics).

 

[JeffLebowski]

Dermatology
Plastic surgery
Neurosurgery
Otolaryngology
Radiation oncology

I really don't understand how radiology is making your lists. There may be a place for ophtho somewhere on this list, but I'd be hard-pressed to bump one of these.

 

[-Goose-]

Dermatology
Plastic surgery
Neurosurgery
Otolaryngology
Radiation oncology

I agree with this list, but I would also add ortho and urology below rad/onc.

I think lifestyle fields will continue to become more competitive. Our generation is relatively lazy, IMO.

 

[tbo]

Pathology is getting more competetive every year, and recieves a big portion of their recruits from the MD PhD pool. This is even more true with Rad-Onc.

Some of this needs to be taken in context. Path and Rad-Onc attracting MD-PhD doesn't necessarily speak to the desirability of these specialties to the masses. I think the predominant selection factor for mudphuds is finding a field they can be a successful (largely, academic) scientist in. Path certainly fits this bill. While there's certain to be a handful of MD-PhDs shunning careers as academic researchers and choosing lifestyle, I'd say judging competitiveness or desirability of a specialty based on the influx of MD-PhDs is a tenuous proposition.

 

[docscience]

just an M2 here....and just curious...do you guys think it is all lifestyle?
i mean...can't you tailor your lifestyle as an internist and make less money?

it is probably a combo of lifestyle + money...or was this presumed when you mention "lifestyle"

 

[badasshairday]

just an M2 here....and just curious...do you guys think it is all lifestyle?
i mean...can't you tailor your lifestyle as an internist and make less money?

it is probably a combo of lifestyle + money...or was this presumed when you mention "lifestyle"

I think technically you can tailor your lifestyle and make less money. But it can be hard to do unless you open up a solo clinic. Opening up a solo clinic means you have to cover overhead before you take anything home so you still have a minimum amount (which could be a lot) you are going to have to work. If you sign with a private practice group, they will expect you to work a certain amount, which is most likely be a lot especially when you are just starting out.

 

[docscience]

Also, I think if you REALLY REALLY want to do a residency (perhaps barring derm), you can get in SOMEWHERE...might be a crappy location and program, but you will still be getting in...

 

[howelljolly]

Some of this needs to be taken in context. Path and Rad-Onc attracting MD-PhD doesn't necessarily speak to the desirability of these specialties to the masses. I think the predominant selection factor for mudphuds is finding a field they can be a successful (largely, academic) scientist in. Path certainly fits this bill. While there's certain to be a handful of MD-PhDs shunning careers as academic researchers and choosing lifestyle, I'd say judging competitiveness or desirability of a specialty based on the influx of MD-PhDs is a tenuous proposition.

Im not saying that you can judge a field as being more competitive for the masses just because mudphuds choose to go into it. Im saying that its a viariable. Similarly, Derm is competitive in itself, and even more so because of the variable that there are so few residency spots.

Probably because of lifestyle, pathology has filled 10% more of its seats each year for the last 4 years or so. I think that lifestyle plays more of a role in the competition than we realize, or are willing to admit. Derm is a perfect example. Only in the US have people committed suicide because they didnt get into Derm. In other countries where physician income is more uniform, and all doctors still make house calls, Derm is the bottom of the barrel. I think thats sad.

Throw a strong applicant who's looking for a good lifestyle, in with the strong applicant who's looking for an academic career, and you're asking for trouble.

 

[yeasterbunny]

I'm a little surprised no one has posted this yet:

Charting outcomes in the match

 

[yeasterbunny]

Dermatology
Plastic surgery
Neurosurgery
Otolaryngology
Radiation oncology

I really don't understand how radiology is making your lists. There may be a place for ophtho somewhere on this list, but I'd be hard-pressed to bump one of these.

Not sure if I would put ENT quite on the same level as those others, and instead might put ortho higher (though, like rads, the higher number of positions makes it harder to compare competetiveness of ortho):

plastics
neurosurg
derm
rad onc
ortho

Ophtho could reasonably be included in a top 5 list too, with ENT, uro, and rads following close behind, and in some cases picking up speed.

Edit: I guess it really depends on what criteria you go by. According to "Charting Outcomes" the specialties with the lowest match success rate of those ranking them first (not taking into account those applicants who don't even get interviews) goes derm, plastics, ortho, ENT, then rad onc. If you look at Step 1 scores it's plastics, derm, ENT, rad onc, rads. For AOA membership it is derm, ENT, plastics, ortho, rads. For publications it is rad onc, derm, ENT, plastics, ortho. Neurosurg, ophtho, and urology are not included in these data.

Long story short, every specialty has something different they are looking for.

 

[yeasterbunny]

Did you know that the average accepted rad-onc student has 6 research presentations/publications?

This is hard to interpret as well. Yes, rad onc places probably the most emphasis on research experience of any of the specialties, but keep in mind that number includes abstracts as well as posters and publications, many of which the student may have taken only a small role in, and many of which may be from undergrad research. Most importantly, 21% of those matching have a PhD (and 5.6% another advanced degree), so you know they are skewing that average quite a bit with 3-4 years of dedicated research/publishing. I think a median number of publications would be more helpful than the mean here. At any rate, I would disagree that the "average accepted student" has 6 pubs given that the average student does not have a PhD. Completely conjecturatively (and I went through this for rad onc), I would say the "average" non-PhD US student has 2-4 pubs, presentations, and abstracts.

Oh, and the quality and your contribution to the research is way more important than the number. I know people with 5 minor projects who didn't match and others with just a poster and a first author pub in a decent journal who did.

 

[howelljolly]

Given that, I would think that though the average rad-onc applicant does not have a PhD, the research experience that they do have is better than your average bear.

Look at a field like pediatric cardiology. There really isnt a whole lot of money to be be made there, not much more than general peds. And, there isnt a major pull from the MD/PhD pool. But... pediatric cardiology tends to look for applications with multiple strong research experiences. People do some quality research as MDs. And, thats good enough for the Program Directors. The success rate in applications is about 60%.

 

[78222]

Plastics
Derm
Neurosurg
ENT
Urology
Rad Onc
Optho (not really sure where this fits because they don't release scores)

I think it's fairly hard to determine where the surgical subs fit in relation to each other. They are all competitive and draw very very impressive applicants. I do think Neurosurg (~70 slots?), Uro, Oto (~270), and Optho are more competitive than Ortho (~577 matched) though because there are far fewer spots.

 

[VincentAdultman]

Kind of sad when you think about what specialties get the best and the brightest.

 

[78222]

Kind of sad when you think about what specialties get the best and the brightest.

I don't see anything sad about it at all. All of those fields, even plastics and derm, significantly improve the lives of patients. A patient who undergoes reconstructive surgery following bad facial trauma, is a much bigger 'win' in my opinion than the gomer whose life critical care was able to extend by a week by putting him on a vent.

 

[Pinkertinkle]

Kind of sad when you think about what specialties get the best and the brightest.

Well theres only about 350 spots total derm and integrated plastics combined. That's quite a small percentage of the graduating class (17,000 + IMG's, etc..)

 

[Blesbok]

Competitiveness = number of spots available vs number of people applying

 

[Pinkertinkle]

Competitiveness = avg step 1 score

 

[masterofmonkeys]

Kind of sad when you think about what specialties get the best and the brightest.

I would say that it's sad what specialties DON'T seem to attract the best and brightest. Psych and PM&R come to mind.

Although if you look at the data from Charting Outcomes there are still quite a few top students going into each of those specialties.

 

[yeasterbunny]

I would say that it's sad what specialties DON'T seem to attract the best and brightest. Psych and PM&R come to mind.

Although if you look at the data from Charting Outcomes there are still quite a few top students going into each of those specialties.

Heck, forget psych and PM&R; how about FAMILY MEDICINE? Those guys are the ones on the front lines. If we could get preventive medicine ratcheted up a couple notches we could make a sizable dent in our "health care crisis."

 

[MrBurns10]

Competitiveness = avg step 1 score

Generally yeah, but you also have to look at the number of spots available. I'd say definitely ortho and maybe ophtho are more competitive than rads, mainly because there are far fewer spots.

 

[gstrub]

Heck, forget psych and PM&R; how about FAMILY MEDICINE? Those guys are the ones on the front lines. If we could get preventive medicine ratcheted up a couple notches we could make a sizable dent in our "health care crisis."

Maybe it's because the people who CAN match into residencies with:
1. Higher salaries
2. Less bickering with insurance companies
3. Less non-compliant patients

will.

 

[howelljolly]

I don't see anything sad about it at all. All of those fields, even plastics and derm, significantly improve the lives of patients. A patient who undergoes reconstructive surgery following bad facial trauma, is a much bigger 'win' in my opinion than the gomer whose life critical care was able to extend by a week by putting him on a vent.

I think thats crap.

Complex reconstructive surgery is not the bread and butter of plastics. Derm improves the lives of patients who would better be treated by a psychiatrist, who, sadly, tends to have lower Step1 scores. Gomers who are going to die in a week are not the bread and butter of critical care.

 

[yeasterbunny]

Maybe it's because the people who CAN match into residencies with:
1. Higher salaries
2. Less bickering with insurance companies
3. Less non-compliant patients

will.

Oh, I completely agree. I'm just saying wouldn't it be great if we could change all of the above (or at least #1) so primary care would be the most attractive to our best and brightest.

 

[RisingSun]

Heck, forget psych and PM&R; how about FAMILY MEDICINE? Those guys are the ones on the front lines. If we could get preventive medicine ratcheted up a couple notches we could make a sizable dent in our "health care crisis."

There are so many things going against Family Medicine right now, I am honestly surprised anyone wants to go into the field at all.

It does surprise me that internal med and peds have such average scores - both fields are the gateway to some awesome specialties, many of which are paid quite well.

 

[yeasterbunny]

Complex reconstructive surgery is not the bread and butter of plastics. Derm improves the lives of patients who would better be treated by a psychiatrist, who, sadly, tends to have lower Step1 scores. Gomers who are going to die in a week are not the bread and butter of critical care.

Much of what you said is true, of course, but that's not to say that boob jobs and facelifts can't be important or life-changing for people either. Or acne or warts or the host of cosmetic issues the dermatologists deal with. The outward appearance is what most people deal with every day, and thus cosmetic ailments can pose huge quality of life issues. Though there is certainly an obvious large psychologic component of how people view their physical appearance, I don't think it's fair to say that these people would benefit more from psychiatric treatment than treatment of their severe refractory acne if such treatment is available. These fields have a small but important niche in the overall health-care schema.

 

[VincentAdultman]

You can't look at it like "oh, there's only x number of derm/plastics spots." If it was just raw numbers, then I would think combined residencies like Med/Peds where there are relatively fewer spots would be more competitive. Obviously they're not.

Let's be honest here. Are students going into integrated plastics doing it because they eventually want to do complex facial trauma/reconstruction? Or or they doing it to have the straight cash private practice where they do nothing but boobies? And derm has, like, TEN and Stevens-Johnson which are practically the same diseases. ooo.

Basically, one would think that you would want the smartest to go to the specialties where the patients are the sickest/have the complex diseases. It's pretty intuitive I would think.

 

[docscience]

Few points I want to make...

I think almost all medical students are "intelligent." It is a very relative term...
Now those who honor all classes, AOA, Step 1>250 are obviously intelligent, but they are also hard workers. So there is a distinction...

Those that go into critical care/internal med/family practice/psychiatry/etc. are still VERY intelligent individuals...they perhaps don't care about honoring every class...perhaps they are rounded in other ways...musical talent/public health knowledge/etc.

I think it is pointless to argue about treating outward appearing acne vs. facial transplants....both are medical services and apply to different populations....both who need medical care.

I don't' know if you guys watched the ABC series "Hopkins" but on that show there is a transplant doc who talks about "failing everything in medical school" (i am sure that is an exaggeration) but he found his passion in transplant surgery and achieved his goal...

I think getting into med school warrants intelligence and working hard warrants specialties of your choice...PDs want people who are willing to work hard....even if that means memorizing the complement cascade for an exam.

 

[gstrub]

Basically, one would think that you would want the smartest to go to the specialties where the patients are the sickest/have the complex diseases. It's pretty intuitive I would think.

You might "want" the smartest students in these specialties, but that will never happen. The "smartest" students would be the ones who pick a field where they will actually make enough money to live comfortably after training for 20+ years without having to worry about government health care (Medicare) cutting their reimbursements every year, while at the same time still feel like they are doing enough good to justify it. Anyone who borrows $250,000 and takes a yearly salary of $120,000 would not, in my opinion, be the "smartest" student.

 

[Blesbok]

Competitiveness = avg step 1 score

Not necessarily. You could have a lot of smart people go into a specialty but still have a 1:1 residency:applicant ratio, meaning that everyone that applies would in theory get in. That isn't very competitive.

 

[VincentAdultman]

You might "want" the smartest students in these specialties, but that will never happen. The "smartest" students would be the ones who pick a field where they will actually make enough money to live comfortably after training for 20+ years without having to worry about government health care (Medicare) cutting their reimbursements every year, while at the same time still feel like they are doing enough good to justify it. Anyone who borrows $250,000 and takes a yearly salary of $120,000 would not, in my opinion, be the "smartest" student.

OMG SO THATS WHY THEY PICK DERM AND PLASTICS

🙄

 

[Pinkertinkle]

Not necessarily. You could have a lot of smart people go into a specialty but still have a 1:1 residency:applicant ratio, meaning that everyone that applies would in theory get in. That isn't very competitive.

Didn't L2D explain self selection to you? Its not like people are free to apply to whatever they want, they apply to what they feel they can match in.

 

[Blesbok]

Didn't L2D explain self selection to you? Its not like people are free to apply to whatever they want, they apply to what they feel they can match in.

And even with self selection, plastics gets 2x the number of available spots...

 

[JeffLebowski]

And even with self selection, plastics gets 2x the number of available spots...

Yeah, but gen surg has the same ratio, and gen surg is no where near the top of competitiveness. There's holes in any of these absolutes everyone's throwing around, can't we all just agree that it's a combination of several factors because there are confounding variables in each objective measure?

There's lots of intersecting factors. Sometimes they're competitive because of lack of spots. They're competitive because more people want each spot. They're competitive because better applicants want each spot. They're competitive because they compensate well. They're competitive because they have a good lifestyle. They're competitive because they're interesting fields. They're competitive because they're prestigious. Pick a few and form your interpretation.

 

[Long Dong]

You might "want" the smartest students in these specialties, but that will never happen. The "smartest" students would be the ones who pick a field where they will actually make enough money to live comfortably after training for 20+ years without having to worry about government health care (Medicare) cutting their reimbursements every year, while at the same time still feel like they are doing enough good to justify it. Anyone who borrows $250,000 and takes a yearly salary of $120,000 would not, in my opinion, be the "smartest" student.

OMG SO THATS WHY THEY PICK DERM AND PLASTICS

🙄

I think logical people ask themselves do I really want to work more for less pay.

 

[DwyaneWade]

For any medical student the most competitive specialty (and therefore the one he/she should be concerned about) is the one they are applying for.

There are no ego points or prizes given how for entering specialties for the sole reason that they are competitive.

 

[Blesbok]

For any medical student the most competitive specialty (and therefore the one he/she should be concerned about) is the one they are applying for.

There are no ego points or prizes given how for entering specialties for the sole reason that they are competitive.

That is teh sole reason I am going into plastodermopaedics.

I am going to replace peoples skin with bone and create an army of exoskeleton humans.

 

[Law2Doc]

Maybe it's because the people who CAN match into residencies with:
1. Higher salaries
2. Less bickering with insurance companies
3. Less non-compliant patients

will.

My take on why these two fields get the short end is (1) PM&R sometimes becomes the backup path for folks who like working with musculoskeletal injuries but didn't have the stats for ortho, (2) in psych it takes a special kind of patience and demeanor to sit and talk with patients all day who make no sense and probably don't comprehend you much better. I don't think there's a whole lot of difference in terms of insurance company issues -- insurance's goal is to pay out as little as possible regardless of the specialty. And in terms of noncompliance, the 60 year old with out of control diabetes is just as unlikely to take his meds as the 25 year old schizophrenic -- in fact the latter is much more likely to have help with compliance from what I've seen.

 

[mikedc813]

It does surprise me that internal med and peds have such average scores - both fields are the gateway to some awesome specialties, many of which are paid quite well.

Medicine and Peds programs require a relatively large number of residents so they can't afford to be as picky as other programs that take 1 or 2 residents each year.