Not matching into a residency

[Ngo3]

I am just a medical student, but it seems to be more and more people are not matching into residencies. Is this a common thing now that there are so many schools?

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[Ismet]

I am just a medical student, but it seems to be more and more people are not matching into residencies. Is this a common thing now that there are so many schools?

What makes you think that?

Check the numbers: http://www.nrmp.org/wp-content/uploads/2016/03/Match-By-the-Numbers.pdf

People don't match because they 1) overestimate their competitiveness or underestimate how competitive their field is, 2) don't apply to or interview at enough places, 3) have red flags like failed step scores, bad LOR, etc, 4) do other stupid things with their applications. Not all positions fill either.

 

[Ngo3]

What makes you think that?

Check the numbers: http://www.nrmp.org/wp-content/uploads/2016/03/Match-By-the-Numbers.pdf

People don't match because they 1) overestimate their competitiveness or underestimate how competitive their field is, 2) don't apply to or interview at enough places, 3) have red flags like failed step scores, bad LOR, etc, 4) do other stupid things with their applications. Not all positions fill either.

Just saw a lot of cases on this forum. But I guess if people don't match, they would be posting on here asking for help.

 

[Crayola227]

I don't know it's common, but I think things will only get suckier from here

as you mentioned, new schools opening, others expanding, more Caribbean school, more competition overal

the average USMLE scores for all the fields way higher than in my day

keep in mind the match rate for IMG is like 50% the first go round, so yeah, SDN can see a lot of people unmatched

 

[Ismet]

Just saw a lot of cases on this forum. But I guess if people don't match, they would be posting on here asking for help.

It's like this every year

 

[Ngo3]

I don't know it's common, but I think things will only get suckier from here

as you mentioned, new schools opening, others expanding, more Caribbean school, more competition overal

the average USMLE scores for all the fields way higher than in my day

keep in mind the match rate for IMG is like 50% the first go round, so yeah, SDN can see a lot of people unmatched

That is such a horrifying reality to not be able to match into any residencies.

 

[Toutie]

Just saw a lot of cases on this forum. But I guess if people don't match, they would be posting on here asking for help.

That's because this is Match week.

 

[BeddingfieldMD]

I am just a medical student, but it seems to be more and more people are not matching into residencies. Is this a common thing now that there are so many schools?

You are correct that the number of residency spots in the United States has remained fairly stable, while the number of medical school positions has increased over last decade. While I think the number of unmatched graduates from American med schools hasn't increased too much (yet), there is certainly increased competition for American residency spots among foreign medical graduates--especially those from Caribbean schools.

For example, I graduated with three Caribbean med school grads. However, as a chief resident, I noted that we did not even interview a single Caribbean grad for our residency spots.

More med school spots are being introduced each year, and Congress continues to keep funding for residency programs stagnant. So this trend will only continue.

 

[the argus]

You are correct that the number of residency spots in the United States has remained fairly stable, while the number of medical school positions has increased over last decade. While I think the number of unmatched graduates from American med schools hasn't increased too much (yet), there is certainly increased competition for American residency spots among foreign medical graduates--especially those from Caribbean schools.

For example, I graduated with three Caribbean med school grads. However, as a chief resident, I noted that we did not even interview a single Caribbean grad for our residency spots.

More med school spots are being introduced each year, and Congress continues to keep funding for residency programs stagnant. So this trend will only continue.

This isn't actually correct. Despite the prevailing narrative on SDN and some media articles, the number of residency positions has increased substantially over the past decade. They are being funded through a number of different sources.

You can look at the data from the ACGME here,
http://www.acgme.org/About-Us/Publi...Graduate-Medical-Education-Data-Resource-Book

On page 79 you will see that the number of AMGs (USMD + DO) starting residency each year has increased quite a bit over the past decade, but the number of IMGs has stayed mostly stable. That's because the increase in residency positions on a yearly basis has basically equaled the increase in AMGs. The increase in yearly AMGs is forecasted to begin to outpace the yearly increase in residency positions over the coming 10 years, but this hasn't happened yet.

 

[the argus]

And to the OP, you can look at NRMP and ACGME data going back many years on their respective websites. People from all educational backgrounds (USMD, DO, IMG) are matching at similar (or higher) rates as they historically have over the past 10-20 years.

 

[BeddingfieldMD]

This isn't actually correct. Despite the prevailing narrative on SDN and some media articles, the number of residency positions has increased substantially over the past decade. They are being funded through a number of different sources.

You can look at the data from the ACGME here,
http://www.acgme.org/About-Us/Publi...Graduate-Medical-Education-Data-Resource-Book

On page 79 you will see that the number of AMGs (USMD + DO) starting residency each year has increased quite a bit over the past decade, but the number of IMGs has stayed mostly stable. That's because the increase in residency positions on a yearly basis has basically equaled the increase in AMGs. The increase in yearly AMGs is forecasted to begin to outpace the yearly increase in residency positions over the coming 10 years, but this hasn't happened yet.

Good point; the number of graduates coming out of the increased medical spots over the last few years will only start entering residency programs now and moving forward into the next decade. I guess we'll see if residency spots continue to maintain pace. That said, the ACGME charts do still bear out that the relative proportion of IMGs matching into US residencies is decreasing, as is the absolute number of IMGs (this number plateaued somewhere around 2012 and is now declining). I agree that AMGs are still doing well--though perhaps with slightly more competition among the already more competitive specialties. But I think IMGs, and particularly those from Caribbean programs that are already discriminated against by many program directors, will increasingly feel the pinch in the coming decade.

Another caveat I would add is that much of the growth in the number of "residents" (as the ACGME refers to them in many of their graphs) comes from subspecialty growth. Per the 2014-15 data you linked to above, it appears the rate of the number of "subspecialty residents" (i.e. fellows) has increased over the last decade by more than double the rate of the number of "primary residents" (i.e. actual "residents"). There has been a 14.6% increase in the total number of specialty residents from 2005-2015, compared to a 33.8% increase in the number of subspecialty residents ("fellows") over the same time period. When talking about matching and the relative number compared to graduating medical students, the primary resident number is the one to measure.

Thanks for posting the links. Lots of good data in there! I was surprised that nuclear medicine is 70% IMGs as of 2015. Who knew?

 

[CCC_MD]

I am just a medical student, but it seems to be more and more people are not matching into residencies. Is this a common thing now that there are so many schools?

I think the average applicant may be more competitive now than back in my day. It was often that we didn't even need Step II for applications, just have a solid Step I and honor here or there and you were good. Now you must have both steps solid, ECs, research etc...

Having said that, there are lot more tools available to do well. I had Goljan paper notes and Kaplan then and now there are lots of resources including UWorld others. I do feel for the upcoming applicants, getting residency spots was taken for granted in my medical school class, it was just a matter of what and where that drove competition.

If I were to flash forward today, I would just spend the money on applying to as many spots as I could and taking it from there. It sucks and there is no current incentive from the government to have guaranteed spots for US grads.

 

[deleted274002]

But I think IMGs, and particularly those from Caribbean programs that are already discriminated against by many program directors, will increasingly feel the pinch in the coming decade.

Discrimination is not the correct word to use here.

 

[BeddingfieldMD]

Discrimination is not the correct word to use here.

Which word would you put in its place, then?

 

[dancingwhitewolf]

I am an IMG with ECFMG certification, great GPA, and first time pass on all USMLE exams. My step 1 score, while passing, was low at 198. Step 2 CK was a massive improvement. I have even taken USMLE step 3 and passed it. I have been working as a medical scribe since graduating. This is the second year that I did not match. Is my Step 1 score preventing me from getting a residency? If my Step 1 score is what is causing the problem, should I retake it to try to get a higher score? What should I do to make myself a more attractive applicant? I have been applying for family medicine and internal medicine. This last year I applied to 203 places and got 3 interviews (huge improvement from the 1 interview I got last year).

 

[PrettyLadyDoc24]

I am an IMG with ECFMG certification, great GPA, and first time pass on all USMLE exams. My step 1 score, while passing, was low at 198. Step 2 CK was a massive improvement. I have even taken USMLE step 3 and passed it. I have been working as a medical scribe since graduating. This is the second year that I did not match. Is my Step 1 score preventing me from getting a residency? If my Step 1 score is what is causing the problem, should I retake it to try to get a higher score? What should I do to make myself a more attractive applicant? I have been applying for family medicine and internal medicine. This last year I applied to 203 places and got 3 interviews (huge improvement from the 1 interview I got last year).

Not knowing much about your application otherwise, I definitely agree that your Step 1 score is holding you back. Also, with each year from graduation your chances of matching go down in general. At this point you may need to take a research position or something to get yourself known to a program director who can advocate for you to help you get a position.

 

[deleted274002]

Which word would you put in its place, then?

Discrimination doesn't really apply to factors that you can control. Program directors interviewing and ranking applicants that went to USMD applicants over those that chose to go to the Caribbean isn't discrimination. By that same logic, if I went to one of my state medical schools and someone from HMS was applying for the same spot, am I being discriminated against if they chose the HMS student over me? No, of course not.

 

[the argus]

I am an IMG with ECFMG certification, great GPA, and first time pass on all USMLE exams. My step 1 score, while passing, was low at 198. Step 2 CK was a massive improvement. I have even taken USMLE step 3 and passed it. I have been working as a medical scribe since graduating. This is the second year that I did not match. Is my Step 1 score preventing me from getting a residency? If my Step 1 score is what is causing the problem, should I retake it to try to get a higher score? What should I do to make myself a more attractive applicant? I have been applying for family medicine and internal medicine. This last year I applied to 203 places and got 3 interviews (huge improvement from the 1 interview I got last year).

It's likely your step 1 score and IMG status holding you back. You unfortunately can not retake USMLE steps if you have passing score, the score you have is the score you will live with.

If you apply again next year I recommend dumping IM completely and applying to every FM program in the country (excluding top programs that you likely have no shot at). Good luck!

 

[W19]

SDN would make you believe any US with a pulse should match somewhere... That might have been the case 10+ years ago, but it's no longer true.

 

[PhillyMed777]

it's no longer true.

It's pretty much still true though, assuming you are applying mindfully, within your league, and playing the game right (if applying to competitive things).

 

[BeddingfieldMD]

Discrimination doesn't really apply to factors that you can control. Program directors interviewing and ranking applicants that went to USMD applicants over those that chose to go to the Caribbean isn't discrimination. By that same logic, if I went to one of my state medical schools and someone from HMS was applying for the same spot, am I being discriminated against if they chose the HMS student over me? No, of course not.

Oh, I see your angle. Look, I didn't go to a Caribbean school, and I routinely caution that people should carefully weigh all the options before doing so. I think they have the potential to be a reasonable last-chance safety net for some people who for whatever reason had a misstep in their college careers--but otherwise are academically sound. But with their high attrition rates and significant uncertainty of placement in American residency programs, it's definitely a gamble that can leave students with a large amount of debt and wasted time. So I want to clarify that I wasn't trying to imply that I think the program directors are being "unfair" or "unjust" in their opinions of Caribbean schools. I think a common concern is that such students clearly had to go down there for a reason (sometimes justified, but often just poor academic history) and that such schools very heavily teach to the board exams with little regard for a broader medical education or performance of research and patient care.

So perhaps you would argue that the negative view of these schools isn't unjust, and that's why discrimination is a bad word choice. Fair enough. Shall we say prejudiced against? View in a negative light? A poor regard?

 

[oshanimalia]

What makes you think that?

Check the numbers: http://www.nrmp.org/wp-content/uploads/2016/03/Match-By-the-Numbers.pdf

People don't match because they 1) overestimate their competitiveness or underestimate how competitive their field is, 2) don't apply to or interview at enough places, 3) have red flags like failed step scores, bad LOR, etc, 4) do other stupid things with their applications. Not all positions fill either.

I've been trying to look for info on this but can't...what is the impact of failing a class/block in first year but no other problems since for a relatively more competitive specialty?

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[mw18]

I've been trying to look for info on this but can't...what is the impact of failing a class/block in first year but no other problems since for a relatively more competitive specialty?

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I think it's more dynamic than that. The rest of the application matters. If everything is average for a 'relatively more competitive specialty' then I think the failed class will factor in some. Other things could probably help overcome it, but holding all those things average (CLINICAL GRADES (probably most important for someone who failed a preclinical course) boards, LORs, aways, research, interviews, vibe with residents, etc), then yes it will affect you. The takeaway is that you have to make up for the class by being great at those things. If you're asking if it absolutely disqualifies you, I would think probably not. Since it's a preclinical grade, and you have plenty of opportunity/time to improve it. But if a PD were to have a bunch of similar applicants, and one failed a class in med school, I'd think it would affect them. I think failing a class is one of the few things that would actually make a PD look at preclinical grades at all really.

 

[Lucca]

Discrimination doesn't really apply to factors that you can control. Program directors interviewing and ranking applicants that went to USMD applicants over those that chose to go to the Caribbean isn't discrimination. By that same logic, if I went to one of my state medical schools and someone from HMS was applying for the same spot, am I being discriminated against if they chose the HMS student over me? No, of course not.

I think you are ascribing a negative connotation to the word 'discrimination' that it does not necessarily have. If you are passed over for a position because of X specifically then you are being discriminated against on account of X. X can be school name, race, your family's last name, your Step 1 score, your credit score, your height, your sales numbers from last quarter, the quality of your references, etc. etc. etc. It is acceptable to discriminate against all sorts of things; i.e. you are reading 'discriminate' in only the narrow sense where it is being used in relation to a quality where it is unethical, illegal or irrational to discriminate (race, gender, etc.).

 

[bannie22]

more people will go unmatched every year because there are more medical schools being created than residency positions
the quality of applicants also keep rising primarily because of the resources that are created to target the step 1 etc.

life gets more and more difficult for the younger generation. but thats not something new

 

[W19]

If anything SDN dramatically swings too far towards doom and gloom, you yourself being one of the worst perpetrators. The actual data is far more optimistic than what you'd think by perusing this site casually.

Well, I don't think SDN has swung too far... It will be a miracle if I match into IM with 215-220 step1 score with no significant research experience while being at the bottom of my class in term of rank.

I already abandoned psych seeing how competitive it has become. I now am thinking about FM as well even if I can't stand OB. The plan is to apply to 75 IM + 50 FM programs. I am going all in.

This is NOT the 1990s anymore...

 

[DrBowtie]

Well, I don't think SDN has swung too far... It will be a miracle if I match into IM with 215-220 step1 score with no significant research experience while being at the bottom of my class in term of rank.

I already abandoned psych seeing how competitive it has become. I now am thinking about FM as well even if I can't stand OB. The plan is to apply to 75 IM + 50 FM programs. I am going all in.

This is NOT the 1990s anymore...

Bruh.jpg

Your statements and opinions just aren't based in reality.

 

[mw18]

Bruh.jpg

Your statements and opinions just aren't based in reality.

I don't know if you did this on purpose, or if it just didn't load. But I kinda love it as the new bruh meme.

 

[DrBowtie]

I don't know if you did this on purpose, or if it just didn't load. But I kinda love it as the new bruh meme.

On purpose. Didn't have the pic handy.

 

[mw18]

On purpose. Didn't have the pic handy.

Amazing.

 

[libertyyne]

Amazing.

man, you should really look into that hacker 4chan , will blow your mind.

 

[mw18]

man, you should really look into that hacker 4chan , will blow your mind.

I had some friends really into 4chan a few years ago, and some of the stuff they showed me was insanely terrible and hilarious. I never went myself because when the FBI shut it down and exposed it I didn't wanna be on the IP address list lol

I just like the laziness of bruh.jpg

 

[Ismet]

Well, I don't think SDN has swung too far... It will be a miracle if I match into IM with 215-220 step1 score with no significant research experience while being at the bottom of my class in term of rank.

I already abandoned psych seeing how competitive it has become. I now am thinking about FM as well even if I can't stand OB. The plan is to apply to 75 IM + 50 FM programs. I am going all in.

This is NOT the 1990s anymore...

No, it's 2017, and you have no idea what you're talking about. No one cares about your class rank. Your Step score will not keep you out of IM or Psych. Study hard for Step 2. Give your Medicine sub-I your all. Find a good mentor who will be honest with you and will go through your list of programs with you. Stop being pessimistic and doom and gloom about everything, buck up, and put your nose to the grindstone.

 

[Lawpy]

SDN would make you believe any US with a pulse should match somewhere... That might have been the case 10+ years ago, but it's no longer true.

If anything SDN dramatically swings too far towards doom and gloom, you yourself being one of the worst perpetrators. The actual data is far more optimistic than what you'd think by perusing this site casually.

Well, I don't think SDN has swung too far... It will be a miracle if I match into IM with 215-220 step1 score with no significant research experience while being at the bottom of my class in term of rank.

I already abandoned psych seeing how competitive it has become. I now am thinking about FM as well even if I can't stand OB. The plan is to apply to 75 IM + 50 FM programs. I am going all in.

This is NOT the 1990s anymore...

Psych is still less competitive than IM so your plan makes absolutely no sense.

But wait I thought you dropped out this week????

interesting that the neurotic, paranoid, pessimistic and doomsday sentiments that plague the premedical forums also haunt the medical student forums. and it unsurprisingly gets worse when coupled with misinformation.

 

[Mr Roboto]

I am an IMG with ECFMG certification, great GPA, and first time pass on all USMLE exams. My step 1 score, while passing, was low at 198. Step 2 CK was a massive improvement. I have even taken USMLE step 3 and passed it. I have been working as a medical scribe since graduating. This is the second year that I did not match. Is my Step 1 score preventing me from getting a residency? If my Step 1 score is what is causing the problem, should I retake it to try to get a higher score? What should I do to make myself a more attractive applicant? I have been applying for family medicine and internal medicine. This last year I applied to 203 places and got 3 interviews (huge improvement from the 1 interview I got last year).

You make @failedatlife look like a goddamn rockstar!

 

[deleted274002]

Oh, I see your angle. Look, I didn't go to a Caribbean school, and I routinely caution that people should carefully weigh all the options before doing so. I think they have the potential to be a reasonable last-chance safety net for some people who for whatever reason had a misstep in their college careers--but otherwise are academically sound. But with their high attrition rates and significant uncertainty of placement in American residency programs, it's definitely a gamble that can leave students with a large amount of debt and wasted time. So I want to clarify that I wasn't trying to imply that I think the program directors are being "unfair" or "unjust" in their opinions of Caribbean schools. I think a common concern is that such students clearly had to go down there for a reason (sometimes justified, but often just poor academic history) and that such schools very heavily teach to the board exams with little regard for a broader medical education or performance of research and patient care.

So perhaps you would argue that the negative view of these schools isn't unjust, and that's why discrimination is a bad word choice. Fair enough. Shall we say prejudiced against? View in a negative light? A poor regard?

I'm not trying to start that kind of flame war. I didn't go to a Caribbean school either. I don't really care one way or another. It doesn't affect me anymore since I have already graduated. I am merely pointing out that things like school choice, your GPA, your Step scores are all things you can, more or less, control. If a residency program ranks candidate X higher than candidate Y because candidate X went to school A, it is not "discrimination" but rather preferring a candidate that went to school A because of whatever reason they like school A. It is discrimination if they rank candidate X higher because of things that they cannot control, like their ethnic background, gender, sex, race, national origin, etc (I'd lump religion in there as well because while that is also a choice, discrimination against religion is real because people can attribute the actions of people who are of one religion to an individual that shares that religion without regard to that individual's personal behavior).

You could say a residency program may hold a negative opinion of a medical school because of any number of characteristics of the school and thus may not rank its graduates very high because of that, but if a student chooses to attend that school, that residency program is not "discriminating" against that student. They are merely judging whether they want that student in their program based upon the school that they chose.

I think you are ascribing a negative connotation to the word 'discrimination' that it does not necessarily have. If you are passed over for a position because of X specifically then you are being discriminated against on account of X. X can be school name, race, your family's last name, your Step 1 score, your credit score, your height, your sales numbers from last quarter, the quality of your references, etc. etc. etc. It is acceptable to discriminate against all sorts of things; i.e. you are reading 'discriminate' in only the narrow sense where it is being used in relation to a quality where it is unethical, illegal or irrational to discriminate (race, gender, etc.).

You're using a very broad definition of the word "discrimination" whereas I am using a more sociological definition. Use of the word "discrimination" in the context of residency programs ranking candidates partially based on where they went to school creates the false implication that it is "unfair" to students. It's not unfair if you chose to attend that school.

 

[BeddingfieldMD]

Fair enough. I guess I would just say that in reality, at the moment of "choosing" one's medical school, virtually nobody attends a Caribbean school preferentially. There probably wasn't a better option. True, sometimes the factors that led to there being no other options were secondary to choices made by the student (too much partying, poor study habits, etc.)--but sometimes they aren't (death in the family, poor memorization abilities, lack of academic ability, etc.).

No flame war here either. Initially, I was just curious what you meant by your comment. I understand now.


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[BeddingfieldMD]

And to the OP, you can look at NRMP and ACGME data going back many years on their respective websites. People from all educational backgrounds (USMD, DO, IMG) are matching at similar (or higher) rates as they historically have over the past 10-20 years.

To add to the discussion, it's also important to note that in addition to med school student increases on the MD side of the equation, the number of matriculating DOs has more than doubled in the last decade:

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