NRMP March 2021 Discussions & Results

[Maimonides1]

Why this year's Match® will be strikingly different

Medical students always worry about getting a residency slot. But the pandemic has made this application cycle even more uncertain. What will Match Week hold?

www.aamc.org

As of March 1, there were more than 47,000 registrants and 38,197 spots, according to NRMP!

With the woes of this unconventional pandemic year and the impending four tsunami waves of SOAP.., stress is all time high for applicants and programs in this match..

Post your discussions, results and experiences here to get the big picture on this MATCH which may turn like nothing else before!!

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[PipetteDreams]

Why this year's Match® will be strikingly different

Medical students always worry about getting a residency slot. But the pandemic has made this application cycle even more uncertain. What will Match Week hold?

www.aamc.org

As of March 1, there were more than 47,000 registrants and 38,197 spots, according to NRMP!

With the woes of this unconventional pandemic year and the impending four waves of SOAP.., stress is all time high for applicants and programs in this match..

Post your discussions, results and experiences here to get the big picture on this MATCH which may turn like nothing else before!!

"Last year, there were 44,959 registrants and 37,256 spots." So we're looking at a ~1.6% increase in people who are unable to Match. Definitely unfortunate, but seems consistent with recent growth (its own giant topic).


There's a really great c/o 2021 panic thread with plenty of discussion, results pending, and experiences. Maybe it's my "woes of this unconventional pandemic... and impending four waves of SOAP," but this post reads like it was written by a circus barker 😬😆

 

[Maimonides1]

"Last year, there were 44,959 registrants and 37,256 spots." So we're looking at a ~1.6% increase in people who are unable to Match. Definitely unfortunate, but seems consistent with recent growth (its own giant topic).


There's a really great c/o 2021 panic thread with plenty of discussion, results pending, and experiences. Maybe it's my "woes of this unconventional pandemic... and impending four waves of SOAP," but this post reads like it was written by a circus barker 😬😆

Did not want to go through whole year of “panic” freaky show and just focus on results and analysis only..
You can cross post or stay in your circus tent..🤔

 

[Ho0v-man]

“But once they calm down, SOAP® can be a great opportunity.”

Man **** that person

 

[Maimonides1]

Great study article about addressing ERAS FEVER explained by behavioral psychology behind GAME THEORY!

Just in IM and GS alone, 12% of applicants holds 50% of the interviews!

Possible solutions:
- Informative: programs publish cut off criteria.
- Marketplace: increase costs and put limits on interviews if not applications all together!
- Early Result Acceptance Program “ERAP”

Application Fever: Reviewing the Causes, Costs, and Cures for Residency Application Inflation

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of “Application Fever” is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of...

www.cureus.com

 

[AzBasRad]

Great study article about addressing ERAS FEVER explained by behavioral psychology behind GAME THEORY!

Just in IM and GS alone, 12% of applicants holds 50% of the interviews!

Possible solutions:
- Informative: programs publish cut off criteria.
- Marketplace: increase costs and put limits on interviews if not applications all together!
- Early Result Acceptance Program “ERAP”

Application Fever: Reviewing the Causes, Costs, and Cures for Residency Application Inflation

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of “Application Fever” is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of...

www.cureus.com

You forgot Bryan Carmody's Application Cap at 20.

 

[Med Ed]

“But once they calm down, SOAP® can be a great opportunity.”

Man **** that person

I invite you to say that to Dr. Dent's face.

 

[Redpancreas]

Just in IM and GS alone, 12% of applicants holds 50% of the interviews!

Where did this statistic come from and how does it compare to the past? If this year is an outlier that’s pretty good news for non-top tier applicants.

 

[Lost in Translation]

You forgot Bryan Carmody's Application Cap at 20.

I advocate for this, and when I’m in some position of influence later in my career will try to build on discussions to implement this.

By limiting the number of apps that can be sent, the applicant needs to put in more effort into picking places they would actually want to go, and that also decreases the number of applications programs will review and therefore they’ll be able to spend more time actually holistically reviewing profiles. Applicants will self-select into their particular “competitiveness” brackets. You won’t have 1%ers siphoning interviews at mid-tier programs because they’ll all be vying for spots at the top-tier programs (and even that won’t be advised because you can’t just apply to the 20 top programs and hope to obtain interviews from all 20, much less guarantee to match at one of them). You won’t have North East applicants with no ties to the west coast taking interviews from PNW programs away from applicants in Colorado. And it saves applicants money in travel costs and application fees.

Limiting the number of applications that can be sent is a great way to maximize everyone’s chances at matching, and even improves people’s chances at matching where they actually want to be.

 

[Lost in Translation]

Where did this statistic come from and how does it compare to the past? If this year is an outlier that’s pretty good news for non-top tier applicants.

On Toilet Paper and Application Caps

Whenever we emerge from the COVID-19 pandemic, we’re all gonna have at least a few horrible memories burned into our minds. This thing is going to take something from everyone – and fro…

thesheriffofsodium.com

Myth #6

 

[AnatomyGrey12]

I advocate for this, and when I’m in some position of influence later in my career will try to build on discussions to implement this.

By limiting the number of apps that can be sent, the applicant needs to put in more effort into picking places they would actually want to go, and that also decreases the number of applications programs will review and therefore they’ll be able to spend more time actually holistically reviewing profiles. Applicants will self-select into their particular “competitiveness” brackets. You won’t have 1%ers siphoning interviews at mid-tier programs because they’ll all be vying for spots at the top-tier programs (and even that won’t be advised because you can’t just apply to the 20 top programs and hope to obtain interviews from all 20, much less guarantee to match at one of them). You won’t have North East applicants with no ties to the west coast taking interviews from PNW programs away from applicants in Colorado. And it saves applicants money in travel costs and application fees.

Limiting the number of applications that can be sent is a great way to maximize everyone’s chances at matching, and even improves people’s chances at matching where they actually want to be.

No. I will advocate against this my entire career. It keeps people from trying to “punch up” and have mobility above their current level.

Of my top 10 ranks I would have only applied to 2 of them if application caps were instituted.

 

[Lost in Translation]

No. I will advocate against this my entire career. It keeps people from trying to “punch up” and have mobility above their current level.

Of my top 10 ranks I would have only applied to 2 of them if application caps were instituted.

On Toilet Paper and Application Caps

Whenever we emerge from the COVID-19 pandemic, we’re all gonna have at least a few horrible memories burned into our minds. This thing is going to take something from everyone – and fro…

thesheriffofsodium.com

Myths #2 and #5

Applicants from notHMS COM who are AOA/GHHS/250+ Step will still apply to top programs and be competitive applicants for those spots. But they shouldn’t only be applying there. And if your application wasn’t going to get an interview when HMS GME Residency gets 200 applications, it sure as hell wasn’t going to get one when that program gets 1200.

Not that program national rank actually matters when it comes to the quality of training you get. But surely you know that. Did you end up matching at one of the 8 programs you wouldn’t have applied to? Do you even know (and you wouldn’t) if those programs ranked you anywhere close to their typical match rank, if they even had you on their list? By limiting applications, that doesn’t mean programs need to limit interviews granted. But it does mean they’re more likely to actually rank their interviewees because they know that everyone they interviewed would actually want to go there (also addressed in Myth #6).

 

[Chibucks15]

No. I will advocate against this my entire career. It keeps people from trying to “punch up” and have mobility above their current level.

Of my top 10 ranks I would have only applied to 2 of them if application caps were instituted.

Exactly. There isn't some magic thing to make everyone equal. As sucky as it is, meritocracy exists in the world and has always existed. You want all the opportunities that come with a "top" medical school? Bust your butt and don't quit until you get there. Too many people are trying to live in this utopia where everyone is completely equal at all times. And before anyone comes at me I'm not talking about stratifying people based on race, religion, sex, etc. Purely merits mean that the people at the "top" places, with the best application overall will get the most opportunities. Are there people with advantages? Sure but that's been the case forever. Welcome to the world. Don't like it? Improve your application.

As a lowly DO, application caps would do nothing but worsen the divide. At the outset, whatever school you get into would put you into a slate of residencies by default from day 1. So why even try to work as hard when you can't raise above a certain level? People would never take the chance at somewhere "above their level" because of the fear of not matching and destroying their lives. Its a higher stakes version of what goes on in business and law. At least with business degrees if you don't go to the top tier places you can still make a damn good living even if its not some massive partner in some bigtime place in NYC or LA.

 

[Lost in Translation]

People would never take the chance at somewhere "above their level" because of the fear of not matching and destroying their lives.

If you know your application won't get reviewed then why bother sending it to XYZ Prestige program?

Also, in that blog post Carmody mentions that one aspect for application caps to work (which is not difficult to implement at all) is more transparency on behalf of the residency programs with respect to who typically gets an interview. No **** you need 3 LORs with 1 being a Chair letter, no **** "competitive applicants passed Step 1/2 on their first try", no **** they want "well rounded" candidates. But what does that actually mean? It's ambiguous, which is why you send your application there anyone and pray to God or Yahweh or Allah. However, if programs were forced to say "The typical applicant that obtains an interview with us has a Step 2 score of at least 240 or a COMLEX score of at least 600," or, "The competitive applicant that obtains an interview has on average 3 publications," or, "We are looking for applicants with a demonstrated commitment to public and community service," and you have none of that, then you would know not to waste your application and money on that program.

 

[AnatomyGrey12]

On Toilet Paper and Application Caps

Whenever we emerge from the COVID-19 pandemic, we’re all gonna have at least a few horrible memories burned into our minds. This thing is going to take something from everyone – and fro…

thesheriffofsodium.com

Myths #2 and #5

Applicants from notHMS COM who are AOA/GHHS/250+ Step will still apply to top programs and be competitive applicants for those spots. But they shouldn’t only be applying there. And if your application wasn’t going to get an interview when HMS GME Residency gets 200 applications, it sure as hell wasn’t going to get one when that program gets 1200.

Not that program national rank actually matters when it comes to the quality of training you get. But surely you know that. Did you end up matching at one of the 8 programs you wouldn’t have applied to? Do you even know (and you wouldn’t) if those programs ranked you anywhere close to their typical match rank, if they even had you on their list? By limiting applications, that doesn’t mean programs need to limit interviews granted. But it does mean they’re more likely to actually rank their interviewees because they know that everyone they interviewed would actually want to go there (also addressed in Myth #6).

Carmody is wrong on this one, and I’ll tell you next week if I matched one of those 8. I am ranking 8 places in my top 10 I wouldn’t have applied to in your scenario and your response is to question if I’m even on their rank list? And then you say this:

Not that program national rank actually matters when it comes to the quality of training you get.

I can’t imagine a more ignorant and dismissive statement. “It won’t matter if you didn’t match the same program because the training quality is the same.” This completely ignores that there are literally dozens of reasons a program would be a better for for someone on a personal level that has absolutely nothing to do with quality of training.

Capping applications at 20 would literally change the matches of hundreds of applicants. The entire course of my career would be changed. Pretending otherwise is ignorance.

 

[AnatomyGrey12]

If you know your application won't get reviewed then why bother sending it to XYZ Prestige program?

I literally just gave you an example of getting a LOT of interviews at places I wouldn’t have applied to with a cap, and this is your response? Hundreds, if not thousands, of students get interviews at reach programs. Many of them match these programs.

 

[Chibucks15]

If you know your application won't get reviewed then why bother sending it to XYZ Prestige program?

Also, in that blog post Carmody mentions that one aspect for application caps to work (which is not difficult to implement at all) is more transparency on behalf of the residency programs with respect to who typically gets an interview. No **** you need 3 LORs with 1 being a Chair letter, no **** "competitive applicants passed Step 1/2 on their first try", no **** they want "well rounded" candidates. But what does that actually mean? It's ambiguous, which is why you send your application there anyone and pray to God or Yahweh or Allah. However, if programs were forced to say "The typical applicant that obtains an interview with us has a Step 2 score of at least 240 or a COMLEX score of at least 600," or, "The competitive applicant that obtains an interview has on average 3 publications," or, "We are looking for applicants with a demonstrated commitment to public and community service," and you have none of that, then you would know not to waste your application and money on that program.

There is no way to limit the ambiguity otherwise you end up with people who have essentially the same application. You lose the diversity of the class and the ability to stratify based on other factors besides numbers. So you have a 236 but interview really well and have great LOR? Nope their "clear" statement prevents you from applying because you don't feel you have a chance. Its a backhandedly selfish way of trying to limit competition for those "under' you. Everyone gets mad when the great kid with the 225 matches over the kid with the 270 and personality problems, but the programs have no obligation to explain why. They choose who they see as a fit to their program, regardless of stats. Yes there are rough levels of competitiveness needed for certain specialties and locations, and that won't change regardless of caps.

We as applicants have no right to demand each program to lay out parameters. I believe every application gets reviewed to a degree. Sure some more than others but it is in the programs best interest to at least review every application. As my good ole pal Anatomy gave you, there are plenty of examples where you are just completely incorrect. Your line of thinking is idealistic and not plausible or even really rooted in reality. Are you an M4?

 

[Lost in Translation]

I can’t imagine a more ignorant and dismissive statement. “It won’t matter if you didn’t match the same program because the training quality is the same.” This completely ignores that there are literally dozens of reasons a program would be a better for for someone on a personal level that has absolutely nothing to do with quality of training.

Capping applications at 20 would literally change the matches of hundreds of applicants. The entire course of my career would be changed. Pretending otherwise is ignorance.

I've seen a small-but-not-insignificant number of fellows (and attendings) from "top tier" residency programs who I wouldn't want touching my mother because they don't know how operate, and I've worked with attendings who went to a not-brand-name residency whose hands I would put my life in because they know what they're doing. Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate.

 

[Chibucks15]

I've seen a small-but-not-insignificant number of fellows (and attendings) from "top tier" residency programs who I wouldn't want touching my mother because they don't know how operate, and I've worked with attendings who went to a not-brand-name residency whose hands I would put my life in because they know what they're doing. Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate.

You're missing the point though. Sometimes program name matters for academic reasons, etc. Not purely clinically.

 

[AnatomyGrey12]

I've seen a small-but-not-insignificant number of fellows (and attendings) from "top tier" residency programs who I wouldn't want touching my mother because they don't know how operate, and I've worked with attendings who went to a not-brand-name residency whose hands I would put my life in because they know what they're doing. Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate.

How far along are you in training?

Because I already addressed this. There are MANY reasons someone would be a good fit for a program that have nothing to do with prestige of program.

Application caps only serve to harm those who are beneath you on the prestige totem pole. They limit mobility. Quite frankly, they could alter someone’s entire career.

I am a really good applicant on paper for my specialty, but I’m also a DO. I had no idea which programs would truly give me a shot, and I never would have applied to many of the places that did. Statistically I am almost guaranteed to match somewhere I wouldn’t have applied to with application caps.

 

[Lost in Translation]

There is no way to limit the ambiguity otherwise you end up with people who have essentially the same application. You lose the diversity of the class and the ability to stratify based on other factors besides numbers. So you have a 236 but interview really well and have great LOR? Nope their "clear" statement prevents you from applying because you don't feel you have a chance. Its a backhandedly selfish way of trying to limit competition for those "under' you. Everyone gets mad when the great kid with the 225 matches over the kid with the 270 and personality problems, but the programs have no obligation to explain why. They choose who they see as a fit to their program, regardless of stats. Yes there are rough levels of competitiveness needed for certain specialties and locations, and that won't change regardless of caps.

We as applicants have no right to demand each program to lay out parameters. I believe every application gets reviewed to a degree. Sure some more than others but it is in the programs best interest to at least review every application. As my good ole pal Anatomy gave you, there are plenty of examples where you are just completely incorrect. Your line of thinking is idealistic and not plausible or even really rooted in reality.

Sorry to break it to you, programs have Step/COMLEX/MD vs. DO filters. But they don't disclose them. Are there a few diamonds in the rough that somehow make it through the filter? Sure. Is that the norm? No. And the ones that do are usually the ones that have done rotations at those programs.

Let's take a look at the most prestigious orthopaedics residency in the country: HSS. They have this to say on their application information page.

The HSS Residency Selection Committee reviews each application. Residents are selected from the pool of eligible applicants based on preparedness, ability, aptitude, academic credentials, communications skills, and personal qualities such as motivation and integrity.

Yet when you look at their current residents, which schools are represented? Penn, Baylor, Cornell, Stanford, Columbia, WashU, UCLA, HMS, Yale, JHU. Of all the 45+ residents in their program, only 3 are from schools outside the Top 20 list. I find it hard to believe that there aren't more medical students from schools outside the Top 20 that weren't worth interviewing or ranking highly enough. Surely it's not the case that applicants from those brand-name medical schools are the only good interviewers. And there's not a single DO resident. I'm there are a handful of ortho hopefuls that are DOs that would certainly be competitive compared to the rest of that resident body. However, their website doesn't explicitly state that they don't take DOs. So do you think they really are reviewing all 800 their applications, including those from from State School College of Medicine, from an applicant who has a 230 Step score?

The stigma against DOs will always exist, cap or no cap. However, as Carmody states in one of his sections, with application caps, when a program receives an application from a student, that in of itself signals to that program that the student would really want to go to that program. So that actually works to the advantage of the DO applicant. You would be competing for interviews against a smaller pool of applicants per program with the application cap.

Like I said above, top-tier applicants will still send most of their applications to top-tier programs, and top tier programs will continue to send the vast majority of their interviews to top-tier applicants. With transparency, you basically get told off the bat whether or not you would be considered a "top-tier applicant" by a given program. And just because your stats don't meet their minimum requirements doesn't mean that you are barred from even applying. It may be ill-advised, but you can still send that application there if you really want to be at that program. And that PD will know that implicitly because they know that you are spending a valuable, limited resource to apply to their program even in the face of being told that they probably won't interview you. So then that might cause them to take a closer look at your application and notice something that they would have filtered out if they had to review 800 applications.

Are you an M4?

No, I'm not. I've already been through that ****.

 

[Chibucks15]

Sorry to break it to you, programs have Step/COMLEX/MD vs. DO filters. But they don't disclose them. Are there a few diamonds in the rough that somehow make it through the filter? Sure. Is that the norm? No.

Let's take a look at the most prestigious orthopaedics residency in the country: HSS. They have this to say on their application information page.



Yet when you look at their current residents, which schools are represented? Penn, Baylor, Cornell, Stanford, Columbia, WashU, UCLA, HMS, Yale, JHU. Of all the 45+ residents in their program, only 3 are from schools outside the Top 20 list. I find it hard to believe that there aren't more medical students from schools outside the Top 20 that weren't worth interviewing or ranking highly enough. Surely it's not the case that applicants from those brand-name medical schools are the only good interviewers. And there's not a single DO resident. I'm there are a handful of ortho hopefuls that are DOs that would certainly be competitive compared to the rest of that resident body. However, their website doesn't explicitly state that they don't take DOs.

The stigma against DOs will always exist, cap or no cap. However, as Carmody states in one of his sections, with application caps, when a program receives an application from a student, that in of itself signals to that program that the student would really want to go to that program. So that actually works to the advantage of the DO applicant. You would be competing for interviews against a smaller pool of applicants per program with the application cap.

Like I said above, top-tier applicants will still send most of their applications to top-tier programs, and top tier programs will continue to send the vast majority of their interviews to top-tier applicants. With transparency, you basically get told off the bat whether or not you would be considered a "top-tier applicant" by a given program.


No, I'm not. I've already been through that ****.

Okay so first off, picking one of the most competitive places and specialties in the country is a bit ambitious. Also, who's to say they didn't interview plenty of non top 20? And what if the non top 20 people didn't rank it as high? Again, meritocracy is something we can't avoid. It also is pretty obvious if you're an applicant who has a shot at certain places or not. Some people are delusional about how great they are but that's their prerogative to waste their money.

Secondly, I know places have filters. I'm not naive. That is the programs discretion and their choice to do so is none of my concern. We can't force a program to "consider" other applicants they don't want. It ends up being like the Rooney Rule in the NFL where a minority coach candidate gets a courtesy interview and doesn't get the job. If they continue to fill while using their filters then we as applicants have no standing to tell them to change. And places with filters, even if you get a demonstration of interest by way of receiving an application, won't change their preferences on if my DO app goes in the trash or not.

Again, I don't see how caps solve any of these issues. As you said, Places will still rank their desired candidates higher and the outcome won't change for the top tier applicants. It barely will change for slightly lower applicants as well. If a program did not choose to interview a candidate based on merits alone, then they are unlikely to rank them to match to begin with. So "stealing" interviews is kind of a flawed idea to begin with.

Plus, if there are a ton of people who use their application spot to rank a certain program, there are only so many spots. Programs do have to fall down their rank lists, and limiting the pool of applicants and interviews to 20 is likely to increase unfilled programs, especially in certain specialties that take double digit classes every year. Just because I want to go do residency at HSS, and submit an application, why am I guaranteed an interview? With caps it essentially turns to programs having to interview everyone in order to ensure they don't go unfilled.

 

[Redpancreas]

I like the concept of limiting residency applications, but why does it have to be a 20-cap? I know no one who applied to only 20 places unless they were restricted to a geographical area or felt so confident they applied to the top programs. I think a 50-cap would be more effective. Right now there are US MD seniors who applied to 100 places in non-competitive fields with above average scores because they're trying to hit that completely arbitrary 15 interview mark to reassure themselves they will match. I do like the application guidelines (i.e. transparency) @Lost in Translation mentions where I think each program's website should be required to post their heuristics (i.e. we prefer US MD seniors, 230+, 240+, Honors in our field) to serve as guides and then if the applicant ignores that because they think XYZ, its their prerogative).

I am thinking aloud here so don't bite me but what mid-cycle adjustments? For example, for anyone not holding an X number of interviews by a given date (including ones they rejected), they should be allowed 10 additional application slots (rinse/repeat x4 (limit)) until everyone is holding let's say 8 interviews or the limit (4 rounds) is reached. The disadvantage is it puts a clear designation of being less competitive on these interview-deficient applicants which is important because I suspect a lot of PDs use heuristics such as "perceived competitiveness" rather than making their own program-specific judgments. The upside though is the resultant equity for less competitive applicants if we end up doing an application cap system. Programs also know that those in the subsequent application waves are increasingly committed to the program given their situation so it's not like they're simply wasting interviews.

 

[DrZoidbergDO]

Sorry to break it to you, programs have Step/COMLEX/MD vs. DO filters. But they don't disclose them. Are there a few diamonds in the rough that somehow make it through the filter? Sure. Is that the norm? No. And the ones that do are usually the ones that have done rotations at those programs.

Let's take a look at the most prestigious orthopaedics residency in the country: HSS. They have this to say on their application information page.

the funny thing about your post is HHS literally until last week said they would not accept DOs.

 

[Maimonides1]

 

[Med Ed]

I like the concept of limiting residency applications, but why does it have to be a 20-cap? I know no one who applied to only 20 places unless they were restricted to a geographical area or felt so confident they applied to the top programs. I think a 50-cap would be more effective.

The number 20 is just something pulled out of thin air. I couldn't see caps working without each specialty have its own. FM might be fine with 20, I'm pretty sure ortho would not.

I'm old enough to have gone through the match when the average number of programs applied to by US seniors was ~20. It was heaven compared to what I see now. I received interview offers from over 75% of the placed I applied to, went to 10, matched at my #1. I did not have to spend half of medical school doing high-yield extracurricular activities to stand out from the crowd. Nor was I ever one of 100 people invited to grab one of 50 interview slots on a first come, first serve basis.

Caps aren't the only way to address the issue, but anyone arguing for the status quo is arguing for an extremely dysfunctional state of affairs.

 

[Prehealth1011]

^ Wow, that sounds amazing. I'm from a DO school and I don't know anyone who applied to <100 IM programs with me this cycle

 

[ohmanwaddup]

I think the match should be in rounds, with a MD/DO grads allowed to apply and match in the first round, and unmatched US grads, IMG and FMG in the second round. Taxpayers are founding these spots, and they should go to US graduates first. I also don't necessarily think the US should be participating in brain drain of medical professionals from other countries, but that is an entirely separate issue.

 

[Redpancreas]

I think the match should be in rounds, with a MD/DO grads allowed to apply and match in the first round, and unmatched US grads, IMG and FMG in the second round. Taxpayers are founding these spots, and they should go to US graduates first. I also don't necessarily think the US should be participating in brain drain of medical professionals from other countries, but that is an entirely separate issue.

I don’t think we would have the system of healthcare we have without IMG participation over the past 50 years. Immigration and diversity are what will keep us great. I understand the sentiment of the American taxpayer $ but I think most IMGs choose to stay once established. Also, even within the US there’s several established private schools less reliant on taxpayer $.

 

[DrZoidbergDO]

I think the match should be in rounds, with a MD/DO grads allowed to apply and match in the first round, and unmatched US grads, IMG and FMG in the second round. Taxpayers are founding these spots, and they should go to US graduates first. I also don't necessarily think the US should be participating in brain drain of medical professionals from other countries, but that is an entirely separate issue.

I wouldnt be an american if not for IMG brain drain, so i'm personally all for it

 

[deleted645092]

I advocate for this, and when I’m in some position of influence later in my career will try to build on discussions to implement this.

By limiting the number of apps that can be sent, the applicant needs to put in more effort into picking places they would actually want to go, and that also decreases the number of applications programs will review and therefore they’ll be able to spend more time actually holistically reviewing profiles. Applicants will self-select into their particular “competitiveness” brackets. You won’t have 1%ers siphoning interviews at mid-tier programs because they’ll all be vying for spots at the top-tier programs (and even that won’t be advised because you can’t just apply to the 20 top programs and hope to obtain interviews from all 20, much less guarantee to match at one of them). You won’t have North East applicants with no ties to the west coast taking interviews from PNW programs away from applicants in Colorado. And it saves applicants money in travel costs and application fees.

Limiting the number of applications that can be sent is a great way to maximize everyone’s chances at matching, and even improves people’s chances at matching where they actually want to be.

Except you pigeonhole people into their own region.

You pigeonhole people into programs that might be DO or MD only only because of the programs historical data.

You prevent people from punching up and breaking ceilings.

You force people to only apply to programs they think they’re competitive for.

There should be a survey given to all of us who applied this year; Question 1: Out of the programs you applied to, where would you expect to get an interview? Question 2: Where did you get interviews? I promise there would be a pretty big disconnect. A girl from the class of 2020 at my school matched into an ortho program that had neither taken a DO or a woman in the past. She was the first of both. She never would’ve even applied if application caps existed.

 

[deleted645092]

No. I will advocate against this my entire career. It keeps people from trying to “punch up” and have mobility above their current level.

Of my top 10 ranks I would have only applied to 2 of them if application caps were instituted.

I’m glad more than one of us said this independently, I didn’t even see your comment til I replied with my own.

 

[Maimonides1]

I am not sure if Roth and Shapley the two Economics Nobel laureates who fixed the NRMP match algorithm in 1996 and won the prize for it in 2012, could thought of the possibility that NRMP might run in feverish pace as it did in the last several years.., especially if you let the Game Theory run wild without modification controls.., which may become evidently more needed after this unusual pandemic year with virtual interviews.., as it can lead to unpleasant surprises for programs and applicants alike..!!

https://www.nobelprize.org/uploads/2018/06/popular-economicsciences2012.pdf

 

[underthesun]

Exactly. There isn't some magic thing to make everyone equal. As sucky as it is, meritocracy exists in the world and has always existed. You want all the opportunities that come with a "top" medical school? Bust your butt and don't quit until you get there. Too many people are trying to live in this utopia where everyone is completely equal at all times. And before anyone comes at me I'm not talking about stratifying people based on race, religion, sex, etc. Purely merits mean that the people at the "top" places, with the best application overall will get the most opportunities. Are there people with advantages? Sure but that's been the case forever. Welcome to the world. Don't like it? Improve your application.

As a lowly DO, application caps would do nothing but worsen the divide. At the outset, whatever school you get into would put you into a slate of residencies by default from day 1. So why even try to work as hard when you can't raise above a certain level? People would never take the chance at somewhere "above their level" because of the fear of not matching and destroying their lives. Its a higher stakes version of what goes on in business and law. At least with business degrees if you don't go to the top tier places you can still make a damn good living even if its not some massive partner in some bigtime place in NYC or LA.

ItS NoT MeRitOCrACY iTs RAciSM. Jk, but that’s exactly what you would be told if you posted this on medtwitter

 

[Jack Donaghy]

View attachment 332367

This is a ridiculous and dumb reality we live in. App caps NOW

 

[ace_inhibitor111]

The number 20 is just something pulled out of thin air. I couldn't see caps working without each specialty have its own. FM might be fine with 20, I'm pretty sure ortho would not.

I'm old enough to have gone through the match when the average number of programs applied to by US seniors was ~20. It was heaven compared to what I see now. I received interview offers from over 75% of the placed I applied to, went to 10, matched at my #1. I did not have to spend half of medical school doing high-yield extracurricular activities to stand out from the crowd. Nor was I ever one of 100 people invited to grab one of 50 interview slots on a first come, first serve basis.

Caps aren't the only way to address the issue, but anyone arguing for the status quo is arguing for an extremely dysfunctional state of affairs.

The increased competition is a product of the nearly 34% increase in number of medical students In the last decade. Application caps won’t solve the issue, it just takes even more power away from the applicants

 

[libertyyne]

View attachment 332367

This is absolutely not OK. This is insanity. On the flip side if you are a competitive applicant who is thoughtful about your list you are essentially being shafted out of interviews because you are being yield protected since the PDs have to deal with a tsunami of applications.

I literally applied to 1/5th the number of programs that the average applicant in my specialty and had to send dumb " continued interest" emails to some programs to extract interviews. This is non-sense. I applied to your program because I read up on it, and I would come there if offered a position. This system penalizes people being rational. Its like tragedy of the commons but for interviews.

In a few years time everyone will say to apply to every single program in your specialty. Does everyone really think that is an appropriate outcome or way we select residents and programs?

 

[Maimonides1]

I am reading your comments carefully in both threads..
Please take the new survey above and elaborate below!
Time is up.., Don’t forget to adjust your clock too before the NRMP Monday Madness!

 

[Med Ed]

The increased competition is a product of the nearly 34% increase in number of medical students In the last decade.

Data from the NRMP:

2010
Active MD seniors: 16,070
Total PGY-1 positions: 22,809
Positions per senior: 1.42

2020
Active MD seniors: 19,326
Total PGY-1 positions: 34,266
Positions per senior: 1.77

A lot of the very recent growth in positions came from the ACGME-AOA merger, but even before that the ratio was >1.40 since 2000, and it crept over 1.50 in 2013. The lowest it ever got was 1.25 in 1984 and 1985.

Application caps won’t solve the issue, it just takes even more power away from the applicants

I wouldn't characterize transferring student loan money to ERAS as "empowerment," especially now that PDs have to screen out large numbers of applications without even reading them.

 

[Redpancreas]

For a large field like IM, US MD seniors are virtually barred out of a majority of programs for both underqualification and overqualification so discussion of Total US MD seniors to PGY-1 slots is pointless as a large number of slots are not for the run of the mill US MDs. Southern Illinois University won't bother looking at my application because they figure someone with my stats would not go there, meanwhile UCSF has not looked at my application because I don't have the features they screen for. There are also tons of programs in NYC that openly admit they're looking for IMGs who're ready to do the job and that's the best fit in their program. There is already some level of automatic screening going on which a application cap would mitigate. I think the low-hanging fruit regardless is for the ACGME/whatever to mandate programs start with the following:

1.) Require programs to publicize any cut-offs and put on their website something like "we generally accept 220+" OR share accurate, yearly, A.) mean/median/mode scores/grades B.) school breakdown/type of applicant breakdown for the students interviewed and those matched to their program instead of self reporting them to Doximity/Texas Star/ResidencyNavigator. Programs have these readily available after match day and are shared with the incoming cohort if they're good to establish good morale.

2.) Disallow discussion of total number of applicationsa program receives as such a statistic means nothing yet PDs currently use it as a denominator now to flex the competitiveness of their program. This will allow programs to be more transparent with their guidelines without worrying about lowering their yield.
----

I think after that, if applications go down enough we would move forward, but if not, I think perhaps a specialty specific cap (like @Med Ed said) with a few rounds of additional application slots for those who are interview deficient would be in order.

The issue that remains is what to do with the applicants with red flags. Some people just know they're going to be less competitive and hence blindly apply. It's going to be difficult for them to find out which PDs are going to take a chance of them something highly variable by PD and changes on a year to year basis.

 

[NotAProgDirector]

Discussing possible changes to the match or residency applications is good. There's often a thread about it this time each year. A prior thread is here: NRMP Match: Good, bad or ugly? | Student Doctor Network

Currently, after match / SOAP / scramble, essentially 100% of all spots are filled. So any change to the match or application system isn't going to improve position fill rate -- benefits would be decreasing cost of applications, and distribution of positions (i.e. whom gets what spot). Decreasing costs is always a good goal. Anytime someone gets a spot that they are happier with, it's quite possible that someone else will get something they are less happy with, measuring how happy people are with the match is complicated.

Proposals to changing the app process include an application cap and signaling (via Gold/Silver/Bronze application limits, or some other mechanism). Getting ERAS to decrease fees for apps is also often discussed, but unclear how that could happen as neither PD's nor students have any leverage -- honestly starting a new application service to compete with them would be the most effective. App caps or signaling are a mixed bag -- each application may have more chance of being fully reviewed, but applicants would need to choose carefully where they want to send their applications, and some programs have benefitted from app inflation. App caps are specifically problematic for couples and for anyone with a "red flag" -- and I doubt we would all agree on what that constitutes.

Proposals to changing the match include an early round for all, a two phase match with the first round for US grads (or US citizens) only. Some suggest doing away with the match entirely. If the early round was complete before the main application phase, that would cut down on applications.

Programs being required to publish their criteria is theoretically reasonable, but unclear how feasible it really is. Let's say I publish that my step cutoffs are 210 and 230. What happens with people who have a 206 on S1 and a 278 on S2? We might require different criteria for DO's and IMG's at some programs, and the criteria might even be school related (i.e. programs might use different criteria for students from schools they have no experience with). And isn't the point of all of this to get away from criteria and move to holistic review?

 

[ace_inhibitor111]

Data from the NRMP:

2010
Active MD seniors: 16,070
Total PGY-1 positions: 22,809
Positions per senior: 1.42

2020
Active MD seniors: 19,326
Total PGY-1 positions: 34,266
Positions per senior: 1.77

A lot of the very recent growth in positions came from the ACGME-AOA merger, but even before that the ratio was >1.40 since 2000, and it crept over 1.50 in 2013. The lowest it ever got was 1.25 in 1984 and 1985.


I wouldn't characterize transferring student loan money to ERAS as "empowerment," especially now that PDs have to screen out large numbers of applications without even reading them.

Even though the number of PGY-1 spots has increased, a disproportionate amount of them are in “low-tier” IM and FM residencies. A large proportion of the +34% new medical students that have enrolled in the past decade still have dreams of going into surgical subspecialties, dermatology, ophthalmology, top-tier residencies in IM, anesthesia, surgery etc. Spots in competitive residencies have not kept up the pace with demand, and “high-tier” residency spots have stayed relatively constant. Hence the increase in medical student stress and competition despite the actual ratio of students/PGY-1 spots technically increasing.

 

[Redpancreas]

Even though the number of PGY-1 spots has increased, a disproportionate amount of them are in “low-tier” IM and FM residencies. A large proportion of the +34% new medical students that have enrolled in the past decade still have dreams of going into surgical subspecialties, dermatology, ophthalmology, top-tier residencies in IM, anesthesia, surgery etc, in which spots have not grown much. Hence the increase in competition despite the actual ratio of students/PGY-1 spots technically increasing.

This exactly. Just like US patients expect the best life-prolonging drugs, best care, etc. US graduates regardless of their medical school and tier are mostly (with some exceptions) vying for the competitive (specialty) residency slots. Even within IM (traditionally seen as PC) the vast majority including myself are targeting fellowship afterwards.

 

[Maimonides1]

Data from the NRMP:

2010
Active MD seniors: 16,070
Total PGY-1 positions: 22,809
Positions per senior: 1.42

2020
Active MD seniors: 19,326
Total PGY-1 positions: 34,266
Positions per senior: 1.77

A lot of the very recent growth in positions came from the ACGME-AOA merger, but even before that the ratio was >1.40 since 2000, and it crept over 1.50 in 2013. The lowest it ever got was 1.25 in 1984 and 1985.


I wouldn't characterize transferring student loan money to ERAS as "empowerment," especially now that PDs have to screen out large numbers of applications without even reading them.

You can slice it in whatever way you like..
But the reality is that USMDs are not alone in the pile..,
DOs, IMGs, FMGs are part of this Fever!
Unless you are proposing tier layered MATCH ?

I am quoting the authors here:

“Coincidentally, 1992 was the last year in which there were more residency positions available than active applicants in the National Residency Matching Program (NRMP). By 1996 - the first year ERAS was used - the ratio of positions to applicants had fallen from >1 to 0.83 [3]. At the same time that ERAS offered the means to apply broadly, a relative reduction in available positions provided the motivation to do so.

However, these factors alone are insufficient to explain Application Fever. Since the introduction of ERAS, the disparity between the number of positions and applicants has been stable - ranging between 0.75 and 0.88 - and the overall odds of matching remain favorable. In the most recent application cycle, the Match rate for U.S. seniors was ~93% (without a significant change in decades), while Match rates for international medical graduates and osteopathic seniors were at or near all-time highs [3].”

 

[FindersFee5]

Discussing possible changes to the match or residency applications is good. There's often a thread about it this time each year. A prior thread is here: NRMP Match: Good, bad or ugly? | Student Doctor Network

Currently, after match / SOAP / scramble, essentially 100% of all spots are filled. So any change to the match or application system isn't going to improve position fill rate -- benefits would be decreasing cost of applications, and distribution of positions (i.e. whom gets what spot). Decreasing costs is always a good goal. Anytime someone gets a spot that they are happier with, it's quite possible that someone else will get something they are less happy with, measuring how happy people are with the match is complicated.

Proposals to changing the app process include an application cap and signaling (via Gold/Silver/Bronze application limits, or some other mechanism). Getting ERAS to decrease fees for apps is also often discussed, but unclear how that could happen as neither PD's nor students have any leverage -- honestly starting a new application service to compete with them would be the most effective. App caps or signaling are a mixed bag -- each application may have more chance of being fully reviewed, but applicants would need to choose carefully where they want to send their applications, and some programs have benefitted from app inflation. App caps are specifically problematic for couples and for anyone with a "red flag" -- and I doubt we would all agree on what that constitutes.

Proposals to changing the match include an early round for all, a two phase match with the first round for US grads (or US citizens) only. Some suggest doing away with the match entirely. If the early round was complete before the main application phase, that would cut down on applications.

Programs being required to publish their criteria is theoretically reasonable, but unclear how feasible it really is. Let's say I publish that my step cutoffs are 210 and 230. What happens with people who have a 206 on S1 and a 278 on S2? We might require different criteria for DO's and IMG's at some programs, and the criteria might even be school related (i.e. programs might use different criteria for students from schools they have no experience with). And isn't the point of all of this to get away from criteria and move to holistic review?

So here's something I'm wondering about. What if, instead of capping the number of applications, you allowed program directors to see how many places each applicant applied to? So an applicant with a red flag or a more borderline applicant would have to make that decision that it was worth taking the hit on specificity to get there application out there, whereas an applicant like me, who has very strong geographic preferences, could clearly signal that by applying to the ~20 or so programs in my geographic region.

 

[Redpancreas]

So here's something I'm wondering about. What if, instead of capping the number of applications, you allowed program directors to see how many places each applicant applied to? So an applicant with a red flag or a more borderline applicant would have to make that decision that it was worth taking the hit on specificity to get there application out there, whereas an applicant like me, who has very strong geographic preferences, could clearly signal that by applying to the ~20 or so programs in my geographic region.

That's an interesting proposal but it would absolutely destroy anyone with red flags in the match unless there was an optional reveal of number of applications. Another interested option is to allow programs to see how many interviews programs have. I have a sneaking suspicion programs already have an ability to estimate this and have their own list serv of applicants.

 

[Med Ed]

Even though the number of PGY-1 spots has increased, a disproportionate amount of them are in “low-tier” IM and FM residencies. A large proportion of the +34% new medical students that have enrolled in the past decade still have dreams of going into surgical subspecialties, dermatology, ophthalmology, top-tier residencies in IM, anesthesia, surgery etc. Spots in competitive residencies have not kept up the pace with demand, and “high-tier” residency spots have stayed relatively constant. Hence the increase in medical student stress and competition despite the actual ratio of students/PGY-1 spots technically increasing.

I had a feeling you might come back with this assertion, so let's check the data. I will use 2004 and 2014 since that is the most recent 10-year span prior to the ACGME-AOA merger, and focus on some relatively popular fields.

Active MD seniors in 2004: 14,609
Active MD seniors in 2014: 17,374
Percent increase: +19

Positions in 2004
Anesthesiology: 443
Emergency Medicine: 1,151
Family Medicine: 2,864
Internal Medicine: 4,751
OB/GYN: 1,142
Orthopedic Surgery: 598
Pediatrics: 2,261
Psychiatry: 1,020
Surgery: 1,044
Total: 15,265

Positions in 2014 (percent increase)
Anesthesiology: 1,049 (+137)
Emergency Medicine: 1,786 (+55)
Family Medicine: 3,109 (+9)
Internal Medicine: 6,524 (+37)
OB/GYN: 1,242 (+9)
Orthopedic Surgery: 695 (+18)
Pediatrics: 2,640 (+17)
Psychiatry: 1,322 (+30)
Surgery: 1,205 (+15)
Total: 19,572 (+28)

IM was indeed a big mover, but so were anesthesiology, EM, and psychiatry, and ortho kept pace. FM and OB/GYN were relatively stagnant. Some of these increases reflect new programs, but not all. For example, in 2004 Johns Hopkins had a total of 149 advanced and categorical positions offered in the match, and in 2014 that number was 198, a 33% increase.

I agree that with increasing enrollment there will naturally be some increased competition for highly desirable residency spots. The question is whether that alone can explain the massive increase in applications observed over the past 15+ years. I don't think it can. In my view this is much better explained by the Prisoner's Dilemma.

 

[AnatomyGrey12]

I could support application caps if 1. They are specialty specific. And 2. A much more reasonable number like say 50 and not something ridiculously low like 20.

In response to some comments before this cycle about possible app caps I actually made my application list in quartiles of which programs I would apply to in various caps scenarios. Last night I went through it and compared it to where my interviews came from (mind you I applied to less than 10 programs I would consider Hail Mary’s where they had never taken a DO before). All my first 25 programs were very reasonable places I should be very competitive for.

With a cap of 25 apps I would have gotten 4 interviews. If that cap was set to 60, I would have gotten a much more acceptable 18 interviews, and most of my top 10 ranks came from my second and third quartile apps.

 

[ace_inhibitor111]

I had a feeling you might come back with this assertion, so let's check the data. I will use 2004 and 2014 since that is the most recent 10-year span prior to the ACGME-AOA merger, and focus on some relatively popular fields.

Active MD seniors in 2004: 14,609
Active MD seniors in 2014: 17,374
Percent increase: +19

Positions in 2004
Anesthesiology: 443
Emergency Medicine: 1,151
Family Medicine: 2,864
Internal Medicine: 4,751
OB/GYN: 1,142
Orthopedic Surgery: 598
Pediatrics: 2,261
Psychiatry: 1,020
Surgery: 1,044
Total: 15,265

Positions in 2014 (percent increase)
Anesthesiology: 1,049 (+137)
Emergency Medicine: 1,786 (+55)
Family Medicine: 3,109 (+9)
Internal Medicine: 6,524 (+37)
OB/GYN: 1,242 (+9)
Orthopedic Surgery: 695 (+18)
Pediatrics: 2,640 (+17)
Psychiatry: 1,322 (+30)
Surgery: 1,205 (+15)
Total: 19,572 (+28)

IM was indeed a big mover, but so were anesthesiology, EM, and psychiatry, and ortho kept pace. FM and OB/GYN were relatively stagnant. Some of these increases reflect new programs, but not all. For example, in 2004 Johns Hopkins had a total of 149 advanced and categorical positions offered in the match, and in 2014 that number was 198, a 33% increase.

I agree that with increasing enrollment there will naturally be some increased competition for highly desirable residency spots. The question is whether that alone can explain the massive increase in applications observed over the past 15+ years. I don't think it can. In my view this is much better explained by the Prisoner's Dilemma.

This data is not accurate because it doesn’t include AOA positions, advanced positions, and DO students. Take the anesthesiology number of spots in 2004 for example, the true number is 443 categorical+863 advanced= 1300 in 2004.

Here are my calculations. The total amount of MD+DO seniors in 2020 is 25,900, vs 20,100 in 2013. That is a 28.8% increase in students. The increase in intern positions is as follows, accounting for the ACGME/AOA merger AND advanced residency positions that have switched to categorical:

 

[DrZoidbergDO]

I could support application caps if 1. They are specialty specific. And 2. A much more reasonable number like say 50 and not something ridiculously low like 20.

This is the best compromise IMO. although I think for less competitive specialties, maybe something like 30 is more reasonable.