NRMP March 2021 Discussions & Results

[Chibucks15]

It's almost certainly yield protection.

A program that is typically filled with IMGs/Caribbean students won't think that an applicant with a 260 Step and AOA/GHHS would want to go there. Whether that's true or not is not taken into account when the program still needs to sort through 800 applications to interview 80. The data would suggest the former, though in @Chibucks15's case it sounds like the latter (e.g. they do want to go there but the program doesn't believe that).



Because with how easy ERAS is, the likelihood everyone just sends apps everywhere is statistically more probable than someone has carefully curated a small list of 20 programs they really want to attend and only applied to them. I think it's a generational thing to be honest; my chair when I was applying was an older fellow and said I only needed to apply to 20-30 programs to match. I was told by the clerkship director and the PD to apply to at least twice that many because that's what everyone else is going to do (and obviously did). I ended up sending 140.

And that's one of the problems the application cap is trying to solve: now, by sending an application there, it's implied that the applicant truly does want to go there and their app should be taken seriously.

Is there any actual proof that places practice yield protection? Or are you simply just extrapolating based on how many applications there are per spot. Like I said it could be a myriad of other reasons one doesn’t “fit the program”. But for a program to say that they don’t want someone because they’re “too good for us” seems BS to me and is something cocky med students say when they don’t get every interview they apply for.

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[Lost in Translation]

Is there any actual proof that places practice yield protection? Or are you simply just extrapolating based on how many applications there are per spot. Like I said it could be a myriad of other reasons one doesn’t “fit the program”. But for a program to say that they don’t want someone because they’re “too good for us” seems BS to me and is something cocky med students say when they don’t get every interview they apply for.

I mean, I'm sure it happens. Personally, I've spoken with several former classmates during my time of Match who said they didn't get interviews at places they expected to (based on Step scores at least).

 

[Chibucks15]

I mean, I'm sure it happens. Personally, I've spoken with several former classmates during my time of Match who said they didn't get interviews at places they expected to.

Generic Anecdotal data aside, I don’t think it’s a widespread thing. And in terms of “interviews they expected” that’s exactly what I’m talking about. There could be a hundred other reasons they don’t get one and it’s easy to save the ego and blame yield protection. The premise of it itself just doesn’t make any sense at all

 

[MICKY MANTLE]

One of my mentors in med school tells of his experience as an ortho resident. He went to a top-ranked "brand-name" program for residency and later went somewhere else for fellowship. One of his co-fellows was a guy from a "no-name" program in Texas or some southern state. However, my mentor told me that that guy from Texas or wherever was the most surgically adept in the OR out of any fellow in that program, and better than many residents that he had worked with. Remember, my mentor went to a "brand-name" program that's one of the powerhouses for ortho research.

The point of my story is that just because USWNR or Doximity says XYZ program is top-tier doesn't automatically mean the best physicians come out of those programs. Quality of training is just one aspect, and NIH/T32 grant money/publications per faculty member per year are other aspects that go into those ranking lists. Hell, I've had some people tell me not to have my child delivered at a big-name university and go to the community hospital across the street (that has their own residency) instead because the quality of the care they get is better at that hospital. But when you look at the rankings, that big-name university program is several programs above that community program.

No one denies what your saying, but my comments came on your posting where you said;

"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."

Program rank and prestige is not only associated with "quality and quantity of research", but quality of training. These "top-tier" programs are that way because they have some of the best in the industry teaching, surgical volume, diversity of cases, research money and the list goes on. When you have access to all of what I just mentioned, your are going to be better equipped when you come out, that's just factual. That's not to say you can't have duds coming out and it also is not to say that someone from a mid-tier program can't be a rockstar, but generally speaking, when you finish at a top residency, you are going to be very well prepared....Leave it at that, no other argument to be made, what I said is just common sense.

 

[buttman]

Dirty DO here. Only applied to 20 places, interviewed at 2/3 top25 Doximity programsI applied to. But also didn’t get love from a ton of “mid tier” programs. Also got a late interview with a program that had never had a DO.

there’s still an obvious bias but it can be overcome. Maybe not for future classes now that step1 is P/F.

 

[The Med-Peds Dude]

It's almost certainly yield protection.

A program that is typically filled with IMGs/Caribbean students won't think that an applicant with a 260 Step and AOA/GHHS would want to go there. Whether that's true or not is not taken into account when the program still needs to sort through 800 applications to interview 80. The data would suggest the former, though in @Chibucks15's case it sounds like the latter (e.g. they do want to go there but the program doesn't believe that).

Again, how do you know this. I've been a PD for ~13 years and I would never pass on a highly qualified applicant. This is a community program. My applicant position ratio is 100. One-half of them are literally junk. Our number to ranks/fill is 12 over the last 3 years. We have not gone unmatched for ~15 years.

Programs have their reach list as well, and if it those don't match, we run down the algorithm until we do. As should you.

 

[AnatomyGrey12]

Generic Anecdotal data aside, I don’t think it’s a widespread thing. And in terms of “interviews they expected” that’s exactly what I’m talking about. There could be a hundred other reasons they don’t get one and it’s easy to save the ego and blame yield protection. The premise of it itself just doesn’t make any sense at all

I know for a fact I was not offered an interview at at least one program because my app was better than what they usually take and they didn’t think I would actually come.

Program rank and prestige is not only associated with "quality and quantity of research", but quality of training. These "top-tier" programs are that way because they have some of the best in the industry teaching, surgical volume, diversity of cases, research money and the list goes on. When you have access to all of what I just mentioned, your are going to be better equipped when you come out, that's just factual. That's not to say you can't have duds coming out and it also is not to say that someone from a mid-tier program can't be a rockstar, but generally speaking, when you finish at a top residency, you are going to be very well prepared....Leave it at that, no other argument to be made, what I said is just common sense.

This is completely off topic but you’re very much wrong. How competent you are after training has absolutely nothing to do with the rank and prestige of your program. Many highly ranked programs honestly produce a crappy clinical product, and their grads require multiple fellowships to achieve competence.

 

[Chibucks15]

I know for a fact I was not offered an interview at at least one program because my app was better than what they usually take and they didn’t think I would actually come.

Interesting. I figured that there is some of that going on but my main point is that it is nowhere near as prevalent as some people on here make it sound. Like the classic SDN thing is to blame almost every non-interview place on something like that and my thought is that it isn't as simple as that and unfortunately there just isn't a way for us to know in a way that's generalizable to every (or even most) programs

 

[Ho0v-man]

Again, how do you know this. I've been a PD for ~13 years and I would never pass on a highly qualified applicant. This is a community program. My applicant position ratio is 100. One-half of them are literally junk. Our number to ranks/fill is 12 over the last 3 years. We have not gone unmatched for ~15 years.

Programs have their reach list as well, and if it those don't match, we run down the algorithm until we do. As should you.

I only got two community interviews. One was from an away and the PD told me she wouldn’t have taken me seriously had I not done the rotation because of how competitive I am.

 

[Redpancreas]

No one denies what your saying, but my comments came on your posting where you said;

"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."

Program rank and prestige is not only associated with "quality and quantity of research", but quality of training. These "top-tier" programs are that way because they have some of the best in the industry teaching, surgical volume, diversity of cases, research money and the list goes on. When you have access to all of what I just mentioned, your are going to be better equipped when you come out, that's just factual. That's not to say you can't have duds coming out and it also is not to say that someone from a mid-tier program can't be a rockstar, but generally speaking, when you finish at a top residency, you are going to be very well prepared....Leave it at that, no other argument to be made, what I said is just common sense.

No one knows for sure, but this goes against everything I've experienced in medicine.

First of all, the use of the word "industry" is questionable. Industry would imply residency selection is a meritocracy solely concerned on getting the best output. Medicine/residency selection is not a meritocracy, but an "old-money oligarchy" where certain programs in each state have essentially been designated as prestigious and have been resting on their laurels using heuristics like school tier to rank applicants. If medicine was an industry, we would have competency based interviews like software engineers where we basically sit down and are given problems and are asked to solve them.

If medicine was strictly about who knows the most relevant information and who can do the job the best, way more DOs and IMGs would be in top programs because we've got some killers. Instead, residency recruitment is skewed those with the prettiest resumes who meet the quotas residencies are trying to fill. There is no incentive to actually recruit talent because at the end of the day these programs aren't even competing with each other after the match is done.

 

[Lem0nz]

No one denies what your saying, but my comments came on your posting where you said;

"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."

Program rank and prestige is not only associated with "quality and quantity of research", but quality of training. These "top-tier" programs are that way because they have some of the best in the industry teaching, surgical volume, diversity of cases, research money and the list goes on. When you have access to all of what I just mentioned, your are going to be better equipped when you come out, that's just factual. That's not to say you can't have duds coming out and it also is not to say that someone from a mid-tier program can't be a rockstar, but generally speaking, when you finish at a top residency, you are going to be very well prepared....Leave it at that, no other argument to be made, what I said is just common sense.

This is wildly, completely false. Only at the top of the top levels in these institutions is this even partly true.

Maybe at the end of a two or three year fellowship in the last year if you’re the star child than you will get that sort of amazing training. But residents? That’s just not true. At all. I’ve been to those ivory towers and watched their 1st year fellows having to double scrub and hold a suction catheter. The residents were at the foot of the bed.

That is not world class training. That’s world class prestige. Nothing more. The name comes at a price. You have to narrow your scope dramatically or your training suffers. And there is only so much volume any surgeon can produce. Quite frankly, I didn’t see that sort of volume at the ivory towers either. Particularly for the senior surgeons who are the “world experts”. They’ve mostly retired. They may have some more complexity and reoperative volume and might be doing experimental surgery, but that is not what 99% of us will do after training, ever.

 

[The Med-Peds Dude]

I only got two community interviews. One was from an away and the PD told me she wouldn’t have taken me seriously had I not done the rotation because of how competitive I am.

Sorry, but one comment from one program does not make this a thing. I can imagine other reasons; I have a good imagination.

 

[longhaul3]

I'm sorry, but you are mistaken when you make such comments. Go look at top programs and see who comes out. Only on SDN would someone make a comment that is factually not true. Are there people that come out of "ranked" and "prestigious "programs" that are not spectacular, of course, but to say that "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" is just incorrect.

I disagree. At least in surgery, clinical ability and research productivity are largely independent.

Also, people all over the internet make comments that are factually not true.

No one denies what your saying, but my comments came on your posting where you said;

"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."

Program rank and prestige is not only associated with "quality and quantity of research", but quality of training. These "top-tier" programs are that way because they have some of the best in the industry teaching, surgical volume, diversity of cases, research money and the list goes on. When you have access to all of what I just mentioned, your are going to be better equipped when you come out, that's just factual. That's not to say you can't have duds coming out and it also is not to say that someone from a mid-tier program can't be a rockstar, but generally speaking, when you finish at a top residency, you are going to be very well prepared....Leave it at that, no other argument to be made, what I said is just common sense.

Not only is this not common sense, it's wrong. The "top-tier" places are "top-tier" because of institutional prestige and faculty notoriety. These days, there are very few famous academic faculty (at least in my field) who are famous because of their clinical mastery. In the past it was much more common, but today the top names are at the top because of their research, not because of their surgical ability outside of a few individuals.

On top of that, surgical training is only as good as what you are allowed to do in the OR. Operating with master surgeons at some places is often nothing more than watching. It is widely acknowledged in my field that graduates of some "top" programs are not fully trained at the end of residency and need to do a fellowship to be able to practice independently. Even still, they may only feel comfortable in a few specific subspecialty areas.

 

[Ho0v-man]

Sorry, but one comment from one program does not make this a thing. I can imagine other reasons; I have a good imagination.

True but multiple others have been in this situation too.

You’re also one person from one program. I’m not sure one person from one program means that much either.

 

[Neopolymath]

Sorry, but one comment from one program does not make this a thing. I can imagine other reasons; I have a good imagination.

Are you one of those people who needs a peer reviewed paper before believing things like water is wet? What I think is a plausible and defendable reason experienced by other applicants in multiple specialties is just as likely as... Wait, you never offered an explanation besides saying you in your one program in your one specialty don't do it so it isn't the reason... Yeah, hard to argue with someone who isn't actually saying anything or making any points lol. Go ahead and explain why with some realistic reasons so we can all be educated by your perspective on the other side, seriously.

Occam's razor here: I am quite literally a spitting image of a couple program's residents year after year in everything but way better board scores. I am from the area and show a track record of staying in the area. They take MDs, DOs, IMGs. I fit the mission statement to a T based on the PDs' mouths in their program info/meet and greets and via knowledge from alum of the programs. I have no red flags and have branded my application to target this type of program specifically. This was illustrated effective by other very, very similar community programs in the same geographic area lauding my application as an excellent fit for that type of program and by some academic programs saying that I don't fit their typical mold but they were intrigued why I would apply there given my community program branding/aspirations/style.

I have a personal relationship with a few PDs in a couple specialties and they say they yield protect due to app numbers and geography. It's brought up on SDN and reddit every year. We know some people in programs still don't understand how the match works based on the dumb stuff they say repeated by applicants on the trail every year.

This scenario for DO students isn't exactly controversial. Solid DO students mention this every year.

@Chibucks15 can think what he wants but I want to make one thing clear. I feel that he is putting words in my mouth saying that I'm using this as some crutch for my ego. That's bull****. I'm specifically trying to go to these programs, even tried to interview at some terrible ones because I would rather be there than move to Minnesota or whatever. I'm committed and since I didn't get an interview no one can say it's because I had a bad attitude at the interview and thought I was too good for them blah blah blah. When I didn't get an interview at Duke (random example) I didn't cry because I'm a DO who doesn't fit their mold in my app or my actual goals.

So I'm comically the same (the homogenous nature of these programs was brought up multiple times each year on the spreadsheets causing URMs to not even apply) but 20+ points higher on boards... Or because that's not a rigorously tested theory we can go with proposed option two: I had the wrong neck angle on my headshot and the Pds decided to suddenly only interview black women in radiology to turn the program 180. I'm using hyperbole clearly but I think the dismissive posts are lazy bull**** and certainly not more supported despite that ironically being the main argument against my thoughts on the matter apparently.

 

[Neopolymath]

I see that all over here people thinking “yield protection” is a widespread thing. It just makes no sense. Why do they think you sent an app in if you’re “too good for them”? Much more likely you overestimated your desirability or you don’t meet their mold of who they are looking for due to a myriad of reasons. But god forbid anybody accepts that fact...it’s gotta be that “I’m just too good for them and they know it”

This concept even exists at the med school application level...

 

[ohmanwaddup]

So I know it’s still early, but is there any word on if the doom and gloom cycle 2021 was supposed to be actually came true?

 

[tony101]

I think a limit on applications would be the incorrect route to go. Rather, I would argue for a limit on interviews, such as only being able to go to 20 or 30. However, the catch would be once you book an interview, you are NOT able to cancel it. (Only change dates if issues come up). So you can't just keep ditching programs for other interview invites to improve your list.

This way, you must carefully pick interviews and won't just take up a ton of interview spots. I would also suggest a limit of 1-2 weeks to book the interview, and if you take any longer, they move onto another candidate on their list. It seems like the real problem is people taking tons and tons of interview spots and never actually wanting to go to a program. Thus knocking out tons of candidates who are lower than them.

This way, if you scored a 260, you can't just mass spam an area and take up a spot in 40 programs when you actually only want to go to 10 of those 40. Of note, I am a DO and only applied to around ~30 programs, but I was extremely competitive. (Got around 27 interviews and only actually attended around 20) So I only applied to places I would want to go and then interviewed at places I wanted to be at (Didn't want to take up places for backup). However, I know people who applied to over 100 programs and interviewed at over 50 places, many places they didn't want to go to but were just using them as a backup.

However, this wouldn't really change the application flood problem PD's face. But I think my fix would help a ton of people going unmatched in the process since lower-tier candidates would have more of a chance of getting spots since higher-tier candidates can't just mass spam and take spots for fun.

 

[longhaul3]

I think a limit on applications would be the incorrect route to go. Rather, I would argue for a limit on interviews, such as only being able to go to 20 or 30. However, the catch would be once you book an interview, you are NOT able to cancel it. (Only change dates if issues come up). So you can't just keep ditching programs for other interview invites to improve your list.

I don't think this works unless programs coordinate to release their interview invitations at the same time. I know this is happening in a few specialties but I think it would have to be the standard in order to enforce a rule like this.

 

[Redpancreas]

I think a limit on applications would be the incorrect route to go. Rather, I would argue for a limit on interviews, such as only being able to go to 20 or 30. However, the catch would be once you book an interview, you are NOT able to cancel it. (Only change dates if issues come up). So you can't just keep ditching programs for other interview invites to improve your list.

This way, you must carefully pick interviews and won't just take up a ton of interview spots. I would also suggest a limit of 1-2 weeks to book the interview, and if you take any longer, they move onto another candidate on their list. It seems like the real problem is people taking tons and tons of interview spots and never actually wanting to go to a program. Thus knocking out tons of candidates who are lower than them.

This way, if you scored a 260, you can't just mass spam an area and take up a spot in 40 programs when you actually only want to go to 10 of those 40. Of note, I am a DO and only applied to around ~30 programs, but I was extremely competitive. (Got around 27 interviews and only actually attended around 20) So I only applied to places I would want to go and then interviewed at places I wanted to be at (Didn't want to take up places for backup). However, I know people who applied to over 100 programs and interviewed at over 50 places, many places they didn't want to go to but were just using them as a backup.

However, this wouldn't really change the application flood problem PD's face. But I think my fix would help a ton of people going unmatched in the process since lower-tier candidates would have more of a chance of getting spots since higher-tier candidates can't just mass spam and take spots for fun.

How does one even go on 50 interviews. Another thing to think about it is that an interview is just another way to get an excused absence from a rotation. There was a lot of grumbling back in the day about schools not letting students take days off but I haven't seen as much of that this year...but 50 interviews!?!? If we assume an interview each day that's interviewing straight for 2 months...not to mention there were probably gaps...

 

[Med Ed]

By 2020, are you talking this season about to finish up or last season? How about a season like 2019?

Last season.

ERAS statistics from 2019: 22,015 US MD seniors filed 1,358,520 applications, which calculates to 61.7 per applicant.

 

[Chibucks15]

Are you one of those people who needs a peer reviewed paper before believing things like water is wet? What I think is a plausible and defendable reason experienced by other applicants in multiple specialties is just as likely as... Wait, you never offered an explanation besides saying you in your one program in your one specialty don't do it so it isn't the reason... Yeah, hard to argue with someone who isn't actually saying anything or making any points lol. Go ahead and explain why with some realistic reasons so we can all be educated by your perspective on the other side, seriously.

Occam's razor here: I am quite literally a spitting image of a couple program's residents year after year in everything but way better board scores. I am from the area and show a track record of staying in the area. They take MDs, DOs, IMGs. I fit the mission statement to a T based on the PDs' mouths in their program info/meet and greets and via knowledge from alum of the programs. I have no red flags and have branded my application to target this type of program specifically. This was illustrated effective by other very, very similar community programs in the same geographic area lauding my application as an excellent fit for that type of program and by some academic programs saying that I don't fit their typical mold but they were intrigued why I would apply there given my community program branding/aspirations/style.

I have a personal relationship with a few PDs in a couple specialties and they say they yield protect due to app numbers and geography. It's brought up on SDN and reddit every year. We know some people in programs still don't understand how the match works based on the dumb stuff they say repeated by applicants on the trail every year.

This scenario for DO students isn't exactly controversial. Solid DO students mention this every year.

@Chibucks15 can think what he wants but I want to make one thing clear. I feel that he is putting words in my mouth saying that I'm using this as some crutch for my ego. That's bull****. I'm specifically trying to go to these programs, even tried to interview at some terrible ones because I would rather be there than move to Minnesota or whatever. I'm committed and since I didn't get an interview no one can say it's because I had a bad attitude at the interview and thought I was too good for them blah blah blah. When I didn't get an interview at Duke (random example) I didn't cry because I'm a DO who doesn't fit their mold in my app or my actual goals.

So I'm comically the same (the homogenous nature of these programs was brought up multiple times each year on the spreadsheets causing URMs to not even apply) but 20+ points higher on boards... Or because that's not a rigorously tested theory we can go with proposed option two: I had the wrong neck angle on my headshot and the Pds decided to suddenly only interview black women in radiology to turn the program 180. I'm using hyperbole clearly but I think the dismissive posts are lazy bull**** and certainly not more supported despite that ironically being the main argument against my thoughts on the matter apparently.

First of all, I never mentioned literally anyone in particular. Weird to get so passionate about a general statement. I stand by that some people (on here especially) default to it even though there really isn't proof in whichever specific case. This whole thing is a relative crapshoot anyway depending on whos reading your application, what time of day, what mood they're in, etc. You cannot tell me based on pure word of mouth that its a widespread thing when I can provide literally the same level of proof to the contrary. Which is what I said. Yes it happens, but it isn't everywhere, and blaming not getting an interview on it is also lazy and lacks self reflection on what other things could have been in your application differently. LORs for example.

Also, I'm not talking about regional ties like you brought up I'm talking purely numerical metrics. I'm saying its BS that a program would reject a 260 with 10 pubs outright over a 225 with 2 pubs all other things being equal. Regional ties and things that are more qualitative than quantitative (in my mind) are not yield protection in the same way. I'm not discounting whatever programs you said, but at least places I applied had people from all over and all different backgrounds.

I matched and am done with the rat race so I really could care less at this point. I've been on here with all y'all since day 1 and we've all always butted heads on a few different things, this being one of them. I can't control what you believe and all I'm doing is providing insight into a different mindset so people who just lurk don't get locked into one idea and can see it from a different angle that it isn't a certainty either way.

 

[Med Ed]

By 2020, are you talking this season about to finish up or last season? How about a season like 2019?

Other fun facts:

1990
3,487 programs
21,757 positions
93,873 applications
Average positions per program: 6.2
Average applications per program: 26.9

2020
5,859 programs
37,256 positions
1,416,061 applications
Average positions per program: 6.4
Average applications per program: 241.7

 

[ohmanwaddup]

Other fun facts:

1990
3,487 programs
21,757 positions
93,873 applications
Average positions per program: 6.2
Average applications per program: 26.9

2020
5,859 programs
37,256 positions
1,416,061 applications
Average positions per program: 6.4
Average applications per program: 241.7

These dont seem fun lol

 

[tony101]

How does one even go on 50 interviews. Another thing to think about it is that an interview is just another way to get an excused absence from a rotation. There was a lot of grumbling back in the day about schools not letting students take days off but I haven't seen as much of that this year...but 50 interviews!?!? If we assume an interview each day that's interviewing straight for 2 months...not to mention there were probably gaps...

He had a couple of online months and booked a ton of them during this time. The rest were during the rotations but only missed like 9 days during that time.

I don't think this works unless programs coordinate to release their interview invitations at the same time. I know this is happening in a few specialties but I think it would have to be the standard in order to enforce a rule like this.

That's a good point and I think that would be fine to try to make it more uniform. That way, it isn't a complete mess when everyone is applying.

 

[DrZoidbergDO]

Other fun facts:

1990
3,487 programs
21,757 positions
93,873 applications
Average positions per program: 6.2
Average applications per program: 26.9

2020
5,859 programs
37,256 positions
1,416,061 applications
Average positions per program: 6.4
Average applications per program: 241.7

those numbers are completely unsustainable in the long term. we def need reform of some kind.

 

[Med Ed]

those numbers are completely unsustainable in the long term. we def need reform of some kind.

Yes, indeed. I can understand why current applicants do not want their choices restricted, but blindly adhering to this principle will ultimately break the entire process. Extrapolate out far enough and every applicant will simply apply to every program in their field(s) of choice. Some already do.

 

[longhaul3]

Other fun facts:

1990
3,487 programs
21,757 positions
93,873 applications
Average positions per program: 6.2
Average applications per program: 26.9

2020
5,859 programs
37,256 positions
1,416,061 applications
Average positions per program: 6.4
Average applications per program: 241.7

those numbers are completely unsustainable in the long term. we def need reform of some kind.

The 1990 numbers also predate the internet, the advent of which probably accounted for a huge, discrete increase in applications due to a fundamental change in the way applications are sent and processed. I assume the growth has been more modest since 2000, for example, although I am sure it is still substantial.

 

[Lawpy]

Yes, indeed. I can understand why current applicants do not want their choices restricted, but blindly adhering to this principle will ultimately break the entire process. Extrapolate out far enough and every applicant will simply apply to every program in their field(s) of choice. Some already do.

What do you think could help?

 

[Neopolymath]

Actually, it's not "nonsense" per se. If I knew you're going to rank me #20 on your list, I wouldn't bother inviting you. Sure, you like to have the interview and one more rank because it marginally increases your chance of matching. But it's mostly a waste of our resources. Of course, there's often no way for us to know. That's how some programs end up using (perhaps) meaningless metrics -- like any connection to geographic area, etc.

Sorry for the notification, NAPD. Don't mind me here. I know you aren't part of this convo and I really think you shouldn't even waste your time reading it lol but I just found the timing funny that you said this in another thread.

Sorry, guys, I was wrong. This couldn't be a reasonable explanation for what I said. This doesn't happen.

THIS IS TOTALLY IMPLAUSIBLE AND IT MUST BE SOMETHING I DID /s

 

[Med Ed]

The 1990 numbers also predate the internet, the advent of which probably accounted for a huge, discrete increase in applications due to a fundamental change in the way applications are sent and processed. I assume the growth has been more modest since 2000, for example, although I am sure it is still substantial.

Total application volume from US seniors increased by 238,632 (20.4%) just from 2016-2020.

 

[Med Ed]

What do you think could help?

It doesn't matter. The Coalition for Physician Accountability has been tasked with finding a solution to the so-called UME to GME transition. We will patiently await their orders.

 

[ace_inhibitor111]

Regardless of application caps or not, there should be no reason for it to cost the amount of money it does to apply to programs on ERAS. I could understand if residency programs wanted to be compensated for their time, but they aren’t seeing any of the funds anyway, it’s all being used to fuel the AAMC. Also, using financial cost as a disincentive for overapplying leads to a bunch of problems as you can imagine.

 

[Espressso]

Regardless of application caps or not, there should be no reason for it to cost the amount of money it does to apply to programs on ERAS. I could understand if residency programs wanted to be compensated for their time, but they aren’t seeing any of the funds anyway, it’s all being used to fuel the AAMC. Also, using financial cost as a disincentive for overapplying leads to a bunch of problems as you can imagine.

The only reason it costs the amount it does is because it's a total racket. Similar to NBOME and the COMLEX, in particular the PE. Total, mobster stuff. And the poor applicants suffer the most, particularly low income applicants. PDs and Programs are handcuffed as well so they don't have much of a chance to fix it.

 

[valuat]

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

ERAP would mainly benefit AMGs. Is it your goal?
Interview cap seems more sensible to me.
YMMV though.

 

[valuat]

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.

It's an estimate, i.e., it depends on many assumptions that may, or may not, be even remotely close to reality.

"Using NRMP data, the authors estimated" from here (Myth #6): On Toilet Paper and Application Caps

 

[deleted645092]

We need to control the continuing flood of applications especially with the recent news of more people going unmatched this year. App caps with a reasonable cap set for each specialty are the way to go

More people went unmatched this year (if even true, no numbers have been released for applicants) because there were more applicants, plain and simple. There is some regional metrics report available for all of us on NRMP showing that there was no difference from previous years in terms of number of unfilled programs. The Match was technically even more successful for everything but family Med, IM, and surgery because there were almost zero spots left unfilled for things like rads, anesthesia, and EM; EM had 14 unfilled spots total around the country with half of those being a single program.

 

[deleted645092]

I'm trying to figure out how you know/why you think these community programs ghosted you because you are too good for them. I've been doing this for a long time, and I'm not familiar with this concept.

I don’t remember if it was this thread or the ERAS panic thread but there’s someone who claims to be involved in the process who admitted as such. They specifically said “if I think for any reason you’re making your ranklist and I’m going to fall at #20, I’m not going to even invite you for an interview”. Paraphrased.

So I believe that yield protection occurs. Where I start getting annoyed with people is when they start talking about “myself and others didn’t get as many as we’d get in a normal year, gosh darn COVID and people over applying”.

 

[valuat]

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?

So you have a 236 but interview really well and have great LOR?

That's me right there. I ranked 11 programs, 9 of them really top academic ones (bottom 2 on my list were "OK" community programs in the city I live and served as my safety net).

I MATCHED. Hopefully in one of those 9 top academic programs. I would have NOT had a chance had programs implemented "hard cut-off" rules. Let alone "application caps". Interview caps make more sense to me but at the end of the day this is all a gimmick to increase "equality".

 

[valuat]

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.

So you'd rather have your mother/father/son/daughter be operated on by a US MD solely because you feel they should have first dibs? Shouldn't taxpayers get the best irrespectively of where they come from?

 

[Chibucks15]

So you'd rather have your mother/father/son/daughter be operated on by a US MD solely because you feel they should have first dibs? Shouldn't taxpayers get the best irrespectively of where they come from?

Was gonna take this on but I feel this is a slippery slope towards SPF territory and is just a way to get burnt at the stake...in short, yes but its complicated. If a US grad meets all criteria set by the US to establish competent physicians then yes they should get the opportunity to practice medicine in this country over someone who is trained to a different countries set of standards and protocols. There are a million very complex things in this that aren't warranted to get into on a spot like this.

 

[valuat]

Was gonna take this on but I feel this is a slippery slope towards SPF territory and is just a way to get burnt at the stake...in short, yes but its complicated. If a US grad meets all criteria set by the US to establish competent physicians then yes they should get the opportunity to practice medicine in this country over someone who is trained to a different countries set of standards and protocols. There are a million very complex things in this that aren't warranted to get into on a spot like this.

USMLE Steps true believer, are you not?

If you ask me these exams are rubbish (you'll do well if you're Anki-savvy); I actually think Step 2 CS is the best one (though far from perfect).

I'd agree with you if we had an unequivocal way of making sure any given US applicant would "meet all criteria set by the US to establish competent physicians".

We don't.

And bear in mind that being trained abroad does not mean being trained at lower standards. Don't fall into the overgeneralization trap.

 

[Steve_Zissou]

USMLE Steps true believer, are you not?

If you ask me these exams are rubbish (you'll do well if you're Anki-savvy); I actually think Step 2 CS is the best one (though far from perfect).

I'd agree with you if we had an unequivocal way of making sure any given US applicant would "meet all criteria set by the US to establish competent physicians".

We don't.

And bear in mind that being trained abroad does not mean being trained at lower standards. Don't fall into the overgeneralization trap.

Do we have an unequivocal way to make sure any given non-US applicant meets “all criteria set by the US to establish competent physicians”?

You’re right that being trained abroad does not necessarily mean trained to lower standards, but we do have a standardized way of training people here in the US (for the most part).

Also, CS is trash.

 

[valuat]

Do we have an unequivocal way to make sure any given non-US applicant meets “all criteria set by the US to establish competent physicians”?

You’re right that being trained abroad does not necessarily mean trained to lower standards, but we do have a standardized way of training people here in the US (for the most part).

Also, CS is trash.

Exactly. The Steps are all we've got. And IIRC, matched IMG's stats are higher than matched AMG's stats. (could be wrong, though)

About Step 2 CS: this is a contentious topic and the point of the post was not to revisit it. That said:
- Expensive, for sure. Unrealistic, arguable. Trash, hardly.
- Cases are easy (you're assessing M4's not Gregory House). It shouldn't take you more than 10/15 minutes to figure them out and 10 min to write a decent note and plan. It's the absolute minimum.
- Memorizing how the expression of gene XYX changes by activation of receptor ABC by drug RUBISHIMAB is way less useful (at this stage).

 

[Goro]

- Memorizing how the expression of gene XYX changes by activation of receptor ABC by drug RUBISHIMAB is way less useful (at this stage).

I feel your pain. I'm waiting for the eventual release of WhambamthankyouMab.

 

[Steve_Zissou]

Exactly. The Steps are all we've got. And IIRC, matched IMG's stats are higher than matched AMG's stats. (could be wrong, though)

About Step 2 CS: this is a contentious topic and the point of the post was not to revisit it. That said:
- Expensive, for sure. Unrealistic, arguable. Trash, hardly.
- Cases are easy (you're assessing M4's not Gregory House). It shouldn't take you more than 10/15 minutes to figure them out and 10 min to write a decent note and plan. It's the absolute minimum.
- Memorizing how the expression of gene XYX changes by activation of receptor ABC by drug RUBISHIMAB is way less useful (at this stage).

The steps aren’t all we’ve got though. We’ve got the steps AND nationally standardized training overseen by US entities.

You dismiss much of the non-minutiae portions of the steps. Being able to ask a fake patient about fake symptoms while they badly fake everything is less useful than knowing causes, presentation and treatments of cardio/GI/pulm/etc.

 

[valuat]

I feel your pain. I'm waiting for the eventual release of WhambamthankyouMab.

I'm a cancer researcher. It's actually joy, not pain. But I believe most people simply don't care or don't need to care.

 

[ohmanwaddup]

So you'd rather have your mother/father/son/daughter be operated on by a US MD solely because you feel they should have first dibs? Shouldn't taxpayers get the best irrespectively of where they come from?

No, I think that when there is this much debt involved those American tax dollars are best spent on American graduates, so as to not waste the massive investment taxpayers have been funding throughout that students medical education, and as to not ruin the lives of American graduates.

 

[DokterMom]

I started out as a fan of interview caps, but after reading those two very interesting articles/studies, have become a convert of the ERAP Two-Step.

"The ERAP consists of a two-round residency application system in which the first round is capped at 5 applications (and 3 interviews). Applicants who do not match in the first round can apply to an unlimited number of programs in the second round."​

While it would definitely up the gamesmanship aspect of the residency application process, it also targets the specific problems of the current system -- over-application on the part of med students and over-reliance on 'convenience screens' by programs.

• The cream-skimming potential interview-hoarders would potentially be funneled off early
• Programs would be highly-motivated to favor ERAP applicants before opening the 'floodgates' to applicants of unknown interest
• The need for back-up specialties would be largely mitigated
• The proportion of applicants matching at their genuinely preferred programs would, I think, increase greatly.
• Yield-protection practices would be largely eliminated in the first round

I'm sure it would create its own set of trickle-down problems, so am very curious to see how well it works for the OB/GYN match this year --

 

[Redpancreas]

No, I think that when there is this much debt involved those American tax dollars are best spent on American graduates, so as to not waste the massive investment taxpayers have been funding throughout that students medical education, and as to not ruin the lives of American graduates.

American taxpayers don’t care about US medical education or what’s happening to people who are SOAPing right now. They only care about how good they think their doctor is, not his or her path. Born and raised here, even I've been asked what country I'm fromt and often they confided in me they want a foreign doctor taking care of them because they've heard they are smarter. Politically, these are the same Americans who align themselves with the bolded policy not for the reasons you or I care about, but to further their politically right world view. You can’t expect world class care and by the same token expect that US grads are all prioritized. To a large extent in residency recruitment, they already are. Additionally:

1.) IMGs who train here plan to stay here so medicare dollars are being allocated to future American providers regardless.
2.) Many U.S. schools are not government subsidized/funded.
3.) American graduates (myself included) choose not to practice the primary care our country desperately needs. IMGs are not more willing, but will take it over what else is offered to them.