P=MD, the Most Glorious Equation

[PL198]

Which is why the best standardized test-takers aren't necessarily the best clinicians (unless their patients have multiple choice answers tattooed to their bodies). Some people love to memorize and regurgitate information (and quiz people in clubs about them. lol.). There's a huge leap from basic science to clinical medicine. You have to be ok with dealing with uncertainty. Or you end up like Cornelius (11:27):

Dang I was gonna go after michelle till I heard her speak

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[Frazier]

So all the hard work us "gunner/nerds" do earn us your disdain and mockery. It is amazing that you have found out that the secret to success is hard work, and yet you aren't willing pay the price. In order to sooth yourself you resort to labeling people who do value the sacrifice and are willing to work hard for it. You are most likely going to be a substandard physician in a weak specialty that is always tearing down people who matched into competitive specialties because after all is said and done you will regret over the long long long long course of your boring career that you didn't put in a mere 2 years of effort to be able to do something interesting. Just be honest with yourself, look in the mirror and admit that your own comfort and "social life" is more important than the next 20 years. Don't drag others into your sad fiction of a life.

I know that many things might be black or white for you and that shows clearly in your post... I don't know what is a 'weak specialty' for you. Lol (that deserves a laugh). I happen to know 2 people that score 240+ in step 1 and just applied for FM/psych for the 2014-2015 match....

BestDoctorEver beat me to it.

I agree with you Shjanzey in that it isn't good to criticize others -- however, there is no such thing as a "weak specialty". They all play an integral role in modern healthcare -- from FM to PRS, from Peds to Geri, from Rads to Psych, from OBGYN to Uro, from Palliative care to REI.

Perhaps the adjective you were looking for was "noncompetitive"?

 

[BestDoctorEver]

Beat me to it.

I agree with Shjanzey that it isn't good to criticize others -- however, there is no such thing as a weak specialty. They all play an integral role in modern healthcare -- from FM to PRS, from Peds to Geri, from Rads to Psych, from Palliative care to REI.

Perhaps you just meant to say "noncompetitive"?

I never in anyway criticize others... My post that he/she quoted was a way to say that people might have different priorities...

 

[Frazier]

I never in anyway criticize others... My post that he/she quoted was a way to say that people might have different priorities...

I wasn't commentating on what you might have said or didn't say... although I can see how my post read like that.

Rather, I am commenting (in a vacuum) that I agree it isn't good to criticize others, but the idea that particular medical specialties are "weak" is erroneous, IMO.

 

[Shjanzey]

BestDoctorEver beat me to it.

I agree with you Shjanzey in that it isn't good to criticize others -- however, there is no such thing as a "weak specialty". They all play an integral role in modern healthcare -- from FM to PRS, from Peds to Geri, from Rads to Psych, from OBGYN to Uro, from Palliative care to REI.

Perhaps the adjective you were looking for was "noncompetitive"?

Yea I see what you are saying. Perhaps I should have worded it as limiting yourself to a subset of specialties due to an underwhelming performance.

I never in anyway criticize others... My post that he/she quoted was a way to say that people might have different priorities...

Calling people nerds/gunners seems fairly critical to me.

 

[HLxDrummer]

A lot of medical students seem to get this wrong. You don't have tests to quiz you extensively on the very common things. You will see the very common things ad nauseum in clinic or in the hospital. If you're on peds why would they show you a picture of hand-foot-mouth when you've seen it a million times? Tests are to make sure that you've covered those common things as well as to make sure that you have exposure to the uncommon things so that you might be able to catch those zebras if they come up. If it never comes up, that's good. If it does, you should catch it. The buck ends with you as an attending. I don't understand these medical students who say that they will refer out the difficult cases to academic centers as if there isn't good medicine being practiced in the community. It's a terrible attitude and doesn't reflect the reality of the situation.

Everyone should try to do their best, not match their efforts to the minimum required for the field that they are planning on based on preconceived notions developed from a quick glance at charting the outcomes. It's not "oh I'm interested in EM so I just want a 230". It should be "I want to know a lot of things to be a great doctor and I'm planning on EM so I will work as hard as I can". How are you going to "understand the big picture" if you don't know the details? I see people whining about having to know about straight tubules but how can you understand the kidneys if you don't understand each part of it? Absurd

Trust me, I want to learn as much as possible and be the best doctor I can. I was actually going to do nursing but switched because I didn't think I would be satisfied not knowing/understanding as much as possible.

But at the same time, you can only do/remember so much. Sure I could study until I go to bed every night like in undergrad but I would be exhausted, miserable, and probably an alcoholic. Instead I spend a few hours with my wife and my overall well being is a million times better. With these few hours I skip studying, I have to decide what to focus on. As a third year, memorizing the metabolic pathways and every transporter protein in the kidney probably isn't the best use of my time.

I would be thrilled if I could not be miserable and have all that stuff memorized but it isn't possible for me. If you and other people can, that's great. I know that being a physician is a huge responsibility and I worry a lot about the chance of me forgetting one thing that leads to a bad outcome for a patient. However, I am a human and can only do so much. I can learn/understand the big picture and do a quick google search to jog my memory of random stuff I chose not to memorize (do you have every dosing schedule for every drug memorized? Catch up schedules for vaccines? Chemo protocols?).

Also, I can explain to a ten year old that your kidneys filter your blood and makes urine. You don't need to know the intracellular pathway for every protein to get the big picture. I can understand that NSAIDs are bad for kidneys because they constrict the afferent arteriolar and cause decreased blood flow without knowing the exact mechanism. That is the difference between a basic scientist and a clinician.

I worked with a PhD that probably knew more than you ever will about the cardiovascular system. Does that mean you are going to be a bad physician?

 

[ChEMD]

Trust me, I want to learn as much as possible and be the best doctor I can. I was actually going to do nursing but switched because I didn't think I would be satisfied not knowing/understanding as much as possible.

But at the same time, you can only do/remember so much. Sure I could study until I go to bed every night like in undergrad but I would be exhausted, miserable, and probably an alcoholic. Instead I spend a few hours with my wife and my overall well being is a million times better. With these few hours I skip studying, I have to decide what to focus on. As a third year, memorizing the metabolic pathways and every transporter protein in the kidney probably isn't the best use of my time.

I would be thrilled if I could not be miserable and have all that stuff memorized but it isn't possible for me. If you and other people can, that's great. I know that being a physician is a huge responsibility and I worry a lot about the chance of me forgetting one thing that leads to a bad outcome for a patient. However, I am a human and can only do so much. I can learn/understand the big picture and do a quick google search to jog my memory of random stuff I chose not to memorize (do you have every dosing schedule for every drug memorized? Catch up schedules for vaccines? Chemo protocols?).

Also, I can explain to a ten year old that your kidneys filter your blood and makes urine. You don't need to know the intracellular pathway for every protein to get the big picture. I can understand that NSAIDs are bad for kidneys because they constrict the afferent arteriolar and cause decreased blood flow without knowing the exact mechanism. That is the difference between a basic scientist and a clinician.

I worked with a PhD that probably knew more than you ever will about the cardiovascular system. Does that mean you are going to be a bad physician?

The goal during medical school is to learn as much as possible, period. There is a difference between people like you who study as much as they can while staying sane and people that purposely neglect studying certain details because they don't want to learn it because it's not "high yield". I think that's what people like Psai are trying to get at.

 

[Ismet]

The goal during medical school is to learn as much as possible, period. There is a difference between people like you who study as much as they can while staying sane and people that purposely neglect studying certain details because they don't want to learn it because it's not "high yield". I think that's what people like Psai are trying to get at.

This exactly.

 

[PL198]

The goal during medical school is to learn as much as possible, period. There is a difference between people like you who study as much as they can while staying sane and people that purposely neglect studying certain details because they don't want to learn it because it's not "high yield". I think that's what people like Psai are trying to get at.

That's your interp. It's not inherently wrong if someone else has a different view than you. If you try to learn as much as possible, you'll probably end up with better career prospectives compared to the avg person that doesn't, but that doesn't make it the hard and fast rule for what being a student entails.

 

[GadRads]

The goal during medical school is to learn as much as possible, period. There is a difference between people like you who study as much as they can while staying sane and people that purposely neglect studying certain details because they don't want to learn it because it's not "high yield". I think that's what people like Psai are trying to get at.

How do you know someone hasn't learned as much as possible? There is this irritating idea in medicine that one can know everything. It is very pretentious. You can study 24 hours a day and you won't know everything.

 

[ChEMD]

How do you know someone hasn't learned as much as possible? There is this irritating idea in medicine that one can know everything. It is very pretentious. You can study 24 hours a day and you won't know everything.

You realize that's exactly what I'm saying right? Try your best and learn as much as you can while still maintaining a level of happiness and sanity that you're comfortable with. Obviously that's going to mean different things for different people.

 

[touchpause13]

You realize that's exactly what I'm saying right? Try your best and learn as much as you can while still maintaining a level of happiness and sanity that you're comfortable with. Obviously that's going to mean different things for different people.

That's my goal. Unfortunately I've been having some difficulty adjusting but I do my best to learn as much as I can, try different methods, start studying early, keep up on the lectures, all of that. But some subjects are just hard for me. I'm not going to kill myself studying 12 hours a day every day in order to maybe get a B+. I'll keep putting in the work, but I need to keep working out, keeping spending time with family and friends or else I'll drive myself mad.

 

[Psai]

How do you know someone hasn't learned as much as possible? There is this irritating idea in medicine that one can know everything. It is very pretentious. You can study 24 hours a day and you won't know everything.

No one says you should know everything. It's impossible. Just saying that you should try your best. Also pretentious is a word people here seem to use for people that are better than them but aren't actively going of their way to make them feel bad

 

[EMDO2018]

I have 2 exams tomorrow, staying up until 2am to study.

 

[Ismet]

I have 2 exams tomorrow, staying up until 2am to study.

You go Glen Coco!

 

[demayette]

So all the hard work us "gunner/nerds" do earn us your disdain and mockery. It is amazing that you have found out that the secret to success is hard work, and yet you aren't willing pay the price. In order to sooth yourself you resort to labeling people who do value the sacrifice and are willing to work hard for it. You are most likely going to be a substandard physician in a weak specialty that is always tearing down people who matched into competitive specialties because after all is said and done you will regret over the long long long long course of your boring career that you didn't put in a mere 2 years of effort to be able to do something interesting. Just be honest with yourself, look in the mirror and admit that your own comfort and "social life" is more important than the next 20 years. Don't drag others into your sad fiction of a life.

That is the most idiotic statement that I have read in SDN... Your status said premed, that is probably why your are labeling specialties as 'weak', 'interesting' etc...

 

[Ismet]

That is the most idiotic statement that I have read in SDN... Your status said premed, that is probably why your are labeling specialties as 'weak', 'interesting' etc...

He's an MS1, and he already stated that that was a bad choice of words.

 

[demayette]

He's an MS1, and he already stated that that was a bad choice of words.

I guess that is say it all... He seems to be a very arrogant MS1 who thinks he will know it all in med school. Good luck to him though!

 

[PL198]

I feel like a significant amount of the competition in residency applications is about location and programs sooo using the profession as a gauge of someone's "life progress" or whatever is probably pretty stupid. ie matching into rads at some community hospital is probably easier than matching into FM in a great program.

 

[Ismet]

I guess that is say it all... He seems to be a very arrogant MS1.

I think we've all had our share of foot-in-mouth.

We all know the people who come into med school hardcore neurosurg or ortho, then pre-clinical and step 1 hits and now they're considering IM and peds. Then you have the people who call "gunner" when they see someone studying hard, which is not the appropriate use of that term, and it usually is a sign of jealousy. You gotta put in the work to get what you want, and respect the work that others do in order to get what they want. I think that's the general sentiment he was trying to achieve. You can't sit back and whine about other people doing better than you when they're putting in more work than you.

 

[demayette]

I feel like a significant amount of the competition in residency applications is about location and programs sooo using the profession as a gauge of someone's "life progress" or whatever is probably pretty stupid. ie matching into rads at some community hospital is probably easier than matching into FM in a great program.

Tel that to that kiddo @Shjanzey that is already labeling specialties an 'uninteresting' and 'weak'. The level of narcissism and self righteousness I have seen in some of these posts here is beyond belief.

 

[Mad Jack]

So all the hard work us "gunner/nerds" do earn us your disdain and mockery. It is amazing that you have found out that the secret to success is hard work, and yet you aren't willing pay the price. In order to sooth yourself you resort to labeling people who do value the sacrifice and are willing to work hard for it. You are most likely going to be a substandard physician in a weak specialty that is always tearing down people who matched into competitive specialties because after all is said and done you will regret over the long long long long course of your boring career that you didn't put in a mere 2 years of effort to be able to do something interesting. Just be honest with yourself, look in the mirror and admit that your own comfort and "social life" is more important than the next 20 years. Don't drag others into your sad fiction of a life.

While I agree with the sentiment of your post in general, there's no such thing as a "weak" specialty, only weak physicians within a specialty. Any physician can excel in their specialty of choice, but the type of physician who chooses to be lazy in med school will likely choose to be lazy in practice.

 

[demayette]

I think we've all had our share of foot-in-mouth.

We all know the people who come into med school hardcore neurosurg or ortho, then pre-clinical and step 1 hits and now they're considering IM and peds. Then you have the people who call "gunner" when they see someone studying hard, which is not the appropriate use of that term, and it usually is a sign of jealousy. You gotta put in the work to get what you want, and respect the work that others do in order to get what they want. I think that's the general sentiment he was trying to achieve. You can't sit back and whine about other people doing better than you when they're putting in more work than you.

It's not only that... He was telling one poster that 'you are going to be a substandard physician' Lol... I would not call that 'foot-in-mouth'. I have seen people use the term gunners loosely here all the time as way of saying the smartest people or the ones who study the most in the class. I did not see anything bad in what 'bestdoctorever' said for him to go on a self-important rant like that...

 

[Ismet]

It's not only that... He was telling one poster that 'you are going to be a substandard physician' Lol... I would not call that 'foot-in-mouth'. I have seen people use the term gunners loosely here all the time as way of saying the smartest people or the ones who study the most in the class. I did not see anything bad in what 'bestdoctorever' said for him to go on a self-important rant like that...

Yes, it was an unnecessary overreaction. However, "gunner" still has quite a negative connotation to it, even though it is typically used incorrectly, and that's probably what he took offense to.

Idk why I even got into this lol

 

[DermViser]

It's not only that... He was telling one poster that 'you are going to be a substandard physician' Lol... I would not call that 'foot-in-mouth'. I have seen people use the term gunners loosely here all the time as way of saying the smartest people or the ones who study the most in the class. I did not see anything bad in what 'bestdoctorever' said for him to go on a self-important rant like that...

Take what he said in context (as much as I hate to defend him):
So all the hard work us "gunner/nerds" do earn us your disdain and mockery. It is amazing that you have found out that the secret to success is hard work, and yet you aren't willing pay the price. In order to sooth yourself you resort to labeling people who do value the sacrifice and are willing to work hard for it. You are most likely going to be a substandard physician in a weak specialty that is always tearing down people who matched into competitive specialties because after all is said and done you will regret over the long long long long course of your boring career that you didn't put in a mere 2 years of effort to be able to do something interesting. Just be honest with yourself, look in the mirror and admit that your own comfort and "social life" is more important than the next 20 years. Don't drag others into your sad fiction of a life.

 

[DermViser]

Yes, it was an unnecessary overreaction. However, "gunner" still has quite a negative connotation to it, even though it is typically used incorrectly, and that's probably what he took offense to.

Idk why I even got into this lol

It's essentially the "med school equivalent" of calling someone the n-word. Call someone a gunner to their face and the gloves are off.

 

[EMDO2018]

I meant to ask if residency matching has a strong regional bias like med school admissions? Hopefully not as strong as med school admissions. I need to get out of the south, maybe move to the northeast

 

[demayette]

Yes, it was an unnecessary overreaction. However, "gunner" still has quite a negative connotation to it, even though it is typically used incorrectly, and that's probably what he took offense to.

Idk why I even got into this lol

I may be overreacting too... But I have seen so many times here that people have a VERY skewed notion of what practicing medicine is like... It is not all ROSY out there...

 

[DermViser]

I meant to ask if residency matching has a strong regional bias like med school admissions? Hopefully not as strong as med school admissions. I need to get out of the south, maybe move to the northeast

Not as bad as medical school admissions, bc residency spots are generally federally funded thru Medicare. That being said, I'm sure the Northeast will find you as insufferable as the South. The NE can tend to be more hardcore when it comes to tradition.

 

[DermViser]

I may be overreacting too... But I have seen so many times here that people have a VERY skewed notion of what practicing medicine is like... It is not all ROSY out there...

Yes, we call that Pre-Allo.

 

[EMDO2018]

Not as bad as medical school admissions, bc residency spots are generally federally funded thru Medicare. That being said, I'm sure the Northeast will find you as insufferable as the South. The NE can tend to be more hardcore when it comes to tradition.

Sure, but is it cold?

 

[DermViser]

Sure, but is it cold?

What do you think?

 

[EMDO2018]

Eh... I can adjust to the cold, but if I had kids I would NOT want them to grow up in the south.

 

[demayette]

Yes, we call that Pre-Allo.

It's not only pre-Allo... I see that here all the time too.

 

[DermViser]

Eh... I can adjust to the cold, but if I had kids I would NOT want them to grow up in the south.

If you think people in the Northeast are any less racist, then I'll think you'll be quite surprised.

 

[EMDO2018]

If you think people in the Northeast are any less racist, then I'll think you'll be quite surprised.

Um it most likely is less racist, but that's not my concern people are racist everywhere, I just really don't like southern culture. People are fat, uneducated, hyper religious, backwards, close minded and yes more racism here than anywhere else. Plus I think the New England area is really nice looking and community is stressed there more, has better schools, etc . The thing that gets me about the south is the amount of poverty, and ignorance here, the bible thumping and fakeness really get to ya. Plus, averaging 95 degress in the summers with hellish humidity isn't great.

 

[Ismet]

Um it most likely is less racist, but that's not my concern people are racist everywhere, I just really don't like southern culture. People are fat, uneducated, hyper religious, backwards, close minded and yes more racism here than anywhere else. Plus I think the New England area is really nice looking and community is stressed there more, has better schools, etc . The thing that gets me about the south is the amount of poverty, and ignorance here, the bible thumping and fakeness really get to ya. Plus, averaging 95 degress in the summers with hellish humidity isn't great.

All of those things happen in the northeast.

 

[deleted480308]

Um it most likely is less racist, but that's not my concern people are racist everywhere, I just really don't like southern culture. People are fat, uneducated, hyper religious, backwards, close minded and yes more racism here than anywhere else. Plus I think the New England area is really nice looking and community is stressed there more, has better schools, etc . The thing that gets me about the south is the amount of poverty, and ignorance here, the bible thumping and fakeness really get to ya. Plus, averaging 95 degress in the summers with hellish humidity isn't great.

yeah people who make sweeping assumptions based on irrelevant characteristics like geography like race and religion sure are losers

 

[PL198]

yeah people who make sweeping assumptions based on irrelevant characteristics like geography like race and religion sure are losers

lol I don't get how irony like this isn't self-apparent.

 

[Venonat]

You should do your best in medical school because knowledge is its own reward, not to get into the specialty of your dreams.

I mean, I know it's tempting to say "I'm going to do amazing in this stuff and get into Neurosurgery."

But specialties like Rad Onc, Rads, and Ortho were uncompetitive a few decades ago. And as I found out at an IM panel, people who went into Cardio at the turn of the millennium for the money ended up disappointed when the powers that be at Medicare slashed their reimbursement.

(Sub)specialties like Urology and Gastroenterology are competitive now. One CMS meeting and they will be on the competitiveness level of Psychiatry (or whatever).

 

[touchpause13]

Northern racism is very much alive, it's just a bit different. At least in the Midwest we generally avoid conflict all at costs so you would experience more passive aggressive racism than anything. Also the population makes a big difference. White Northerners tend to not have a lot of experience interacting with a person of color and may say stupid stuff because of it. I mean come on this is America, you aren't going to find any part of the country that's not racist. You also arent going to find a part of the country without any poor or fat people. And while the NE may not give a damn about religious traditions, WASPs have their own strict sets of conditions and you'll also be dealing with a lot of old money which is a type within itself.

 

[PL198]

Northern racism is very much alive, it's just a bit different. At least in the Midwest we generally avoid conflict all at costs so you would experience more passive aggressive racism than anything. Also the population makes a big difference. White Northerners tend to not have a lot of experience interacting with a person of color and may say stupid stuff because of it. I mean come on this is America, you aren't going to find any part of the country that's not racist. You also arent going to find a part of the country without any poor or fat people. And while the NE may not give a damn about religious traditions, WASPs have their own strict sets of conditions and you'll also be dealing with a lot of old money which is a type within itself.

you will never find another organism that is not racist. it's a completely normal biological response.

 

[Venonat]

you will never find another organism that is not racist. it's a completely normal biological response.

There are some things that are intrinsic to the human condition, no matter how much we would wish it otherwise, and racism is one of those things.

 

[touchpause13]

you will never find another organism that is not racist. it's a completely normal biological response.

Idk about normal but I'd agree that everyone has racist ideas/tendencies. We all grew up in a racist society, it's impossible not to internalize some of it. It's just what you choose to do with that, that makes a difference. Do you have a racist thought and then go "why did I think that, that's incorrect? " or do you go "I'm going to act on that"

 

[PL198]

Idk about normal but I'd agree that everyone has racist ideas/tendencies. We all grew up in a racist society, it's impossible not to internalize some of it. It's just what you choose to do with that, that makes a difference. Do you have a racist thought and then go "why did I think that, that's incorrect? " or do you go "I'm going to act on that"

I don't say it's incorrect, because it is correct biologically.

From my experience, the people that tend to actually act most racist are the ones that outwardly work towards preventing people thinking they are racist. such as a catholic mother who hosts an advocacy group for diversity, but the moment her daughter talks to a black guy, she freaks out and it can't happen. vs I know people that make racial jokes and people would outwardly call them racist, yet if someone from another race as them carries their own weight, they couldn't care less about the person's race.

 

[touchpause13]

I don't say it's incorrect, because it is correct biologically.

From my experience, the people that tend to actually act most racist are the ones that outwardly work towards preventing people thinking they are racist. such as a catholic mother who hosts an advocacy group for diversity, but the moment her daughter talks to a black guy, she freaks out and it can't happen. vs I know people that make racial jokes and people would outwardly call them racist, yet if someone from another race as them carries their own weight, they couldn't care less about the person's race.

I know both of the types, functionally I don't see much of a difference between the two in the amount of harm they cause.

 

[PL198]

I know both of the types, functionally I don't see much of a difference between the two in the amount of harm they cause.

I wouldn't say either intrinsically cause harm. I'm completely fine with people being racist, they should just be able to admit it. We prefer humans over other animals, because they are more similar to us. Why would this comparison stop at the species level?

 

[touchpause13]

I wouldn't say either intrinsically cause harm. I'm completely fine with people being racist, they should just be able to admit it. We prefer humans over other animals, because they are more similar to us. Why would this comparison stop at the species level?

Have you ever heard of the term minority stress?

I'm saying that racists cause harm to the people they are racist against. While you may be fine with people being racist in general, just personally I'm not okay with someone saying my race makes me somehow lesser. I think most people would agree with me. Going beyond racist words, you also have to consider racist actions such as hate crimes, creating racist policies, etc etc.

 

[Venonat]

Idk about normal but I'd agree that everyone has racist ideas/tendencies. We all grew up in a racist society, it's impossible not to internalize some of it. It's just what you choose to do with that, that makes a difference. Do you have a racist thought and then go "why did I think that, that's incorrect? " or do you go "I'm going to act on that"

Agreed. You can't live underwater and not get wet.

When the OKCupid founder came out with his Dataclysm thing that showed the brutal racial realities of online dating, a lot of people got angry because they claimed not to be racist, yet there choices reflected the exact opposite.

Well, perhaps you are not consciously racist, but we all grew up in a world where whites reap the benefit of centuries of entrenched privilege, and the media and Hollywood do their best to buttress this. Combine that with the human propensity to prefer their own kind, and how can you not end up with racism?

 

[DrEnderW]

You should do your best in medical school because knowledge is its own reward, not to get into the specialty of your dreams.

I mean, I know it's tempting to say "I'm going to do amazing in this stuff and get into Neurosurgery."

But specialties like Rad Onc, Rads, and Ortho were uncompetitive a few decades ago. And as I found out at an IM panel, people who went into Cardio at the turn of the millennium for the money ended up disappointed when the powers that be at Medicare slashed their reimbursement.

(Sub)specialties like Urology and Gastroenterology are competitive now. One CMS meeting and they will be on the competitiveness level of Psychiatry (or whatever).

Are you serious?

I can't relate to this is any way. Of course a huge reason I'm busting my *** is to get the specialty I want. Who cares how competitive a specialty was 10 years ago or could be in 10 years, the only going that matters to me is how competitive it is on match day.

There's colossal differences between specialties. Just because you're going to be a doctor doesn't mean you're going to be the doctor you want. The differences between being in outpatient psych and CV surgery at a huge academic center are almost as dissimilar as completely unrelated careers. People don't pick their specialty, the majority of the time, based on perceived current competitiveness or arbitrarily.

If someone wants to do NS and has 7 publications on the subject and wants to slog through that residency, they likely have developed some passion for the field. It makes 100% sense to do all you can if that's what you want to do for the next 40 years not only because "knowledge is its own reward." If you want to do Uro or GI now it doesn't matter what it will be in the next CMS meeting because you need a certain threshold of credentials now to get the specialty and program you desire today.