Pecking order of residencies

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Hollywood Mike

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I realize this isn't exactly a pre-med question but I feel much more posting on this subforum than the MD/DO forum. Where can I find a pecking order of residencies? I attended a seminar this past summer and one of the speakers mentioned how Orthopedic Surgery is towards the top and Internal Medicine is towards the bottom. Thanks in advance.

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Mr. Hollywood,
I'm afraid you are mistaken and are probably about to get a lot of flak on this thread. There is no pecking order. Period. Each specialty has strengths a weaknesses. When you get to medical school, you will realize why this question doesn't really make much sense, but since you still have a long road ahead of you, this is a forgivable mistake. Once you get to med school and start exploring different fields, you will gravitate towards one or the other - whichever one it ends up being is "the best" one. Best of luck.
 
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Stop focusing on residencies and specialties. If you're pre-med, statistically, it's unlikely you will ever reach the point where you will be picking residencies, so you should focus all your energy on trying to make that statistic not come true for you. AKA focus on getting INTO med school before worrying about what kind of doctor you want to be. You underestimate the amount of growth that lies ahead of you, growth that can and probably will impact the specialty you want to go into.
 
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Stop focusing on residencies and specialties. If you're pre-med, statistically, it's unlikely you will ever reach the point where you will be picking residencies, so you should focus all your energy on trying to make that statistic not come true for you. AKA focus on getting INTO med school before worrying about what kind of doctor you want to be. You underestimate the amount of growth that lies ahead of you, growth that can and probably will impact the specialty you want to go into.
It's just a damn question cut me some slack. I'm not saying I'm going to even be a doctor in 10 years, I am just curious. It's always good to ask questions, even if they are not relevant to your current situation. So please, spare me the lecture.
 
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Mr. Hollywood,
I'm afraid you are mistaken and are probably about to get a lot of flak on this thread. There is no pecking order. Period. Each specialty has strengths a weaknesses. When you get to medical school, you will realize why this question doesn't really make much sense, but since you still have a long road ahead of you, this is a forgivable mistake. Once you get to med school and start exploring different fields, you will gravitate towards one or the other - whichever one it ends up being is "the best" one. Best of luck.
Maybe I need to clarify. I'm saying as far as which residencies fill up before others. It is a fact that thoracic surgery, orthopedics, and neurosurgery residencies fill up before family medicine, pediatrics, etc. If I'm lucky enough to get into medical school, I realize I will be gravitating towards certain specialties over others during rotations. I was just simply curious if there was a website or list available that notes which residencies fill up before the others. That's all.
 
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"Fill up" or are more competitive?

With more medical students in the pipeline every year, the number of available positions is tight in every specialty.

Within each specialty, there are programs which are more competitive which is generally defined as having more applicants, with more impressive applications, and fewer (if any) positions open after the match. For example, IM at Harvard may be more competitive (using the above criteria) than Ortho in Louisiana.

At any rate, this thread is just another version of the us vs them mentality.
 
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It's just a damn question cut me some slack. I'm not saying I'm going to even be a doctor in 10 years, I am just curious. It's always good to ask questions, even if they are not relevant to your current situation. So please, spare me the lecture.

It's a very stupid question - that's your problem. That you think there's a "pecking order" demonstrates that you know next to nothing about how actual medicine works. Only in the ego-driven world of premeds does such a scheme exist.
 
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I attended a seminar this past summer and one of the speakers mentioned how Orthopedic Surgery is towards the top and Internal Medicine is towards the bottom.

Translated into english: "I went to a seminar this past summer where at least one of the speakers was a huge douchebag."
 
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OP, I'll answer...there's no "pecking order". And certain residencies don't "fill up before others". There is only 1 time each year to apply to residencies. Most people typically choose a specialty they are interested in and THEN apply to x number of residency programs in that specialty. If your stats suck, then your advisor in medical school may warn you against applying to residencies in a specialty that is very competitive (because there is a risk you won't match).

Yes, some residencies are more more competitive than others. Statistically the most competitive is integrated plastics. Followed by, generally, neurosurg, ortho, derm, ENT, integrated vascular, integrated cardiothoracic in no particular order. (And cardiology and GI fellowships which are done AFTER an internal medicine residency) Generally, the most competitive residencies are in higher paying specialties....or specialties that just don't have many spots. Also the top dozen residency places in pretty much every specialty is competitive (i.e. internal medicine at harvard).

But saying that certain residencies are "above" others just because there are in more competitive specialties is :nono: because PLENTY of the best students with the highest step 1 scores will choose a less competitive specialty because....surprise surprise...they actually have a medical interest in that specialty. Only a FOOL would dedicate their life to a field just because it is the "most competitive" specialty at the time (and yes- what's competitive changes. In the past Anesthesiology and Radiology was the near the top in competitiveness and they've gone down).
 
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Maybe I need to clarify. I'm saying as far as which residencies fill up before others. It is a fact that thoracic surgery, orthopedics, and neurosurgery residencies fill up before family medicine, pediatrics, etc. If I'm lucky enough to get into medical school, I realize I will be gravitating towards certain specialties over others during rotations. I was just simply curious if there was a website or list available that notes which residencies fill up before the others. That's all.
They don't "fill" at different speeds. Everything fills at the same time during the Match (except the SF Match, AOA Match, and Milmatch). Some IM programs are more competitive than some orthopedic surgery residencies. Thoracic surgery isn't nearly as competitive as you'd think. Neurosurgery is extremely competitive. There is no "pecking order" of residencies. Some things are more competitive some years, while others are more competitive in others. There are sinking and up-and-coming specialties (rads is in the former category and EM in the latter category at the moment, for instance) but these things change year-to-year.
 
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It's a very stupid question - that's your problem. That you think there's a "pecking order" demonstrates that you know next to nothing about how actual medicine works. Only in the ego-driven world of premeds does such a scheme exist.

What if I rephrased, "which residencies are more competitive"? Regardless, I agree with you that I know next to nothing about how ACTUAL medicine works. That's why I asked the question in the first place. Instead of being the egotistical premed that you have me pegged as, I was just being inquisitive. Instead of being a condescending douche about it, you could have just said there is no real pecking order. You could have explained that to me like freemontie and Mad Jack did. Congratulations on making it to med school, but don't act like your **** don't stink just because you're there.
 
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Translated into english: "I went to a seminar this past summer where at least one of the speakers was a huge douchebag."
She was actually a pediatrician, and she grouped pediatrics towards the bottom with internal medicine. It wasn't coming from an orthopedic surgeon.
 
Here's an exercise for you: don't take the criticism of your question personally and stop defending it. Instead, take a step back and try to figure out why the reaction has been universally negative.
 
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Here's an exercise for you: don't take the criticism of your question personally and atop defending it. Instead, takeva step back and try to figure out why the reaction has been universally negative.
I'm not justifying or defending the question. All I'm saying is there is no point in being mean about it. If someone in one of my classes asks me a question that is simple, I don't point and laugh at him/her, I answer the question as nicely as possible.
 
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I'm not justifying or defending the question. All I'm saying is there is no point in being mean about it. If someone in one of my classes asks me a question that is simple, I don't point and laugh at him/her, I answer the question as nicely as possible.

You asked a loaded question, you got a loaded response.
 
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I realize this isn't exactly a pre-med question but I feel much more posting on this subforum than the MD/DO forum. Where can I find a pecking order of residencies? I attended a seminar this past summer and one of the speakers mentioned how Orthopedic Surgery is towards the top and Internal Medicine is towards the bottom. Thanks in advance.
There are very competitive specialties, where just getting in is difficult. For most specialties, however, competitiveness is more about where you complete it (academic center versus rural hospital). In the end, residency tends to be less about prestige, and more about money/lifestyle/actual interest in a field (the latter being for those who didn't completely burn out during med school). Believe it or not, when you get older most people tend to stop caring what other people think about them and start actually acting in their own self interest. Thus, prestige becomes a little less important than getting a residency that will lead to a lifestyle that a person wants or at least can tolerate. There's a reason very few people at any individual med school are applying for neurosurgery at Hopkins.

tl;dr People don't just line up down a pecking order for their residency based on their step I score and grades. It's much more complex than that.
 
The question OP asked was indeed slighty ignorant but that is because he is indeed ignorant about that part of medicine (ignorance - in the actual form of the word, not intended to be insulting)
No need for the hostility - just answer the question in the best and most respectful way that you can so he can be informed and corrected. It's hard to believe that some of you are aspiring physicians and this is how some respond to an common misconception (medicine which holds some of the most common misconceptions on earth).
Smh anyways good luck in your continued research into medicine, and the best way to learn is to ask questions regardless how 'stupid' it may seem. ;)
 
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Ahh god that's funny.

Matching plastics makes you look like a tool bag, IMO

Not sure if srs. If srs you need to learn a lot more about PRS.
 
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Although you say IM is low, but there are tons of great specialties that one can go into that require going through IM first...
 
Not sure if srs. If srs you need to learn a lot more about PRS.

There's nothing toolish about wanting to do elective cosmetic surgeries for big paychecks. Nothing at all.

gI_79587_Dr.%20Rey.jpg
 
I'm not justifying or defending the question. All I'm saying is there is no point in being mean about it. If someone in one of my classes asks me a question that is simple, I don't point and laugh at him/her, I answer the question as nicely as possible.

You asked a question that slighted numerous specialties, suggesting they were lower on some pecking order. It's essentially a thinly veiled insult. They you backpedaled saying you means which one fills up first (which is a ridiculous question because theres a match and they all fill simultaneously. That's why the responses are hostile -- you, maybe unknowingly, took a swing at a bunch of people and it's only right that they come back swinging too.

I think you need to understanding that once you get to the clinical years of med school, the game chnges. it's no longer about trying to get whatever is the most competitive, that's the undergrad mindset. instead the goal is to end up in a specialty you are going to enjoy working in for the next 40 years. So if you enjoy peds, you pick peds. You don't say, well my stats are uber competitive so I need to do something like derm or ortho even though I enjoyed my peds rotations best. that's silly. Its no longer about outdoing your peers at that juncture, its about how do you want to spend your life. There are more and less competitive programs within each specialty so once you decide on a specialty perhaps there is somewhat of a choice within the field that you might base on competitiveness. But the initial threshold is to pick the field you like best. In most med schools nationally one of the top students will choose IM. They could gave done plastics or derm or ortho. But they liked IM or one of the subspecialties under that umbrella. So that's the kind of decision we are talking about. No pecking order driving this train.
 
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There's nothing toolish about wanting to do elective cosmetic surgeries for big paychecks. Nothing at all.

gI_79587_Dr.%20Rey.jpg
Again, this post just tells me you know very little about what plastic surgeons can do. I agree that a lot of the bread and butter stuff they do I would never want to do, but I respect them. They have to be able to operate all over the place, invent creative solutions to surgical problems, and make a huge difference for their patients. They're also some of the most technically capable surgeons around. Your abject ignorance of PRS beyond what you see on TV doesn't make it a less noble field.
 
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Again, this post just tells me you know very little about what plastic surgeons can do. I agree that a lot of the bread and butter stuff they do I would never want to do, but I respect them. They have to be able to operate all over the place, invent creative solutions to surgical problems, and make a huge difference for their patients. They're also some of the most technically capable surgeons around. Your abject ignorance of PRS beyond what you see on TV doesn't make it a less noble field.

Residency heirachy questions by a trollish OP deserve the answer I gave, homie
 
Not sure why plastics has to suffer because of OPs failings. :cryi:

Okay, I take it back, then. I don't dislike plastics. It's an awesome specialty that's hard to get into. You do have to admit that it attracts a lot of tools, though
 
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Okay, I take it back, then. I don't dislike plastics. It's an awesome specialty that's hard to get into. You do have to admit that it attracts a lot of tools, though
All the plastic surgeons I know are badasses, but it's because they work at an academic medical center. It wouldn't surprise me if the average PP breast augmentation specialist has a slightly different personality...
 
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All the plastic surgeons I know are badasses, but it's because they work at an academic medical center. It wouldn't surprise me if the average PP breast augmentation specialist has a slightly different personality...
Yep. Don't forget that plastic surgeons don't solely operate on people who want bigger boobs or smaller noses or whatever. They fix major congenital deformities. They restore breasts to women who have had total mastectomies and are self-conscious about it. They fix injuries from car crashes and violent attacks. They do a lot to restore a sense of "normal" to people who have had it taken away (or who have never had it all their lives).
 
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All the plastic surgeons I know are badasses, but it's because they work at an academic medical center. It wouldn't surprise me if the average PP breast augmentation specialist has a slightly different personality...
I agree, the academic plastic surgeons do amazing work and tend to be really cool people. Plastic surgery gets a bad rap because of the outpatient elective cosmetic surgeries, but academic plastic surgery is super interesting and do fairly complicated surgeries.
 
OP: I think your question was very reasonable, as I understood your question to mean "what specialties are more competitive" . I'm sorry to see that you got some negative responses.

Competitiveness is best gauged by the average USMLE Step 1 scores, and not percentage of applicants who match, because a lot of self-selection goes on.

Here is a list of Match outcomes. It's not for the most recent years, ( I did only a cursory Google search ) but it will give you an idea of which specialties are the most competitive.

http://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2011.pdf ( this is for 2011. The format was easier to follow than the 2014 results I found. Scroll down and look for the mean match scores for each specialty.

http://medicine.osu.edu/students/life/academic_advising/usmle/specialty_selection/pages/index.aspx

I think you're wise to have some idea of how competitive a specialty is early in your medical career, so that you have realistic expectations of your chances. If you find that you are at the top of your class in your first year, you are more likely to do well on your Step exams and will be able to pick whatever you're most interested in. If your performance is average, then you will be able to adjust your plans and goals accordingly.

However, I will comment on "pecking order " in general. I have seen posts in which students ask about which specialties have the most prestige, both within medicine and to the lay public. In my experience, there is little to no prestige associated with the more competitive specialties among physicians. While there may be some "pecking order" among residents ( mostly muttering complaints and eye rolling among residents within a specialty ) , I have encountered none that I am aware of outside (or inside, for that matter) of academia. In practice, we are all very happy to get help from whichever specialist we need. Pediatrics may be easy to match into, but I can assure you, when I'm taking care of a sick child, whether one of my patients or one of my own childern, I'm very grateful for the help of a pediatrician. And my assumption, when dealing with any specialty outside of my own, is that the physician went into that specialty because they wanted to, not because they couldn't match into derm or ortho.

On another note: One comment about the reference to "academic plastic surgeons" above. Don't underestimate the quality of medicine outside of university medical centers. While it's true that the very biggest, most complex and cutting edge procedures are done in tertiary care centers, I you might be surprised to see how complex the procedures done in community hospitals can be. As you all go through your medical training, remember that every single physician practicing in small community hospitals originally trained in a university hospital, and most did residencies in tertiary centers. Academicians, unsurprisingly, push academia, but it's not the only way to go.

As for plastic surgery, yes, face transplants and conjoined twin surgery will be at tertiary care centers. But many bigger cases, including craniofacial surgery and microsurgery cases, are done at community hospitals. For example, the acknowledged worlds experts on ear reconstruction, nasal reconstruction, and rhinoplasty all work or worked out of small community hospitals or outpatient surgery centers. The pioneering microsurgery group in the country operates out of a community hospital.

After I completed my residency in surgery, I was moonlighting in an ER in a rural area for a few months. I subsequently ran into one of the most senior surgeons from my residency. I told him how impressed I was with the quality of the surgeons in this small hospital. He laughed at me and said, " who do you think we've been training for the past 50 years". So, regardless of specialty, don't underestimate what goes on in private practice.
 
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As you all go through your medical training, remember that every single physician practicing in small community hospitals originally trained in a university hospital, and most did residencies in tertiary centers. Academicians, unsurprisingly, push academia, but it's not the only way to go.

That's not entirely accurate. There are lots of residency programs that are at community based hospitals, and only have one or two specialties for residency. I worked at one where the only residents were family medicine residents who took care of a select group of patients. Similarly, there are med schools that aren't university affiliated, and send their students to community practices for clerkships. So, no, not all physicians practicing in small community hospitals trained in a university hospital.

There are also hospitals that are university affiliated, but function more like community hospitals in that research is not emphasized. I interviewed at a couple of peds programs like that, and did my surgery clerkship at a similar hospital.
 
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Some of the Peds, FMs, IMs that I've worked with seem to have an inferiority complex and speak of specialized physicians (like neurosurgeons, cardiologists, etc.) as more important than themselves. They seem to be star-struck when talking to them on the phone for consults. It's similar to how a middle-ranked med student would speak of a top-10 classmate.

I also know of a trauma surgery resident who dropped out of the program because of how often Ortho surgery residents slapped him around. Whenever he consulted ortho on a trauma patient, ortho would just order him around. It really hurt his ego.

I think this pecking order idea does exist in the minds of some doctors, but is probably not universal.
 
As you all go through your medical training, remember that every single physician practicing in small community hospitals originally trained in a university hospital, and most did residencies in tertiary centers. Academicians, unsurprisingly, push academia, but it's not the only way to go.
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That's not entirely accurate. There are lots of residency programs that are at community based hospitals, and only have one or two specialties for residency


You are correct. When I wrote that they all trained in university hospitals, I was referring to their medical school training. That's why I followed that by saying that most, i.e. not all, did their residencies in tertiary centers.
Perhaps I shouldn't have used the word "training" to refer to medical school.

Some of the Peds, FMs, IMs that I've worked with seem to have an inferiority complex and speak of specialized physicians (like neurosurgeons, cardiologists, etc.) as more important than themselves. They seem to be star-struck when talking to them on the phone for consults. It's similar to how a middle-ranked med student would speak of a top-10 classmate.

True, that's why I referred to resident behavior as the one exception. I have rarely, if ever, encountered any such behavior among attendings in private practice. It may exist on the attending level in some university medical centers, but it's not a big issue in the real world as I know it. That's not to say that within my own department, we don't grumble or complain or roll our eyes about the general poor quality of one department or another, but the complaints tend to be quality related, not specialty related. We might complain about how useless a particular department is, but we know which specific physicians in that department we consult when we have a problem.

Regarding the issue of getting consults from specialists: There's always some trepidation when calling for a consult as a resident, because no one wants the extra work a consult entails. That changes in private practice, where every consult, no matter how simple, brings in extra money. In private practice, assuming the patient has insurance, the most obvious, simple consult is a cause for joy, not complaints. No one wants to insult a referral source.

Also, remember that as a medical student and a resident, you are very close to your basic training, and know a lot more primary care, pathology, and pharmacology than you will ever know again, outside of your specialty field. So consults that seem unnecessary to a med student or resident, are not so obvious to a specialist. When I was a medical student, I knew how to manage hypertension and diabetes. I wouldn't dream of doing that now. If a patient has high blood pressure when they come into my office, I call primary care, and I'm just as happy to have them take the problem off my hands as they are to have me take a surgical problem off their hands. And I'm always impressed that when I give the patient's name, they almost always know the patient's history from memory.

There are some exceptions, of course, but my point is that the competition and conflict between specialties mostly or completely disapears when you leave residency, so don't make career decisions based on prestige issues that for the most part won't exist later.
 
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Some of the Peds, FMs, IMs that I've worked with seem to have an inferiority complex and speak of specialized physicians (like neurosurgeons, cardiologists, etc.) as more important than themselves. They seem to be star-struck when talking to them on the phone for consults.

Although the term "some" can almost never be refuted completely, I think you might be missing the primary dynamic here. When I talk to a neurosurgeon about a neonate with a life-threatening problem that they need to address, I am "deferential" and polite to the skills and experiences they offer my patient that I do not have. This is not the same as having an inferiority complex or seeing these fields as more important than mine. Courtesy in asking for consults of highly specialized services involves thanking them for their input and expressing appreciation for their effort on behalf of my patient.
 
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I also know of a trauma surgery resident who dropped out of the program because of how often Ortho surgery residents slapped him around. Whenever he consulted ortho on a trauma patient, ortho would just order him around. It really hurt his ego.

Trauma Surgery is a fellowship, not a residency.

If you're referring to a GS resident who quit because some Ortho resident(s) gave him a hard time, that's pretty weak sauce and unlikely the reason.
 
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I'll answer the question.

Top: neurosurgery
Middle: everything else
Bottom: emergency medicine
 
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