Residencies.

[Kikaku21]

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Competitive ones. Like surgery or derm, etc. what does "competitive" mean???

http://residency.wustl.edu/medadmin...745696e2fe3fa99586256f850071b846?OpenDocument

This link says competitive means <90% of seniors match. That does not sound competitive to me. Only 50% of undergrads applying to medical school get it. That is WAY more competitive. Sooooo. I figure I MUST be missing something here. Can anyone fill in the gap for me?

 

[SoCuteMD]

Competitive ones. Like surgery or derm, etc. what does "competitive" mean???

http://residency.wustl.edu/medadmin...745696e2fe3fa99586256f850071b846?OpenDocument

This link says competitive means <90% of seniors match. That does not sound competitive to me. Only 50% of undergrads applying to medical school get it. That is WAY more competitive. Sooooo. I figure I MUST be missing something here. Can anyone fill in the gap for me?

Yeah, that the definition of competitive changes when you are 250K in debt and trying to fulfill a dream rather than just starting out.

Plus, a large number of those applying to med school are simply not qualified to go (not represented on SDN, I know), whereas every student applying through the Match is fully qualified to train in any given specialty.

 

[MollyMalone]

Competitive ones. Like surgery or derm, etc. what does "competitive" mean???

http://residency.wustl.edu/medadmin...745696e2fe3fa99586256f850071b846?OpenDocument

This link says competitive means <90% of seniors match. That does not sound competitive to me. Only 50% of undergrads applying to medical school get it. That is WAY more competitive. Sooooo. I figure I MUST be missing something here. Can anyone fill in the gap for me?

Self-selection.

 

[8744]

Yeah, I might have wanted a neurosurgery residency but I probably could have applied to every program in the United States and not got a single interview.

Which is not to say you need to give up, just that you need to know your limitations.

 

[8744]

Yeah, that the definition of competitive changes when you are 250K in debt and trying to fulfill a dream rather than just starting out.

Plus, a large number of those applying to med school are simply not qualified to go (not represented on SDN, I know), whereas every student applying through the Match is fully qualified to train in any given specialty.

And I bet medical school is more competative than 50%. I'm sure a large group of people would like to be doctors but know they don't have the grades to even think of applying...another example of self-selection.

A good way to see how competative a specialty is would be to see how many unmatched spots there are after the match as a percentage of the total available spots. Derm, Opthamology, Urology, and other ultra-competative programs rarely have any unfilled spots. EM, surgery, OB and other competative specialties have a few every year. IM and FM have a surplus.

 

[NY Musicologist]

This link says competitive means <90% of seniors match. That does not sound competitive to me. Only 50% of undergrads applying to medical school get it. That is WAY more competitive. Sooooo. I figure I MUST be missing something here. Can anyone fill in the gap for me?

I think you may have misread the statistic: "<90%" means "fewer than" 90 percent of the applicants match; i.e., only 10% who seek a match in that particular area succeed in getting one. (Those odds are a bit long for my liking, but maybe you'll be one of the lucky 10%!)

Actually, wait--that doesn't make sense--I can't believe even the most insanely competitive residencies would reject 90% of (presumably) qualified applicants, would they? 😱

 

[g3pro]

I think you may have misread the statistic: "<90%" means "fewer than" 90 percent of the applicants match; i.e., only 10% who seek a match in that particular area succeed in getting one. (Those odds are a bit long for my liking, but maybe you'll be one of the lucky 10%!)

No, it means 10% get rejected. It's self-selection.

 

[SoCuteMD]

only 10% who seek a match in that particular area succeed in getting one.

Ummm...nope, I think you misread it...

 

[deuist]

Surgery is definitely not competitive. There are 1.4 spots per American applicant. The reason that only 80% of seniors match into surgery is that the other 20% match into more competitive specialties such as ortho and plastic. Derm, on the other hand, is very competitive. Only 7% of applicants match into PGY-1 spots, while 59% match into PGY-2.

 

[NY Musicologist]

Ummm...nope, I think you misread it...

Yep...and edited. So much for my basic skills... 😳

 

[jbrice1639]

I think you may have misread the statistic: "<90%" means "fewer than" 90 percent of the applicants match; i.e., only 10% who seek a match in that particular area succeed in getting one.

if fewer than 90% match, how is that only 10% matching? 89% is less than 90%...so if less than 90% match, 89% could match....

 

[Kikaku21]

Yeah, I might have wanted a neurosurgery residency but I probably could have applied to every program in the United States and not got a single interview.

Which is not to say you need to give up, just that you need to know your limitations.

Self selection???? I don't buy it. I draw the parallel to getting into medical school. Avg GPA of applicant: 3.4 Avg MCAT: 27. Avg of accepted?? 3.6 and 30. These people are not qualified enough and they still apply. 50% of them get rejected.

I'd expect to see similiar numbers for neurosurgery. But 90%?? No way.

 

[SoCuteMD]

Self selection???? I don't buy it.

Ok, then you be the experiment. Earn nothing higher than a "Pass" for your entire med school career, and then visit your Dean's office with an announcement of your intention to pursue matching in Derm. See what he/she says about it.

I'm telling you - it's all self-selection.

I draw the parallel to getting into medical school. Avg GPA of applicant: 3.4 Avg MCAT: 27. Avg of accepted?? 3.6 and 30. These people are not qualified enough and they still apply. 50% of them get rejected.

Ummmm...like we already told you:
med school - lots of unqualified applicants
residency - not nearly as many unqualified applicants

Market principles here chica: when it comes to residency, the SUPPLY outweighs the DEMAND in many areas (IM, FP and in the past Anes, and Ob/gyn). Therefore, many programs won't fill completely. Even when you get into things like derm/neurosurg/ortho, the number of people competing for one derm spot is like 3:1. The match rate: 50% went UNMATCHED in derm (the match rate is listed differently for 2006 due to a change in the way they calculated it: now if you apply to derm and a backup and match to the backup, you are considered "matched" even if you didn't match in derm). VERY similar to the med school stats.

 

[flukemcd]

A 90% match rate means that on average, 90% of an institution's residency spots are filled each year. Hospitals will take as many residents as they can get, because they are so cheap and are expected to complete a great deal of work. So they technically have more spots available than residents that are working there.

This is based on what this "How to get a Residency" book I read says.

 

[drmota]

you guys are missing the point entirely. someone who knows they don't have a good chance of matching plastic surgery will be advised to NOT apply to plastic surgery, but rather apply to general surgery and then plastic surgery later. same for derm or orthopedics. you have advisors in med school too, you know. so the ones applying to derm and plastics are the ones that know they have a good shot of actually matching. that's why most of them match. case closed
-mota

 

[SoCuteMD]

you guys are missing the point entirely. someone who knows they don't have a good chance of matching plastic surgery will be advised to NOT apply to plastic surgery, but rather apply to general surgery and then plastic surgery later. same for derm or orthopedics. you have advisors in med school too, you know. so the ones applying to derm and plastics are the ones that know they have a good shot of actually matching. that's why most of them match. case closed
-mota

Ummm...you mean self-selection?

 

[Law2Doc]

Competitive ones. Like surgery or derm, etc. what does "competitive" mean???

http://residency.wustl.edu/medadmin...745696e2fe3fa99586256f850071b846?OpenDocument

This link says competitive means <90% of seniors match. That does not sound competitive to me. Only 50% of undergrads applying to medical school get it. That is WAY more competitive. Sooooo. I figure I MUST be missing something here. Can anyone fill in the gap for me?

90% of those in US allo who go into the match match someplace. It's totally self selection though -- you go through an interview process and are heavilly advised at your home school and you then rank the programs you want, and the schools rank the applicants they want. If you are not interviewed anywhere, or have been advised by the programs or your advisors that you have zero chance of matching into a specific specialty, you don't list those programs. So people know what places they have a shot at, and list their choices realistically. You don't bother listing programs that have not indicated some receptiveness. A computer gives people their highest possible match from a list of choices, realistically chosen. And thus most match. The most competitive programs are the ones that you don't list unless you have the credentials and a shot. You don't want to shoot for the moon and come crashing down to earth when you come up really short.

 

[Kikaku21]

Ummm...you mean self-selection?

No. Most of the same forces that are at play when one applies to medical school are also at play when one applies to residency. You have counselers telling you what to do, books of statistics telling you how likely you are to get into one place or another, etc.

The only thing that is different, as you said... Is that way more people are "actually" qualified. I even question the extent to which this is true. I personally believe that the cutoff for getting into medical school is much higher than what would make a "qualified physician." Furthermore, is someone who scrapes by on the boards really qualified to be a neurosurgeon?? Both of these claims are really subjective and not verifiable.

Take for granted that more people are qualified. Supply exceeds demand, as you said. In the competitive residency market, demand exceeds supply by 10% (90% match, the other 10% don't) In macroeconomic jargon this is called a surplus.

Now only 50% of applicants applying to medical school get it, as we've discussed. The parallel is that supply exceeds demand by 50%. BUT... If we follow your logic, a portion of those 50% are just not qualified so are thus not considered part of the demand.... To be in along the same order of magnitude in proportion, 40% of those applying to medical school would have to be unqualified. I don't buy it for 2 reasons.

Two reasons:
1. There IS self selection in the process of applying to medical school. The average applicant GPA suggests that NOT many people with a 2.4 apply. (The average GPA of the medical applicant is much greater than the average GPA of an American college graduate)

2. So there is self selection in applying to medical school AND self selection in applying to residency. Nothing has been said that explains why the magnitude of self selection is SO MUCH HIGHER in residency applications. This is not explained by differences in the number qualified.

 

[Kikaku21]

90% of those in US allo who go into the match match someplace. It's totally self selection though -- you go through an interview process and are heavilly advised at your home school and you then rank the programs you want, and the schools rank the applicants they want. If you are not interviewed anywhere, or have been advised by the programs or your advisors that you have zero chance of matching into a specific specialty, you don't list those programs. So people know what places they have a shot at, and list their choices realistically. You don't bother listing programs that have not indicated some receptiveness. A computer gives people their highest possible match from a list of choices, realistically chosen. And thus most match. The most competitive programs are the ones that you don't list unless you have the credentials and a shot. You don't want to shoot for the moon and come crashing down to earth when you come up really short.

What you are saying makes sense. What doesn't make sense is that the process is so much more regulated than a similar process. Applying to medical school in the first place. you are saying that the self selection for one process is Much much greater than the other. People with not shot in hell apply for medical school too.... So why is the self selection so much greater in residency apps?

 

[Law2Doc]

Nothing has been said that explains why the magnitude of self selection is SO MUCH HIGHER in residency applications. This is not explained by differences in the number qualified.

When someone is applying to med schools, no one is going to stand over them and tell them they are an idiot and cannot apply to top ten schools. When applying to residencies, if you are at the bottom of your class with a low board score and you say you want to do derm, that is exactly what the dean (from whom you need a letter for this process) is going to tell you though.

 

[Kikaku21]

When someone is applying to med schools, no one is going to stand over them and tell them they are an idiot and cannot apply to top ten schools. When applying to residencies, if you are at the bottom of your class with a low board score and you say you want to do derm, that is exactly what the dean (from whom you need a letter for this process) is going to tell you though.

Ok. THAT makes sense.

 

[DrBowtie]

Basically you can be shut out from specialties due to low grades/boards and there is no point in trying to match in them. Hence self selection.

 

[deuist]

You have counselers telling you what to do, books of statistics telling you how likely you are to get into one place or another, etc.

How many pre-meds use these resources? I can't think of anyone who has actually talked to a pre-med adviser to seek assistance on getting into medical school. Further, most pre-med offices are filled with liberal arts majors who are not familiar with the application process. For residencies, however, your dean and program director are practicing physicians and know the requirements for getting interviews at various programs around the country. Further, all med students are required to meet with their deans to get a realistic overview of where to apply. The two application procedures---college to med school and med school to residency---are vastly different. Students have matured over those four years and have an appreciation for what they are qualified for.

 

[tequila_farm]

You know these stats are published by the NRMP, right?

http://www.nrmp.org/res_match/data_tables.html

Don't worry about any of this crap. Just enjoy yourself and work hard. It will all pan out.

 

[medgator]

Surgery is definitely not competitive. There are 1.4 spots per American applicant. The reason that only 80% of seniors match into surgery is that the other 20% match into more competitive specialties such as ortho and plastic. Derm, on the other hand, is very competitive. Only 7% of applicants match into PGY-1 spots, while 59% match into PGY-2.

PGY-1 and PGY-2 derm spots only differ wrt whether you have an integrated internship or not. Either type of spot is as competitive.

Gen surg is definitely competitive.... there was only ONE spot in the entire nation left after the 2006 match was completed (aka one spot people could scramble for). In a field with >1000 positions, that's exceedingly competitive. After the match, FP/IM/peds had a ton of spots, Radiology had like ~30 spots open, Ortho had 4-5, rad onc had 2.... you get the idea. For example, Ortho had far less than the 1000 spots of general surgery, but still had more open spots after the match.

A lot of factors come into play when people apply to residencies.... it's a very different beast compared to getting into med school. A lot of the intangibles like personality, who you know, who writes your letters, rappoire with the program faculty and residents etc. can play a role in addition to the objective criteria like USMLE board scores and class rank. Research in a respective field can also play a huge role (especially in the more competitive fields).

I personally found that getting into medical school was much more objective (high MCATs + high GPA + Adequate ECs + good interview = admission).

 

[Gabby]

I don't understand something. If you don't match, what happens to you? Can you still do your internship year? If so, in what specialty, or would you just do a general internship?

Also, I've seen the match stats for residency, but how competitive would a fellowship in rheumatology be after an IM residency?

 

[aliziry]

Just wondering why is dermatology so competitive?

 

[Law2Doc]

Just wondering why is dermatology so competitive?

Part of it is artificial -- the specialty doesn't offer as many residency spots as could be supported, in order to limit competition. But a lot of it is due to the fact that it is a true lifestyle specialty -- better hours, fewer emergencies than most specialties, very limited need for night call. Most of your patients don't die and most also never get permanently cured (good for business).

 

[aliziry]

Part of it is artificial -- the specialty doesn't offer as many residency spots as could be supported, in order to limit competition. But a lot of it is due to the fact that it is a true lifestyle specialty -- better hours, fewer emergencies than most specialties, very limited need for night call. Most of your patients don't die and most also never get permanently cured (good for business).

Thanks. I just saw how many slots were offered for the past year (30). That in itself explains it.

 

[infiniti]

You must have misread something. There is no way there were only 30 spots offered last year. That number is simply unrealistic.

Thanks. I just saw how many slots were offered for the past year (30). That in itself explains it.

 

[aliziry]

You must have misread something. There is no way there were only 30 spots offered last year. That number is simply unrealistic.

Wouldnt be the first time mate.

 

[medgator]

I don't understand something. If you don't match, what happens to you? Can you still do your internship year? If so, in what specialty, or would you just do a general internship?

Also, I've seen the match stats for residency, but how competitive would a fellowship in rheumatology be after an IM residency?

Yes.... you can do a prelim year in med or surg and try to convert that into a "categorical" residency in either of those fields. A prelim year counts as the first year of a medicine or surgery residency, but is used as an internship for residencies such as anesthesia, derm, optho, rads, rad onc, PM&R etc that begin at the PGY-2 level and arent as "clinical" as med or surg.

Rheum is not competitive as far as IM fellowships go. The ones that are the most difficult are generally cards, GI, and heme/onc.

 

[Syringe3131]

Where can I find this statement? Curious to read it. 🙂

 

[medgator]

Wouldnt be the first time mate.

I believe there are ~200 derm spots, give or take. Derm also has an excellent reimbursement at present... and for a lot of the stuff, it's cash only 😉 That and plastics are probably the only fields that will not be trampled when the medicare cuts get really bad.

 

[deuist]

Thanks. I just saw how many slots were offered for the past year (30). That in itself explains it.

There were 30 spots for PGY-1, making it one of the most competitive specialties to match into. There were, however, 276 spots for PGY-2 with 59% of American medical students matching into those spots (comparable to anesthesiology and rad onc).

 

[medgator]

You must have misread something. There is no way there were only 30 spots offered last year. That number is simply unrealistic.

http://www.nrmp.org/2006advdata.pdf

As mentioned previously, there are 30 PGY-1 slots and 276 PGY-2 slots. Either is equally competitive, the only difference being that the PGY-2 spot requires you to match into a separate 1-year program prior to entry. The % of US seniors is one stat to look at, but a better one would be the number of unfilled spots post match. Again, this isnt ideal either. It's just field specific-- The average derm candidate is usually at the top of their class.

 

[NewIMdoc]

Remember, too, that even in very competitive specialties, there are some very non-competitive programs, so if you really want to go into a specialty, with the possible exception of derm and optho, and are a reasonable candidate (i.e. not AOA, but average or better boards, no failures, etc) you can probably find a program to match into, if you play the application process right. I know some decidedly ordinary candidates over the past few years who have matched into ortho, gen surg, radiology, etc, not to mention EM. On the other hand, even the "non-competitive" specialties have some very competitive programs that are as hard to get into as derm, etc. And vice-versa. In the "non-competitive" specialties, there is a huge gap (in difficulty matching I mean) between the top programs where applicants who could match in any specialty apply, and many of the community programs. Basically, if you couldn't match to Radiology at Podunk Community Hospital, you won't match in IM at Hopkins!

The bottom line is "competitiveness" is way over emphasized. Look at the NRMP charts and see the percent filled by US grads. The highest is derm, and that is only at 93%. Positions left unfilled isn't really a good indicator because it doesn't take into consideration the number of applicants per position. (I'm not sure if that chart is on the nrmp site). Anyway, explore the NRMP site to get a realistic idea.

Also, at many places your dean's letter is going to be written without any consideration of your specialty. It's okay to reach.

At any rate it is really much too early in the pre-allopathic forum to be worrying about residency matching! Do your best in med school, and eventually it will work out.

Good luck.

 

[mchou]

I don't understand something. If you don't match, what happens to you? Can you still do your internship year? If so, in what specialty, or would you just do a general internship?

Also, I've seen the match stats for residency, but how competitive would a fellowship in rheumatology be after an IM residency?

If you don't match, there is what is unofficially known as "scramble day" where everyone who didn't match gets contacted by their dean, as they are informed a little ahead of time. And you basically have to scramble for one of the open spots, which may or may not be in your field of interest. (unpleasant sounding, isn't it?)

My SO didn't match into ENT for intern year and ended up scrambling for a general surgery spot for intern year. Eventually matched into ENT (*edit after intern year) but is basically repeating PGY-1 year despite being a PGY-2.

Avoiding "scramble day" is probably one of the many reasons why the self selection is so great in applying to residency, yea?