Saturation

[SandyH]

Do you guys ever worry that field of medicine is going to become saturated? And we just become another "class of employees" who happen to work in a company called "hospitals"? With all these new medical schools opening up, all the other nurses, PAs, and pharmacists claiming practicing independence and fighting to be seen equivalent to physicians, as well as IMGs keep coming in and also fight for a piece of the cake, I think the healthcare field is going to get saturated soon.

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[DrfluffyMD]

Do you guys ever worry that field of medicine is going to become saturated? And we just become another "class of employees" who happen to work in a company called "hospitals"? With all these new medical schools opening up, all the other nurses, PAs, and pharmacists claiming practicing independence and fighting to be seen equivalent to physicians, as well as IMGs keep coming in and also fight for a piece of the cake, I think the healthcare field is going to get saturated soon.

What’s a real worry with those wide spread opening of DO schools is that there will be two tiers of physicians base on their title.

 

[Giovanotto]

Yes, to all of your questions. I would of had even more pause attending medical school if I knew COCA was gonna green-light every business, errr, I mean, new school. I erroneously thought our leadership was better than that, and that our students had better foresight. Some of our classmates tout DO school expansion as if it were a positive. Color me concerned.

 

[AnatomyGrey12]

And we just become another "class of employees" who happen to work in a company called "hospitals"

This has already happened.... for saturation no I’m not worried.

What’s a real worry with those wide spread opening of DO schools is that there will be two tiers of physicians base on their title.

You realize MD schools have opened at the same rate right?

 

[DrfluffyMD]

This has already happened.... for saturation no I’m not worried.



You realize MD schools have opened at the same rate right?

Check both the number and velocity of DO school enrollment increase compared to MDs. It’s frankly easy to see that if the current trend continues, most DO will be relegated to primary care and people will come to associate DOs as PCPs and MDs as specialists.

 

[Postictal Raiden]

What’s a real worry with those wide spread opening of DO schools is that there will be two tiers of physicians base on their title.

So a DO radiologist who trained at midtier university program would be inferior to an MD one who trained at a no name community hospital?

 

[DrfluffyMD]

So a DO radiologist who trained at midtier university program would be inferior to an MD one who trained at a no name community hospital?

No. But the proliferation of DO school can certainly make it more difficult for the average DO to get a radiology spot. Radiology isn’t competitive at the moment and in its worst year we matched some DOs and FMGs. But this is beginig to change and proliferation of DO school doesn’t help.

 

[Postictal Raiden]

No. But the proliferation of DO school can certainly make it more difficult for the average DO to get a radiology spot. Radiology isn’t competitive at the moment and in its worst year we matched some DOs and FMGs. But this is beginig to change and proliferation of DO school doesn’t help.

I agree with you here.

 

[Robotfishbrain]

The truth is no one can answer your question right now. Even people involved with the merger are not sure what will happen to DOs, but beyond that if (and this is a HUGE if) congress decides to expand medicare in the next 4-8 years, I don't see saturation being a problem. If the # of residencies stay the same, then there's no arguing the increasing number of graduates will overcome the residency slots and saturation will occur.

 

[Mad Jack]

What’s a real worry with those wide spread opening of DO schools is that there will be two tiers of physicians base on their title.

There have been as many MD schools and campuses created as DO in the last twenty years. The problem isn't so much two tiers of provider as it is the prospect of large numbers of US-educated students going unmatched

 

[NontradCA]

No because I’m going into Psychiatry.

 

[TheaterOfTheme]

No because I’m going into Psychiatry.

Haha let's hope that saturation of med students doesn't make that even harder as well.

 

[DrfluffyMD]

There have been as many MD schools and campuses created as DO in the last twenty years. The problem isn't so much two tiers of provider as it is the prospect of large numbers of US-educated students going unmatched

Most of those unmatched students will be DOs. How will that look to students? To the mainstream? Before you know there will be expose article about McMedical schools with hundreds of students per class, no affilated core academic hospital and don’t necessarily need to take the same licensing test as USMDs. Journalist will sensationalize it (wrongly) but the poor reputation of DO education will be hard to shake then.

 

[Mad Jack]

Most of those unmatched students will be DOs. How will that look to students? To the mainstream? Before you know there will be expose article about McMedical schools with hundreds of students per class, no affilated core academic hospital and don’t necessarily need to take the same licensing test as USMDs. Journalist will sensationalize it (wrongly) but the poor reputation of DO education will be hard to shake then.

I doubt it. The same already happens to Carib grads and you rarely see sensationalizing of it, despite the multibillion cost to taxpayers

 

[Osminog]

Either more residency spots will open to accommodate the new graduates, which would cause there to be a larger supply of physicians --> lower salaries, more "saturation."

...Or larger numbers of graduates from Caribbean schools and new DO schools will end up unmatched.

 

[DrfluffyMD]

Either more residency spots will open to accommodate the new graduates, which would cause there to be a larger supply of physicians --> lower salaries, more "saturation."

...Or larger numbers of graduates from Caribbean schools and new DO schools will end up unmatched.

Having more residency spot is unacceptable. We have too many radiology and radonc spots as it is. I maintain that we don’t have a physician shortage problem, only a maldistribution one for most specialties.

 

[Osminog]

Having more residency spot is unacceptable. We have too many radiology and radonc spots as it is. I maintain that we don’t have a physician shortage problem, only a maldistribution one for most specialties.

The maldistribution you're talking about is a symptom of the physician shortage.

 

[DrfluffyMD]

The maldistribution you're talking about is a symptom of the physician shortage.

No. It’s a symptom of people prefer to stay in coastal areas where most of the population lives anyway and near their families and friends.

BFE can’t recruit people because they don’t have enough bonuses. Over in auntminnie radiology fellows were offered primary care salary starting in the midwest OUTSIDE of chicago. Laughable.

 

[Goro]

Do you guys ever worry that field of medicine is going to become saturated? And we just become another "class of employees" who happen to work in a company called "hospitals"? With all these new medical schools opening up, all the other nurses, PAs, and pharmacists claiming practicing independence and fighting to be seen equivalent to physicians, as well as IMGs keep coming in and also fight for a piece of the cake, I think the healthcare field is going to get saturated soon.

Medicine is not the Law.
The "nurses R taking R jobs" meme is mostly med student paranoia.

It will be harder to get a job in a nice big city, and at some point you might have to end up practicing in Kalispell, MT or Joensboro, AR.

But also keep in mind that the Baby Boom generation of doctors will be retiring or dying off in droves over the next two decades. Somebody has to replace them.

 

[DrfluffyMD]

Medicine is not the Law.
The "nurses R taking R jobs" meme is mostly med student paranoia.

It will be harder to get a job in a nice big city, and at some point you might have to end up practicing in Kalispell, MT or Joensboro, AR.

But also keep in mind that the Baby Boom generation of doctors will be retiring or dying off in droves over the next two decades. Somebody has to replace them.

That’s the issue. Folks grew up and spent all their lives in NYC shouldn’t be made to go to Joensboro, AR. They should be enticed to go by a fitting compensation and enough vacation time so they can visit home often.

 

[Osminog]

No. It’s a symptom of people prefer to stay in coastal areas where most of the population lives anyway and near their families and friends.

BFE can’t recruit people because they don’t have enough bonuses. Over in auntminnie radiology fellows were offered primary care salary starting in the midwest OUTSIDE of chicago. Laughable.

People's work preferences are shaped by economic realities. Due to an overall undersupply of physicians, the physician wages in highly desirable locations are too high to push doctors out of those areas.

As more doctors are added into the equation, wages will decrease in highly desirable areas, causing physicians to "spill over" into less desirable locations.

The underlying problem is a shortage of physicians, and this shortage directly stems from the various medical groups' and licensing organizations' monopolistic policies and practices.

Unfortunately, many physicians advocate for the continuation of these monopolistic policies and practices because these physicians value their yachts and beach houses more than they value healthcare accessibility for socioeconomivally disadvantaged people in rural areas. And that's a damn shame.

I can back up anything I said in this post with extensive data. If you don't think that American healthcare, as it exists today, is a seller's market, then you're kidding yourself.

 

[073116]

No. It’s a symptom of people prefer to stay in coastal areas where most of the population lives anyway and near their families and friends.

BFE can’t recruit people because they don’t have enough bonuses. Over in auntminnie radiology fellows were offered primary care salary starting in the midwest OUTSIDE of chicago. Laughable.

There is opposing trend across USA too - the one where you see a lower salary for IM (for example only) in big cities like NYC or desired places like LongIsland etc. - while same IM has 10-20% higher salary in let's say upstate NY - just because most people wants to be in NYC/LongIsland rather than in some upstate NY small city. So there's always a offer/demand curves at play imho

 

[073116]

People's work preferences are shaped by economic realities. Due to an overall undersupply of physicians, the physician wages in highly desirable locations are too high to push doctors out of those areas.

As more doctors are added into the equation, wages will decrease in highly desirable areas, causing physicians to "spill over" into less desirable locations.

The underlying problem is a shortage of physicians, and this shortage directly stems from the various medical groups' and licensing organizations' monopolistic policies and practices.

Unfortunately, many physicians advocate for the continuation of these monopolistic policies and practices because these physicians value their yachts and beach houses more than they value healthcare accessibility for socioeconomivally disadvantaged people in rural areas. And that's a damn shame.

I can back up anything I said in this post with extensive data. If you don't think that American healthcare, as it exists today, is a seller's market, then you're kidding yourself.

Already happened long time ago. Compare Long Island salaries with a smaller cities in upstate NY salaries. Folks in Long Island get 10-20% less salary - just because there's tons of people who are happy to take their place and hospitals know it

 

[DrfluffyMD]

People's work preferences are shaped by economic realities. Due to an overall undersupply of physicians, the physician wages in highly desirable locations are too high to push doctors out of those areas.

As more doctors are added into the equation, wages will decrease in highly desirable areas, causing physicians to "spill over" into less desirable locations.

The underlying problem is a shortage of physicians, and this shortage directly stems from the various medical groups' and licensing organizations' monopolistic policies and practices.

Unfortunately, many physicians advocate for the continuation of these monopolistic policies and practices because these physicians value their yachts and beach houses more than they value healthcare accessibility for socioeconomivally disadvantaged people in rural areas. And that's a damn shame.

I can back up anything I said in this post with extensive data. If you don't think that American healthcare, as it exists today, is a seller's market, then you're kidding yourself.

Got it. Docs in NYC should work for free so some of them will go to Kentucky. Sounds like an excellent plan.

Why are you on a premed/physician forum again?

 

[073116]

Got it. Docs in NYC should work for free so some of them will go to Kentucky. Sounds like an excellent plan.

Why are you on a premed/physician forum again?

Ok, here's some real numbers: IM hospitalist in NYC/LongIsland earns about $190k a year. A bit low - but it's because, a lot of people want to work there - it's a desirable location. Same IM can find a job in Rochester, NY (upstate NY) for $220-230k - why? Because less people go there and Hospitals have higher salaries to compensate for less demand (tho this is a bit exaggerated, as I'm sure there are much more less desirable places lol)

 

[DO2015CA]

Already happened long time ago. Compare Long Island salaries with a smaller cities in upstate NY salaries. Folks in Long Island get 10-20% less salary - just because there's tons of people who are happy to take their place and hospitals know it

Yes. As it should be. I am not saying to pay cut city docs but rather increase rural compensation to attract doctors. @DrfluffyMD is right when saying physicians shouldn't be forced out of their homes. This maldistribution needs to be dealt with by compensation not by shear numbers requiring docs to flee to the countryside in order to pay off their loans. On top of our own numbers, midlevels are cashing in on the "shortage" too, yet their practitioners geography distribution is oddly similar to physicians. We cant sit back and act like physician salaries are at a tipping point already when systems are paying administers more than PCPs yet they are not really doing much. Increasing rural compensation is the best chance of actually fixing this "shortage"

....Unless we do what other countries do and decrease tuition but require graduating docs to work in a rural area for 2 years. This doesn't help for long term retention rate though

 

[SandyH]

Sigh, shouldve gone into PA

 

[073116]

Sigh, shouldve gone into PA

Should have gone into dental - that's where money is and those lucky bastards don't even have residencies lol

 

[Osminog]

Got it. Docs in NYC should work for free so some of them will go to Kentucky. Sounds like an excellent plan.

Why are you on a premed/physician forum again?

No. I'm not saying that anyone should work for free. I'm saying that once wages in NYC hit a certain point, the NYC market there will be fully saturated and most doctors will opt to work in a less desirable area at a higher wage.

I'm on a pre-med/physician forum because I'm a pre-med.

 

[DO2015CA]

Sigh, shouldve gone into PA

No! gotta stick up for your profession.

 

[AMEHigh]

No. Not anytime in our lifetime at least. And I don't have hope the planet will be around much longer after that :/

Myself and all my friends get plenty of job offers starting very early in residency in many different specialties. There are very few specialities that don't have their pick of job opportunities. The baby boomers are going to retire/die soon and then that's going to create even more jobs.

 

[SandyH]

No! gotta stick up for your profession.

Not sure if it's worth sticking up for....

 

[Neopolymath]

People's work preferences are shaped by economic realities. Due to an overall undersupply of physicians, the physician wages in highly desirable locations are too high to push doctors out of those areas.

As more doctors are added into the equation, wages will decrease in highly desirable areas, causing physicians to "spill over" into less desirable locations.

The underlying problem is a shortage of physicians, and this shortage directly stems from the various medical groups' and licensing organizations' monopolistic policies and practices.

Unfortunately, many physicians advocate for the continuation of these monopolistic policies and practices because these physicians value their yachts and beach houses more than they value healthcare accessibility for socioeconomivally disadvantaged people in rural areas. And that's a damn shame.

I can back up anything I said in this post with extensive data. If you don't think that American healthcare, as it exists today, is a seller's market, then you're kidding yourself.

You have said this in several threads and it is not a thing nor does it make any sense except at its most literal economic definition. And yes, I value Porsche more than I value some random person in BFE getting healthcare. The difference is that there is a solution that doesn't involve paying me less for the excessive time and money put into this career path. It also doesn't affect the quality of medical graduates in a negative way like opening the flood gates. Yeah, we are selfish. If any successful person in America should be it should be physicians. Maybe I think most of rural america is selfish because they won't live in highly efficient cities that cost less to maintain in the name of xenophobia and other bs reasons... Those people are making a choice too.

You ever thought that maybe intelligent people don't want to or shouldn't be forced to live in the middle of nowhere and it has less to do with money? Yeah, if you want to go 10th grade econ we can talk about that there is a theoretical $ value at which people would move from NYC to Arkansas (if Arkansas ALSO paid more), but that won't and can't happen for a lot of reasons.

There is opposing trend across USA too - the one where you see a lower salary for IM (for example only) in big cities like NYC or desired places like LongIsland etc. - while same IM has 10-20% higher salary in let's say upstate NY - just because most people wants to be in NYC/LongIsland rather than in some upstate NY small city. So there's always a offer/demand curves at play imho

What you are saying is not disagreeing with what the other poster said... Read what he said again.

 

[QueenJames]

LMAO at this thread.

No.

Medicine is only saturated in places that spoiled brats want to live in because god forbid there isn't a starbucks or an organic-coffee-vegan-cafe-shop grocery market or a swanky beach town nearby that you can spend all of your free time at filled with people that have excellent insurance that reimburses well.

Boo-hoo.

Suck it up.

So you have to live in city on the outskirts of New York City and can't catch a game at MSG every week... or you have to live in some hillbilly town 3 hours away from your nearest Cheesecake Factory.

You will live.

The problem with medicine isn't "saturation" so to speak.

It's the entitled, coddled, spoiled little brats that enter medicine every year and think they can have everything they want, when they want, and how they want because they are special little snowflakes that have a white coat and a stethoscope now and falsely believe the grand delusions that they need a Range Rover, and a 7,000 square foot "doctor" mansion on the beach that medicine will magically provide for them.

Some of you dummies don't remember.... but a lot of DO programs are tailored to providing PRIMARY CARE PHYSICIANS.

IM, FM, Peds, Psych, and EM.

This is what a majority of DOs have been getting EVERY year... across EVERY school... across EVERY match list.

IMGs are getting squeezed out every year and are solely relegated to crappy spots in crappy programs in IM, FM, and/or Psych.

That's how it is.

That's how it will be.

If you are scared about being "replaced" or not getting a job... then cut your losses and drop out now.

Y'all got a longgggg ride til you see your first attending contract anyway lol

If not... put your big boy pants on and let your work speak for itself.

You'll end where you needed to end up all along.

 

[QueenJames]

Sigh, shouldve gone into PA

PA makes decent coin no doubt.

BUT...

If you are not proud of being in medical school and being a future PHYSICIAN... then sure.

You should really consider dropping out.

Medicine doesn't need people who want the most profit for the least investment.

That's not how medicine is.

You simply cannot "half-ass" medical school and expect to be a great doctor.

Have a spine and be proud of your decision dude. Seriously.

Laziness is absolutely unattractive.

 

[QueenJames]

Haha let's hope that saturation of med students doesn't make that even harder as well.

It won't.

Because not everybody wants to treat the veteran with PTSD, the teenager with depression, or the homeless schizophrenic and chuck pills at them hoping that they don't come off of them and go full-blown cray cray.

This isn't a knock against psych. Some of the most nicest and caring people I know are doing psych.

But you couldn't pay me $500,000 to ask a schizophrenic patient about their voices and beliefs about how they are a conduit for Jesus Christ.

That's not the type of doctor many people ever saw themselves becoming.

It's all about fit.

God bless those who find joy in mental health and psychiatry. It's absolutely necessary.

People who have psych at the top of their list will change their mind once they do their first inpatient rotation in a psych hospital. Lol

To each their own for sure but don't let SDN overhype a bunch of stuff that simply is a lot of hearsay.

 

[SandyH]

I guess you're right, I should quit before I start

PA makes decent coin no doubt.

BUT...

If you are not proud of being in medical school and being a future PHYSICIAN... then sure.

You should really consider dropping out.

Medicine doesn't need people who want the most profit for the least investment.

That's not how medicine is.

You simply cannot "half-ass" medical school and expect to be a great doctor.

Have a spine and be proud of your decision dude. Seriously.

Laziness is absolutely unattractive.

 

[073116]

You have said this in several threads and it is not a thing nor does it make any sense except at its most literal economic definition. And yes, I value Porsche more than I value some random person in BFE getting healthcare. The difference is that there is a solution that doesn't involve paying me less for the excessive time and money put into this career path. It also doesn't affect the quality of medical graduates in a negative way like opening the flood gates. Yeah, we are selfish. If any successful person in America should be it should be physicians. Maybe I think most of rural america is selfish because they won't live in highly efficient cities that cost less to maintain in the name of xenophobia and other bs reasons... Those people are making a choice too.

You ever thought that maybe intelligent people don't want to or shouldn't be forced to live in the middle of nowhere and it has less to do with money? Yeah, if you want to go 10th grade econ we can talk about that there is a theoretical $ value at which people would move from NYC to Arkansas (if Arkansas ALSO paid more), but that won't and can't happen for a lot of reasons.


What you are saying is not disagreeing with what the other poster said... Read what he said again.

I wasn't disagreeing, you are right. I was kinda trying to bridge people arguing about same thing from 2 different points of view - by stating a true fact that relates to both of what they were saying. Maybe I failed in that lol

 

[073116]

It won't.

Because not everybody wants to treat the veteran with PTSD, the teenager with depression, or the homeless schizophrenic and chuck pills at them hoping that they don't come off of them and go full-blown cray cray.

This isn't a knock against psych. Some of the most nicest and caring people I know are doing psych.

But you couldn't pay me $500,000 to ask a schizophrenic patient about their voices and beliefs about how they are a conduit for Jesus Christ.

That's not the type of doctor many people ever saw themselves becoming.

It's all about fit.

God bless those who find joy in mental health and psychiatry. It's absolutely necessary.

People who have psych at the top of their list will change their mind once they do their first inpatient rotation in a psych hospital. Lol

To each their own for sure but don't let SDN overhype a bunch of stuff that simply is a lot of hearsay.

What about EM? I kinda like it - but I'm getting a hint that it's going to be similarly bad/crazy lifestyle lol (I'm just a 2nd year now)

 

[bigindian4891]

Ah, the monthly DOOM AND GLOOM thread

 

[TheaterOfTheme]

It won't.

Because not everybody wants to treat the veteran with PTSD, the teenager with depression, or the homeless schizophrenic and chuck pills at them hoping that they don't come off of them and go full-blown cray cray.

This isn't a knock against psych. Some of the most nicest and caring people I know are doing psych.

But you couldn't pay me $500,000 to ask a schizophrenic patient about their voices and beliefs about how they are a conduit for Jesus Christ.

That's not the type of doctor many people ever saw themselves becoming.

It's all about fit.

God bless those who find joy in mental health and psychiatry. It's absolutely necessary.

People who have psych at the top of their list will change their mind once they do their first inpatient rotation in a psych hospital. Lol

To each their own for sure but don't let SDN overhype a bunch of stuff that simply is a lot of hearsay.

I can't wait honestly--I had the rare experience of having exposure to a good amount of psych before med school. I can't imagine anything else, personally, based on all of the specialties I have shadowed/worked with. Maybe family med or peds

 

[QueenJames]

What about EM? I kinda like it - but I'm getting a hint that it's going to be similarly bad/crazy lifestyle lol (I'm just a 2nd year now)

Stop worrying about lifestyle.

Worry about the specialty that you hate reading up on when you have to read up on it for your 10-year license recertification exam.

No money in the world will replace the time you spent reading up on a specialty that you absolutely hate learning about and reading about to stay up to date on.

The learning will NEVER stop.... well... that is... until your corpse is rotting in the ground eventually.

Welcome to the big leagues son.

 

[QueenJames]

View attachment 230241

https://members.aamc.org/eweb/upload/2016 Medical_School_Enrollment_Survey_Report.pdf

So...

DO will pretty much be the new Caribbean (but with more strict entrance guidelines).

Mommy and daddy can't bust that checkbook open now! lolz

 

[ortnakas]

Many DO schools’ stated goal is to create primary care physicians— like it’s in their mission statements. It continues to surprise me that people are shocked by DO match lists comprised of largely primary care fields. Not that you can’t successfully pursue specialties, but when we all (or at least, a lot of us) signed up for schools with this goal, it shouldn’t be mind-blowing that the majority of available support and guidance from the school are going to be primary-care driven.

 

[DO2015CA]

Many DO schools’ stated goal is to create primary care physicians— like it’s in their mission statements. It continues to surprise me that people are shocked by DO match lists comprised of largely primary care fields. Not that you can’t successfully pursue specialties, but when we all (or at least, a lot of us) signed up for schools with this goal, it shouldn’t be mind-blowing that the majority of available support and guidance from the school are going to be primary-care driven.

Everyone wanna be that special snowflake

 

[Neopolymath]

Many DO schools’ stated goal is to create primary care physicians— like it’s in their mission statements. It continues to surprise me that people are shocked by DO match lists comprised of largely primary care fields. Not that you can’t successfully pursue specialties, but when we all (or at least, a lot of us) signed up for schools with this goal, it shouldn’t be mind-blowing that the majority of available support and guidance from the school are going to be primary-care driven.

I get where you are coming from, but you have to acknowledge that some schools actively take steps to thwart their students' ambition. The silly part is that being ambitious could mean the student is trying to go to the best programs in an uncompetitive specialty overall not just specializing. I signed up for an uphill battle and lack of emphasis on specializing, not a systemic attempt to prevent it.

 

[DrfluffyMD]

I get where you are coming from, but you have to acknowledge that some schools actively take steps to thwart their students' ambition. The silly part is that being ambitious could mean the student is trying to go to the best programs in an uncompetitive specialty overall not just specializing. I signed up for an uphill battle and lack of emphasis on specializing, not a systemic attempt to prevent it.

What are some example of school actively take steps to thwrat their students?

 

[ortnakas]

I get where you are coming from, but you have to acknowledge that some schools actively take steps to thwart their students' ambition. The silly part is that being ambitious could mean the student is trying to go to the best programs in an uncompetitive specialty overall not just specializing. I signed up for an uphill battle and lack of emphasis on specializing, not a systemic attempt to prevent it.

I believe you, but I haven't seen it firsthand (so @DrfluffyMD -- I can't think of any). Plenty of students from my school are going into surgery, ortho, anesthesia, radiology, even quite a few urology matches this year-- but more resources are definitely allocated toward the primary care end of the spectrum. Maybe I just didn't see it because I was applying IM, but my friends who were applying for those specialties felt more not-well-supported than actively-opposed.

 

[Toast Chee]

What are some example of school actively take steps to thwrat their students?

Like schools that limit the number of electives you can do in a certain specialty that might prevent you from either matching into a competitive specialty if you're academically strong, or matching into anything if you are academically weak (i.e. board failures, repeat years, etc.)

 

[DrfluffyMD]

Like schools that limit the number of electives you can do in a certain specialty that might prevent you from either matching into a competitive specialty if you're academically strong, or matching into anything if you are academically weak (i.e. board failures, repeat years, etc.)

And why would a school do that?