Second choices

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AmoryBlaine

the last tycoon
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On my last rotation (FM) I worked with at least 3 residents who were in their 2nd choice career. 2 of them had failed to match in EM and 1 had wanted to do EM but hadn't even tried to apply (Carribean, low steps, think he had failed some stuff too).

This is just madness to me, especially considering the article I recently read that said med schools are slated to add 17% more spots by 2012 (this doesn't even count DO schools). Every time I cruise over to Pre-Allo there's the student with very marginal numbers asking about his "chances." Yes, yes, I know that there are plenty of people who do badly in UG and then turn it around in med school (that's not the point here).

Seriously though, what do you tell this guy/girl with the 3.1 GPA and the 26 MCAT? Because "go for it! you can do anything you want!" is almost certainly a lie.

As I think about my career choice, I imagine I would be absolutely sick if I knew that realistically I had no shot at my first choice. There is something to be said for tenacity and dogedness - the prelim year followed by the reapplication. But at the end of the day some people will end up in a residency they never wanted to do.

So I guess I don't have any questions, I'm just sort of thinking out loud.


(P.S. This is not a bash FM thread, I liked FM alot and most of my residents were ecstatic to be doing it.)

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Seriously though, what do you tell this guy/girl with the 3.1 GPA and the 26 MCAT? Because "go for it! you can do anything you want!" is almost certainly a lie.

The odds of getting into choice specialties are low even for those who have better stats and get into decent allo med schools. I think the best advice you can give is that if a person finds the notion of doing primary care (and/or the possibility of earning less than $150k) repugnant, s/he should probably consider other career paths besides medicine, as both those things are quite likely these days. As class sizes increase and no increase in residency slots to date (and most likely to be added to the primary care fields when/if they get added), things are getting tighter and tighter. I would never advise someone to go to med school if the only thing they could picture themselves doing was a ROAD specialty. But if their goal is to just be a doctor who works with patients, and anything else is gravy, then tilt your cap to them and assume they know what they are getting into.
 
On my last rotation (FM) I worked with at least 3 residents who were in their 2nd choice career. 2 of them had failed to match in EM and 1 had wanted to do EM but hadn't even tried to apply (Carribean, low steps, think he had failed some stuff too).

This is just madness to me, especially considering the article I recently read that said med schools are slated to add 17% more spots by 2012 (this doesn't even count DO schools). Every time I cruise over to Pre-Allo there's the student with very marginal numbers asking about his "chances." Yes, yes, I know that there are plenty of people who do badly in UG and then turn it around in med school (that's not the point here).

Seriously though, what do you tell this guy/girl with the 3.1 GPA and the 26 MCAT? Because "go for it! you can do anything you want!" is almost certainly a lie.

As I think about my career choice, I imagine I would be absolutely sick if I knew that realistically I had no shot at my first choice. There is something to be said for tenacity and dogedness - the prelim year followed by the reapplication. But at the end of the day some people will end up in a residency they never wanted to do.

So I guess I don't have any questions, I'm just sort of thinking out loud.


(P.S. This is not a bash FM thread, I liked FM alot and most of my residents were ecstatic to be doing it.)


Competitive specialties are just that, competitive. Every program director of any specialty wants the most competitive residents that they can find. This means not only getting into medical school but doing well in medical school. If your grades are high and you do well on USMLE Step I (provided you have attended a US medical school, you can determine your fate.

If you did not attend a U.S. medical school, you face an uphill battle attempting to get into a competitive specialty. People who go offshore need to realize that no matter how well they do in medical school, there are still residencies that will be difficult for them to match into.

There have been people who were able to get into a US medical school with a GPA of 3.1 and a MCAT of 26 who excelled in medical school and went on to enter a competitive specialty. While the odds are not in favor of every person with those stats getting into a US medical school, it can be done.

Even the person who enters medical school with a 3.9 GPA and 43 MCAT is not going to have a choice of residency programs if they did not perform well in medical school and on USMLE Step I. On the other hand, there are people who have graduated first in their class in medical school that chose Family Medicine because they loved it.

What do you tell the person who has a GPA of 3.1 and MCAT of 26? You tell them to get that MCAT score higher, make sure their medical school application is as competitive as possible, apply broadly and do extremely well once they are in medical school.

The people who are top performers in a US medical school are quite likely to match into their first choice specialty and into a good residency program. If not, all bets are off. Bottom line, keep your grades up and do well on your board exams.
 
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On my last rotation (FM) I worked with at least 3 residents who were in their 2nd choice career. 2 of them had failed to match in EM and 1 had wanted to do EM but hadn't even tried to apply (Carribean, low steps, think he had failed some stuff too).

This is just madness to me, especially considering the article I recently read that said med schools are slated to add 17% more spots by 2012 (this doesn't even count DO schools). Every time I cruise over to Pre-Allo there's the student with very marginal numbers asking about his "chances." Yes, yes, I know that there are plenty of people who do badly in UG and then turn it around in med school (that's not the point here).

Seriously though, what do you tell this guy/girl with the 3.1 GPA and the 26 MCAT? Because "go for it! you can do anything you want!" is almost certainly a lie.

As I think about my career choice, I imagine I would be absolutely sick if I knew that realistically I had no shot at my first choice. There is something to be said for tenacity and dogedness - the prelim year followed by the reapplication. But at the end of the day some people will end up in a residency they never wanted to do.

So I guess I don't have any questions, I'm just sort of thinking out loud.


(P.S. This is not a bash FM thread, I liked FM alot and most of my residents were ecstatic to be doing it.)

You know, I have to say that I disagree with you on some of what you are saying. I WAS the underdog applicant - with a 3.3something GPA and a low 30s MCAT. I struggled through a challenging undergrad major in chemistry at a school well-known for grade deflation and for producing excellent pre-medical students. Even with all of this taken into account, I was still a little bit behind the curve. I did wrangle an acceptance to one allopathic medical school, though.

At the beginning of my first year I was undoubtedly still "behind the curve." 2 years off had not sharpened my study skills in the least, and I was fairly slow to adjust to my new environment. I figured it all out, though, and by the end of first year I was routinely scoring well on classroom and national shelf exams - usually about a standard deviation above average. This trend continued through the 2nd year. For all I know it could all blow up tomorrow - I could tank Step 1, be a really horrible clinical student, or something COMPLETELY out of my control could blow me off track. For the moment, however, I truly have pulled myself up from a low-performing medical student to one of the strongest students in my class - and I'm definitely not the only one I know who has done this.
 
You know, I have to say that I disagree with you on some of what you are saying. I WAS the underdog applicant - with a 3.3something GPA and a low 30s MCAT. I struggled through a challenging undergrad major in chemistry at a school well-known for grade deflation and for producing excellent pre-medical students. Even with all of this taken into account, I was still a little bit behind the curve. I did wrangle an acceptance to one allopathic medical school, though.

At the beginning of my first year I was undoubtedly still "behind the curve." 2 years off had not sharpened my study skills in the least, and I was fairly slow to adjust to my new environment. I figured it all out, though, and by the end of first year I was routinely scoring well on classroom and national shelf exams - usually about a standard deviation above average. This trend continued through the 2nd year. For all I know it could all blow up tomorrow - I could tank Step 1, be a really horrible clinical student, or something COMPLETELY out of my control could blow me off track. For the moment, however, I truly have pulled myself up from a low-performing medical student to one of the strongest students in my class - and I'm definitely not the only one I know who has done this.

2 things, and I'm just discussing here, not trying to slam you.

1. Nothing about what you said makes you an "underdog" applicant. If you got a 3.3 in a hard major at a hard school that is good. Low 30s on the MCAT is above average for students accepted to medical school. So quite to the contrary it looks like you were an average to slightly above average applicant.

2. It's cool that you've done so well, congrats. But I'm really not talking about annecdotal evidence of turnaround. I'm talking more about what Law2Doc hit on. When I was an undergrad I "wanted to be a doctor." Now that I'm an M3 I realize that I don't just "want to be a doctor," I want to be an emergency physician (or a neurosurgeon, or an anesthesiologist, or a dermatologist -- you fill in the blank). I'm lucky enough to be competitive for my chosen specialty, barring some huge snafu I can reasonably expect to match. But if I wasn't, I'm not sure I would want to do anything else. I'm just trying to imagine how terrible it would be to be faced with that reality.

I'm all for tenacity, but I'm just thinking about how these residents must have felt when they realized that their first love was closed to them. If we throw 2000 more students into the mix over the next few years are the competitive residencies going to swell to accomadate them or are we going to have alot of disgruntled former Anesthesia applicants in FP/IM residencies?
 
Worse is the feeling after you work your rear off for years and do get that coveted residency that you thought you loved (at the time). It turns out the work was not for you when you hit the real world or some years into it. At that point you realize it's probably too late to go back and do something else. But people still do.
 
If we throw 2000 more students into the mix over the next few years are the competitive residencies going to swell to accomadate them or are we going to have alot of disgruntled former Anesthesia applicants in FP/IM residencies?

Very likely the latter. Which is good for the nation's resource allocation -- nationally, we need more FPs more than we need more gas residents. Although I personally bet there won't be a quick increase in residencies, even in FP -- as there might be an ulterior motive of tightening the screws on the caribbean crowd by leaving the number of slots constant for a while.

Hopefully premeds know the odds when they sign up for this increasingly competitive game of musical chairs though.
 
One small additional point to consider is that there is not necessarily a dichotomy between getting a "ROAD" (or surgery) residency and doing primary care for life. I agree that anyone who enters med school focused on a single high competition residency, regardless of their numbers going in, and to some degree, during med school may be disappointed, and of course some folks may match into a competitive residency despite a low MCAT. :)

But, if going in, people recognize that "some" of the things they are looking for in the competitive specialties can be found by other routes, it might make for a better perspective. For example, someone interested in EM, could go pedi and then pedi EM fellowship assuming they liked pedi. Critical care, which offers many of the sorts of things people interested in EM and anesthesia are looking for, can be approached from IM or pedi as well.

Certainly, this may not work for those determined to do derm or those who absolutely only want EM, rads, anesthesiology, but, this is not going to change. We will always have fixed needs for these and limited spots. Nonetheless, assuming the only possibility is ROAD/surgery or primary care is not true. I would have hated either and did not need to do either.
 
Isn't ROAD the opposite of general surgery wrt lifestyle? I never thought of general surgery as particularly competative these days. Moreso than primary care fo sho, but I think that the majority of US grads can get into general surgery if they want to.

I've been flamed plenty of times in pre-allo for being honest with students, so I won't continue my ranting here regarding people who wonder why they have no success applying oos to California schools with a 25 MCAT.

I really do believe people when they tell me that most US grads do in fact get to do the specialty that they want. It may get tougher as the years go on, but I'm not worried about being forced to something that I don't want to do.
 
One small additional point to consider is that there is not necessarily a dichotomy between getting a "ROAD" (or surgery) residency and doing primary care for life. I agree that anyone who enters med school focused on a single high competition residency, regardless of their numbers going in, and to some degree, during med school may be disappointed, and of course some folks may match into a competitive residency despite a low MCAT. :)

One of my best friends matched into Urology with a 27 MCAT...the point is just work your tail off and you won't have to worry about not matching in one of your top choices, barring you are a total social reject :laugh:
 
Like folks were saying competitve specialties are are, well, competitive, but it's more than that, they are also plauged with nepotism and elitism. That's life. Have good grades, score well on Step I (and II - more and more programs want to see II), but also KNOW somebody, and find a jewel to put in your cap, like a decent research project.

If you don't match to your competive speciality of choice, know that it was for whatever various reasons you were not what they were looking for and in some ways, if you think about it, why would you want to go somewhere where the people didn't want you, or didn't want you enough to make sure you matched? We take it personally, but don't.

If you don't match you'll find a IM/Peds/FM/Psych residency. Worse case scanario . . . Doctor is that you will be board certified and working in 3-4 years as a physician. That is the worse case scenario . . .

Find your peace with it . . .
 
It should go without saying that most people will not get to do whatever their first career choice is. That's a given. Half of Americans will find something tolerable, however. When all is said and done, about 1 in 7 Americans are very happy with their job, and these numbers are going down. Being able to enjoy pretty much any kind of thankless, grueling work is probably a valuable skill because even the most lucrative careers seem to have times when they aren't a lot of fun (like certain aspects of internship/residency for medical students). I've seen tons of people who seem to have really cool jobs and complain about silly little issues and people who seem to have an intolerable jobs laughing and joking with their coworkers. While demands keep going up, some people just seem to be able to enjoy what's in front of them moreso than others.

http://www.conference-board.org/utilities/pressDetail.cfm?press_ID=2582
"U.S. Job Satisfaction Keeps Falling, The Conference Board Reports Today

"Americans are growing increasingly unhappy with their jobs, The Conference Board reports today. The decline in job satisfaction is widespread among workers of all ages and across all income brackets.

"Half of all Americans today say they are satisfied with their jobs, down from nearly 60 percent in 1995. But among the 50 percent who say they are content, only 14 percent say they are "very satisfied."

"This report, which is based on a representative sample of 5,000 U.S. households, conducted for The Conference Board by TNS, a leading market information company (LSE: TNN), also includes information collected independently by TNS. This information reveals that approximately one-quarter of the American workforce is simply "showing up to collect a paycheck."

Obviously, medicine is not immune to job dissatisfaction. That 3.1 GPA individual with the 26 MCAT might end up being happier with his or her physician job than that 4.0 GPA 40 MCAT premed. There is also no guarantee that the 3.1 GPA / 26 MCAT individual would enjoy the alternatives to FM: nursing, High School Biology teacher, realtor, ... job satisfaction in these careers isn't exactly skyrocketing either. At the same time, I do agree that we shouldn't create unrealistic expectations; a pre-med who gets admitted to medical school is not necessarily going to be able to do whatever specialty they might like as their first choice.
 
I think saying I want to go into dermatology or not be a physician at all (be unhappy enough to not want to do another speciality) is similar (albeit not exactly the same) as saying I won't be happy unless I go to Harvard Medical School. If you're in medicine because you truly love it, you are likely to be happy in more than one speciality just like there is more than one medical school that suits your needs. You may not think it at the time of rejection, but I'm more than sure it won't cause most people to completely abandon medicine and regret going into the field.
 
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On my last rotation (FM) I worked with at least 3 residents who were in their 2nd choice career. 2 of them had failed to match in EM and 1 had wanted to do EM but hadn't even tried to apply (Carribean, low steps, think he had failed some stuff too).

This is just madness to me, especially considering the article I recently read that said med schools are slated to add 17% more spots by 2012 (this doesn't even count DO schools). Every time I cruise over to Pre-Allo there's the student with very marginal numbers asking about his "chances." Yes, yes, I know that there are plenty of people who do badly in UG and then turn it around in med school (that's not the point here).

Seriously though, what do you tell this guy/girl with the 3.1 GPA and the 26 MCAT? Because "go for it! you can do anything you want!" is almost certainly a lie.

As I think about my career choice, I imagine I would be absolutely sick if I knew that realistically I had no shot at my first choice. There is something to be said for tenacity and dogedness - the prelim year followed by the reapplication. But at the end of the day some people will end up in a residency they never wanted to do.

So I guess I don't have any questions, I'm just sort of thinking out loud.


(P.S. This is not a bash FM thread, I liked FM alot and most of my residents were ecstatic to be doing it.)

3.1 and 26 are kind of the averages for Osteopathic... I mean, perhaps the GPA's are slightly higher (since they replace retakes with the higher grade unlike AMCAS), and it seems that osteopaths do all right in the match. Do they do better, worse, who knows? Thinking out loud.

Also, there's one guy in my class who I know didn't do too well on his MCAT, but had a very high GPA from a tough school. He works extremely hard and I always see him studying at the medical school, driving me to guilt (to study). He does well on tests, and I think he works very hard to achieve those results. However, I find myself working a fewer number of hours and still achieving high grades on tests.

I think it's safe to say that people who work hard and have some sort of strong strong driving force will be able to perform well for boards. Now how does this correlate with GPA and MCAT scores? There may well not be a correlation, as hard workers have a gamut of GPA/MCAT scores. However, it may be safe to say that there is a significant chunk of the low GPA/MCAT segment that either is lacking in the mental / cognitive skills dept, or the hard work dept.
 
However, it may be safe to say that there is a significant chunk of the low GPA/MCAT segment that either is lacking in the mental / cognitive skills dept, or the hard work dept.

I'm not sure what OP's point was in mentioning MCAT/GPA scores in his post, as I think the answer to his question is not dependant on that. The MCAT does not pretend to be an aptitude or intelligence test, so I think you are probably too far out on a limb attributing a lack of mental/cognitive skills to that. And GPA is often as reflective of the school and courses you chose (and/or your level of maturity and focus at age 17-18) as it is of hard work or raw intellect. Those barometers are largely over once you get to med school. We all know folks with unimpressive premed careers or MCATs who ended up at the top of their class and vice versa. Med school rewards the people who best adapt to the rigors of med school above all else. Schools correctly place emphasis on Step 1 and later year evaluations precisely because most recent indicators are always better ones. So someone who gets into med school with lackluster numbers basically has a clean slate and the best advice is to tell them is to figure out a study method that works in med school (undergrad methods often don't) and to work as hard as they can to do as well as they can. But that is basically the same advice as you would give to anyone, even with top stats.

The real question, I think, is what you advise people who are going into med school with expectations of top specialties -- to which my initial post is responsive.
 
I think saying I want to go into dermatology or not be a physician at all (be unhappy enough to not want to do another speciality) is similar (albeit not exactly the same) as saying I won't be happy unless I go to Harvard Medical School. If you're in medicine because you truly love it, you are likely to be happy in more than one speciality just like there is more than one medical school that suits your needs. You may not think it at the time of rejection, but I'm more than sure it won't cause most people to completely abandon medicine and regret going into the field.


I'd be curious to hear what some other people think, to me this statement is categorically false.
 
I'm not sure what OP's point was in mentioning MCAT/GPA scores in his post, as I think the answer to his question is not dependant on that. The MCAT does not pretend to be an aptitude or intelligence test, so I think you are probably too far out on a limb attributing a lack of mental/cognitive skills to that. And GPA is often as reflective of the school and courses you chose (and/or your level of maturity and focus at age 17-18) as it is of hard work or raw intellect. Those barometers are largely over once you get to med school. We all know folks with unimpressive premed careers or MCATs who ended up at the top of their class and vice versa. Med school rewards the people who best adapt to the rigors of med school above all else. Schools correctly place emphasis on Step 1 and later year evaluations precisely because most recent indicators are always better ones. So someone who gets into med school with lackluster numbers basically has a clean slate and the best advice is to tell them is to figure out a study method that works in med school (undergrad methods often don't) and to work as hard as they can to do as well as they can. But that is basically the same advice as you would give to anyone, even with top stats.

The real question, I think, is what you advise people who are going into med school with expectations of top specialties -- to which my initial post is responsive.

Good points. I personally think that getting a superlative MCAT score, i.e. once you're beyond the low 30's range, depends on various factors... and it's not like one can train oneself to get a 40 on the MCAT (vs training for a 240 on the USMLE). However, as an MCAT instructor, many of the students I see start with 22-24's on their very first practice test, without having reviewed any material at all. This isn't too far from a 26, and so I really have to scratch my head about people who get such low scores and apply with them.

Speaking of unrealistic expectations, I often see the "Oh, I'll just go to the Caribbean, kick ass, then transfer to an American school"... these are ones I have to roll my eyes at, and nothing can seem to give these people a dose of reality.
 
Speaking of unrealistic expectations, I often see the "Oh, I'll just go to the Caribbean, kick ass, then transfer to an American school"... these are ones I have to roll my eyes at, and nothing can seem to give these people a dose of reality.

I think in 4 years reality will give them a dose of reality.:laugh:
 
I'd be curious to hear what some other people think, to me this statement is categorically false.

Totally depends. If your goal is just to work with patients and practice "medicine" then you will probably be fine with whatever field you can manage. If you show up wanting to do both medicine and have a certain lifestyle, the choices of fields you will be happy in will be significantly more limited. If you show up with a very specific specialty/role in mind, you will probably be doomed to be unsatisfied when you don't achieve it.
 
Good points. I personally think that getting a superlative MCAT score, i.e. once you're beyond the low 30's range, depends on various factors... and it's not like one can train oneself to get a 40 on the MCAT (vs training for a 240 on the USMLE). However, as an MCAT instructor, many of the students I see start with 22-24's on their very first practice test, without having reviewed any material at all. This isn't too far from a 26, and so I really have to scratch my head about people who get such low scores and apply with them.

Speaking of unrealistic expectations, I often see the "Oh, I'll just go to the Caribbean, kick ass, then transfer to an American school"... these are ones I have to roll my eyes at, and nothing can seem to give these people a dose of reality.


This is what I was referring to in my OP, although the topic seems to have diverted off onto MCAT/GPA stuff. There is going to be plenty of anecdotal evidence of people who sudddenly turn into all-stars in medical school.
 
Rereading the original post makes me think that the number of "desirable" residency spots in the specialties of choice not keeping pace with increased med school admissions is the concern ....

Maybe this offers some hope:

http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1286
Secretary Nicholson: VA Increasing Support for Medical Education

February 2, 2007

WASHINGTON – The Department of Veterans Affairs (VA), which already helps train nearly half of the physicians in the United States, will increase its support for medical education in the 2007-2008 academic year, adding 2,000 positions for advanced residency training over the next five years.

...

More than 31,000 medical residents and 16,000 medical students receive some of their training in VA each year. The expansion in medical education begins in July 2007 when VA adds 341 new positions.

**********

Here is a bit more about the problem:

The hazy doc shortage., By: Romano, Michael, Modern Healthcare, 01607480, 6/5/2006, Vol. 36, Issue 23

"Last year, the AAMC, in its first acknowledgement of concerns about a doctor shortage, recommended that the nation's 125 allopathic medical schools boost enrollment about 15% by 2015, increasing the student body by approximately 2,500 a year. Officials are now revising that estimate, and expect to recommend at the AAMC board meeting later this month that medical schools, which have turned out about 16,000 graduates per year over the past quarter century, double that earlier estimate and shoot for increases of about 30%.

"That revision was overdue, says Richard Cooper, a longtime expert on physician workforce issues who is a professor at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. A pessimist on physician supply, Cooper believes the U.S. needs far more than the 5,000 or so additional physicians that will be produced if the AAMC institutes its plan to boost enrollment. He predicts that the nation will need about 125,000 more doctors in 2015 than we have today. The nation is already scrambling to meet demand, says Cooper, who estimates that the U.S. is already about 50,000 doctors short of what is needed.

...

"Still, even if medical schools ramp up graduates to the level suggested by the AAMC's modest proposals--churning out 5,000 more future doctors sometime over the next five to seven years-there may not be enough additional slots in residency programs to accommodate these new doctors-in-waiting. In 2004, for instance, slightly more than 24,000 men and women entered residency training in the U.S., with a total of slightly more than 100,000 of these future doctors spread across the system. That number has not varied widely in recent years, primarily because the level of federal funding for graduate medical education has remained fairly constant for the past eight years or so. About 64% of those individuals were products of U.S. allopathic medical schools, and about 25% were graduates of international medical schools, with 11% graduating from schools of osteopathy.

"The AMA, which for years voiced concerns about an overabundance of physicians adopted a policy last year acknowledging "a shortage of physicians, at least in some regions and specialties," and offered a general proposal to identify funding sources for new medical schools and residency slots to meet those needs. According to the AMA, there are shortages in neurosurgery and geriatrics, among other specialties. Several states are in need of additional doctors, including Georgia, where growth in the workforce has "stalled," and Kentucky, which experienced a net loss of physicians from 2000 to 2002. In that two-year period, the AMA says, 36% of the practicing neurosurgeons in the state retired or relocated.
 
I believe it stands for Radiology, Ophthalmology, Anesthesiology, and Dermatology.
 
I believe it stands for Radiology, Ophthalmology, Anesthesiology, and Dermatology.

Traditionally this was called the ROAD to happiness because these were all considered lifestyle specialties with decent income potential. Some have suggested editing this list in recent years.
 
I'd be curious to hear what some other people think, to me this statement is categorically false.

I strongly disagree. I am loving med school (though not my boards studying at the moment) simply because I am finding so much stuff so interesting. Heart caths? Swanz Ganz? Intubating someone crashing from septic shock? Laparoscopic cholecystectomy? ERPCs? ENT microsurgery? Pathology and teaching at a med school on the side? Hospital vs. clinic? All of these have their pluses and own individual excitement associated with them.

I think that those people who have a harder time deciding what they want to do as a practicing doc stand a greater chance of being satisfied in more than one thing, simply because more than one specialty is appealing to begin with. The hard part isn't always chosing what to do, but deciding what you won't do.

As far as residency choices go, the more people interested in so-called ROAD specialties, the more people that will be let down when they don't get in. Speaking about residency program expansion...many of these sub-specialties are not the ones feeling a shortage of doctors. Rather it is the specialties that aren't always filling in the match (primary care across the board) that are suffering the shortage. Besides expanding residency slots to fill the number of medical graduates, residencies like FP and medicine need to get on the horse and make those careers desireable again. Allocation of resources will go foremost to where it is needed to serve the general public's needs (and they need more primary care doctors), and second to the programs that everyone wanting to make money with less work want.
 
Rather it is the specialties that aren't always filling in the match (primary care across the board) that are suffering the shortage. Besides expanding residency slots to fill the number of medical graduates, residencies like FP and medicine need to get on the horse and make those careers desireable again. Allocation of resources will go foremost to where it is needed to serve the general public's needs (and they need more primary care doctors), and second to the programs that everyone wanting to make money with less work want.

Agree with this -- to the extent residency slots get increased they will likely be in primary care.

But I actually don't think they will be rapidly increased to match the increase in med school seats. If you search on the web, you will find various medical organization bigwhigs in recent years have made comments like 'US medical schools need to meet US needs' without relying on non-LCME accredited caribbean schools to fill the overlap (See eg. http://www.aamc.org/newsroom/pressrel/2005/051106.htm - toward the end of the article). So it seems to me like an increase in med school seats not rapidly followed by additional residency slots is a good and painless way to put the squeeze on the caribbean crowd, and might be the game plan. Maybe it's a conspiracy theory, but seems logical to me.
 
Agree with this -- to the extent residency slots get increased they will likely be in primary care.

But I actually don't think they will be rapidly increased to match the increase in med school seats. If you search on the web, you will find various medical organization bigwhigs in recent years have made comments like 'US medical schools need to meet US needs' without relying on non-LCME accredited caribbean schools to fill the overlap (See eg. http://www.aamc.org/newsroom/pressrel/2005/051106.htm - toward the end of the article). So it seems to me like an increase in med school seats not rapidly followed by additional residency slots is a good and painless way to put the squeeze on the caribbean crowd, and might be the game plan. Maybe it's a conspiracy theory, but seems logical to me.

I can see that. I also just had this pop into my mind: what about DO's into allo residencies? I'm not sure what the stats are on how much the DO schools fill their own osteopathic residencies, but I know that there are lots of DO's who go to allo residencies via USMLE's. I guess I was wondering if there is any intent to squeeze them out as well, which, in my opinion, would be pretentious and foolish.
 
I bet if primary care payed more, we wont be having this discusion.
 
I bet if primary care payed more, we wont be having this discusion.

As if $130,000 - $150,000 is now somehow inadequate for life's needs...part of the 'satisfaction' in any medical field is going to be being 'satisfied' with what you have. Be smart with the money, and a difference of $50K - $100K ends up being less of a difference. Or you can just go marry another doctor...
 
As if $130,000 - $150,000 is now somehow inadequate for life's needs...part of the 'satisfaction' in any medical field is going to be being 'satisfied' with what you have. Be smart with the money, and a difference of $50K - $100K ends up being less of a difference. Or you can just go marry another doctor...

Not me. To be 'satisfied,' I need at least $200k with 8 weeks vacation. There's no reason for me to settle for anything less because the current market sustains this kind of compensation. Settling, in Ayn Rand's terms, would be immoral.
 
Not me. To be 'satisfied,' I need at least $200k with 8 weeks vacation. There's no reason for me to settle for anything less because the current market sustains this kind of compensation. Settling, in Ayn Rand's terms, would be immoral.

Most physicians in most specialties do not get 8 weeks off per year in my experience.
 
Most physicians in most specialties do not get 8 weeks off per year in my experience.

It's not that uncommon in radiology, EM, or anesthesiology in certain areas, particularly the south and midwest. Might be tougher to come by in the more saturated areas, but there are docs in private practice groups who get this sweet of a deal or sweeter, though you probably sacrifice job security.
 
It's not that uncommon in radiology, EM, or anesthesiology in certain areas, particularly the south and midwest. Might be tougher to come by in the more saturated areas, but there are docs in private practice groups who get this sweet of a deal or sweeter, though you probably sacrifice job security.

Right, but what percentage of physicians are in radiology, anesthesia, or EM? My point is not that these deals can't be found, but rather that they are hardly what the market rate is for the average physician.
 
I strongly disagree. I am loving med school (though not my boards studying at the moment) simply because I am finding so much stuff so interesting. Heart caths? Swanz Ganz? Intubating someone crashing from septic shock? Laparoscopic cholecystectomy? ERPCs? ENT microsurgery? Pathology and teaching at a med school on the side? Hospital vs. clinic? All of these have their pluses and own individual excitement associated with them.

I think that those people who have a harder time deciding what they want to do as a practicing doc stand a greater chance of being satisfied in more than one thing, simply because more than one specialty is appealing to begin with. The hard part isn't always chosing what to do, but deciding what you won't do.

I think you might be confusing finding stuff interesting with wanting to do it. I mean no one is going to watch an ORIF for the first time and find it totally uninteresting, that doesn't mean everyone wants to do Ortho.
 
I'm a pre-allo (hopefully). I noticed that MCATs and UGrad GPA were mentioned a lot earlier in this thread. Does your MCAT and UGrad GPA have anything to do with your residency options, or do you essentially start with a 'clean slate' when you begin medical school?

Also, does anyone know how the military affects your odds of landing one of the more difficult specialties, especially Ortho and EM?

As far as I know, it's a clean slate issue. As far as military, (I'm one) you play under a completely different match process. You would have to post on the military side of this forum for that question. I want to go IM or FP, so it's a moot point for me, I think I'll match. As far the more competetive fields, don't know.
 
I think you might be confusing finding stuff interesting with wanting to do it. I mean no one is going to watch an ORIF for the first time and find it totally uninteresting, that doesn't mean everyone wants to do Ortho.

No, by saying I find it interesting I am saying I have considered that it is appealing enough to want to do for work. I used the above examples of a random smattering of things. The matter will moreso be what do I find myself most desiring to do, so maybe it's the same as what you're saying only in a little different way. It would also involve what my long-term goals are, and there are some things I went into medicine to do that are not going to lead me to a ROAD specialty. On another note, even in a ROAD specialty you can find yourself without any time outside of work; medicine as a field will take whatever man hours you throw at it and still have room for more.

PerrotFish said:
I'm a pre-allo (hopefully). I noticed that MCATs and UGrad GPA were mentioned a lot earlier in this thread. Does your MCAT and UGrad GPA have anything to do with your residency options, or do you essentially start with a 'clean slate' when you begin medical school?

Also, does anyone know how the military affects your odds of landing one of the more difficult specialties, especially Ortho and EM?

You get a clean slate. The good MCAT and GPA gets you into med school, but once there no one will bother caring about how well you did to get there. Everyone around you will be top-tier students, and everyone will see you as being capable, but to get to the level beyond med school you've gotta show your stuff all over again. Any clout you built as far as test scores you got before go is moot. If you can do good enough in undergrad to get into medical school though, you're competent enough to do well in med school. That's why you were accepted. You study hard, rock your Step 1, get good evals in your rotations, and you'll be in the drivers seat.
 
I'm a pre-allo (hopefully). I noticed that MCATs and UGrad GPA were mentioned a lot earlier in this thread. Does your MCAT and UGrad GPA have anything to do with your residency options, or do you essentially start with a 'clean slate' when you begin medical school?

It's a clean slate. The OP seemed to be suggesting that the folks who got middling numbers in undergrad were likely to continue to do so at the next stage, thereby limiting their career options, and/or that people with such numbers end up doing caribbean options that limit their career options.
 
As if $130,000 - $150,000 is now somehow inadequate for life's needs...part of the 'satisfaction' in any medical field is going to be being 'satisfied' with what you have. Be smart with the money, and a difference of $50K - $100K ends up being less of a difference. Or you can just go marry another doctor...

Not to belabor the point, but when you graduate with an amount of debt that is GREATER than your annual salary after finishing residency...yes, that is inadequate for life's needs IMHO.
 
If you're in medicine because you truly love it, you are likely to be happy in more than one speciality just like there is more than one medical school that suits your needs

I'd be curious to hear what some other people think, to me this statement is categorically false.

I agree with you, this is completely false in my opinion. The differences between med schools are negligible compared to the variety of cases and procedures (or lack of procedures) between specialties in medicine.

I also think that some of you are mistakingly substituting "what I find interesting" with "what I want to do on a daily basis for the rest of my life". I know plenty of Surgery residents who though Psychiatry was interesting but that doesn't mean they wanted to be a shrink. It's like what they say about Emergency Med - it's for those who found most of their rotations interesting but not interesting enough to focus on for the rest of their lives.
 
Not to belabor the point, but when you graduate with an amount of debt that is GREATER than your annual salary after finishing residency...yes, that is inadequate for life's needs IMHO.

I'm glad that physicians are well paid. At the same time, I'm not sure that the fact that medical students accumulate a lot of debt should justify high physician salaries. In my mind, it's actually the opposite dynamic: the high physician salaries enable medical schools to charge large tuitions and enable medical students to acquire huge debts.

If entry level physicians made, say, $80K/yr, banks might not loan medical students as much money and students might be less willing to borrow that much. Thus, there would not be same debt problem; we would need to rethink paying for medical education and most likely develop a different funding model. With the exception of maybe Canada, most other countries are able to pay their physicians $40K - $80K and in many cases deliver superior healthcare to their population with superb physicians (because they are less expensive, so you actually could have more of them or just spend money on other healthcare equipment and medication, for example).

You can't tell me that Spanish physicians making ~$40K are somehow clinically inferior to American physicians making ~$200K. Both groups are excellent. We do need to rethink the financing of healthcare so that financial incentives are more in line with the contribution to the wellbeing of our society (which is not especially healthy). That might also help promote primary care (which is apparently what we need more of) and make the need to become a specialist to pay student debt or keep up with the "Dr. Jones's" less of an issue.
 
Not to belabor the point, but when you graduate with an amount of debt that is GREATER than your annual salary after finishing residency...yes, that is inadequate for life's needs IMHO.

Um, I image this happens to more people than you think. How many people borrow money to attend an expensive undergrad and then go on to things like teaching? Unless the average salary right out of school for a graduate of a private school is more than $160,000 or so then either the student wasted their money by borrowing it or their parents wasted money by spending it on an expensive school (many undergraduate schools have total budgets that exceed $40k).
 
Not to belabor the point, but when you graduate with an amount of debt that is GREATER than your annual salary after finishing residency...yes, that is inadequate for life's needs IMHO.

Have you ever heard of "living below your means"? Wait until the debt is paid off to fully appreciate a physician salary. As they say, live like a student now, or live like one later. People buy houses on mortgage, buy cars on finance, etc., and those are generally not drop it all on the table and pay off at once expenses. They're paid off over time by wise financial management. Same with loan debt.

I guess it also depends on what you "need" for life. For me, that's some shirts and pants, some food, and a roof over my head, and that's about it. All the other stuff in life is just icing. I think someone would be hard pressed to legitimately argue a "need" for Tivo, a car less than 5 years old, a car period...Sure it'll be nice to be paid well as a physician, but quite honestly we don't need people earning $200K+. Most people in America live on $30,000 - $40,000/year. Most people don't get college educations even. The more people act against the rising costs of medicine, the more we're going to see these large salaries normalized with other average physician salaries, because it's an easy first cut.

Anywho, we're just hijacking the OP's original post now.
 
Um, I image this happens to more people than you think. How many people borrow money to attend an expensive undergrad and then go on to things like teaching? Unless the average salary right out of school for a graduate of a private school is more than $160,000 or so then either the student wasted their money by borrowing it or their parents wasted money by spending it on an expensive school (many undergraduate schools have total budgets that exceed $40k).

Yes, people do this all the time...that doesn't make it a good idea. People make silly financial decisions all the time - this would be an example of that.
 
Most professionals are lucky to get more than 4.

In the (small) clinic where I worked doctors had pretty nice vacation time, definitely more than 4 weeks. I think it depends on finding the right kind of employer.
 
Have you ever heard of "living below your means"? Wait until the debt is paid off to fully appreciate a physician salary. As they say, live like a student now, or live like one later. People buy houses on mortgage, buy cars on finance, etc., and those are generally not drop it all on the table and pay off at once expenses. They're paid off over time by wise financial management. Same with loan debt.

I guess it also depends on what you "need" for life. For me, that's some shirts and pants, some food, and a roof over my head, and that's about it. All the other stuff in life is just icing. I think someone would be hard pressed to legitimately argue a "need" for Tivo, a car less than 5 years old, a car period...Sure it'll be nice to be paid well as a physician, but quite honestly we don't need people earning $200K+. Most people in America live on $30,000 - $40,000/year. Most people don't get college educations even. The more people act against the rising costs of medicine, the more we're going to see these large salaries normalized with other average physician salaries, because it's an easy first cut.

Anywho, we're just hijacking the OP's original post now.

Who is this 'WE' that you are talking about. BTW, if the so called salary normalization that you are talking about happens, could you explain to us how you plan on getting people to spend extra years in residency/fellowship pursuing more difficult specialties.
 
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