Should there be a Limit on # of residency programs you can apply to?

[cbrons]

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Heard via a very reliable source (reddit) that there will be a meeting between deans soon to discuss limiting the number of programs you can apply to on ERAS.

Regardless of whether that meeting is real or fake, do you think there should be a hard cap on the number of programs you can apply to and why?

EDIT: See this post for detailed background information on this issue.

 

[Brorthopedic]

Stopped reading after you said reddit was a reliable source

 

[DrBowtie]

Heard via a very reliable source (reddit) that there will be a meeting between deans soon to discuss limiting the number of programs you can apply to on ERAS.

Regardless of whether that meeting is real or fake, do you think there should be a hard cap on the number of programs you can apply to and why?

Sent from my SM-N910P using SDN mobile

No cap. Free market. What's the reason to limit it? Make more people SOAP?

 

[cbrons]

Stopped reading after you said reddit was a reliable source

Couldnt catch the sarcasm eh?

Sent from my SM-N910P using SDN mobile

 

[IsWhat]

A tiered system would probably be best. AMGs first, then IMGs, etc.

 

[Anicetus]

Heard via a very reliable source (reddit) that there will be a meeting between deans soon to discuss limiting the number of programs you can apply to on ERAS.

Regardless of whether that meeting is real or fake, do you think there should be a hard cap on the number of programs you can apply to and why?

Sent from my SM-N910P using SDN mobile

What would this accomplish?

 

[Bancrofti]

What would this accomplish?

Depends on the field. I feel like this would be something the "competitive specialties" could benefit from. People basically just flood the system and obviously aren't really heavily involving research of program type or preference of location into their decisions.

It won't happen though. It would lead to some programs going unfilled initially, but the obvious more influential reason is that it would lead to ERAS making less money off of us.

 

[cbrons]

Reasoning is as follows -

Used to be that US Seniors applied to a small handful of programs, did like 3-4 interviews and matched. Nowadays, most applicants over-apply and "over-interview". Even the most highly competitive applicants do this.

There is a flood of applications to programs that the applicant has 0 intention of actually interviewing at much less ranking. It's kind of a strong paranoia out there, and its causing programs (esp mid tier and lower tier ones) to receive thousands of apps, which they have no real way of sorting out who the serious candidates are for their program vs. the (likely) majority who applied there as a back-up/safety.

Limiting the # of total apps would help alleviate it this, in that the programs could would have much fewer #s of apps and will be a lot more confident about the applicant pool being open to going there.

I don't know if that's good reasoning, but I think that is the reasoning for it.

 

[akwho]

We talked a lot about this last year on the interview trail. The number of apps has gone up significantly in the last five years in ortho, but the same number of people are still applying which creates this falsely competitive bubble and wastes everyones time and money. Programs applied to per person went from ~50 in 2011 to over 80 in 2016.

"Tokens" is the solution. You can only hand out "gold tokens" to the top 25 programs. That way the program knows you are genuinely interested in them. You can still flood the market with your app so no anti-competitive law suits against the NRMP, ERAS will still make cash money on your bajillion apps, and programs will be able to sort by who is actually interested in them.

 

[PL198]

It would be pretty hard to stratify apps when you literally get in the thousands.

What do you guys think the number would be if they made a cap? Like are we talking 50 here or 200.

 

[DrBowtie]

Reasoning is as follows -

Used to be that US Seniors applied to a small handful of programs, did like 3-4 interviews and matched. Nowadays, most applicants over-apply and "over-interview". Even the most highly competitive applicants do this.

There is a flood of applications to programs that the applicant has 0 intention of actually interviewing at much less ranking. It's kind of a strong paranoia out there, and its causing programs (esp mid tier and lower tier ones) to receive thousands of apps, which they have no real way of sorting out who the serious candidates are for their program vs. the (likely) majority who applied there as a back-up/safety.

Limiting the # of total apps would help alleviate it this, in that the programs could would have much fewer #s of apps and will be a lot more confident about the applicant pool being open to going there.

I don't know if that's good reasoning, but I think that is the reasoning for it.

Used to be when? 15 years ago?

Why would programs want fewer apps? It is relatively easy to filter down applications given the way ERAS is setup.

It's easy to offer interviews and as people not interested decline then fill them with other applicants given reasonable lead time.

This sounds like the medical school academicians trying to protect their weak applicants.

 

[Frazier]

It would be pretty hard to stratify apps when you literally get in the thousands.

What do you guys think the number would be if they made a cap? Like are we talking 50 here or 200.

I think 30 would be a reasonable number.

Competitive people apply to competitive programs -- or less competitive programs (they would know you're actually interested in their program despite you appearing "over-qualified" being that you spent one of your 30 slots on them).

Less competitive people can throw a few hail mary's as they please but are better served applying to the programs they are more likely to match at in reality.

The current system has gone haywire. Each cycle it gets worse and subsequent classes go one step further since all they have to go off of is their seniors' hysteria. The amount of money (applicants) and hours (programs) being wasted is ludicrous.

This cycle the new growing trend is to cold-call and email residencies to try to get noticed that way from the masses. Early October. It's just crazy.

On the flip side, what is the argument for there being "no cap"? Can an applicant really not narrow down to a mere 30 programs that they might like? Okay, apply to all 60 that you like. That doesn't mean you will get an invite. Does it better your chance of matching? I believe prior statistics indicated not really. It just bogs everything down.

 

[Donald Juan]

Used to be when? 15 years ago?

Why would programs want fewer apps? It is relatively easy to filter down applications given the way ERAS is setup.

It's easy to offer interviews and as people not interested decline then fill them with other applicants given reasonable lead time.

This sounds like the medical school academicians trying to protect their weak applicants.

People in competitive specialties don't necessarily decline the interviews. They go on them and then rank the program 25/25 or something similarly ridiculous. It makes it harder for places to match people as they also have to interview more people, as many of the more competitive applicants will just be wasting interview time. It should be that places could interview 10-15 people per slot, but now many are doing 20-30 people, because otherwise they risk going unmatched.

And if you think limiting the number of allowed residency apps would protect weak applicants, you're thinking backwards. It would hurt weak applicants as they can't apply across the board. Do you think weak applicants apply to more or less places?

 

[DrBowtie]

People in competitive specialties don't necessarily decline the interviews. They go on them and then rank the program 25/25 or something similarly ridiculous. It makes it harder for places to match people as they also have to interview more people, as many of the more competitive applicants will just be wasting interview time. It should be that places could interview 10-15 people per slot, but now many are doing 20-30 people, because otherwise they risk going unmatched.

And if you think limiting the number of allowed residency apps would protect weak applicants, you're thinking backwards. It would hurt weak applicants as they can't apply across the board. Do you think weak applicants apply to more or less places?

If they want to interview at 25 places that's their business. They earned those interviews. Also you never know about places until you interview. Lots of prestigious places are not great places to train and lots of places you wouldn't expect have good programs.

Residency programs adapt and learn their place on the pecking order. Just like in medical school there is yield protection and bottom tier places aren't offering interviews to superstar applicants.

The idea of limiting the number of apps would be more people would apply within their tiers. So the lower level applicants wouldn't get lost amongst mid tier applicants at their safety programs.

The way to combat all of this is to be a good applicant for your desired field, not rely on the deans to help rig the system.

 

[Donald Juan]

If they want to interview at 25 places that's their business. They earned those interviews.

Residency programs adapt and learn their place on the pecking order. Just like in medical school there is yield protection and bottom tier places aren't offering interviews to superstar applicants.

The idea of limiting the number of apps would be more people would apply within their tiers. So the lower level applicants wouldn't get lost amongst mid tier applicants at their safety programs.

The way to combat all of this is to be a good applicant for your desired field, not rely on the deans to help rig the system.

Yeah, but it's not just one superstar who is getting 25 interviews. This is a self perpetuating system that will only get more ridiculous. Everybody applies to more places, because they look at the year before and realize that everybody applies to more places. Programs realize everybody applies to everywhere. Yes, they try and filter by region and staying within their tier, but ultimately they have to interview more people. By the nature, people have to interview at more places to match as well.

I don't know if instituting a cap is the right solution, but it would solve a problem we are having. ENT tried to combat this interview inflation by making everyone write a stupid secondary for every institution they apply to telling them why they want to go there. Did it change the amount of places people applied? Not really. Now if you apply to ENT just be prepared to write 60 secondary applications. Fun times. I'm sure others will suggest just rising the cost of applications over X amount. You all know how med students are, and we have an endless fountain of student loans. It won't stop anybody; we'll still look at the average number of apps of matched students from the year before, add 10 to it and apply to that many places. And the rising number of students in med school is only going to make things more competitive, and make us more compelled to do it.

Again, I don't know if a cap is the solution. But it would save everyone involved in this process a lot of time and money.

 

[Brorthopedic]

Yeah, but it's not just one superstar who is getting 25 interviews. This is a self perpetuating system that will only get more ridiculous. Everybody applies to more places, because they look at the year before and realize that everybody applies to more places. Programs realize everybody applies to everywhere. Yes, they try and filter by region and staying within their tier, but ultimately they have to interview more people. By the nature, people have to interview at more places to match as well.

I don't know if instituting a cap is the right solution, but it would solve a problem we are having. ENT tried to combat this interview inflation by making everyone write a stupid secondary for every institution they apply to telling them why they want to go there. Did it change the amount of places people applied? Not really. Now if you apply to ENT just be prepared to write 60 secondary applications. Fun times. I'm sure others will suggest just rising the cost of applications over X amount. You all know how med students are, and we have an endless fountain of student loans. It won't stop anybody; we'll still look at the average number of apps of matched students from the year before, add 10 to it and apply to that many places. And the rising number of students in med school is only going to make things more competitive, and make us more compelled to do it.

Again, I don't know if a cap is the solution. But it would save everyone involved in this process a lot of time and money.

The problem is med students, especially those applying to competitive specialties with huge amounts of student debt, don't care about "wasting" time or money. They spent 8 years in school after HS and accumulated 200k+ in debt just to get to the spot they're at. They'll pay whatever the cost is and attend as my interviews as physically possible to secure a residency spot.

 

[Anicetus]

The problem is med students, especially those applying to competitive specialties with huge amounts of student debt, don't care about "wasting" time or money. They spent 8 years in school after HS and accumulated 200k+ in debt just to get to the spot they're at. They'll pay whatever the cost is and attend as my interviews as physically possible to secure a residency spot.

My thoughts exactly.

I applied to 40+ medical schools and got into 2. I plan to utilize a similar strategy to maximize my chances in residency.

 

[Ismet]

I don't think there needs to be a cap, I think the hysteria needs to tone down. I went into a less competitive specialty, but from talking to my home program director, it seemed like it became unusually competitive last year just to get interviews. A bunch of my classmates and I applying to the same specialty didn't get the bulk of our interviews until November, supposedly when people who got the early invites cancelled. People with AOA and a bunch of honors and research applying to 40 programs and getting 30 interviews and going on all of them...of course they're completely entitled to go see all those programs and they earned those interviews, but that's also taking up a ton of interview spots.

 

[Med Ed]

Heard via a very reliable source (reddit) that there will be a meeting between deans soon to discuss limiting the number of programs you can apply to on ERAS.

Regardless of whether that meeting is real or fake, do you think there should be a hard cap on the number of programs you can apply to and why?

This was THE topic of conversation at AAMC's main meeting last year. While I agree that opinions like that shared by @DrBowtie certainly have a point, it is hard to argue that the entire system is now trapped in a vicious cycle that makes it more dysfunctional with each passing year. Taken to its logical extreme, one day we could see a world where every applicant applies to every program.

I can foresee two potential ways to address the problem. One is to establish so-called "traffic rules," which would likely force applicants to batch their applications and send them out in chunks over a period time. There would be no cap on the number of programs one could apply to, but it would force applicants to essentially declare up front which ones they are most interested in.

The other is to publish an MSAR for residency programs, so that applicants can get objective information about who matches into a given program.

The former would piss off some applicants, the latter would piss off some PD's, but that's compromise, right?

 

[giantswing]

Meh. Filter out by step score and rotators. In ortho, something like 80% of people match at places they rotated at. If you want to go there, rotate there fourth year, that way they know you're interested.

 

[Donald Juan]

The problem is med students, especially those applying to competitive specialties with huge amounts of student debt, don't care about "wasting" time or money. They spent 8 years in school after HS and accumulated 200k+ in debt just to get to the spot they're at. They'll pay whatever the cost is and attend as my interviews as physically possible to secure a residency spot.

Well, that's my whole point. We'll do whatever it takes. I went for a competitive residency...I looked at the average number of applications for matched people and added 10 to it. I understand all of these things. The only reason anyone needs to apply to 60 programs is because everybody else does it. You're at a disadvantage in the pool if you don't have a comparable amount of applications and subsequently interviews to others, so it becomes an arms race for everyone to make sure they have more apps than everyone else.

 

[cbrons]

This was THE topic of conversation at AAMC's main meeting last year. While I agree that opinions like that shared by @DrBowtie certainly have a point, it is hard to argue that the entire system is now trapped in a vicious cycle that makes it more dysfunctional with each passing year. Taken to its logical extreme, one day we could see a world where every applicant applies to every program.

I can foresee two potential ways to address the problem. One is to establish so-called "traffic rules," which would likely force applicants to batch their applications and send them out in chunks over a period time. There would be no cap on the number of programs one could apply to, but it would force applicants to essentially declare up front which ones they are most interested in.

The other is to publish an MSAR for residency programs, so that applicants can get objective information about who matches into a given program.

The former would piss off some applicants, the latter would piss off some PD's, but that's compromise, right?

I think your solutions or something similar will be in the pipeline very soon, if not an outright limit.

One thing which I think will make this inevitable is the number of people cold-calling and cold e-mailing programs this year to express interest. That is a lot of extra e-mails/calls that programs are not going to be happy with in the long-run, but in the immediate term, is probably necessary and welcomed in many if not most cases (especially at lower tier or mid tier programs in non-competitive specialties) because there is no way to sort through the deluge of 1,000 applications for 10 spots, when you know that 70% of those will never rank you regardless of interview offer.

 

[PL198]

knowing how medical education works they won't set a hard cap, they will just make it like 100 bucks a program to apply to so they can extract like 10k from all the people who want competitive stuff

 

[PL198]

My thoughts exactly.

I applied to 40+ medical schools and got into 2. I plan to utilize a similar strategy to maximize my chances in residency.

right and that's what everyone does. which is the problem because a residency can't sift through 2000 candidates

 

[DrBowtie]

This was THE topic of conversation at AAMC's main meeting last year. While I agree that opinions like that shared by @DrBowtie certainly have a point, it is hard to argue that the entire system is now trapped in a vicious cycle that makes it more dysfunctional with each passing year. Taken to its logical extreme, one day we could see a world where every applicant applies to every program.

I can foresee two potential ways to address the problem. One is to establish so-called "traffic rules," which would likely force applicants to batch their applications and send them out in chunks over a period time. There would be no cap on the number of programs one could apply to, but it would force applicants to essentially declare up front which ones they are most interested in.

The other is to publish an MSAR for residency programs, so that applicants can get objective information about who matches into a given program.

The former would piss off some applicants, the latter would piss off some PD's, but that's compromise, right?

Having gone through the match (applied to 50-60 rads and 10-20 prelims, interviewed at 22 combined) and now on a selection committtee I've seen both sides of the equation.

The benefit of the match is that you have the freedom to interview as many places as you want/can during the interview period and can rank them according to your preference.

My pre application match list varied widely from my post interview list because you can't assess a program based upon a website without meeting the program leadership and residents. By artificially lowering the amount of applications, I think it will lead to many more unhappy residents. Not only that, it will potentially limit reach program applications. Similar to the randomness of medical school applications, if you applied to all top 20 programs you might get 2-3 but if you had to choose 5 ahead of time you might get 0.

From a program standpoint, filtering extra apps doesn't take too much extra time. Knowing historical match data for your program helps immensely. Programs would rather have too many than too few applications.

 

[akwho]

We talked a lot about this last year on the interview trail. The number of apps has gone up significantly in the last five years in ortho, but the same number of people are still applying which creates this falsely competitive bubble and wastes everyones time and money. Programs applied to per person went from ~50 in 2011 to over 80 in 2016.

"Tokens" is the solution. You can only hand out "gold tokens" to the top 25 programs. That way the program knows you are genuinely interested in them. You can still flood the market with your app so no anti-competitive law suits against the NRMP, ERAS will still make cash money on your bajillion apps, and programs will be able to sort by who is actually interested in them.

This Golden Token idea is like the Superlike on Tinder. If people can use the superlike to match up people who really want to hook up, rather than those that just kind of want to hook up, everyone will be happier.

 

[Dires]

What about limiting the number of interviews an applicant can attend to whatever the charting outcomes shows us a >90% match?

 

[DrBowtie]

What about limiting the number of interviews an applicant can attend to whatever the charting outcomes shows us a >90% match?

So you want more people to SOAP? Also in some fields that would be like a handful of IVs.

 

[Dires]

So you want more people to SOAP? Also in some fields that would be like a handful on IVs.

How would that cause more people to soap? I don't think it's the 20th interview that saves people from the soap.

 

[Med Ed]

Having gone through the match (applied to 50-60 rads and 10-20 prelims, interviewed at 22 combined) and now on a selection committtee I've seen both sides of the equation.

The benefit of the match is that you have the freedom to interview as many places as you want/can during the interview period and can rank them according to your preference.

Been through it, thanks.

By artificially lowering the amount of applications, I think it will lead to many more unhappy residents.

I cannot argue with your anecdotal experience, but it is somewhat at odds with the panels of PD's who turn up at regional and national meetings to plead for relief. You also seem to be assuming that the current situation is normal, and that decreasing the total number of applications would be "artificial." Back in my day (shakes cane) the only people who applied more than 20 programs were those who were going for the most competitive fields. Now the average is over 35 among all domestic allopathic seniors.

That's f-ed up, especially considering that most people still match in their top three.

More apps, more interviews, more games, more uncertainty, more anxiety, same results. How is this desirable?

 

[DrBowtie]

How would that cause more people to soap? I don't think it's the 20th interview that saves people from the soap.

You said put the limit at 90% chance of match by statistics. There are obviously people who need the extra ranks to match.

 

[DrBowtie]

Been through it, thanks.



I cannot argue with your anecdotal experience, but it is somewhat at odds with the panels of PD's who turn up at regional and national meetings to plead for relief. You also seem to be assuming that the current situation is normal, and that decreasing the total number of applications would be "artificial." Back in my day (shakes cane) the only people who applied more than 20 programs were those who were going for the most competitive fields. Now the average is over 35 among all domestic allopathic seniors.

That's f-ed up, especially considering that most people still match in their top three.

More apps, more interviews, more games, more uncertainty, more anxiety, same results. How is this desirable?

Qualifying my experience wasn't necessarily for you but the vast majority of people who haven't been through the match or not been on the selection side commenting in this thread.

I don't know how old you are so I'm not sure how far back you are talking about not applying to more than 20. Was this electronic ERAS era where clicking checkboxes was far easier than individual paper apps?

Your top three comment is misleading. The top three is defined by the final rank list. If I apply to 60 programs and interview at 20, my top three might be very different than if I applied to 21 and interviewed at 7. On the surface I would still probably match in my top 3 but who knows if I would fall in love with X,Y,Z instead of A,B,C.

Btw, more apps, more interviews, less anxiety, less uncertainty, potentially different results.

 

[Donald Juan]

Btw, more apps, more interviews, less anxiety, less uncertainty, potentially different results.

You really think that applying to 80 places and getting 15 interviews is "less anxiety, less uncertainty" than applying to 20 places and getting 10 interviews, where in both scenarios these are the average numbers to match?

 

[DrBowtie]

You really think that applying to 80 places and getting 15 interviews is "less anxiety, less uncertainty" than applying to 20 places and getting 10 interviews, where in both scenarios these are the average numbers to match?

15 ranks > 10 ranks. More room to drop. Less risk = less anxiety. Some classmates matched in the teens for competitive stuff.

 

[DrBowtie]

Not sure why people care how many places anyone else is applying, interviewing, and ranking. It's a personal decision. Suicide match 1 program if you want. No skin off anyone else's back.

Why would students advocate for LESS choice and LESS opportunity?

 

[Donald Juan]

15 ranks > 10 ranks. More room to drop. Less risk = less anxiety. Some classmates matched in the teens for competitive stuff.

But you have inflated everyones rank list. It's artificially making you think you are safer. You are less safe with 15 ranks if the average is 20 ranks, than you are with 10 ranks if the average is 7.

Not sure why people care how many places anyone else is applying, interviewing, and ranking. It's a personal decision. Suicide match 1 program if you want. No skin off anyone else's back.

Why would students advocate for LESS choice and LESS opportunity?

It's because we work in a match system. We've designed it where we all have to needlessly spend more money and waste more time because nobody can just say, "we like you, here's a job offer. Do you want to take it?" I know that the match has many benefits. I know that it solves a lot of problems, but we also have to recognize that by structuring this system, we can make things overly complicated. We can't just put some elaborate system for choosing required residencies for all doctors in the US, then pretend it's a free market of choice and that any structure to it is some elimination of freedom.

 

[Med Ed]

Qualifying my experience wasn't necessarily for you but the vast majority of people who haven't been through the match or not been on the selection side commenting in this thread.

I don't know how old you are so I'm not sure how far back you are talking about not applying to more than 20. Was this electronic ERAS era where clicking checkboxes was far easier than individual paper apps?

Your top three comment is misleading. The top three is defined by the final rank list. If I apply to 60 programs and interview at 20, my top three might be very different than if I applied to 21 and interviewed at 7. On the surface I would still probably match in my top 3 but who knows if I would fall in love with X,Y,Z instead of A,B,C.

Btw, more apps, more interviews, less anxiety, less uncertainty, potentially different results.

I am young enough to have clicked electronic checkboxes on ERAS.

I must say, among the cacophony of applicants and program directors who have decried the state of the current system, I did not expect to encounter someone in favor of the (new) status quo. It seemed fairly obvious that reducing the number of paranoia clicks would be a good thing for all. I guess I stand both mistaken and corrected.

 

[DrBowtie]

But you have inflated everyones rank list. It's artificially making you think you are safer. You are less safe with 15 ranks if the average is 20 ranks, than you are with 10 ranks if the average is 7.


It's because we work in a match system. We've designed it where we all have to needlessly spend more money and waste more time because nobody can just say, "we like you, here's a job offer. Do you want to take it?" I know that the match has many benefits. I know that it solves a lot of problems, but we also have to recognize that by structuring this system, we can make things overly complicated. We can't just put some elaborate system for choosing required residencies for all doctors in the US, then pretend it's a free market of choice and that any structure to it is some elimination of freedom.

Everyone has their own risk tolerance. When people have 100,200,300k riding on you getting a job, I'm making my risk of not matching as small as possible. That means maximizing my chances relative to the pool. If you want to roll the dice, that's your choice too.

As for your second point, I've been through a non match for fellowship. I far preferred the match. You are overestimating the "elaborate" system of the match. From the NRMP standpoint, they are just running an algorithm of lists. It tries to remove the human tampering that occurs in non match systems.

 

[Stagg737]

We talked a lot about this last year on the interview trail. The number of apps has gone up significantly in the last five years in ortho, but the same number of people are still applying which creates this falsely competitive bubble and wastes everyones time and money. Programs applied to per person went from ~50 in 2011 to over 80 in 2016.

"Tokens" is the solution. You can only hand out "gold tokens" to the top 25 programs. That way the program knows you are genuinely interested in them. You can still flood the market with your app so no anti-competitive law suits against the NRMP, ERAS will still make cash money on your bajillion apps, and programs will be able to sort by who is actually interested in them.

This sounds like the most reasonable solution I've heard presented, although 25 programs still seems like a lot to rank as a top choice after interview season. I really can't imagine someone having "genuine interest" in specific programs outside their top 10 or 15.

 

[Gordon Gekko]

A good read. http://www.jgme.org/doi/full/10.4300/JGME-D-14-00270.1#/doi/full/10.4300/JGME-D-14-00360.1


Sent from my iPhone using SDN mobile

 

[DrBowtie]

I am young enough to have clicked electronic checkboxes on ERAS.

I must say, among the cacophony of applicants and program directors who have decried the state of the current system, I did not expect to encounter someone in favor of the (new) status quo. It seemed fairly obvious that reducing the number of paranoia clicks would be a good thing for all. I guess I stand both mistaken and corrected.

I'm just of the opinion that it isn't our right or responsibility to tell an applicant to limit their time or money in figuring out where they want to get the most critical piece of their medical training.

 

[Brorthopedic]

This sounds like the most reasonable solution I've heard presented, although 25 programs still seems like a lot to rank as a top choice after interview season. I really can't imagine someone having "genuine interest" in specific programs outside their top 10 or 15.

The genuine interest first and foremost lies with the specialty, not the residency.

We would all love to match into our top programs, but if you're applying to a competitive specialty, I'd assume one would much rather match into their 25/25 choice than have to SOAP into something else.

 

[Med Ed]

I'm just of the opinion that it isn't our right or responsibility to tell an applicant to limit their time or money in figuring out where they want to get the most critical piece of their medical training.

I have heard Amy Mathis state the very same, but you must agree that the current situation is an unintended consequence, is unsustainable, and therefore should be dealt with.

 

[DrBowtie]

I have heard Amy Mathis state the very same, but you must agree that the current situation is an unintended consequence, is unsustainable, and therefore should be dealt with.

I don't think the situation is nearly as troubled as you think it is but maybe that is because things are different across fields, program sizes, program tiers.

 

[Donald Juan]

It's largely the "have nots" arguing it as they perceive a potential self benefit.

I don't know why people keep saying this. The "have nots" are the ones that would stand to lose from a application cap, as they are the ones who typically feel the need to apply to a substantially greater than average number of places. If IMGs had to apply to the same amount of FM programs as USMDs, then they would be at a huge disadvantage as currently many of them apply to 100s of programs to receive 6-7 interviews.

In turn, the more competitive candidates would actually benefit. If there was a cap, then every program may actually consider someone who seems desirable as they know that person chose the program carefully and isn't just a backup.

Anyways, the JGME article above nicely demonstrates how we're all just screwing each other and ourselves over.

 

[mimelim]

For context, I am at one of the more competitive programs in one of the most competitive specialties... But, having just reviewed ~200 applications so we can interview ~30 my thoughts...

The process is inefficient. I say this as someone who 5 years ago would have advocated getting rid of the match system entirely and replace it with a normal job recruitment process. From a pure personal benefit perspective, it would have suited me fine. I would not have worried about finding a residency, even in vascular surgery. I would likely have interviewed at fewer places and ended up at the same place that I am at. I sent out 60+ applications to GS and IVS. I interviewed at ~20 programs. I ranked all but one. I wasted a ton of time and energy my 4th year dealing with a process that if done in the normal, "find a job" way, would have been ridiculously easy for me. I don't like the match process for that reason, I don't like the amount of control that it exerts on applicants. Which is the primary reason why I don't like the concept of a cap. It is simply more restriction.

I don't know why people keep saying this. The "have nots" are the ones that would stand to lose from a application cap, as they are the ones who typically feel the need to apply to a substantially greater than average number of places. If IMGs had to apply to the same amount of FM programs as USMDs, then they would be at a huge disadvantage as currently many of them apply to 100s of programs to receive 6-7 interviews.

In turn, the more competitive candidates would actually benefit. If there was a cap, then every program may actually consider someone who seems desirable as they know that person chose the program carefully and isn't just a backup.

Anyways, the JGME article above nicely demonstrates how we're all just screwing each other and ourselves over.

The "have nots" are less qualified AMGs that depend on their AMG status over FMG to get residency. Those AMGs will benefit because there will be less competition at those programs. This is why American medical schools are generally for this, because they think it will help their weaker students match. This isn't about helping students lower their stress/anxiety/paranoia. This is about trying to improve AMG matching.

 

[W19]

A tiered system would probably be best. AMGs first, then IMGs, etc.

Can people comment on this?

 

[Med Ed]

Can people comment on this?

Ain't gonna happen. The system does not exist to protect AMG's.

 

[Med Ed]

I don't think the situation is nearly as troubled as you think it is but maybe that is because things are different across fields, program sizes, program tiers.

We'll see what the ERAS/NRMP gang has to say in Seattle next month. I will report back.

 

[mimelim]

Can people comment on this?

It entirely depends on your point of view. If you are coming from a public health (or government) perspective, the goal is to maximize the best healthcare you can get while keeping costs the same. In that regard, good FMG are better than marginal AMG. If you are a patient, you individually want to get the best medical care you can. The better the physician, the better your care, regardless of what school they went to. On the flip side, if you are a marginal AMG, you want to maximize your chances of matching, so a system that is tilted in your favor is a better system. If you are a American school that has superstar, good and marginal AMGs, you will benefit from a system that gives advantage to AMGs.

Personally, I don't advocate weaker applicants getting spots based on where they went to school. I have met/know many of those AMGs that fail to match or SOAP and then don't get a categorical spot. I would take our FMGs over them every day of week.