Specialty Distribution of US MD Seniors with a 250+ Step 1 Score

[efle]

This may be common sense to many, but was interesting to plot out for me. Based on the Tableau data for 2018.

Many of us fall victim to heuristics, and one I caught myself thinking was that high board scores were synonymous with matching to a handful of specialties, most of the time.

Namely, I thought that the eight specialties with the highest proportion of 250+ scorers (high scorers) were capturing the majority of them. These eight specialties, defined in my mind by filling 25-50% of their residency spots with high scorers, included: Ortho, Diagnostic Rads, Derm, ENT, Rad Onc, Plastics, Neurosurg, and Interventional Rads.

Turns out, these combined only account for 38% of high scorers. Far more choose everything else! Even discounting internal medicine, a randomly selected high scorer is more likely to match outside those specialties than within them (41.3% vs 38.0%).

The Y axis of this chart is the percentage of 250+ scorers that chose to match this specialty. For example, among the population of 250+ scorers, 6.8% matched diagnostic radiology.

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[Lawpy]

yes, more @efle charts!

thoughts? @Angus Avagadro @Lucca @FindersFee5 @AnatomyGrey12 ?

will add to directory

 

[Angus Avagadro]

Lots of very smart people in medicine. Note FM has more than Neurosurg or IR. It would make sense that they would be sprinkled across all specialties due to varying interests and lifestyle concerns. I have said in other posts some of the smartest people I know are in FM.

 

[sab3156]

There are so many factors at play here - numbers of seats in the various specialties, for starters... as well as the competitiveness of programs at the top tier (and how many seats there are) within a specialty (compared to the competitiveness of the specialty overall - this is huge in IM, for example, where programs at the top are extremely competitive and filled with people with high Step scores). Is there any chart that takes number of seats in specialties into account?

But I think you summed it up well with what you stated - that's really all we can get from this, I guess.

 

[VA Hopeful Dr]

Lots of very smart people in medicine. Note FM has more than Neurosurg or IR. It would make sense that they would be sprinkled across all specialties due to varying interests and lifestyle concerns. I have said in other posts some of the smartest people I know are in FM.

It's almost like people with lots of options still go with what interests them

 

[slowthai]

Unfortunately, there is no data on uro, ophtho, or CT. I'm pretty sure it would increase the percentage. Not by much though, because these are quite small fields.

 

[CidHighwind]

Ok, but how many of those people SOAPed onto those spots or transferred their after hating their surgical residency?

 

[Ho0v-man]

With the way folks act on here, I’m a little surprised to see EM and Peds so highly represented.

Obviously the reason for these findings are that they matched into their back ups when they failed to match ortho/derm.

 

[CidHighwind]

With the way folks act on here, I’m a little surprised to see EM and Peds so highly represented.

Obviously the reason for these findings are that they matched into their back ups when they failed to match ortho/derm.

At least based on the SDN EM application thread, it seems like everyone has a 250+. Although I feel like it’s like that for most things posted online. Or maybe people add 10+ points to their real score when they post it online.

 

[efle]

There are so many factors at play here - numbers of seats in the various specialties, for starters... as well as the competitiveness of programs at the top tier (and how many seats there are) within a specialty (compared to the competitiveness of the specialty overall - this is huge in IM, for example, where programs at the top are extremely competitive and filled with people with high Step scores). Is there any chart that takes number of seats in specialties into account?

But I think you summed it up well with what you stated - that's really all we can get from this, I guess.

I think the Charting Outcomes medians and IQRs is the closest thing to controlling for population size. Lets you eyeball the proportion scoring 250+ within each specialty regardless of its size.

 

[efle]

Ok, but how many of those people SOAPed onto those spots or transferred their after hating their surgical residency?

None afaik, these numbers come from the successfully matched applicants on the tableau page, should be only successful 1st time applicants in the 2018 match.

 

[FindersFee5]

yes, more @efle charts!

thoughts? @Angus Avagadro @Lucca @FindersFee5 @AnatomyGrey12 ?

will add to directory

I don't actually find this that surprising. IM and FM have >10000 spots between them. The competitive specialties, as defined by average step 1 >245 have around 2000. A 250+ step 1 is 84th percentile, meaning 16% of people score above that. With around 35,000 people entering the match every year, that means 5600 of them have a score above 250. Even if every single spot in the competitive specialties was filled with somebody who got >250, there would STILL be more super high scorers in the other specialties.

Anecdotally, I know of only 2 people who switched from #primarycare4life to more competitive specialties after their step scores were higher than expected. I know 8 people who switched from gung-ho about surgical subs or derm to "uh probably EM I guess" after step 1. Many more people got good scores and were just happy that it would make matching in their originally intended specialty easier.

I think this sampling bias is why these viewpoints exist. Consciously, we all know that step 1 is only permissive for more competitive specialties. However, the majority of people we hear about who make decisions based off of step 1 are applying to or no longer applying to competitive specialties. You'll never hear somebody say, "I got a 255, so I'm thinking I might apply to peds instead of neurology now," because the step 1 score isn't pertinent to that situation.

 

[libertyyne]

Thanks for the chart Efle!
I do think ratio of applicants with 250+ and ratio of the population matching would be a great addition to this data and might illuminate the self selecting nature of a lot of these fields.

 

[efle]

Thanks for the chart Efle!
I do think ratio of applicants with 250+ and ratio of the population matching would be a great addition to this data and might illuminate the self selecting nature of a lot of these fields.

Wouldnt be too hard to make a ratio. Maybe will make later

 

[MeoMio]

This-
"people got good scores and were just happy that it would make matching in their originally intended specialty easier."

 

[stickgirl390]

High scores open the doors to top tier programs of less competitive specialties.

 

[Cognovi]

Thanks for the chart Efle!
I do think ratio of applicants with 250+ and ratio of the population matching would be a great addition to this data and might illuminate the self selecting nature of a lot of these fields.

Here it is

 

[libertyyne]

Here it is
View attachment 293057

This chart with the exception of ENT above Derm lives up to the stereotypes of competitiveness of specialties.

 

[CidHighwind]

Here it is
View attachment 293057

This is a much better graph. Most medical students do IM, so them having the greatest number of high scorers is a pretty “duh” point.

 

[odyssey2]

Doing percentage of each specialty who matched with >250 is going to give you a better idea of what's the most competitive, not just the specialty choice of that group. Derm comes out on top with that metric

 

[ace_inhibitor111]

Pretty sure the point of efle’s data is that if you took a random person in medical school who scored >250, most of the time they WON’T be applying to ortho, derm, ENT, ophtho, etc.

 

[odyssey2]

Pretty sure the point of efle’s data is that if you took a random person in medical school who scored >250, most of the time they WON’T be applying to ortho, derm, ENT, ophtho, etc.

Yes, but those are much smaller fields which attract students with more specialized interests so that makes sense. They do however make up a disproportionate amount of the more competitive specialties, as one would expect.

Also competitive fields don't just exist at the residency level. Many of those high scorers can go on to highly competitive medical or surgical subspecialties from IM or GS.

 

[efle]

Guys, data similar to Cognovi's has always been very readily available as IQRs directly from the NRMP in every edition of the Charting Outcomes. It's this one. My whole point was to see it without adjusting for specialty size, to see whether the most competitive specialties were skewed enough to be matching most of the 250+ crowd.

Interesting note more visible on his though: IM and GS have roughtly 15% matching with a 250+ and a 250 is roughly the 85th percentile of all test takers. So no skew whatsoever for the high scoring crowd!

 

[Cognovi]

Guys, data similar to Cognovi's has always been very readily available as IQRs directly from the NRMP in every edition of the Charting Outcomes. It's this one. My whole point was to see it without adjusting for specialty size, to see whether the most competitive specialties were skewed enough to be matching most of the 250+ crowd.

Interesting note more visible on his though: IM and GS have roughtly 15% matching with a 250+ and a 250 is roughly the 85th percentile of all test takers. So no skew whatsoever for the high scoring crowd!

Sometimes people need to be spoon-fed obvious data.

 

[Lawpy]

Guys, data similar to Cognovi's has always been very readily available as IQRs directly from the NRMP in every edition of the Charting Outcomes. It's this one. My whole point was to see it without adjusting for specialty size, to see whether the most competitive specialties were skewed enough to be matching most of the 250+ crowd.

Interesting note more visible on his though: IM and GS have roughtly 15% matching with a 250+ and a 250 is roughly the 85th percentile of all test takers. So no skew whatsoever for the high scoring crowd!

Sometimes people need to be spoon-fed obvious data.

i'm here for pretty charts, since I like visuals

 

[CidHighwind]

Pretty sure the point of efle’s data is that if you took a random person in medical school who scored >250, most of the time they WON’T be applying to ortho, derm, ENT, ophtho, etc.

Most of those fields the scores aren’t enough. One needs demonstrated interest in the field, research, etc.

 

[efle]

Most of those fields the scores aren’t enough. One needs demonstrated interest in the field, research, etc.

I dunno man. Maybe if someone is OK with matching anywhere in the country or in much less desired programs. If I wanted a spot at a solid academic center on a coast in ortho, derm, ENT or optho I would be VERY nervous with a score outside the top quartile, even with field specific research.

 

[odyssey2]

I dunno man. Maybe if someone is OK with matching anywhere in the country or in much less desired programs. If I wanted a spot at a solid academic center on a coast in ortho, derm, ENT or optho I would be VERY nervous with a score outside the top quartile, even with field specific research.

I think he's saying you need the field-specific stuff on top of the high scores for the chance to match. Good Step 1 will get you an interview but you need the grades, LORs, and research to seal the deal.

 

[CidHighwind]

I think he's saying you need the field-specific stuff on top of the high scores for the chance to match. Good Step 1 will get you an interview but you need the grades, LORs, and research to seal the deal.

Exactly. I’m rereading my post as to why that isn’t clear. Also even with the “top scores” people in those fields are just happy to match period.

 

[Engrailed]

Lets say for one of the less competitive specialties like neurology or maybe even oncology etc, if one wants to work in/match into a major city at a top tier academic center, what kind of step score would one need to have? 250+

 

[odyssey2]

Lets say for one of the less competitive specialties like neurology or maybe even oncology etc, if one wants to work in/match into a major city at a top tier academic center, what kind of step score would one need to have? 250+

I have no hard data on this, but n=1 I know plenty of med students with subpar step scores who have matched very well in less competitive specialties. I have heard of top-level programs in IM setting cutoffs of 240. 250+ would make it very easy to match well in a field like neurology (oncology is a fellowship done after IM residency) or an equivalent specialty.

 

[libertyyne]

Lets say for one of the less competitive specialties like neurology or maybe even oncology etc, if one wants to work in/match into a major city at a top tier academic center, what kind of step score would one need to have? 250+

If you want name and location, there is a liklihood that there are many people in line who want the same thing. How are you going to differentiate yourself from the masses ? Step is one way to do so, having connections, or having research is another way.

 

[Engrailed]

How does one go about making connections? Is it between schools/institutions mostly? or should students be reaching out to programs directly-shadow doctors at that institution etc..? So if one has a score of 240+, with research, is it VERY likely to match into a good program for one of the less competitive ones?

 

[radsisrad]

Lots of very smart people in medicine. Note FM has more than Neurosurg or IR. It would make sense that they would be sprinkled across all specialties due to varying interests and lifestyle concerns. I have said in other posts some of the smartest people I know are in FM.

Out of curiosity, does anyone on the thread know people who scored 260+ on Step 1 honored all clinical rotations, and went for FM?

 

[radsisrad]

Lets say for one of the less competitive specialties like neurology or maybe even oncology etc, if one wants to work in/match into a major city at a top tier academic center, what kind of step score would one need to have? 250+

?

Are you a medical student?

 

[Engrailed]

Im not, but starting med school this year! It seems like the most competitive ones are the surgical specialties, radiology etc.
Did you bold it because oncology is a fellowship after IM?

 

[libertyyne]

Out of curiosity, does anyone on the thread know people who scored 260+ on Step 1 honored all clinical rotations, and went for FM?

yes, i know of one atleast. He was set on a different field, but in the end he wanted to be close to family and loved his family medicine rotaiton. He will end up ranking a no-name program in the midwest as his number 1.

 

[libertyyne]

How does one go about making connections? Is it between schools/institutions mostly? or should students be reaching out to programs directly-shadow doctors at that institution etc..? So if one has a score of 240+, with research, is it VERY likely to match into a good program for one of the less competitive ones?

connections are made through conferences, away rotations, mentors that hook you up etc.

 

[efle]

Out of curiosity, does anyone on the thread know people who scored 260+ on Step 1 honored all clinical rotations, and went for FM?

I know of one yeah. I also know an Osler residency alum who, instead of doing a fellowship, started practicing primary care in the low-income East Baltimore center for complex high need population. Some people really are in this for the right reasons.

Most of those fields the scores aren’t enough. One needs demonstrated interest in the field, research, etc.

I have no idea why, but my brain read this as "most of those fields the scores aren't high enough." My b!

 

[Deecee2DO]

At least based on the SDN EM application thread, it seems like everyone has a 250+. Although I feel like it’s like that for most things posted online. Or maybe people add 10+ points to their real score when they post it online.

both lmao sdn standards not real life

 

[CidHighwind]

both lmao sdn standards not real life

You be reading those and everyone there has a 250 or 260 even though most of those programs have Step averages in the high 230s.

 

[Angus Avagadro]

Out of curiosity, does anyone on the thread know people who scored 260+ on Step 1 honored all clinical rotations, and went for FM?

The guy who graduated number 1 in my class did. Dude has a photographic memory.

 

[redmugblackcoffee]

Out of curiosity, does anyone on the thread know people who scored 260+ on Step 1 honored all clinical rotations, and went for FM?

me! was thinking primary care from the get go, once I was accepted to med school. had clinical experiences first and second year that showed me how awesome FM was. Got 262 on step 1. I was between FM and IM going into third year, decided FM for sure by january, three days into my FM elective. applied only FM this year. I am both incredibly nervous and excited for next year as an FM intern!!

 

[Lawpy]

This may be common sense to many, but was interesting to plot out for me. Based on the Tableau data for 2018.

Many of us fall victim to heuristics, and one I caught myself thinking was that high board scores were synonymous with matching to a handful of specialties, most of the time.

Namely, I thought that the eight specialties with the highest proportion of 250+ scorers (high scorers) were capturing the majority of them. These eight specialties, defined in my mind by filling 25-50% of their residency spots with high scorers, included: Ortho, Diagnostic Rads, Derm, ENT, Rad Onc, Plastics, Neurosurg, and Interventional Rads.

Turns out, these combined only account for 38% of high scorers. Far more choose everything else! Even discounting internal medicine, a randomly selected high scorer is more likely to match outside those specialties than within them (41.3% vs 38.0%).

The Y axis of this chart is the percentage of 250+ scorers that chose to match this specialty. For example, among the population of 250+ scorers, 6.8% matched diagnostic radiology.

View attachment 292602

RIP chart and analyses. Ended by P/F Step 1

 

[FMDoge2020]

May have missed it. Is this number based on people who only applied to only one specialty or does it include people who dual applied?

Edit: oh oops! that's based on specialty of preference

 

[nimbus]

My highest scoring classmate did an entire IM residency at Brigham followed by a radiology residency also at Brigham. So he was smart but not too smart😉