Specialty interest with the most attrition

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Arewestilldoingphrasing?

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It seems like half my M1 class wants to do NSG or ortho. In your experience what specialty interests do people give up on the most/lose interest in? Conversely which gain interest? Just curious after seeing our match list from this year
 
Little kid: I wanna be a NBA player! Turns 15, realizes he's topped out at 5'10, discovers a passion for accounting.

M1: I wanna be an ENT surgeon! Turns into an M3, realizes Step I is a 220, discovers a passion for psych.
 
Guys: Ortho. Multiple attrition points including first year when guys have a chance to reassess their competitiveness, after Step 1, and January of M3 as people start thinking about actually applying to things.

Girls: OB/GYN. Attritition point is OB/GYN Rotation.

For both genders, I’d imagine Emergency probably gains the most people who change their minds, but IM gains a lot a lot of people who aren’t as competitive for what they were interested in previously. The Triple Threes: 300K, 3 year residency, 3-4 days a week is quite appealing.
 
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MS1s are notorious for wanting something they can use to impress people. It's that "I'm a med student, isn't that cool?" phase of life where they post white coat photos all over their social media and every tweet has the hashtag #medstudent. Of course they want to all be neurosurgeons or orthopods. When they get further in training and realize what's actually involved in getting there and staying there, most will change their minds.
 
OrthoTraumaMD said:
Ortho. Everyone thinks it’s cool but most don’t have the grades or work ethic to survive the hours.


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Not sure if you meant most don't have the grades to be successful in ortho or don't have the grades to match ortho. It is important to remember that competitiveness of matching into certain specialties does not equal nor even correlate with the difficulty of practicing/learning the specialty. Competitiveness is largely driven by some combination of lifestyle and compensation. And there is quite a lot of politics involved in limiting the amount of people entering high-paying specialties to avoid a decrease in compensation.

While there is a certain level of intellectual ability required to do various specialties, there are diminishing returns after a certain point and this certain point is well below the board scores and grades needed to match. Passion for the field/work ethic matter more. I can't tell you the number of attendings I met who literally walked into neurosurg/ortho/CT surg residencies because they were the only ones willing to do it several decades ago. Can also just take a look at any other country with less disparity in compensation; the fields that are highly regarded in those countries are not the same as those highly regarded in the US.
 
Syncrohnize said:
Guys: Ortho. Multiple attrition points including first year when guys have a chance to reassess their competitiveness, after Step 1, and January of M3 as people start thinking about actually applying to things.

Girls: OB/GYN. Attritition point is OB/GYN Rotation.

For both genders, I’d imagine Emergency probably gains the most people who change their minds, but IM gains a lot a lot of people who aren’t as competitive for what they were interested in previously. The Triple Threes: 300K, 3 year residency, 3-4 days a week is quite appealing.
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Just out of curiosity, what do you mean by the 3-4 days a week?
 
Interesting, in my observation people get interested in ortho once they see their nice board score. Same for derm, plastics, maybe other surgical subspecialties.

What drives the extreme shift into anesthesia at my local institution (60! About 1/5 of total class in this year’s match) I don’t know but am very curious about.
 
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AcademicNeurosurgery said:
Not sure if you meant most don't have the grades to be successful in ortho or don't have the grades to match ortho. It is important to remember that competitiveness of matching into certain specialties does not equal nor even correlate with the difficulty of practicing/learning the specialty. Competitiveness is largely driven by some combination of lifestyle and compensation. And there is quite a lot of politics involved in limiting the amount of people entering high-paying specialties to avoid a decrease in compensation.

While there is a certain level of intellectual ability required to do various specialties, there are diminishing returns after a certain point and this certain point is well below the board scores and grades needed to match. Passion for the field/work ethic matter more. I can't tell you the number of attendings I met who literally walked into neurosurg/ortho/CT surg residencies because they were the only ones willing to do it several decades ago. Can also just take a look at any other country with less disparity in compensation; the fields that are highly regarded in those countries are not the same as those highly regarded in the US.
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I meant to match Ortho.
You are mostly, but not entirely, correct. Grades do matter because they correlate with the in training exam and ortho board pass rates. But that grade is well below the average for ortho applicants today. The USMLE score “needed” to pass the boards part 1 is 227; the average for a matched applicant today is 245.
As for what you said re: walking into a specialty. That’s been actually looked at in Ortho, and it’s not actually more competitive now if you crunch the numbers. Link here:
Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 appl... - PubMed - NCBI


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sharkbyte said:
Just out of curiosity, what do you mean by the 3-4 days a week?
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That's the # of days EM physicians work. When every place is paying $200-250/hr, EM docs can afford to work 30 hrs/wk and still make $$$$$. However, 30 hrs/wk in EM is equivalent to 45 hrs in many other specialties in terms of how draining these 30 hrs can be.
 
AcademicNeurosurgery said:
Not sure if you meant most don't have the grades to be successful in ortho or don't have the grades to match ortho. It is important to remember that competitiveness of matching into certain specialties does not equal nor even correlate with the difficulty of practicing/learning the specialty. Competitiveness is largely driven by some combination of lifestyle and compensation. And there is quite a lot of politics involved in limiting the amount of people entering high-paying specialties to avoid a decrease in compensation.

While there is a certain level of intellectual ability required to do various specialties, there are diminishing returns after a certain point and this certain point is well below the board scores and grades needed to match. Passion for the field/work ethic matter more. I can't tell you the number of attendings I met who literally walked into neurosurg/ortho/CT surg residencies because they were the only ones willing to do it several decades ago. Can also just take a look at any other country with less disparity in compensation; the fields that are highly regarded in those countries are not the same as those highly regarded in the US.
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I agree with you, but she’s an attending orthopod, so she probably knows what goes into it.
 
Matthew9Thirtyfive said:
I agree with you, but she’s an attending orthopod, so she probably knows what goes into it.
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It’s fine to disagree, I don’t care. I provide data to back myself up if questioned. Everyone should be questioned regardless of status.


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OrthoTraumaMD said:
It’s fine to disagree, I don’t care. I provide data to back myself up if questioned. Everyone should be questioned regardless of status.


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I agree. I was speaking more to the tone than anything.
 
Wordead said:
Is this the med student equivalent of "dude hes so smart he just doesnt apply himself" where the guy works at a gas station and smokes weed?
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Well gas station guy is probably lying to himself about how he could've been at an Ivy league school if he had wanted to. But there will be those people every year that go Derm who could have been neurosurgeons and just didn't want to work that hard in residency and beyond. They're only working crazy hard in med school so they can work a lot less after
 
DNC127 said:
Ortho. I swear 25% of the MS1s and MS2s at my school wanted ortho. Now its maybe 3 or 4 between the two classes hahah.
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I never understand why people find it funny when people get their dreams crushed. It kinda sucks when I see people who really want a specialty fall short because of their step grades or clinical grades. Most of these people realize that its a long shot and when they dont make it I dont find it funny, mostly sad.
 
Wordead said:
Is this the med student equivalent of "dude hes so smart he just doesnt apply himself" where the guy works at a gas station and smokes weed?
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Yeah, working at a gas station and smoking weed is totally analogous to choosing a medical specialty that doesn't require hellish 100-hour work weeks. Lol.
 
efle said:
Well gas station guy is probably lying to himself about how he could've been at an Ivy league school if he had wanted to. But there will be those people every year that go Derm who could have been neurosurgeons and just didn't want to work that hard in residency and beyond. They're only working crazy hard in med school so they can work a lot less after
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I have a work ethic, I just dont want to use it is nonsense to me.

I say this as someone who is doing a difficult surgical residency with the end goal of working some pretty sweet hours.
 
I don’t know. I can work hard and long hours and overnight shifts and whatever else relatively happily doing what I enjoy doing. Even normal hours having to operate on bones would make me wanna die.

Also much better hours but having to freeze warts and shave biopsies all day would also make me very unhappy. Work ethic dependent on interest in the work makes sense to me.
 
Wordead said:
I have a work ethic, I just dont want to use it is nonsense to me.

I say this as someone who is doing a difficult surgical residency with the end goal of working some pretty sweet hours.
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Why don't you plan to work insane neurosurg/orthopod hours? Aren't you yourself someone clearly capable of working hard but not planning to do so all career long?
 
I feel that most of the medical school applicants I interview are interested in EM, and when I ask why they'll say "There's always something interesting to do/see and I like the excitement of not knowing what comes next." That's all great and everything but then they eventually get more experience and desire something with more of a set schedule and predictability.

I commend all you EM docs out there, it sounds like a nightmare for me!
 
efle said:
Why don't you plan to work insane neurosurg/orthopod hours? Aren't you yourself someone clearly capable of working hard but not planning to do so all career long?
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No dude I'm just good at finding the best way to not work that much. Just like all the dermies.
 
Chelsea FC said:
I never understand why people find it funny when people get their dreams crushed. It kinda sucks when I see people who really want a specialty fall short because of their step grades or clinical grades. Most of these people realize that its a long shot and when they dont make it I dont find it funny, mostly sad.
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Plus, if you want to get into neurosurg or ortho, you need to start investing in the field right from the get go. Yet, first years are always met with judgement when they say they want to pursue something ambitious. Not everyone can afford to make the decision during third year and be succesful.
 
RTD said:
Plus, if you want to get into neurosurg or ortho, you need to start investing in the field right from the get go. Yet, first years are always met with judgement when they say they want to pursue something ambitious. Not everyone can afford to make the decision during third year and be succesful.
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Yup. I decided on derm and started doing derm research in the last couple months of M1, and, as crazy as it sounds, I literally regret not starting earlier. I would have been much better off if I knew what I wanted to do right from Day 1. It's unfortunate that we shame and discourage people from deciding early.
 
Chelsea FC said:
I never understand why people find it funny when people get their dreams crushed. It kinda sucks when I see people who really want a specialty fall short because of their step grades or clinical grades. Most of these people realize that its a long shot and when they dont make it I dont find it funny, mostly sad.
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I don’t think people are laughing at crushed dreams, but at the fact that many people who want to do ortho have no idea what it actually entails and just think it’s “cool” and sporty. They then learn it actually requires work and a brutal residency, and suddenly they want to go elsewhere.


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OrthoTraumaMD said:
I don’t think people are laughing at crushed dreams, but at the fact that many people who want to do ortho have no idea what it actually entails and just think it’s “cool” and sporty. They then learn it actually requires work and a brutal residency, and suddenly they want to go elsewhere.


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I think vast majority of these people change their mind after not doing well in step 1 not third year after finding out how hard it will be. It has been a common theme I notice with people laughing at people who dreamt big and got held back by less than stellar grades. It' the same type of students who will look down on students who say they are inteested in X competitive field as a MS1. Just like the poster I quoted, it' pretty messed up to find humor in that. Maybe I'm extra sensitive to this because I'm interested in a competitive specialty but realized quickly how average I am compared to my colleagues and get rubbed the wrong way by these comments out of fear of being on the receiving end of those chuckles one day. But people on this site and in medical school do chuckle/laugh at when people have to change interest due to less than stellar step grades.
 
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Agree with a lot of what's said here. I know plenty of brilliant people who are "hard workers" not going into surgical fields because they have no interest in killing themselves day in and day out, and because they have interests outside of medicine (i.e. having a healthy family life). Not being able to survive the hours and not willing to survive the hours are quite different things. You just have to find what you enjoy and what you're willing to do. Easier said than done though.
 
M2 who recently dropped ortho here - can attest to that it’s probably the highest attrition field.

Our starting ortho cohort was ~30 people, we are down to around 8 now (9 before I left) and haven’t even taken step yet.

From a med students prospective, even if you have the academic ability, the desire to “put it all on the line” trims away a lot of the students. You’ve gotta really love the field - live and breath nothing but ortho from day 1 of med school. Terrible M3/4 schedule to get all the necessary aways? Lose all your vacation time? 1/4 chance of not matching? Skip social events and sleep to do research? Accept that you will be judged harder & held to a higher standard than possibly anyone else on your rotations? Understand that any one slip up can be the difference between matched and unmatched?

Ortho is an awesome field, but you have to be willing to work harder than almost any other med student to get there - and that’s if you even have the academic ability to get your foot in the door. And that’s not even counting the brutal residency.

I think lots of people realize at some point that they like the field, but don’t LOVE the field, so they find something that doesn’t require quite as much buy in.
 
AthleteDoc7 said:
Agree with a lot of what's said here. I know plenty of brilliant people who are "hard workers" not going into surgical fields because they have no interest in killing themselves day in and day out, and because they have interests outside of medicine (i.e. having a healthy family life). Not being able to survive the hours and not willing to survive the hours are quite different things. You just have to find what you enjoy and what you're willing to do. Easier said than done though.
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+++1. A plastic surgeon once told me it takes a lot of smarts to match plastics, and even more smarts to not match plastics.
 
Radiology is one field for which med students seem to gain interest. Pretty much no M1 imagines doing radiology since it's not clinical and you don't get to use your fancy new stethoscope. Then M3 hits and you realize how unappealing clinical medicine truly is. I remember going into summer of fourth year knowing only myself and one other person in my class who were even interested in radiology. All of a sudden when it was time to submit the application on ERAS, people were coming out of the woodwork applying to rads. We ended up matching about 10 from our class.
 
Matthew9Thirtyfive said:
I can't wait to be super interested in neurosurgery and then discover my passion for primary care, an event that in no way correlates with getting my Step 1 score.
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already a step ahead of you.

giphy.gif
 
My med school class had more than a handful initially interested in Ortho.... not sure any actually went into Ortho though a couple of those did end up in ENT.

I initially went to med school thinking EM was it for me, that changed quickly during rotations.
 
Chelsea FC said:
I never understand why people find it funny when people get their dreams crushed. It kinda sucks when I see people who really want a specialty fall short because of their step grades or clinical grades. Most of these people realize that its a long shot and when they dont make it I dont find it funny, mostly sad.
Click to expand...

bitternessdemotivator.jpeg


 
Arewestilldoingphrasing? said:
It seems like half my M1 class wants to do NSG or ortho. In your experience what specialty interests do people give up on the most/lose interest in? Conversely which gain interest? Just curious after seeing our match list from this year
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Ortho has the highest attrition rates as far as I've seen for numerous reasons, including loss of interest/gain of other interest as well as inability obtain the necessary stats for it. I also think there's so much initial interest because so many med students who were athletes in former lives come in thinking they really want to go ortho.

IM gains the most interest by far imo because it's one of the easiest fields to get into, is one of the shortest residencies, and still leaves the most career options available (hospitalist, outpt, and at least a dozen fellowship options).

Wordead said:
I have a work ethic, I just dont want to use it is nonsense to me.

I say this as someone who is doing a difficult surgical residency with the end goal of working some pretty sweet hours.
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Disagree. I say this as someone who had meh grades because I decided lifestyle and being able to be there for my family mattered more to me as an M1 than getting a 250 Step 1. The one test/class I did work as hard as the kids gunning for ortho I had the highest grade in the class on the final. However, I didn't want to put in that many hours on a regular basis and honestly believe I would have burnt out hard if I did. It's a big reason I decided relatively early that I no longer wanted to pursue ortho. It ended up being a great decision for me as I matched exactly where I wanted, plus who knows if I would have had the stats for it in the end if I had burnt myself out.
 
Stagg737 said:
Disagree. I say this as someone who had meh grades because I decided lifestyle and being able to be there for my family mattered more to me as an M1 than getting a 250 Step 1. The one test/class I did work as hard as the kids gunning for ortho I had the highest grade in the class on the final. However, I didn't want to put in that many hours on a regular basis and honestly believe I would have burnt out hard if I did. It's a big reason I decided relatively early that I no longer wanted to pursue ortho. It ended up being a great decision for me as I matched exactly where I wanted, plus who knows if I would have had the stats for it in the end if I had burnt myself out.
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Well, presumably the kids gunning hard for ortho were spreading their effort among the whole gamut of classes going on at the time and didn't focus on just that one as you did, which probably skewed the results there. Defending a small chokepoint is a lot easier than defending the perimeter of the Sino-Russian border. Just sayin'😉
 
Money Moniker said:
Well, presumably the kids gunning hard for ortho were spreading their effort among the whole gamut of classes going on at the time and didn't focus on just that one as you did, which probably skewed the results there. Defending a small chokepoint is a lot easier than defending the perimeter of the Sino-Russian border. Just sayin'😉
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At my school we only take one class at a time (systems based) which last 3-5 weeks depending on the system, so no skew on those results as everyone was focusing solely on that course (also during 1st year, so not yet studying for Step 1). I just studied harder for that class than I had for any others to the point that I was sacrificing more of my time than I was willing to. In retrospect, I wouldn't advise any med student to study as little as I did during my first year, but it worked out well for me.
 
An unfair fact of life is some of the people pulling ortho/whatever stats were not working particularly hard to do it, and it just turned out that they could achieve gunner level results with high QOL compatible input. And then they decided bones were incredible and they wanted to work on bones and research bones forevermore. Substitute in skin. I don’t see the appeal but whatever butters your banana. Im chuckling benignly at these people too if it soothes our friend above.

There’s nothing about these fields that is uniquely suited to top tier brainiacs either. One of my mentors switched to derm when she couldn’t hack peds emotionally back in the day. Because it was relatively easy to get into and less desirable than the glorious IM residencies of the day. It’s all reimbursements and lifestyle considerations and whatever else is cycling through medical culture at the time when you’re choosing, what’s competitive or isn’t very.
 
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Matthew9Thirtyfive said:
I can't wait to be super interested in neurosurgery and then discover my passion for primary care, an event that in no way correlates with getting my Step 1 score.
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My personal favorite was hearing a few people talk non stop about ortho all of orientation and then just a few weeks later after the first anatomy exam talking about FM with a sports med fellowship. Anatomy had absolutely nothing to do with it I’m sure. The real students who will end up on those fields don’t necessarily talk about it, they are just the ones that quietly show up at the crack of dawn to do Anki cards and sit in their study room all day. Randomly after first year you come to find out they have already helped with a handful of research projects and presented posters at conferences and are somehow still in the top 20% of the class.
 
I admit - I was one of those first years who was highly considering ortho so I could be cool. Then, I grew up...after a few rotations I found myself really uninterested in bones and slept through several knee scopes. I also didn't want to limit myself to doing the same procedure (foot or knee or hip) for the rest of my life, and got myself into a more grueling specialty as far as work hours go...
 
OrthoTraumaMD said:
I meant to match Ortho.
You are mostly, but not entirely, correct. Grades do matter because they correlate with the in training exam and ortho board pass rates. But that grade is well below the average for ortho applicants today. The USMLE score “needed” to pass the boards part 1 is 227; the average for a matched applicant today is 245.
As for what you said re: walking into a specialty. That’s been actually looked at in Ortho, and it’s not actually more competitive now if you crunch the numbers. Link here:
Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 appl... - PubMed - NCBI


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Click to expand...

Interesting article, although I would argue self-selection is probably a bigger factor now than it was back then. Just my opinion. The article also only looks at Step 1, research and connections are gaining importance over the years.

Matthew9Thirtyfive said:
I agree with you, but she’s an attending orthopod, so she probably knows what goes into it.
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Most attendings and PDs I have talked to believe what I posted so I was really explaining things for other readers moreso than for her. When I was a third year, I had a neurosurgery PD at a solid program tell me that he has no evidence-based reason to screen applicants for 240+ board scores, clinical honors, research etc other than the fact that he gets a stack of applications of people who have all those credentials plus have the soft skills to be great team players. In other words, his program screens for top board scores and grades because they can, not because it’s prognostic.

Also agree with the sentiment here that it’s a little odd that people find joy in talking about people having their dreams crushed due to lack of credentials.
 
AnatomyGrey12 said:
Randomly after first year you come to find out they have already helped with a handful of research projects and presented posters at conferences and are somehow still in the top 20% of the class.
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So real. I've been feeling pretty good about getting a little bit involved in some research started during second half of M1... come to find out that several classmates (derm/IR/ortho hopefuls) are quietly already almost at the point of submitting 1st author publications :scared: They knew what they were interested in, found research mentors early on, had the experience to hit the ground running and apparently know how to push projects through.
 
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