stats dont make plastics seem THAT competitive

[drseanlive]

so i was looking at the stats on 'matching the outcome' from nmrp....

i thought plastics would have much different stats...it showed that only 30% were AOA and that the avg USMLE step 1 was along the lines of a 230....

what percentage of people who want plastics end up getting it?
If you show a very strong interest (via letters etc) and apply broadly, are you likely to get a spot?

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[Mariah246]

is that the integrated plastics program?

 

[pseudoknot]

so i was looking at the stats on 'matching the outcome' from nmrp....

i thought plastics would have much different stats...it showed that only 30% were AOA and that the avg USMLE step 1 was along the lines of a 230....

I don't know what document you were reading, but in 2007 those figures were 36.5% AOA, Step I mean 241.

what percentage of people who want plastics end up getting it?

Nobody knows this, but for US seniors who got interviews the match rate was only 63% in plastics. Remember that only pretty competitive applicants even get interviews in the first place.

If you show a very strong interest (via letters etc) and apply broadly, are you likely to get a spot?

Not unless you're competitive.

 

[DrDre311]

When I interviewed at Wake Forest, the average Step I score for the 40 people they interviewed for their 2 spots was 251 and 50% were AOA. I can think of a few people (off the top of my head) present at this interview that did not match.

I believe that the average Step I score for U.S. seniors matching in plastics in 2008 will be somewhere around 248-250 and that scores will continue to rise in future classes.

I also think that we, as applicants, lend a lot more weight to these scores than programs do. I think programs generally use Step I scores as a cutoff for granting interviews, and after that point I'm not sure having a 265 vs. 255 vs. 245 really matters to them, unless you have something ridiculous like a 280. I think PD's rely more heavily on letters from people they know and trust, while hypercompetitive plastics applicants try to label themselves and each other with a number from Step I.

Trust me, plastics is absolutely the hardest match. There is nothing in medicine more competitive right now.

 

[Mariah246]

When I interviewed at Wake Forest, the average Step I score for the 40 people they interviewed for their 2 spots was 251 and 50% were AOA. I can think of a few people (off the top of my head) present at this interview that did not match.

I believe that the average Step I score for U.S. seniors matching in plastics in 2008 will be somewhere around 248-250 and that scores will continue to rise in future classes.

I also think that we, as applicants, lend a lot more weight to these scores than programs do. I think programs generally use Step I scores as a cutoff for granting interviews, and after that point I'm not sure having a 265 vs. 255 vs. 245 really matters to them, unless you have something ridiculous like a 280. I think PD's rely more heavily on letters from people they know and trust, while hypercompetitive plastics applicants try to label themselves and each other with a number from Step I.

Trust me, plastics is absolutely the hardest match. There is nothing in medicine more competitive right now.

not even derm??

 

[bigfrank]

Integrated plastics is the MOST competitive of all residencies, Period. This is one scenario in which you should believe the drama/hype.

 

[droliver]

It's funny, on my blog (linked below) I posted today about what was going on 25 years ago in plastic surgery in the major journals.

It was amusing to see an editorial fretting in Feb 1983 about whether plastic surgery would be able to compete with other specialties (like CTVS) for the top applicants and whether or not they'd need to turn efforts towards "marketing" our field to medical students to promote interest to keep the field vital.

It's kind of one of those "Dewey defeats Truman" moments no?

 

[DrDre311]

nope, not even derm. just look at the numbers. there are something like 330 derm spots, maybe 340 if you count some of the combined derm-medicine programs.

there are only about 90 total plastics spots every year, maybe half of which are truly integrated (vs. the combined or coordinated model). Plastics programs get 250-300 applicants and maybe 180 of these applicants are actually granted interviews.

The NRMP's statistics (based on U.S. seniors who submit a rank list with any plastic surgery program ranked first--they do not account for people applying to plastics who are not granted any interviews, which is a fairly common situation) show that, year-to-year, there's about a 50% match rate for all applicants who are extended interviews and about 60% for those U.S. seniors granted interviews.

For every available plastics spot, there are also 1.5 U.S. seniors ranking plastic surgery programs first--compared to a ratio of 1.3 for derm. This ratio is the number that the NRMP uses to define the relative "competitiveness" of each specialty. For FMG's, it's even worse: 6 FMG's matched in plastics in 2008--71 FMG's matched into derm.

What all this means is that the cream of the crop applies to these specialties--because plastics and derm are comparable in terms of average Step I/Step II, AOA, research, etc., but there are so many more available derm spots--but all things being equal, you are MUCH more likely to match in dermatology than in plastics.

Not that derm is easy to get into either! Better be a stud if you want to get into either specialty.

 

[pseudoknot]

The real question is, how many people applied to the 3 integrated cardiothoracic spots this year? Or the 6 integrated vascular programs (some of which may have more than one position)? The senior:spot ratio could be way higher than 1.5. Take that, plastics!

 

[DrDre311]

To answer your question:

8 U.S. seniors ranked integrated CT surgery first and there were 3 available spots.

21 U.S. seniors ranked integrated vascular surgery first and there were 9 available spots.

The NRMP has not posted any information on Step I/II scores, AOA membership, smoking/drinking habits, etc. for these specialties.

So, by the NRMP definition, I guess that makes CT surgery the most competitive specialty! Operating on the heart is the most awesome thing I can think of, but what a terrible lifestyle...I know a CT attending who's in the hospital more than I am with a ton of sick patients, and the guy makes like $150k. It's kind of messed up that a heart surgeon makes less than half of the average dermatologist's salary.

 

[Mariah246]

I know a CT attending who's in the hospital more than I am with a ton of sick patients, and the guy makes like $150k. It's kind of messed up that a heart surgeon makes less than half of the average dermatologist's salary.

I highly doubt that.

 

[pseudoknot]

I highly doubt that.

I don't doubt that for a minute. You ought to read up on the job market for CT surg, and the current Medicaid reimbursement rates. They get paid very little for complicated procedures on extremely sick patients, including all follow-up care. Many graduating CT fellows have been unable to find any work at all in the field.

 

[pseudoknot]

Whoa, not so fast, Tex.

Apparently 18 US seniors applied for 5 spots in Medicine-Family Medicine, making that The Most Competitive Medical Specialty 2008!

You heard it here, folks.

To answer your question:

8 U.S. seniors ranked integrated CT surgery first and there were 3 available spots.

21 U.S. seniors ranked integrated vascular surgery first and there were 9 available spots.

The NRMP has not posted any information on Step I/II scores, AOA membership, smoking/drinking habits, etc. for these specialties.

So, by the NRMP definition, I guess that makes CT surgery the most competitive specialty! Operating on the heart is the most awesome thing I can think of, but what a terrible lifestyle...I know a CT attending who's in the hospital more than I am with a ton of sick patients, and the guy makes like $150k. It's kind of messed up that a heart surgeon makes less than half of the average dermatologist's salary.

 

[mosfet]

So, by the NRMP definition, I guess that makes CT surgery the most competitive specialty! Operating on the heart is the most awesome thing I can think of, but what a terrible lifestyle...I know a CT attending who's in the hospital more than I am with a ton of sick patients, and the guy makes like $150k. It's kind of messed up that a heart surgeon makes less than half of the average dermatologist's salary.

I doubt that. CT surgery is still one of the highest paid surgical subspecialties.....granted I agree they work their *** off and of course have a hard time finding a job when they finish fellowship.

 

[bulldoc]

PRS average board score is in the mid to high 240's. it is the most competitive specialty, followed by derm. when you hear figures "30% or 50% are AOA" that is extremely high, given the fact that many schools do not have an AOA chapter at their school, and even if there is a chapter, is an honor hard to acheive in itself.

 

[DrDre311]

you can doubt it all you want...I spent 2 hours talking to the guy about why he hates his job and salary was one of the reasons.

 

[pseudoknot]

I think a lot of starting salaries in academia are in that range.

 

[Moravian]

I think a lot of starting salaries in academia are in that range.

In an academic practice, it can be difficult to know what someone is making unless they tell you. Some places will publish the salaries of their faculty and some use a scale based on professorial rank as to how much the salary is, but that's only part of the story. There are a bunch of other models and it really will depend on where you go and what you can negotiate (yes, believe it or not, you can negotiate). Here are some of the models I know from interviewing and from what I've been offered contract-wise:

1) Salary based on national mean for academic rank with a small percentage of collections over salary available for bonus.

2) Salary based on that particular university pay scale with support from other sources and bonuses once your share of overhead is met. I mean office overhead here.....salary is separate and guaranteed.

3) Base salary (lower than national average for rank) but 50% of all collections reimbursed quarterly. This was in a state that had high reimbursement rates so if you were busy, you could do well.

Then there are other add-ons. Some place give a little extra for directorships, education, being program director, etc.

Some other offers I had were employed positions (i.e., the hospital itself is your employer) and these included salary plus 90% of collections after the salary line was met, and just salary with yearly review. One might wonder why anyone would choose the latter, but it was a a nationally known place and the upfront money was more than all the others were offering. There were no expenses coming out of the paycheck and the support was great. While I didn't take that job (although I gave it some serious consideration) it was helpful in the respect of having a position to negotiate from when interviewing at other places.

The bottom line is that, except for certain special circumstances, an academic paycheck is generally less than the private world, but there are residents to see the ER patients, the benefits (which should also be calculated into your over reimbursement) such as retirement, malpractice, etc. are really nice, and you're able to get more time off without killing your practice.

 

[MOHS_01]

Regarding the CT surgeon who makes 150K / year -- there are a ton of jobs out there where his starting salary would more than triple that should he desire to make more.

Regarding plastics "not being that competitive" -- seriously, it is, and will only become moreso in the coming years. Derm is competitive, but I personally know many dermatology residents and attendings who would not have what it takes to match in a competitive integrated plastics program. There is a lot more to matching in residency than board scores, publications, and letters of rec.

 

[Mariah246]

Derm is competitive, but I personally know many dermatology residents and attendings who would not have what it takes to match in a competitive integrated plastics program. There is a lot more to matching in residency than board scores, publications, and letters of rec.

err...what would they be missing?

 

[MOHS_01]

Mariah,

I assume that you are asking what else goes into residency selection criteria? For the past six years I have been involved (sometimes more, sometimes less) in the selection of dermatology residents. Dermatology programs, for the most part, are small and tight knit units -- that we prefer to keep them cohesive units. One person who does not "fit" or get along with the others is a sore for three years. Integrated plastics is even worse as their headache would be for a minimum of 5 or 6 years.

Research pubs, letters of rec, board scores, etc are used predominantly as screening criteria, as it allows for an easy way to pare down the applicant numbers in the ERAS system. Once you have an interview, we (not always the program director, though) considered everyone on equal footing. Work ethic weighs heavily in demanding residencies, which plastics qualifies as. The ability to "fit" in with the current team and not cause problems is paramount. Unfortunately, because of these soft requirements, "the most deserving" by the numbers is not always the person ranked highest.

If you are asking about what some derm residents (and attendings) are lacking? Work ethic is probably the single easiest answer. Perhaps work ethic is not the best way of saying it -- the capacity and willingness to do what it takes, including put up with the sh** that goes hand in hand with surgical residency... We have far too many prima donnas in derm (no offense or characterization intended). The rest of medicine sees it; I do to.