Surgical Specialties

[Ballwera]

Is it really that difficult to get into some of the more competitive surgical specialties? I know there is one at the plastics program at wright state. How rare is this? In no way am i trying to start a flame war here i'm just curious as i am highly considering going to an osteopathic school.

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[TexasPhysician]

Surgical subspecialties are probably some of the hardest programs to match in period.

I just went through the match. My ex-roommate from a Top 10 allopathic program who was AOA with top board scores matched his 8th choice ortho surgery spot. He still matched, but I don't know how he could have improved much to get into one of his higher choices.

 

[FutureCTDoc]

Is it really that difficult to get into some of the more competitive surgical specialties? I know there is one at the plastics program at wright state. How rare is this? In no way am i trying to start a flame war here i'm just curious as i am highly considering going to an osteopathic school.

Considering only 73% of applicants for plastics matched and there are only 101 positions in the match and you're competing against the best and brightest in America, it's tough. As a DO you have a snowballs chance in hell. As an MD the odds don't move much. To be competitive you should be 250+ step scores and amazing clinical performance i.e. all honors, with only one or two high passes mixed in, excellent LORs from big names and Sigma Sigma Phi. In other words you have to be amazing irrespective of letters after your name. Also in regards to "Is it really that difficult to get into some of the more competitive surgical specialties?", that's why they are considered competitive. Neurosurgery, orthopedics, plastics, urologic surgery and a few others can be exceedingly competitive as are top flight G surg programs at name brand medical schools.

 

[Dissected]

If you're that worried about getting into a surgical sub-specialty, don't freak out about the categorical match. Worry about matching general surgery and going into specialized field from there if you don't think you will be a shooting star coming out of med school. That is a really common way to do most surgical specialties, although the categorical route is gaining more popularity in some fields. General surgery is not THAT hard to match into. It's competitive, but there are some really awesome DO programs out there as well as MD programs that students go to every year (look at University of Nebraska's current general surgery residents..nearly half are DO's). And DO's that complete an osteopathic general surgery residency have great opportunities to go into osteopathic and allopathic fellowships. You won't be as limited as you think once you reach that point.

 

[Dissected]

As a DO you have a snowballs chance in hell.

Oh, and this is not true. You've got to be on top of your game, and maybe you're right about most allopathic programs, but osteopathic residency programs only look at DO's...slightly better off than a snowball in hell

 

[FutureCTDoc]

Oh, and this is not true. You've got to be on top of your game, and maybe you're right about most allopathic programs, but osteopathic residency programs only look at DO's...slightly better off than a snowball in hell

If you want to do integrated plastics, CT, CV, there are no DO residencies, they are fellowship only. There is one CT fellowship program in the AOA match it has 9 spots. There are 9 uro programs with a total of 15 spots per year. Two proctology programs with 2 spots per year. 5 Plastics programs with 7 spots per year. 19 ENT programs with 25 spots per year. 11 Neurosurg programs with 21 spots. 1 Hand fellowship. 7 General vascular surg with 9 spots. This works out to per graduating year roughly 100 slots per roughly 3000 grads per year and that number is increasing. There are enough spots to accommodate 3.3% of all DO grads. Also most DOs prefer ACGME residencies over AOA, they tend to be better in terms of volume and faculty.

 

[DOwnage]

If you want to do integrated plastics, CT, CV, there are no DO residencies, they are fellowship only. There is one CT fellowship program in the AOA match it has 9 spots. There are 9 uro programs with a total of 15 spots per year. Two proctology programs with 2 spots per year. 5 Plastics programs with 7 spots per year. 19 ENT programs with 25 spots per year. 11 Neurosurg programs with 21 spots. 1 Hand fellowship. 7 General vascular surg with 9 spots. This works out to per graduating year roughly 100 slots per roughly 3000 grads per year and that number is increasing. There are enough spots to accommodate 3.3% of all DO grads. Also most DOs prefer ACGME residencies over AOA, they tend to be better in terms of volume and faculty.

Makes sense that DO's prefer the ACGME residencies, but according to the NRMP 2009 Match statistics (page 13), zero DO's matched into Otolaryngology, with 5 IMG's matching and 2 unfilled spots. For plastic surgery, only one DO matched, 4 IMG's matched, and 2 slots remain. Are these low match numbers due to some kind of undetectable "anti-DO attitude" or is self-selection working in this situation, where DO's don't even try to match at an ACGME ENT or Plastics program?

If there are unfilled slots in ENT at the end of the match, is it possible for a DO to enter or can programs purposely leave those spots unfilled in hopes of snagging an unhappy someone from another residency program?

Also, doesn't this kind of put DO's in a hard situation, where there are so few AOA residency slots for these very desirable specialties, and there are plenty of ACGME ones but if many PD's for these ACGME slots don't take DO's because they figure that they have their AOA slots, that it has a collective effect of making it harder to gain these spots as a DO? In other words: the combination of low numbers of AOA spots plus ACGME looking out for their own kind (especially from expanding schools and stuff) that us DO's get screwed over?

 

[FutureCTDoc]

Makes sense that DO's prefer the ACGME residencies, but according to the NRMP 2009 Match statistics (page 13), zero DO's matched into Otolaryngology, with 5 IMG's matching and 2 unfilled spots. For plastic surgery, only one DO matched, 4 IMG's matched, and 2 slots remain. Are these low match numbers due to some kind of undetectable "anti-DO attitude" or is self-selection working in this situation, where DO's don't even try to match at an ACGME ENT or Plastics program?

If there are unfilled slots in ENT at the end of the match, is it possible for a DO to enter or can programs purposely leave those spots unfilled in hopes of snagging an unhappy someone from another residency program?

Also, doesn't this kind of put DO's in a hard situation, where there are so few AOA residency slots for these very desirable specialties, and there are plenty of ACGME ones but if many PD's for these ACGME slots don't take DO's because they figure that they have their AOA slots, that it has a collective effect of making it harder to gain these spots as a DO? In other words: the combination of low numbers of AOA spots plus ACGME looking out for their own kind (especially from expanding schools and stuff) that us DO's get screwed over?

The low number of matches are for a number of reasons, DOs are less likely to score the requisite Step Scores, they are less likely to have the same level of LORs, there is an anti-DO bias and it's a numbers game too. If these programs want the top 5% there are 150 DOs to 925 MDs, some will fill those DO spots, assuming that there also 3.3% going into the aforementioned specialties you are left with 51 DOs in the top 5%. Of these some will go into other DO specialties i.e. anesthesia, ortho etc. But there definitely is some discrimination.

A DO could potentially scramble for one of those empty spots, however they would have to be unmatched as well and the odds are not good for a single individual in the scramble.

Future DOs are in a hard spot as the number of grads increases and the residencies stay the same.

 

[DOwnage]

So if you were a DO student who actually had the grades and scores to potentially land one of these prestigious residencies, what strategy would be best?

Go through the AOA match, if that doesn't work, then go through the ACGME match as insurance?

 

[FutureCTDoc]

So if you were a DO student who actually had the grades and scores to potentially land one of these prestigious residencies, what strategy would be best?

Go through the AOA match, if that doesn't work, then go through the ACGME match as insurance?

I plan to do SF Match for ophtho, AOA for ophtho and integrated CT Surg and IM in the ACGME match, when the time comes. I'm luckier than most my father was a professor at my top choice program, he also was a resident there and was well liked, the program is DO friendly and my father's best friend is the department chair and one of my LORs is coming from a physician who is a distinguished academic and regarded as one of the best ophthalmologists in the world. Even with all that said I wouldn't be surprised even with 99/99 steps and honors in clerkships if I didn't get either an SF Match or AOA match, even with all of that in my favor, simply due to ophtho being a hyper-competitive field. I would apply to all 3 (or 4 including military match) matches if I was unsure I would get the position in one of those matches. It also depends on how you do in school and your LORs/Dean's Letter.

 

[Dissected]

Categorical is great...but I see nothing wrong with going g-surg first and then specializing. It may take a few more years but its not as hard to get into the field that way (as far as boards and all the med-school mumbo jumbo is concerned)..some programs apparently prefer this anyway. Plus it seems to me that you will have a better shot at acgme fellowships after being board certified in general surgery..

http://www.oucom.ohiou.edu/news/press/Foglietti/index.htm

PS, how do you plan on juggling both the acgme and aoa matches? once you match aoa you are pulled from the acgme match...are you just going to try and get a feel for what your chances are at interviews and then pick one or what?

 

[FutureCTDoc]

Categorical is great...but I see nothing wrong with going g-surg first and then specializing. It may take a few more years but its not as hard to get into the field that way (as far as boards and all the med-school mumbo jumbo is concerned)..some programs apparently prefer this anyway. Plus it seems to me that you will have a better shot at acgme fellowships after being board certified in general surgery..

http://www.oucom.ohiou.edu/news/press/Foglietti/index.htm

PS, how do you plan on juggling both the acgme and aoa matches? once you match aoa you are pulled from the acgme match...are you just going to try and get a feel for what your chances are at interviews and then pick one or what?

My plan is optho in SF Match, ophtho in the AOA and cat CT surg and IM in the NRMP. I would use it as a backup especially IM or perhaps neuro as a segue to neuro-opth.

 

[Dissected]

My plan is optho in SF Match, ophtho in the AOA and cat CT surg and IM in the NRMP. I would use it as a backup especially IM or perhaps neuro as a segue to neuro-opth.

right, but if you match optho in the aoa, that pulls you out of the nrmp automatically. I guess if the aoa spot is your first choice that wouldn't be a problem though. I follow. I have no idea how the SF match works.

 

[FutureCTDoc]

right, but if you match optho in the aoa, that pulls you out of the nrmp automatically. I guess if the aoa spot is your first choice that wouldn't be a problem though. I follow. I have no idea how the SF match works.

SF Match is for some speciaties like ophtho, plastics, child neuro and neurotology. It has a much earlier match date i.e. December and is the fiercest in terms of competitiveness of any match. The AOA is mid-Feb and I get my second shot at ophtho then. Then the NRMP comes up and my second choices become available. I would hope to get pulled prior to the NRMP.

 

[DOwnage]

Sorry if I don't understand quite well; are you saying that you would pretty much rank Optho as top on all of your matches and you wouldnt mind if you landed CT Surg as a backup by ranking that in the NRMP?

 

[FutureCTDoc]

Sorry if I don't understand quite well; are you saying that you would pretty much rank Optho as top on all of your matches and you wouldnt mind if you landed CT Surg as a backup by ranking that in the NRMP?

Ophtho is available in the SF Match and the AOA, it is not available in the NRMP. I would use the NRMP as a backup match.

 

[MadysonBelinda]

In some cases, the specialties of surgeons overlap. A good example of this is spinal surgery, which can be performed by both neurosurgeons and orthopedic surgeons. The neurosurgeon might be more appropriate for surgery on the spine itself, while the orthopedic surgeon could be more appropriate for problems with the bones of the spine.
Anesthesiology

The specialty of anesthesia during surgery and pain management.
Bariatric Surgery

The specialty of treating obesity with surgery.
Cardiac Surgery

The specialty of treating heart problems with surgery.
Cardiothoracic Surgery

The specialty of treating heart, lung and other problems in the chest with surgery.
Colon & Rectal Surgery

The specialty of treating problems of the small and large intestine, the rectum and anus with surgery.
General Surgery

The specialty of treating common abdominal problems such as hernias and appendicitis with surgery.
Gynecologic Surgery

The specialty of treating problems with the female reproductive system with surgery.
Maxillofacial Surgery
The specialty of treating problems of the mouth, jaw, neck and facial bones with surgery.
Neurosurgery

The specialty of treating the central nervous system, including the brain and spinal cord, with surgery.
Obstetrics

The specialty of treating women before, during and after childbirth which may include surgery such as a C-section.
Oncology

The specialty of treating cancer with surgery.
Ophthalmology

The specialty of treating conditions of the eye with surgery.
Oral Surgery

The specialty of treating dental problems with surgery, such as wisdom tooth removal and root canals.
Orthopedic Surgery

The specialty of treating problems of the bones, joints, ligaments and tendons with surgery.
Otolaryngology (Ear, Nose and Throat, ENT )

The specialty of treating problems of the ears, nose and throat with surgery.
Pediatric Surgery

The specialty of treating health problems of children with surgery.
Plastic Surgery: Cosmetic & Reconstructive Surgery
The specialty of improving the appearance for cosmetic reasons, or to correct defects for a more appealing appearance.
Podiatry Surgery (Podiatry)
The specialty of treating problems of the feet with surgery.

 

[MossPoh]

SF Match is for some speciaties like ophtho, plastics, child neuro and neurotology. It has a much earlier match date i.e. December and is the fiercest in terms of competitiveness of any match. The AOA is mid-Feb and I get my second shot at ophtho then. Then the NRMP comes up and my second choices become available. I would hope to get pulled prior to the NRMP.

Except for the fact that you have to interview at all those programs in a limited time. You also have to have more than just a couple letters of recommendation. It is far better to interview and rank 12-15 programs in one match program than spread 3 or 4 ranks in each. I think at this stage of the game, planning your matching strategy is a few steps too far.

Also, someone mentioned empty spots at a program and whether they just didn't want applicants or whatever else. A program is usually approved for a certain amount of spots. That doesn't mean they have the funding for those spots. So, they choose not to fill them.

Some surgical subspecialities are pretty easy to get as well. If you wanted a CT surgery fellowship, at this point you'd need a pulse and that is about it. Naturally the very top programs are competitive, but they are having serious trouble filling those spots.

 

[Postictal Raiden]

Except for the fact that you have to interview at all those programs in a limited time. You also have to have more than just a couple letters of recommendation. It is far better to interview and rank 12-15 programs in one match program than spread 3 or 4 ranks in each. I think at this stage of the game, planning your matching strategy is a few steps too far.

Also, someone mentioned empty spots at a program and whether they just didn't want applicants or whatever else. A program is usually approved for a certain amount of spots. That doesn't mean they have the funding for those spots. So, they choose not to fill them.

Some surgical subspecialities are pretty easy to get as well. If you wanted a CT surgery fellowship, at this point you'd need a pulse and that is about it. Naturally the very top programs are competitive, but they are having serious trouble filling those spots.

I've always had the impression that CT surgery is one of the most competitive, lucretive, and prestigous fields. Atherosclerosis the leading cause of death in the country. Is it the hours and workload that cause the specialty to be less appealing? or the reduction in reimbursement? or both?

 

[TexasTriathlete]

Competitive surgical specialties are really easy to get into. That's why they're called "competitive".

Every pre-med thinks they want to be a surgeon. I assure you that most of you do not. Surgery is cool and all, but it really, truly appeals to a very small number of people.

We had a video conference with Philly's surgical residency director, and that program sounds pretty amazing. If you're into that sort of thing. I am really not that much (compared to other things), but his presentation definitely gives a moment of pause.

I've always had the impression that CT surgery is one of the most competitive, lucretive, and prestigous fields. Atherosclerosis the leading cause of death in the country. Is it the hours and workload that cause the specialty to be less appealing? or the reduction in reimbursement? or both?

there are a number of specialties who manage atherosclerosis, and I doubt that a CT surgeon is going to be at the top of that list. CT surgeon will manage it in the heart, but they can also do some of those things with interventional radiology and cardiology. The vascular surgeon makes his living in the arteries and veins.

 

[FutureCTDoc]

CT hasn't been doing as well as they were in the golden age because of advances in stents and Interventional rads and cards moving in on them. The pay still beats the hell out of G surg and there will always be places without cards or IR where I am looking to practice.

 

[GregsAnatomy]

I plan to do SF Match for ophtho, AOA for ophtho and integrated CT Surg and IM in the ACGME match, when the time comes. I'm luckier than most my father was a professor at my top choice program, he also was a resident there and was well liked, the program is DO friendly and my father's best friend is the department chair and one of my LORs is coming from a physician who is a distinguished academic and regarded as one of the best ophthalmologists in the world. Even with all that said I wouldn't be surprised even with 99/99 steps and honors in clerkships if I didn't get either an SF Match or AOA match, even with all of that in my favor, simply due to ophtho being a hyper-competitive field. I would apply to all 3 (or 4 including military match) matches if I was unsure I would get the position in one of those matches. It also depends on how you do in school and your LORs/Dean's Letter.

One of the funniest posts I have read on SDN in a long time. Ahhh clueless pre-meds....

 

[Ballwera]

Thanks for all the help guys! With the thought of applying soon looming over my head i just want to get the most info i can

 

[FutureCTDoc]

One of the funniest posts I have read on SDN in a long time. Ahhh clueless pre-meds....

You do recognize that the matches hold their interviews at entirely different times? SF match takes place my mid-december. AOA mid-feb and NRMP mid-march. If your applying in a hyper-competitive specialty it's intelligent to have a back up plan. Integrated CT and/or IM are significantly less competitive than allopathic ophto.

 

[TeamZissou]

You do recognize that the matches hold their interviews at entirely different times? SF match takes place my mid-december. AOA mid-feb and NRMP mid-march. If your applying in a hyper-competitive specialty it's intelligent to have a back up plan. Integrated CT and/or IM are significantly less competitive than allopathic ophto.

I think what he meant is that yes on paper it all works out and seems great, but no one is going to do that in real life.

 

[FutureCTDoc]

I think what he meant is that yes on paper it all works out and seems great, but no one is going to do that in real life.

It depends, if I get 10+ interview offers I doubt I would go through the effort, however if I'm doing poorly in that regard I'd at least through out a few apps to my hometown IM programs.