"Top Programs" not filling in the match?!?!

[iron2md]

Looking at NRMP, I noticed that 3 of what is commonly considered the "Top Programs" - Johns Hopkins, Mass General, and UCSF have not filled all their slots in the match in the last few years. Whats up with that?!?!?

UCSF: in 2008 did not match 6 Advanced positions, and in 2006 did not match 1 Advanced position.

Mass General: in 2007 did not match 4 Advanced positions.

Hopkins: in 2008 did not match 4 Advanced positions, and in both 2007 and 2006 did not match 1 Advanced position.



However, looking through the data, a lot of the lesser known programs match every year. I know they all interview enough tons of people, so I can't understand how this could happen. I know that is is either one of the following:

• The programs don't actually rank enough people that interviewed there.
• The people that interviewed there decided they would rather go elsewhere.

Which do you think it is and why?

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[tabula0rasa]

Could it be possible that those top programs are leaving those spots open so that if residents want to transfer into their advance program, they can? I'm not sure what the advantage of this would be, but i think its a possibility.

 

[gasseous]

Actually, neither of the two reasons you suggested is (necessarily)correct...

I trained in Boston at one of the other Harvard programs, and am now staff at the same hospital. We INTENTIONALLY do not fill via the match because we want to leave spots available for non-match candidates. Many of these candidates enter anesthesia from other fields, or are ridiculously well-qualified applicants from abroad. Anyhow, i would be careful in using that as a criterion to judge or compare programs.

Hope that helps!

 

[EternalMD]

I think tabula is correct. On one of my interviews, the PD informed us that they typically reserve 2 spots every year for individuals to transfer into from other specialties, unable to match the previous year, those who have to take a year off during residency and thus fall a year back, etc.

 

[Jack Burton]

Nope - its a combination what you thought originally.

#1 - Not interviewing enough people
#2 - Assuming those that you interview will want match there

UCSF pays 10-15000 less a year than Stanford, and equivalent to the salaries of UAB, Wake Forest, etc to live in one of the 3 most expensive places in the country - not worth it

Hopkins - well its Baltimore, you either gamble with safety and live close or have to life half hour and commute in - thats getting less and less attractive for residents as other programs have become equally as good

Mass General - think they realized the name doesnt go as far as it used to and started interviewing more - thats why it only happened once, but same principal, very expensive city to live in


All three are weak in regional anesthesia - which is the new cool thing

Bottom line - great progams, but no longer the top 3, many can list 10-15 programs as good if not better, combine that with the fact that they are in either unsafe or expensive cities and are weak in regional anesthesia, makes them less attractive - relatively - still attractive, they just cant bank on everyone wanting to come there anymore and they have to interview more.


And they keep spots aside from those in the match for residents wanting to transfer

In my opinion some of these programs are as popular or more so than those 3 as they have better regional, cheaper areas to live in (or pay more - like Stanford or Penn with either higher salaries or moonlighting): Utah, Duke, Stanford, Penn

 

[Gern Blansten]

Actually, neither of the two reasons you suggested is (necessarily)correct...

I trained in Boston at one of the other Harvard programs, and am now staff at the same hospital. We INTENTIONALLY do not fill via the match because we want to leave spots available for non-match candidates. Many of these candidates enter anesthesia from other fields, or are ridiculously well-qualified applicants from abroad. Anyhow, i would be careful in using that as a criterion to judge or compare programs.

Hope that helps!

That doesn't really make sense. If you wanted to intentionally save a spot for those out of match candidates, you would not submit that position for the match. I know that many programs do that. If you submit 12 positions (or however many) to the match, that says you are trying to fill all 12 of those positions. If you have 14 overall spots and submit 12 through the match, you are saving 2 spots for outside of match candidates. You don't submit 14 to the match and then, when you don't fill, call it intentionally saving spots. It could cause a program to leave people they interviewed off of their rank list thinking that, if they don't fill, it's not a big deal because they can fill it with outside candidates. To me, that is different than what you are saying. I believe that Jack Burton's explanation better describes the situation.
This is a topic that has been discussed at length elsewhere and you could search and find more about why these may have occurred. As mentioned in other threads, don't be fooled by the fact that these excellent programs go unfilled and think that you can scramble into a spot easily in a strong program. If a strong program does not fill, they will have no problem filling the spots and will have their choice of several good internal candidates from other specialties and if those aren't around, they will have a year to find some good candidates. So, if those good spots aren't spoken for before the scramble even takes place, they may not feel pressure to even consider filling them in the scramble. So 50 unfilled spots may really be more like 10.
This is what I have noticed over the years.

 

[RxBoy]

Actually, neither of the two reasons you suggested is (necessarily)correct...

I trained in Boston at one of the other Harvard programs, and am now staff at the same hospital. We INTENTIONALLY do not fill via the match because we want to leave spots available for non-match candidates. Many of these candidates enter anesthesia from other fields, or are ridiculously well-qualified applicants from abroad. Anyhow, i would be careful in using that as a criterion to judge or compare programs.

Hope that helps!

That made me laugh.

They don't fill because they don't fill. U of Michigan was distraught they didn't fill last year (7 spots unmatched). The program was very upset about it. It certainly wasn't because they wanted extra spots on the side... They had to scramble just to fill them.

U of Miami traditional has 18 categorical spots. 5 of the spots were filled outside the match this year so they only submitted 13 spots for the match (+11 spots for advanced). This is what programs do when they offer spots outside the match. They don't submit match spots with hopes they don't fill.

What if you submit a rank list for 20 spots and intentionally make the list short but end up only filling 5 spots? Programs would never take that chance by making a "short list". I am sure they end up getting very well qualified applicants in the end anyways, but its def. not "intentional".

I personally think they don't fill because they are arrogant. They think that they can fill with a short list and they get burned. Simply put.

I think Mass Gen learned their lesson from 07 and interviewed and ranked more applicants for 08. UCSF and Hopkins are probably doing the same this year.

 

[periopdoc]

It has little to do with the number interviewed. It is due to the restricted number of applicants that these programs rank for the match. They could interview 500 more applicants and still not come up with more applicants that they would be interested in having join the program.

The "top tier" programs are all competing with each other for a relatively small number of "top tier" candidates while "lower tier" programs are not as picky as to which candidates they will rank. From the admissions committee perspective would you rather rank more of the "less qualified" applicants and fill or not rank these applicants and take a chance of not filling only to cherry pick for unfilled spots later on? Of course neither is an appealing proposition, but it is a tricky balancing act to try to get only the best applicants.

As Gern mentions, these are not intentionally left out of the match spots as they would not appear in the unfilled stats. The only way these could be intentionally empty is if the program ranked fewer applicants than they had spots listed in the match. That would be extremely risky and very unlikely.

It is just that the other "top tier" programs were more attractive to the "top tier" candidates in that given year.

While I would not be particularly suspicious of "top tier" programs that do not fill, I would be very leery of "lower tier" programs that do not fill.

Oh and if you didn't guess, my opinion is that the whole top tier, lower tier is mostly b.s. There are terrible top tier programs and great lower tier programs.


-pod

edited to add: That is unless you are planning on going into academic administration or NGO work in which case training at a "top tier" institution will give you a bit of a leg up due to name recognition

 

[error404]

I personally think they don't fill because they are arrogant. They think that they can fill with a short list and then get f*ed. Simply put.

When I interviewed at UCSF, the PD addressed their not having filled, and said, (paraphrased, because of course I can't remember a direct quote) "Basically, we ranked only the top applicants who we really wanted, and it turns out that some of them went elsewhere. We had no problems with filling those spots with wonderful applicants. We won't make that mistake again."

I know Stanford has ~25 spots every year, but only does 21 through the match in order to leave room for transfers/nontraditional applicants.

 

[G0S2]

When I interviewed at UCSF, the PD addressed their not having filled, and said, (paraphrased, because of course I can't remember a direct quote) "Basically, we ranked only the top applicants who we really wanted, and it turns out that some of them went elsewhere. We had no problems with filling those spots with wonderful applicants. We won't make that mistake again."

I know Stanford has ~25 spots every year, but only does 21 through the match in order to leave room for transfers/nontraditional applicants.

I am glad to see they are at least saying that now. When I was there in Dec, the PD skirted the issue and left everyone scratching their heads. They never simply stated that they failed to rank enough applicants.

 

[scotchnwater]

Nope - its a combination what you thought originally.

#1 - Not interviewing enough people
#2 - Assuming those that you interview will want match there

UCSF pays 10-15000 less a year than Stanford, and equivalent to the salaries of UAB, Wake Forest, etc to live in one of the 3 most expensive places in the country - not worth it

...........

All three are weak in regional anesthesia - which is the new cool thing

Bottom line - great progams, but no longer the top 3, many can list 10-15 programs as good if not better, combine that with the fact that they are in either unsafe or expensive cities and are weak in regional anesthesia, makes them less attractive - relatively - still attractive, they just cant bank on everyone wanting to come there anymore and they have to interview more.


And they keep spots aside from those in the match for residents wanting to transfer

In my opinion some of these programs are as popular or more so than those 3 as they have better regional, cheaper areas to live in (or pay more - like Stanford or Penn with either higher salaries or moonlighting): Utah, Duke, Stanford, Penn

I think for the sake of applicants submitting their rank lists that a couple of erroneous statements need to be corrected here:

1) While the base salary at Stanford is indeed higher than UCSF, the TOTAL compensation is essentially equal since ALL residents at UCSF (medicine, peds, surgery, etc) get a generous housing stipend. If you interviewed at both places you know this since both provide you with compensation packages. Asserting that there is a "10k-15k/year" pay difference is simply not true.

2) A more minor point, but trying to imply that Palo Alto is more affordable than SF is laughable as well.

They are both great programs, and I think tend to attract different types of people, so perhaps it's a moot point.

I'm not trying to split hairs here, but I remember as an applicant moving from the Midwest where I paid $330/month for rent all through medical school, it was a pretty scary proposition to rank a program out here #1. I ended up doing so, and can assure you that it is extremely liveable out here, I do JUST FINE living alone, and even belong to a few wine clubs .

Don't buy in to the hype about how poor you will be. It's just not true. While you may have relatively more money by going somewhere in the Midwest, you will by no means be destitute living on the West Coast.

While JB's point is well-taken that there are plenty of excellent programs (which I totally agree with), don't be scared away from what could be a good fit by mythology and frank misinformation about salary and cost of living.

 

[jennyboo]

Some very respected "top tier" programs don't fill because they didn't rank enough candidates.

Some very respected "top tier" programs do have "outside the match" positions for special candidates. These are NOT included in the tally of unfilled spots (the spots are not included in the match count).

Some lower tier programs regularly and intentionally rank few candidates in order to intentionally not fill, because their scramble candidates are actually smarter than their match candidates. Their scramblers are often people with otherwise good statistics and records who failed to match in more competitive specialties (dermatology, ophthalmology etc).

The two former types of programs that don't fill probably turn out to be reasonable places to work. Be careful about the latter type of program.

 

[Jack Burton]

My fault, I did interview at both, not this year, and did not remember the stipend at UCSF being that much, but heard many medical students talking about the difference in cost between the two this year and assumed it was a similar situation - I was not trying to point out a misconception, I apologize if things are indeed more equal now.

Either way, I have to disagree with you on the west coast. Doable, very much so and if you are single you can live it up. Southeast, Midwest programs are now paying close to 50 a year - it does go alot farther, particularly if you are not single. And if you are single, you can live for $3-400 a month rent and pay off a hell of a lot more debt, with interest rates at 6.8% now, that is a big deal

 

[Jack Burton]

For example UAB - with their moonlightling, the majority of residents make 70-80 a year - if you have 1-200 grand in debt, that is big

 

[Gern Blansten]

It has little to do with the number interviewed. It is due to the restricted number of applicants that these programs rank for the match. They could interview 500 more applicants and still not come up with more applicants that they would be interested in having join the program.

Exactly right. And these same top tier candidates are being offered interviews all over the country. It makes it hard to get a feel for how the match will go when you are interviewing a whole bunch of candidates and almost all of them have the credentials that you might see in 1-2% of the candidates from 8-10 years ago.
Don't forget that it is not only the so called top tier programs that are successfully recruiting the top tier candidates. There are programs that never get a mention here that recruit outstanding candidates and have an extremely high percentage of AOA residents.
The program directors have had the luxury of getting to be pretty picky the last couple of years. We have been spoiled by high numbers of excellent candidates. There may soon come a time again where speaking english and having a pulse will move you to the top of the rank list. That's how it was back in '96-'99. For now, the residency programs have the upper hand. Back then, the candidates brave enough to go into anesthesiology despite warnings of imminent doom had the upper hand.

 

[sethco]

Actually, neither of the two reasons you suggested is (necessarily)correct...

I trained in Boston at one of the other Harvard programs, and am now staff at the same hospital. We INTENTIONALLY do not fill via the match because we want to leave spots available for non-match candidates. Many of these candidates enter anesthesia from other fields, or are ridiculously well-qualified applicants from abroad. Anyhow, i would be careful in using that as a criterion to judge or compare programs.

Hope that helps!

Same thing at Hopkins. Sometimes they leave positions for pediatric residents to "transfer" into Anesthesia/Critical Care. I know of one individual that took a position outside the match. He is a military flight surgeon and therefore he would take a match spot without actually going through the match. In fact, I have quite a few flight surgeon friends that have accepted positions "outside the match" (including myself), so the numbers would appear skewed.

 

[fakin' the funk]

Want to add my 2 cents...

100% agree that the reason they do not fill is due to overestimated demand for their program vs. the length of their list. Not many programs can rank 3-4 people per spot and fill every year.

100% agree that the COL vs. pay equation for UCSF and Stanford is about equal. They are equally expensive to live and the pay works out to very similar when you consider Stanford's pay + housing versus that of UCSF. Having, parking, and driving a car is another issue!

 

[G0S2]

Want to add my 2 cents...

100% agree that the reason they do not fill is due to overestimated demand for their program vs. the length of their list. Not many programs can rank 3-4 people per spot and fill every year.

100% agree that the COL vs. pay equation for UCSF and Stanford is about equal. They are equally expensive to live and the pay works out to very similar when you consider Stanford's pay + housing versus that of UCSF. Having, parking, and driving a car is another issue!

UCSF not paying or subsidizing resident parking is sh*tty is my opinion.

 

[DrN2O]

This is all academic. If you interviewed at UCSF, hopkins or MGH, then you probably also interviewed at Stanford, penn or Mayo (if you wanted to). No one needs to remind you how much the subsidies or moonlighting there is at each place. If you can't afford to live in SF with a family and debt, then that's a decision you have to make. Last year, SF didn't fill and I don't think they even opened up the slots for the scramble. So if you interviewed there and don't match there, you prboably will get your 2nd choice. If you didn't interview, then probably shouldn't counting on scramble either. The thread is just another opportunity for people rub those "top programs" noses in the dirt. Never fails when the phrase in quotation is used.

Just remember, making the best ranking list has nothing to do how the programs will rank you (if at all), but only how you rank the programs you like the best.

 

[CaliDOC81]

Its true that UCSF didn't match 6 spots last year. I don't know if it was because they intentionally left spots open for outside the match applicants or if it was because they were arrogant. Regardless I do know that they leave >2 spots open each year for outside the match applicants and this is a fact. Also to address the resident pay in comparison to Stanford, what was not mentioned is that the base pay is set by the University of California. This means that all UC medical centers have the same base pay regardless of what city you live in. To offset this financial burden UCSF gives a $600/month subsidy and the anesthesia dept gives an additional $200/month subsidy. So if you do the math thats an additional $9600/year so the disparity in pay between the two institutions is not as great as it first appears. Furthermore, may I remind you that Palo Alto isn't exactly a cheap city to live in, it has been ranked amongst the most expensive cities in America year after year.

 

[Tenesma]

i can't speak for UCSF or Hopkins... but I can speak for MGH.

MGH routinely doesn't fill ALL of its spots (on purpose), because they have one or two people transfer into the program (ie: from surgery or OB/Gyn) and especially because they have a fondness for Chinese, Japanese and German FMG that they slip into those slots.... those FMGs are usually (but not always) fully trained in their respective countries, and typically bring with them a lot of research capabilities.

trust me, if MGH wanted to have a full match it would be full every year....

just talk to the program director about how the match works...

 

[periopdoc]

i can't speak for UCSF or Hopkins... but I can speak for MGH.

MGH routinely doesn't fill ALL of its spots (on purpose), ....

As has been repeatedly pointed out in this thread, the out of match spots you are talking about are not reflected in the unfilled statistics because they are never submitted for the match.

The only reason there are unfilled spots is if the program does not rank enough applicants to fill. They set a threshold below which they will not rank a candidate. In any given year, that can result in the best programs competing for fewer candidates than the total number of spots available. in these years one or more of the programs will not fill because there are not enough "top notch" candidates to fill all of the "top notch" spots in that year.

That does not make it a "bad program," and is in fact a good strategy from the PD viewpoint as they retain stronger control over the credentials of the individuals getting into their program. The only way it can be bad is if it happens repeatedly and begins to degrade the reputation of the program.

The only way that a program could be unfilled despite ranking an adequate number of candidates is if for some reason fewer applicants ranked the program than the program had spots. Say only 4 applicants had MGH on their rank list. In this case even if all 4 applicants had MGH as number 1 and matched there, there would still be unfilled spots even if MGH ranked >1,000 applicants. This scenario is almost unimaginable as even the poorest candidates tend to throw one or two razzle dazzle passes and toss a MGH or a Hopkins on their rank list for the hell of it

trust me, if MGH wanted to have a full match it would be full every year...

This is true, but they would not necessarily have the quality of residents that they want to maintain. It is better to not rank anyone below your threshold and later recruit surgeons/ obs etc or fully trained academic type FMGs that are above your threshold than to lower your standards just so that you can fill.

-pod