Top Residencies of the Past. and Future?

[scrubswannabe]

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I think it's common knowledge now that some of the residency positions to get are dermatology, plastics, orthopedic surgery, anesthesioloy radiology, and cardiology and GI fellowships.
I wanted to see how this has changed from the past because I'm pretty sure almost all of these weren't that hard to get into 15 or so years ago, or at least a lot less difficult. Why the change? And if not these, what were the top residency positions med students were trying to get into back then? And can we predict anything about the future? Just some questions to think about and discuss.

 

[Law2Doc]

I think it's common knowledge now that some of the residency positions to get are dermatology, plastics, orthopedic surgery, anesthesioloy radiology, and cardiology and GI fellowships.
I wanted to see how this has changed from the past because I'm pretty sure almost all of these weren't that hard to get into 15 or so years ago, or at least a lot less difficult. Why the change? And if not these, what were the top residency positions med students were trying to get into back then? And can we predict anything about the future? Just some questions to think about and discuss.

Most of those have been pretty competitive for many years. Anesthesiology has had its lows but is strong currently. Not sure if IM fellowships really belong in the same category as competitive residencies. And you omitted optho, one of the traditional "road" specialties.

 

[scrubswannabe]

100 views, only 1 reply? I thought this was an interesting topic. Oh yes, I did forget to mention optho. What do you mean by "traditional road specialties"?
And I'm pretty sure I read somewhere that around 20 years ago (maybe it was 50 don't kill me) orthopedic surgery was what the bottom part of the medical class went into, not the top kids. So yes, maybe in the last 10 years these specialties have stayed at the top, but I doubt it was always like that. What could have caused the change in salary/preference in orthopedic surgery and other specialties also?

 

[scrubswannabe]

Oh yes and thanks for the quick reply Law2Doc

 

[MSKalltheway]

This is often due to the cyclic nature of specialty popularity. I do remember something about how cards and GI fellowships were not as competitive in the past (this was decades ago, though) because there we're not as many interventions and breakthroughs in the field as there are today. Once the inventions and reimbursements got better, the competition for these fields increased drastically. Its all about the money in the end. CT surg used to be huge, but now that interventional cards got big it is on the decline, and fellowship positions are a dime a dozen apparently. It is predicted to be huge again by time I am an attending (finally!) I'm not going to comment on other specialties specifically because I simply dont know about their past states, but im sure that cycles will continue to happen. Mark my words, neurology will get huge someday as well. Once we figure out the brain more, you'll have to figure out how to fit an 'N' into 'ROAD' to still get a word out of it. Neuro is the final frontier of medicine, and when the field gets procedures where they can bill out the @$$ for, im sure the specialty will suddenly attract tons of AOA's and >230 step 1's as well.

 

[Taurus]

And I'm pretty sure I read somewhere that around 20 years ago (maybe it was 50 don't kill me) orthopedic surgery was what the bottom part of the medical class went into, not the top kids.

It's because ppl started to notice that the ortho guys got all the hot chicks.

 

[lord_jeebus]

Neuro is the final frontier of medicine, and when the field gets procedures where they can bill out the @$$ for, im sure the specialty will suddenly attract tons of AOA's and >230 step 1's as well.

If the neurosurgeons and neuroradiologists don't get them first...

 

[colbgw02]

about 15 years ago radiology was actually pretty easy to get into. not like psychiatry easy, but middle-of-the-road. i find this somewhat ironic, because many of the current attendings and program directors who got into the field then are now pretty snotty towards current day applicants, who are actually much stronger applicants than they were.

around the same time, there was a big primary care push (much more so than today), so family medicine was much more competitive than today.

agree with the poster who mentioned anesthesia, there was a real, although unfounded, concern that anesthesia was a dying specialty. now everyone realizes that's not the case, and anesthesia is gaining popularity, especially since it offers a good lifestyle with excellent reimbursement.

i would not be surprised to see general surgery go up in competitiveness. with the 80 hour work week in place, i think fewer people will overlook surgery because of a horrible lifestyle during residency.

 

[MSKalltheway]

about 15 years ago radiology was actually pretty easy to get into

Thank you. This is what I was thinking before that I purposefully did not address in my prior post, but Rads came to mind also, as it has become more competitive in recent years.

 

[H_Caulfield]

Mark my words, neurology will get huge someday as well. Once we figure out the brain more, you'll have to figure out how to fit an 'N' into 'ROAD' to still get a word out of it.

Why don't we add N, remove R and put in a G. Let's face it: looking at black and white pictures in the dark for 30 years MUST get old at SOME point. Plus G can stand for Gastroenterology, as in... stick this tube/camera/pole up @ss for 7 hours a day, 4 days per week and then go vacationing with your 250k.

Follow these suggestions and you'll have: GONAD.

 

[Law2Doc]

What do you mean by "traditional road specialties"?

The traditional cushy specialties were Rads, Optho, Anest, and Derm, aka the ROAD to happiness.

 

[Law2Doc]

I do remember something about how cards and GI fellowships were not as competitive in the past (this was decades ago, though) because there we're not as many interventions and breakthroughs in the field as there are today. Once the inventions and reimbursements got better, the competition for these fields increased drastically. Its all about the money in the end.

I meant that for cards and GI you are only competing at a later subspecialty stage with those who went into IM, so it's not as competitive as a derm, optho, rads because a big chunk of the pool of top students is already gone by that later stage. IM is not all that competitive. So by my understanding you have to be at the top of a smaller mountain.

Thus these don't get to be included in HCaulfield's Gonad.

 

[postbacker]

Derm has been extremely competitive for at least 30 years (per my doc contacts)...radiology has had ups and downs, but for the most part has always attracted top students (for the same 30 years) but is definitely much "hotter" now...

From what i have observed, ortho would be a fantastic surgical specialty and with the aging population will continue to be for years to come - there is a a constant, growing stream of rotator cuffs, hip replacements, etc., for these guys to fix.

Ophtho I wonder about a bit - I go to one, and my annual eye exam is a 30 minute, $75 exam, and I get the feeling that most of the day is filled with this mundane, low paying activity. I understand that the money is in the procedures like corrective surgery, etc., but I still have doubts about this field...and I am not very interested in it for myself anyway...for example, a radiologist spends most of his day looking at X rays, and lots of them...that is his "bread and butter" but from what I saw I think it would get old...

One thing that has been impressed upon me in my shadowing experiences is that for any specialty, the really "cool" and "glam" (= high paying) procedural stuff makes up the smallest part of the specialist's day - learn what the specialist has to do over and over and over 80 percent of the time and think about the boredom and tedium factor when considering different fields...

 

[Orthodoc40]

A radiation oncologist friend of mine told me that she deliberately sought out a specialty that no one really knew much about when she was in school. Now it seems like everyone is trying to get into their residency program! (I think she graduated in '89.)

 

[Law2Doc]

Ophtho I wonder about a bit - I go to one, and my annual eye exam is a 30 minute, $75 exam, and I get the feeling that most of the day is filled with this mundane, low paying activity. I understand that the money is in the procedures like corrective surgery, etc., but I still have doubts about this field...

My last ophthalmologist seemed to be able to see about 4 patients an hour, kept his waiting room constantly full and charged the same $75, plus ran a glasses store on the premises. While I'm sure the procedures are where the money is at, if you can keep busy you do fine even with the more mundane stuff.

 

[postbacker]

My last ophthalmologist seemed to be able to see about 4 patients an hour, kept his waiting room constantly full and charged the same $75, plus ran a glasses store on the premises. While I'm sure the procedures are where the money is at, if you can keep busy you do fine even with the more mundane stuff.

I am sure you are right...one of the first docs I shadowed told me to be sure and note what these various docs do "80 percent" of the time to get a feel for how the majority of their day is structured, and then try to place yourself in that position - I guess the reason I have questions or doubts about ophtho is based on my being a patient, and I think I would go freaking nuts if I had to do 20 to 30 eye exams a day...

Same thing with radiology and the X Rays...these guys spend most of their day cloistered in the "reading room" looking at X rays, taking and making lots of phone calls (lots of disruptions), dictating their findings, and doing this over and over and over...I don't know if I can see myself doing that ad nauseum or not...

So many SDNers think these specialties offer glamorous, varied, exciting days filled with all kinds of different challenges, but based on my limited shadowing, I am starting to look at these specialities more critically...

And although most SDNers would be loathe to be seen in the company of an FP doc, it is an eye opening experience to see the variety of patients and problems one encounters every day in an FP practice...

 

[MSKalltheway]

I meant that for cards and GI you are only competing at a later subspecialty stage with those who went into IM, so it's not as competitive as a derm, optho, rads because a big chunk of the pool of top students is already gone by that later stage. IM is not all that competitive. So by my understanding you have to be at the top of a smaller mountain.

Thus these don't get to be included in HCaulfield's Gonad.

You make a cogent point, the fellowships aren't really in the same category, especially since the application process and requirements for fellowships is different for specialties. Thats too bad though, I was enjoying the acronym

 

[carn311]

Why don't we add N, remove R and put in a G. Let's face it: looking at black and white pictures in the dark for 30 years MUST get old at SOME point. Plus G can stand for Gastroenterology, as in... stick this tube/camera/pole up @ss for 7 hours a day, 4 days per week and then go vacationing with your 250k.

Follow these suggestions and you'll have: GONAD.

 

[MSKalltheway]

I guess the reason I have questions or doubts about ophtho is based on my being a patient, and I think I would go freaking nuts if I had to do 20 to 30 eye exams a day...

I hear you on that one! You have to remember though, whatever your specialty is, you'll get lots of well visits, but a good amount of every day will be with patients who are actually sick, because most people dont decide to see a doctor until something is wrong.

So many SDNers think these specialties offer glamorous, varied, exciting days filled with all kinds of different challenges, but based on my limited shadowing, I am starting to look at these specialities more critically...

I agree. I bet most of these are pre-meds who haven't a clue what medicine is actually like, thats the sense I get at least...

And although most SDNers would be loathe to be seen in the company of an FP doc, it is an eye opening experience to see the variety of patients and problems one encounters every day in an FP practice...

👍

I enjoy the concept and variety of patients of an FP doc, but I also agree with you here, most people are deluded into thinking the "bottom of the barrel" go into FP. I dont know where people get this from...most do it because they want to.

 

[Winged Scapula]

i would not be surprised to see general surgery go up in competitiveness. with the 80 hour work week in place, i think fewer people will overlook surgery because of a horrible lifestyle during residency.

Its already happened (general surgery increasing in competitiveness) and its not clear whether that's a function of the 80 hr work week or the simple ebb and flow which most specialties experience.

Nonetheless, there still isn't a great lifestyle after residency so applicants had better understand it...its not like its 5+ years of hell and then the gravy train afterwards.

 

[MossPoh]

Thank you. This is what I was thinking before that I purposefully did not address in my prior post, but Rads came to mind also, as it has become more competitive in recent years.

Rads used to be really easy, and some what frowned upon by top applicants even. My dad was AOA and all that and decided to go into rads. He was considered a freak amongst much of his class. Mainly because 40 years ago radiology was not THAT interesting. It was radiographs, radiographs, and radiographs with other dated and fairly miserable procedures for patients. Once the digital stuff started rolling out it became much more interesting and popular.....I actually think that is the perfect example of something that became real popular from nothing. I am under the impression that radiation oncology kind of started off slow too....many of the older docs seem surprised that it is such a difficult residency to get.

 

[owlet]

Follow these suggestions and you'll have: GONAD.

Or A DONG

 

[Wahoos]

I beleve the current day most competitive fields are Derm, Plastics integrated, Ortho, ENT, Rad Onc, Optho, Urology, and General Surgery. Usually the competitiveness of the speciality correlates with how much money you can make and better life style. I disagree with one of the above posters that people in the bottom of their medical school class go into orthopedics 30-40 years ago. The surgery and ortho residencies in the past used to be pyramidal, which means that the intern class composed of 10-12 people, they are not guranteed a job at the end of the year, only the best ones gets promoted through each year, and by the end, only 4-5 chiefs will graduate from the program. This system is pretty crapy if you ask me.... probably will create a lot of competitiveness among your own colleagues. So now a days, all the surgical residencies are categorical, which means 5 people gets in and 5 people will go on to graduate as chiefs.

Also one of my ortho attendings have been in practice for 25-27 years and his brother is a cardiac surgeon, he used to say that his brother wanted to do ortho 25 years ago, but did not do well enough on the tests to get into a residency. In fact one of the chief of urology at a major hospital, was in the same intern class as my chairman as a ortho resident, but he was droped mid way through by the pyramidal system about 20 years ago.

Good thing we have the categorical system now and thank god for the MATCH as well.

 

[Taurus]

My derm prof told us that until like the 50's or 60's derm used to be really easy to get into. Nobody wanted to look at cases of syphillis all day long.

If outsourcing becomes a big factor in radiology, then you'll see a huge drop in interest.

If midlevels start to cherry pick the easiest specialties to do, derm may also lose some of its luster.

It all depends.

 

[AmoryBlaine]

I am sure you are right...one of the first docs I shadowed told me to be sure and note what these various docs do "80 percent" of the time to get a feel for how the majority of their day is structured, and then try to place yourself in that position - I guess the reason I have questions or doubts about ophtho is based on my being a patient, and I think I would go freaking nuts if I had to do 20 to 30 eye exams a day...

Same thing with radiology and the X Rays...these guys spend most of their day cloistered in the "reading room" looking at X rays, taking and making lots of phone calls (lots of disruptions), dictating their findings, and doing this over and over and over...I don't know if I can see myself doing that ad nauseum or not...

So many SDNers think these specialties offer glamorous, varied, exciting days filled with all kinds of different challenges, but based on my limited shadowing, I am starting to look at these specialities more critically...

And although most SDNers would be loathe to be seen in the company of an FP doc, it is an eye opening experience to see the variety of patients and problems one encounters every day in an FP practice...

Great point. One of the really sad things about the current state of medical specialties is that people have equated a field's being easy to get into with being an uninteresting field.

(and vice versa)

 

[-Goose-]

I think this thread brings up a very interesting point...

I believe that medicine is definitely at a crossroads. With the looming election and historical probability that we will have a D following the name of our next president (and therefore, as of today, either Hillary or Obama), socialized medicine has a real possibility of being on the agenda for the next 4-8 years. Who knows what the consequences of this will be? Will we all be paid the same as government employees? I, as a pretty staunch pro-capitalist, sure as hell hope not.

But, if this nightmare comes to fruition, what will you want to practice? I feel that this will drive many people towards "lifestyle specialties." And without $$ to consider, this will mean that many people will want specialties with fewer and more regular working hours: EM, FP, IM, peds, etc. You will still have people attracted to the specialties with heavier hours (ortho, gen surgery, neurosurgery, etc.) just based on interest, but the greed factor will have been negated.

Just an interesting idea to consider...

 

[BlazerMed]

I think we can count on the lobbyists of the insurance industry and med mal lawyers to prevent a single-payer system for quite a while.

 

[Taurus]

If healthcare reform happens, what would irk me more than anything else, even salary cuts, is if they allow midlevels to assume equivalence with physicians. I didn't spend all this time and money to go to med school so that somebody with just a master's degree boasts that they can do my job, albeit not as well.

 

[soonerfan77]

This same socialized medicine fear always comes up. 🙄

Until hard-working Americans are willing to pay 40-60% in taxes, there will never be funding for a universal healthcare system. Hillary and Obama both know it. They are doing nothing different than every other politician out there, telling there constituencies what they want to hear to get their vote.

😎

 

[Its_MurDAH]

If healthcare reform happens, what would irk me more than anything else, even salary cuts, is if they allow midlevels to assume equivalence with physicians. I didn't spend all this time and money to go to med school so that somebody with just a master's degree boasts that they can do my job, albeit not as well.

Honestly, this kind of stuff is already happening.

You have no idea how many PAs and NPs I have met that claim that they know just about as much as (sometimes more than) the doctors they work for. One extremely cocky blonde even claimed that most of the time she had to tell the physician she was working for what to do because he/she was "clueless". This same woman had a tattoo of an anchor on top of her left boob...very classy. I almost had the urge to remind her that PA stands for Physician ASSISTANT.

God she made my blood boil.

 

[NCF145]

I think this thread brings up a very interesting point...

I believe that medicine is definitely at a crossroads. With the looming election and historical probability that we will have a D following the name of our next president (and therefore, as of today, either Hillary or Obama), socialized medicine has a real possibility of being on the agenda for the next 4-8 years. Who knows what the consequences of this will be? Will we all be paid the same as government employees? I, as a pretty staunch pro-capitalist, sure as hell hope not.

But, if this nightmare comes to fruition, what will you want to practice? I feel that this will drive many people towards "lifestyle specialties." And without $$ to consider, this will mean that many people will want specialties with fewer and more regular working hours: EM, FP, IM, peds, etc. You will still have people attracted to the specialties with heavier hours (ortho, gen surgery, neurosurgery, etc.) just based on interest, but the greed factor will have been negated.

Just an interesting idea to consider...

If this happens, doctors will be salaried. This means that neurosurgeons and the other specialties that generally worked long hours will no longer work long hours. The point is is that doctors will work as little and see as few patients as possible to meet their quota.

 

[PeepshowJohnny]

Honestly, this kind of stuff is already happening.

You have no idea how many PAs and NPs I have met that claim that they know just about as much as (sometimes more than) the doctors they work for. One extremely cocky blonde even claimed that most of the time she had to tell the physician she was working for what to do because he/she was "clueless". This same woman had a tattoo of an anchor on top of her left boob...very classy. I almost had the urge to remind her that PA stands for Physician ASSISTANT.

God she made my blood boil.

I don't see what her physical apperance has to do with it, but I have to agree that there's nothing as infuriating as someone with an inferiority complex because there's technically "below" a doctor compensating with outlandish claims.