Trends in specialty competitiveness

[Cassowary]

What specialties have been historically competitive that are not so competitive anymore? What specialties that are competitive today used to be easy? Which residencies have always been competitive, in the past and in the present?

I’m very curious about trends in residency competitiveness.

Also as a second part to the question, do you foresee any specialty in the future becoming more competitive/lucrative?

Personally, I hold a slight but admittedly unsubstantiated suspicion of neurology becoming more difficult and lucrative in the future. This is because the demand will rise, it is on so few med students’ radars that interest is low, and because of the heavy growth in neurology research that will develop new technologies and paid procedures for neurologists in the future.

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[lagbydesign]

What specialties that are competitive today used to be easy?

Ortho used to be for the bottom of the class 30-40 years ago. Oh, how the tables have turned.

Which residencies have always been competitive, in the past and in the present?

Derm.

 

[operaman]

I think the more surprising ones in recent years have been EM and Psych. EM trended up the competitiveness curve a few years ago and psych has started doing that recently too. Used to be you just needed a pulse to match psych but that seems no longer the case.

Some of the rads and gas programs are more accessible than in years past though it’s still far from a guaranteed match.

The surgical subs and derm seem like they will be staying insanely competitive for awhile. We just did our interviews and holy crap these people are ballers. We are talking 260+, AOA, 10+ pubs with most as first author (even some non phds crossing 30 and 40 pubs), tons of presentations and posters, fascinating backstories, flawless grades — it was insane. And that was the majority of our list! There are definitely applicants with more impressive CVs than many junior faculty.

Hard to see trends in the smaller fields. Our field had fewer applicants than total positions a few years ago and this year that rebounded with a vengeance. Even so the average step 1 has remained near 250 with generally stellar candidates.

 

[lagbydesign]

I think the more surprising ones in recent years have been EM and Psych. EM trended up the competitiveness curve a few years ago and psych has started doing that recently too. Used to be you just needed a pulse to match psych but that seems no longer the case.

Some of the rads and gas programs are more accessible than in years past though it’s still far from a guaranteed match.

The surgical subs and derm seem like they will be staying insanely competitive for awhile. We just did our interviews and holy crap these people are ballers. We are talking 260+, AOA, 10+ pubs with most as first author (even some non phds crossing 30 and 40 pubs), tons of presentations and posters, fascinating backstories, flawless grades — it was insane. And that was the majority of our list! There are definitely applicants with more impressive CVs than many junior faculty.

Hard to see trends in the smaller fields. Our field had fewer applicants than total positions a few years ago and this year that rebounded with a vengeance. Even so the average step 1 has remained near 250 with generally stellar candidates.

I knew that that was just a temporary dip for your field. There was no way it was going to stay that way.

What I'm really wondering is, will the surgical subs always remain around this level of competitiveness even with the greater focus on lifestyle with this generation? Obviously, number of spots, perceived competitiveness, money, prestige, and other factors will probably keep them up there.

 

[Raryn]

What specialties have been historically competitive that are not so competitive anymore? What specialties that are competitive today used to be easy? Which residencies have always been competitive, in the past and in the present?

I’m very curious about trends in residency competitiveness.

Also as a second part to the question, do you foresee any specialty in the future becoming more competitive/lucrative?

Personally, I hold a slight but admittedly unsubstantiated suspicion of neurology becoming more difficult and lucrative in the future. This is because the demand will rise, it is on so few med students’ radars that interest is low, and because of the heavy growth in neurology research that will develop new technologies and paid procedures for neurologists in the future.

They've been saying Neurology is going to get more competitive since before I was a medical student - and I started a decade ago. There's zero evidence it's any more competitive than it was 20 years ago (that linked post is one I wrote for an IMG, but the same truth holds for US MDs).

Pendulum does swing a fair bit for some specialties. For example, anesthesia has had wide variation over the last 30 years - in the early 1990s my parents tell me it was very noncompetitive, became highly competitive around the turn of the century, less so a few years later.

Radiology is a classic "competitive" specialty that the last 5-6 years has really not been that competitive - the raw statistics of the students who self-select into it are still good, but c. 2014 there were so few applicants that if you were a US MD all you needed to get into *a* radiology program was a pulse. It's gotten better the last couple years, but still isn't nearly as hard as the rest of the ROAD.

EM is very popular and getting more competitive all the time, but they're also opening programs like crazy - eventually the supply of programs will outstretch the demand, especially if the job market hits any stumbles at any point.

 

[nimbus]

Ortho used to be for the bottom of the class 30-40 years ago. Oh, how the tables have turned.

Strange. It was top of the class 25 years ago.

 

[bonedoc5576]

Fracture is correct that ortho was at one time the field for the bottom of the class, but it was more like 50-60 years ago. When I applied 35 years ago ortho was even then among the most competitive specialties, but there were stories passed down from the older generations about how orthopedic surgeons had the reputation for being "strong as ox and twice as smart." One attending told the story of one of his associates in training who was asked to insert cranial pins for skeletal traction on a cervical spine injury and proceeded to place a transcranial steinman pin

 

[lagbydesign]

Fracture is correct that ortho was at one time the field for the bottom of the class, but it was more like 50-60 years ago. When I applied 35 years ago ortho was even then among the most competitive specialties, but there were stories passed down from the older generations about how orthopedic surgeons had the reputation for being "strong as ox and twice as smart." One attending told the story of one of his associates in training who was asked to insert cranial pins for skeletal traction on a cervical spine injury and proceeded to place a transcranial steinman pin

Wow, that far ago? Crazy. Guess I heard wrong. I wonder if it'll be the same 50 years from now.

 

[CyrusHabs7695]

it honestly seems like >half the people interested in the competitive fields are due to the fact they will feel inferior if they go for a field that is deemed less competitive

 

[WedgeDawg]

it honestly seems like >half the people interested in the competitive fields are due to the fact they will feel inferior if they go for a field that is deemed less competitive

Probably during M0-M2, but after M3, people generally end up doing what they're interested in as long as its a realistic option for them

 

[Cassowary]

it honestly seems like >half the people interested in the competitive fields are due to the fact they will feel inferior if they go for a field that is deemed less competitive

Not at all, for me it’s 90% money and hours.

 

[Mad Jack]

Ortho used to be for the bottom of the class 30-40 years ago. Oh, how the tables have turned.



Derm.

Derm wasn't competitive in the 70s/80s. There's an article out there, I believe it was called "Dermatology: Least Among Equals" from the 80s that discussed the lack of prestige and interest in the field. By controlling the number of programs they changed this

 

[OrthoTraumaMD]

proceeded to place a transcranial steinman pin

Well... it is biomechanically optimal for traction.


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[Mr.S]

Any field that requires an intimate relationship with a hospital is inherently a terrible specialty nowardays that hospitals have meddled into our practices. They are dictating our practice, who gets credentialed, who gets disciplined , who gets hired? How much you make? e tc etc etc.

Derm needs NO hospital LOL. They are like dentists. ALl they need is an office and exam rooms etc

I predict a resurgence of the GP IM primary practitioner. They will truly be independent.

In fact I predict that the "housecall" will make a comeback. and it will liberate the primary practitioner from the corporate mess.

 

[mymembernames]

Psych is making its way up


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[operaman]

I knew that that was just a temporary dip for your field. There was no way it was going to stay that way.

What I'm really wondering is, will the surgical subs always remain around this level of competitiveness even with the greater focus on lifestyle with this generation? Obviously, number of spots, perceived competitiveness, money, prestige, and other factors will probably keep them up there.

The number of spots alone combined with increased enrollment will probably keep them contentious for the foreseeable future. I don’t see any extrinsic pressures that will hit any of them more than the rest of medicine. Lifestyle is really good across the subs unless you particularly want a practice that’s busier.

 

[MSTP18]

. Pendulum does swing a fair bit for some specialties. For example, anesthesia has had wide variation over the last 30 years - in the early 1990s my parents tell me it was very noncompetitive, became highly competitive around the turn of the century, less so a few years later.

Radiology is a classic "competitive" specialty that the last 5-6 years has really not been that competitive - the raw statistics of the students who self-select into it are still good, but c. 2014 there were so few applicants that if you were a US MD all you needed to get into *a* radiology program was a pulse. It's gotten better the last couple years, but still isn't nearly as hard as the rest of the ROAD.

It does feel like Optho and Derm have pulled away from Radiology and Anesthesia in at least the last decade or so.

 

[lagbydesign]

The number of spots alone combined with increased enrollment will probably keep them contentious for the foreseeable future. I don’t see any extrinsic pressures that will hit any of them more than the rest of medicine. Lifestyle is really good across the subs unless you particularly want a practice that’s busier.

But I feel like the lifestyle thing even extends to residency. Even in the chiller subs, like ENT and uro, the residencies are pretty hardcore from what I've heard. The only sub that has a decent lifestyle even during residency is ophtho.

 

[operaman]

But I feel like the lifestyle thing even extends to residency. Even in the chiller subs, like ENT and uro, the residencies are pretty hardcore from what I've heard. The only sub that has a decent lifestyle even during residency is ophtho.

That’s true. I think anyone looking at lifestyle that hard even during residency is not going to pick any surgical field. Subs will never ever approach the lifestyle of derm or the free time of EM.

All that said, lifestyle can be very program specific too. I would argue that my lifestyle is better than just about anyone in any other program or field. Nearly all weekends are golden weekends (work 6 weekends this year, 4 next year), all holidays off, 3 weeks vacay in addition, 3 weeks professional leave in addition to that, home call q10-14, most days hours are 6-6, and extremely supportive faculty and fellow residents. It’s hard to imagine any program in any field being more lifestyle friendly.

That said, lifestyle in residency is a stupid reason to pick a field unless there are extenuating circumstances.

 

[nimbus]

Not to get too far off topic but I always thought if dentistry and podiatry were medical specialties, they would be extremely competitive.

 

[Raryn]

Not to get too far off topic but I always thought if dentistry and podiatry were medical specialties, they would be extremely competitive.

Maybe. Dentists don't make that much money.

 

[nimbus]

Maybe. Dentists don't make that much money.

My dentist makes a LOT more than me.

 

[liquidcrawler]

.

 

[Cassowary]

I feel like everyone I know who obtained competitive board scores is suddenly into interventional rads. Seems like they get a lot of cool toys and procedures, but honestly it seems they live a surgeon's lifestyle without the accompanying clout.

All that exposure to radiation has made me not want anything to do with interventional. They are selling their life.

 

[deleted500612]

I feel like everyone I know who obtained competitive board scores is suddenly into interventional rads. Seems like they get a lot of cool toys and procedures, but honestly it seems they live a surgeon's lifestyle without the accompanying clout.

It's still a burgeoning field... I'm curious to see the follow up studies for interventional radiologist cancer rates after a 40 year career of constant low-level radiation exposure.

 

[Dr.Bruh]

Not at all, for me it’s 90% money and hours.

Other than Derm the majority of competive specialties have the worst possible hours (on average).

 

[DrGoon]

new derm

 

[deleted950463]

It's still a burgeoning field... I'm curious to see the follow up studies for interventional radiologist cancer rates after a 40 year career of constant low-level radiation exposure.

Not an issue at all. Studies have been done

 

[libertyyne]

It's still a burgeoning field... I'm curious to see the follow up studies for interventional radiologist cancer rates after a 40 year career of constant low-level radiation exposure.

There are literally nuclear physicists who monitor radiation exposure via those badges and long term studies and osha standards have already been done. Yes there is an increased risk for cancer, but it is not an earth shattering increase. Just like there is an increased risk for prion diseases for brain Surgeons.

 

[IMreshopeful]

All that exposure to radiation has made me not want anything to do with interventional. They are selling their life.

This is a generally incorrect statement. The studies exist looking at longitudinal cancer risk and are generally showing a non clinically significant increase over lifetime risk

The increase in cancer risk has been shown to be minimal over the lifetime risk with background radiation (something like 20% to 20.01% increase). Good shielding and good lead (plus possibly lead cap/zero gravity shielding) can effectively reduce radiation exposure to near zero. EP and IC cases are generally done without tons of fluoroscopy on and without using a ton of DSA which delivers the highest dose.

Also keep in mind that fluoro and shielding technology has continued to advance dramatically. The amount of radiation exposure as a result over several decades has dropped precipitously

 

[IMreshopeful]

There are literally nuclear physicists who monitor radiation exposure via those badges and long term studies and osha standards have already been done. Yes there is an increased risk for cancer, but it is not an earth shattering increase. Just like there is an increased risk for prion diseases for brain Surgeons.

Correct - it depends on how smart or stupid you are with radiation shielding. If you position everything appropriately your effective dose becomes almost nil. Also don’t stand so close to the patient when you don’t have to!