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Thus far I have been fortunate in the application process. I have been told by a derm resident to go on every interview possible. Is this good advice? What is a safe # to ensure a match? This process is becoming very expensive very quickly. I hate to throw money away and take up an interview slot someone else can benefit from. I guess I was hoping for a magic number of interviews but I suspect this does not exist. Last year I heard of an applicant matching at their # 17.

Thoughts?
 

Long Dong

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Cost of reapplying > cost of going to every interview offered this year. When I say cost I'm not talking just money, but mental stress.
 
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Based on the 2009 NRMP data, it says that 8.5 contiguous ranks was the mean for those who successfully matched. I haven't seen the 2010 data, but the NRMP website may have some of that information.
 
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My magic number is 10 (not there yet...it may not be a problem!). I know that people have scrambled with more interviews than that, but everyone has to come up with what's realistic for them. For example, the advice to apply to every derm program (100+ ?) is not great in my opinion, as the application fees alone would be thousands. It seems like that is just throwing lots of cash/debt at a problem. To each his own though; I understand that different things work for different people.
 

reno911

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My magic number is 10 (not there yet...it may not be a problem!). I know that people have scrambled with more interviews than that, but everyone has to come up with what's realistic for them. For example, the advice to apply to every derm program (100+ ?) is not great in my opinion, as the application fees alone would be thousands. It seems like that is just throwing lots of cash/debt at a problem. To each his own though; I understand that different things work for different people.
For the vast majority of applicants, not applying to every single program is just plain stupid. I think I have posted extensively on this subject in the past so, I'll be brief here.

When I was in your position, I thought the same way, and I didn't apply as broadly as I should have. Luckily I matched, but it doesn't change the fact that what I did was incredibly stupid.

Once you become a dermatologist, your salary for one to two days of work will be more than enough to cover the cost of applying to every program. The return on your investment is huge, and therefore you should do everything possible to maximize your chance of matching. I know that the cost is high, but as a poster above succintly mentioned, the cost of not matching is so much worse.

I know that money is tight when you're a student, but you should do everything possible to apply to every program and then go to every interview that you get invited to. The only thing that should prevent you from accepting an interview is conflicting dates with another interview.
 

dermathalon

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I suspect most people are going to look at this thread and realize that you have a pretty unique and good problem. I agree with Long Dong...you don't want to do this twice. The rest is up to your level of risk/benefit that are you willing to take. No one is going to be able to answer this question for you. It's fine and dandy to look at "average", and I emphasize the word average, stats on NRMP to decide that you need a certain set of interviews to become comfortable. Some say 8.5, some say 10, some will pick another number that is as good as any of the other numbers picked. I find stats very interesting (for not only SDN derm but for clinical practice as well) but they really don't do much for the individual. I know people that matched with only two interviews but they had a solid, solid connection. So, you should go on as many interviews as you feel comfortable doing, knowing that you don't want to go through this twice.

A perk of interviewing at many places is that you get to see a lot of places and see how the different dermatology departments run and you get a window into many of the faculty in the nation.

You worked hard and probably had a good dose of luck (I know I did) to get your set of interviews. Like Otis601 said, to each his/her own and you ultimately have to be comfortable with the decision to cancel interviews.
 
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dermathalon

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For the vast majority of applicants, not applying to every single program is just plain stupid. I think I have posted extensively on this subject in the past so, I'll be brief here.

When I was in your position, I thought the same way, and I didn't apply as broadly as I should have. Luckily I matched, but it doesn't change the fact that what I did was incredibly stupid.

Once you become a dermatologist, your salary for one to two days of work will be more than enough to cover the cost of applying to every program. The return on your investment is huge, and therefore you should do everything possible to maximize your chance of matching. I know that the cost is high, but as a poster above succintly mentioned, the cost of not matching is so much worse.

I know that money is tight when you're a student, but you should do everything possible to apply to every program and then go to every interview that you get invited to. The only thing that should prevent you from accepting an interview is conflicting dates with another interview.

I respect your opinion but I disagree with the bit about applying everywhere (I agree with you on going to every interview possible).

Some programs are known to offer regional interviews and it would be a waste of money to apply to these programs. You have to take an honest appraisal of your application (and you need to ask people that are willing to give you an honest appraisal) and then decide. If you truly do have a strong application with a lot of research and good scores, I think you are throwing your money away to apply to all programs. If you do not have a strong application or there are major "perceived holes" in your application, then you need to sit down with an advisor (or several advisors) that you trust and discuss your application. The problem with these applications is that it is easy to apply in a vacuum since most derm applications are pretty good at being independent. For some select people, applying to all derm programs makes good sense (again individualize) but I don't think this should be the "vast majority." Using this as a general strategy only leads to a wastage of money, regardless of whether you'll make this back as a dermatologist or not.

I, for one, would have totally wasted my money with the extra 40+ applications that I could have submitted.
 
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reno911

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Some programs are known to offer regional interviews and it would be a waste of money to apply to these programs. You have to take an honest appraisal of your application (and you need to ask people that are willing to give you an honest appraisal) and then decide. If you truly do have a strong application with a lot of research and good scores, I think you are throwing your money away to apply to all programs. If you do not have a strong application or there are major "perceived holes" in your application, then you need to sit down with an advisor (or several advisors) that you trust and discuss your application. The problem with these applications is that it is easy to apply in a vacuum since most derm applications are pretty good at being independent. For some select people, applying to all derm programs makes good sense (again individualize) but I don't think this should be the "vast majority." Using this as a general strategy only leads to a wastage of money, regardless of whether you'll make this back as a dermatologist or not.


This type of thinking, while it sounds persuasive, is unfortunately wrong. I don't mean to single you out, but the reason why you are coming to this conclusion is because your analysis is, for lack of a better term, wishy-washy.

If you assign some actual numbers and probabilities to the various events occuring, you will see that it is mathematically incorrect not to apply to every program.

Now, I'm far removed from applying, and I no longer am in academia, so l'm not exactly sure about the numbers I'm going to use below, but I'm sure they are close enough that the conclusion won't change. Let's assume that it costs $100 to apply to an extra program. Let's further assume that there are 400 applicants at this extra program and we'll say they have 3 spots. If you are an average applicant we'll say that your chance of matching at that program is 1/133 (i.e., 3/400). But we'll say that for whatever reason you think your odds are much worse than average (because of regional bias or whatever), so we'll drop it to 1/500.

So the only question before you is is spending the extra $100 worth a 1 in 500 shot. For the 1 in 500 shot to be worth it, the one time you win has to be worth the 499 times you will lose, so in other words winning has to be worth $49,900 for your expectation to be neutral. Clearly matching in dermatology is worth way more than that, so applying to this program is the right choice.

Now there are a couple of things I left out of my analysis because I really didn't want to spend a lot of time on something that should be obvious. I didn't factor in the time value of the money, your risk tolerance, your perceived chances of matching at the other programs you have already applied to, etc. These factors will change the calculation a little bit, but I don't think you can concoct a scenario where not applying to an extra program is the correct choice. If you can, in all likelihood, you are probably undervaluing the cost of not matching.

I, for one, would have totally wasted my money with the extra 40+ applications that I could have submitted.
Seriously? And I guess I will have wasted my money on disability insurance if I never get disabled.
 

rabbitsfeet777

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Lately I keep hearing about people with 18, 22, and 30 interviews that didn't match. I know this may be just a fluke, but do you think you could have so many interviews or such a strong candidate that no program actually ranks you high enough so that you don't match?

I know as applicants we should rank programs where we want to go, but how do programs rank applicants?
 
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I agree with dermathalon whole-heartedly, and I think his/her argument was very well worded. I also will say that most everyone should go to every interview possible. Reno, you're talking about statistics and math. Well the NRMP said that in 2008, if an average applicant received 10 interviews, then they would have something like a 90% chance of matching. Those are risks that I (and others) can live with.

Rabitsfeet, in my opinion the NRMP is talking about the average student. When it comes down to how many interviews you need, shouldn't one factor in their interview / interpersonal skills? For example, it's easy to imagine someone (there are people like this in my class) who is AOA, top step scores, and good research -- but the personality of a cardboard box. This person would likely not look as good in person as they do on paper. I'm sure there are many, many people like this. They would probably need to do more interviews than the average person. Doesn't that make some sense?
 

reno911

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Lately I keep hearing about people with 18, 22, and 30 interviews that didn't match. I know this may be just a fluke, but do you think you could have so many interviews or such a strong candidate that no program actually ranks you high enough so that you don't match?
It happens frequently enough that "fluke" is probably not the right word to describe it. But with that many interviews, the chances of not matching are low.

I know as applicants we should rank programs where we want to go, but how do programs rank applicants?
It varies widely, but it is more arbitrary than you might imagine. Which is why sometimes the 30 interview people get unlucky.
 

reno911

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Well the NRMP said that in 2008, if an average applicant received 10 interviews, then they would have something like a 90% chance of matching. Those are risks that I (and others) can live with.
Just because you can live with the risk doesn't mean it is the right decision. I'm glad that you can live with your bad decision.

Of course, this stat (10 interviews = 90% match) is only tangentially related to my argument (i.e., apply everywhere). You don't know how many interviews you are going to get until after you apply.
 

mohderm

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If someone has 20+ plus interviews and does not match it's most likely due to their personality. They got 20+ interviews because they scored 300 on Step1 and when they get to the interviews they absolutely had no social skills. I know this is just echoing what otis601 says, but I can not stress enough the importance of just being normal.

When it comes time for me to start meeting students at interview dinners and interviews this year I'm looking for someone who I can enjoy working with the next few years. If you have been invited for an interview we have already decided that academically you can make the cut. Now we want to know if you will fit in with the group. I do not care about your board scores, research, blah blah blah at the interview dinner. This is a time to learn more about other things such as hobbies, etc. We know your smart, now be normal. Sounds easy and like common sense but many people blow it.

Sorry not sure how I got off on that topic. Not really what the OP was asking. :laugh:
 

reno911

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If someone has 20+ plus interviews and does not match it's most likely due to their personality. They got 20+ interviews because they scored 300 on Step1 and when they get to the interviews they absolutely had no social skills. I know this is just echoing what otis601 says, but I can not stress enough the importance of just being normal.
I find that this type of person (great on paper, but really weird personality) is rarer than you might think. The reason for this is because it's difficult to do well on clinical rotations if you have no people skills (since you have to interact with the rest of the team).

Maybe I'm just a pretty flexible guy, but I've interviewed many applicants for derm residency positions and I can only think of one that was so weird that I didn't want to work with them. That person happened to be not that great on paper either.

The bottom line is that the type of person you are describing exists, but is not very common at all. Besides, if you do some searches on SDN you will see people who don't match with 20+ interviews that are (at least according to the person telling the story) normal, nice people.

Interestingly, I think that you do find this type of person a little more frequently when you are looking at med school applicants, because you can get good grades and MCAT scores and not really have to interact with anyone.
 
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According to the most recent charting outcomes in the match report (2009), 118 people had 10 or more interviews. Of these 118 people, 4 didn't match. 100% of the 43 people who ranked 14+ programs matched.

Sure this is only one year, but if you hear lots of stories of people interviewing at ~30 places and not matching you gotta call BS on them.
 

sore eye asses

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Seriously? And I guess I will have wasted my money on disability insurance if I never get disabled.
Reno's been hanging out with Blaise Pascal. Believe in the derm Gods! All of them. It's for your benefit.
 
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N-Surge

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Risk management... If you have the opportunity to decrease the risk of not matching, do it.
 

dermathalon

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This type of thinking, while it sounds persuasive, is unfortunately wrong. I don't mean to single you out, but the reason why you are coming to this conclusion is because your analysis is, for lack of a better term, wishy-washy.

If you assign some actual numbers and probabilities to the various events occuring, you will see that it is mathematically incorrect not to apply to every program.

Now, I'm far removed from applying, and I no longer am in academia, so l'm not exactly sure about the numbers I'm going to use below, but I'm sure they are close enough that the conclusion won't change. Let's assume that it costs $100 to apply to an extra program. Let's further assume that there are 400 applicants at this extra program and we'll say they have 3 spots. If you are an average applicant we'll say that your chance of matching at that program is 1/133 (i.e., 3/400). But we'll say that for whatever reason you think your odds are much worse than average (because of regional bias or whatever), so we'll drop it to 1/500.

So the only question before you is is spending the extra $100 worth a 1 in 500 shot. For the 1 in 500 shot to be worth it, the one time you win has to be worth the 499 times you will lose, so in other words winning has to be worth $49,900 for your expectation to be neutral. Clearly matching in dermatology is worth way more than that, so applying to this program is the right choice.

Now there are a couple of things I left out of my analysis because I really didn't want to spend a lot of time on something that should be obvious. I didn't factor in the time value of the money, your risk tolerance, your perceived chances of matching at the other programs you have already applied to, etc. These factors will change the calculation a little bit, but I don't think you can concoct a scenario where not applying to an extra program is the correct choice. If you can, in all likelihood, you are probably undervaluing the cost of not matching.
So this was not the original question in this post and I hate to digress but I figure this is an interesting side conversation in itself since the question comes up frequently if an applicant should just apply to every program. I have maintained a respectful attitude toward your initial post although you were quite brazen with your language with words such as "plain stupid" in reference to any student that does not apply to all the programs and "wishy-washy" in regards to my post.

You present one perspective in the camp of apply to every program. I cannot say that your viewpoint is "wrong," and likely shared by many on this forum, as there is no wrong or right here. I do disagree with your analysis and methodology and leave it up to the reader to decide, while taking into account the very real subjective forces in play.

Since you have introduced math into this subject, I'll comment. I don't want applicants holding on to 1/500 or $49,900 as a solid analysis. Although you set up the overall structure of your analysis well, your numbers are way off and this does make a huge difference. Many programs only have two slots which significantly alters your probability discussion. Furthermore, you are quoting "overall average probabilities" with no reference to the individual schools is a fallacy in this argument. To me, 1/500 is a gross overestimate on a school by school basis (and an overall basis) and I don't know where you are getting your numbers. If you have regional bias or no history of interviewing students from your school, you're probability is much much closer to zero and that significantly influences the overall conclusions. The law of diminishing returns plays a significant impact and that's where the mentor/advisor is very important. Even if you apply to all the programs, there is still a real risk of not matching. Again, mentorship and guidance are key.

If you are concerned about the strength of your application and believe that applying everywhere is important, then applying everywhere should be taking into STRONG consideration. However, you CANNOT quote future salary as a replacement for today's money for applicants that are taking care of children, a spouse, or have a mortgage payment. That is simply bad financial advice and causes people to feel more anxiety about the application process. To call such applicants "simply stupid" is simply too simplistic.


Finally to your point about disability insurance. Equating disability insurance to the application cycle is like comparing apples to oranges. Disability insurance has many factors associated with it because you will not be able to work. People that do not match still have the option to practice medicine. But, I'll bite. Do you take out insurance for every single catastrophe possible? Do you own insurance to protect against flood, earthquake, tornado, fire, etc?...I doubt it. You take out insurance on what would make the most sense and you have a law of diminishing returns after some point. I doubt you own every insurance of the land. You make an educated analysis of the situation and then decide how you will apportion your risk while maintaining financial harmony. That is all that I am suggesting.

And yes, for me, spending the extra money with my spouse instead of on the 40+ applications resulted in a well-worth trip and time spent together. I will never look back and feel like I made the "wrong" decision. If anything, I made the right one for me.

There is ultimately no "right" decision and only the decision that works best for each person. That's the problem with these right or wrong discussions when there is so much gray area in play.

To be fair, I'll give you the last word on this one since I started this whole thing by disagreeing with your initial post.
 
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reno911

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So this was not the original question in this post and I hate to digress but I figure this is an interesting side conversation in itself since the question comes up frequently if an applicant should just apply to every program. I have maintained a respectful attitude toward your initial post although you were quite brazen with your language with words such as "plain stupid" in reference to any student that does not apply to all the programs and "wishy-washy" in regards to my post.

You present one perspective in the camp of apply to every program. I cannot say that your viewpoint is "wrong," and likely shared by many on this forum, as there is no wrong or right here. I do disagree with your analysis and methodology and leave it up to the reader to decide, while taking into account the very real subjective forces in play.

Since you have introduced math into this subject, I'll comment. I don't want applicants holding on to 1/500 or $49,900 as a solid analysis. Although you set up the overall structure of your analysis well, your numbers are way off and this does make a huge difference. Many programs only have two slots which significantly alters your probability discussion. Furthermore, you are quoting "overall average probabilities" with no reference to the individual schools is a fallacy in this argument. To me, 1/500 is a gross overestimate on a school by school basis (and an overall basis) and I don't know where you are getting your numbers. If you have regional bias or no history of interviewing students from your school, you're probability is much much closer to zero and that significantly influences the overall conclusions. The law of diminishing returns plays a significant impact and that's where the mentor/advisor is very important. Even if you apply to all the programs, there is still a real risk of not matching. Again, mentorship and guidance are key.

If you are concerned about the strength of your application and believe that applying everywhere is important, then applying everywhere should be taking into STRONG consideration. However, you CANNOT quote future salary as a replacement for today's money for applicants that are taking care of children, a spouse, or have a mortgage payment. That is simply bad financial advice and causes people to feel more anxiety about the application process. To call such applicants "simply stupid" is simply too simplistic.


Finally to your point about disability insurance. Equating disability insurance to the application cycle is like comparing apples to oranges. Disability insurance has many factors associated with it because you will not be able to work. People that do not match still have the option to practice medicine. But, I'll bite. Do you take out insurance for every single catastrophe possible? Do you own insurance to protect against flood, earthquake, tornado, fire, etc?...I doubt it. You take out insurance on what would make the most sense and you have a law of diminishing returns after some point. I doubt you own every insurance of the land. You make an educated analysis of the situation and then decide how you will apportion your risk while maintaining financial harmony. That is all that I am suggesting.

And yes, for me, spending the extra money with my spouse instead of on the 40+ applications resulted in a well-worth trip and time spent together. I will never look back and feel like I made the "wrong" decision. If anything, I made the right one for me.

There is ultimately no "right" decision and only the decision that works best for each person. That's the problem with these right or wrong discussions when there is so much gray area in play.

To be fair, I'll give you the last word on this one since I started this whole thing by disagreeing with your initial post.
A few things.

1. I already stated that I omitted some factors from my calculation. Read my post again. Many of them are ones that you pointed out. If you factor them in, you will probably not change the calculation enough to make not applying the right decision. That's because the value of matching is so high.

2. You say my numbers are wrong. But what are your numbers? As I mentioned, my numbers are estimates. You need to make some sort to analyze the situation properly. Instead of just hand-waving, why don't you do some actual cost-benefit analysis.

3. We agree entirely on the principle of insurance. However, not matching in derm is a realistic catastrophe. It's not at all far-fetched as are some of the scenarios you are trying to equate it to.

4. You are nit-picking at the wrong things. For example you seem to think that, in my analysis, changing from three to two slots would "significantly" alter the discussion. It actually wouldn't. Even if the overall number is off by 1/3, it is still much lower than the value of derm residency spot. Why don't you tell me how much you think a derm residency spot is worth?

5. In case it wasn't clear, my position is that applying to every program is the right thing for the vast majority of applicants. Surely some people can have rare cases which make not applying to every program correct. But for the vast majority, it is the correct thing to do.
 
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Long Dong

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How many times have I ordered DIF, SPEP, or chest x-ray on that itchy patient who have seen 3 other dermatologist before and come up with nothing. But that one time I picked up that lymphoma, BP, or myeloma it was all worth it.

I applied to all programs and went to every interview offered to me (all 4 of them), with my signing bonus I'm going to get this:



and put a down payment on this:



And still have money in the bank.
 

reno911

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LD,

Not a fan of the watch, but love the car. Good luck with the new job.
 

dermathalon

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Congrats LD! I, too, am more of a fan of the car.

Reno, to answer your question about my math:
For the interview stage, an applicant has an approximate random chance of 10% (1/10) to get an interview. There are about five regions (west, south, midwest, northeast, southeast) and so for schools that favor regional applicants, especially if you are from a coast, you have to adjust the probability with another 1/5 to 2/5 (we'll go with 2/5 since I give the benefit of the doubt that a regional will draw from a similar region...coast form a coast and midwest would prefer from midwest or adjacent region) so we are at 1/10x2/5 so far. Then there is the adjustment for internal candidates. There is no real accurate way to adjust for this but I would say that a school prefers a good known person much more over the unknown that shows up as a CV on their desk but a reasonable estimate is a factor of 4 (they know your work ethic and your personality...2x2) so you have another 1/4 against you. So we're at 1/10x2/5x1/4 = 1/100 to just get an interview. then you go through the whole elimination process again so you have another 1/10x2/5x1/4...except that schools talk to their preferred applicants at the time of ranking...if done right this is also within the rules of the NRMP as long as they do not solicit. You have to account for this and I think that it is another factor of 4 (likely an underestimate) because it makes it that much harder to proceed down the rank list beyond the preferred candidates. So for the interview/ranking phase it is 1/10x2/5x1/4x1/4 which works out to 1/400. Since the interview phase is in series with the ranking phase you have to multiply the probabilities together so you have 1/100x1/400 which gives you 1/40,000. I think the subjective factors are very important and connections are so important in derm. And I believe that this number is an overestimated probability in favor of the applicant. But, it's only for certain schools where you have the odds stacked against you and it's not an average across the board. That's why I say that your chance of matching will be close to zero in certain situations. Still, for some, the right choice is still to apply everywhere.

Don't hold on to my 1/40,000 as fact...both of our numbers are our estimates.

I only make this estimate for certain programs. It's is NOT meant to be a generalization and it also depends on the applicant since one applicant can have a 1/40,000 shot but another applicant applying to the same program may have a 1/5 shot because all of the subjective odds (ie. connections, internal well liked candidate, etc.) are in your favor.
 
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N-Surge

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LD,

Not a fan of the watch, but love the car. Good luck with the new job.
Dude! The watch is hot! However, I thought you were going to get this...



And when you do, try not to do this...



When I think of math and Derm it reminds me of the Pet Shop Boys song, "Two Divided by Zero".
 
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reno911

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Congrats LD! I, too, am more of a fan of the car.

Reno, to answer your question about my math:
For the interview stage, an applicant has an approximate random chance of 10% (1/10) to get an interview. There are about five regions (west, south, midwest, northeast, southeast) and so for schools that favor regional applicants, especially if you are from a coast, you have to adjust the probability with another 1/5 to 2/5 (we'll go with 2/5 since I give the benefit of the doubt that a regional will draw from a similar region...coast form a coast and midwest would prefer from midwest or adjacent region) so we are at 1/10x2/5 so far. Then there is the adjustment for internal candidates. There is no real accurate way to adjust for this but I would say that a school prefers a good known person much more over the unknown that shows up as a CV on their desk but a reasonable estimate is a factor of 4 (they know your work ethic and your personality...2x2) so you have another 1/4 against you. So we're at 1/10x2/5x1/4 = 1/100 to just get an interview. then you go through the whole elimination process again so you have another 1/10x2/5x1/4...except that schools talk to their preferred applicants at the time of ranking...if done right this is also within the rules of the NRMP as long as they do not solicit. You have to account for this and I think that it is another factor of 4 (likely an underestimate) because it makes it that much harder to proceed down the rank list beyond the preferred candidates. So for the interview/ranking phase it is 1/10x2/5x1/4x1/4 which works out to 1/400. Since the interview phase is in series with the ranking phase you have to multiply the probabilities together so you have 1/100x1/400 which gives you 1/40,000. I think the subjective factors are very important and connections are so important in derm. And I believe that this number is an overestimated probability in favor of the applicant. But, it's only for certain schools where you have the odds stacked against you and it's not an average across the board. That's why I say that your chance of matching will be close to zero in certain situations. Still, for some, the right choice is still to apply everywhere.

Don't hold on to my 1/40,000 as fact...both of our numbers are our estimates.

I only make this estimate for certain programs. It's is NOT meant to be a generalization and it also depends on the applicant since one applicant can have a 1/40,000 shot but another applicant applying to the same program may have a 1/5 shot because all of the subjective odds (ie. connections, internal well liked candidate, etc.) are in your favor.
Well, now that you've given me some numbers, I can tell you why you're wrong.

1. First, the idea that there exists a significant population of applicant that have a 1/40,000 chance of matching at a given program (even with a regional bias) is just ridiculous on face. I guarantee if you look at every single derm program (even those with a strong regional bias), they will have in their history someone who wasn't in their region that had no connection. They simply had something on their application that attracted someone's attention and cause them to match. And no derm program has ever had anywhere near 40,000 residents, so it is very unlikely that the chance is 1/40,000.

Furthermore, I can tell you that in my experience as faculty at a program which had a very strong regional bias (despite my efforts to neutralize it), that the chance of an any applicant matching (even an FMG) is far greater than 1/40,000. You can choose to believe that or not.


But even if you don't believe the above, your calculation is still obviously wrong for the following reasons:


2. You're double counting and triple counting some things. First you say that the average applicant has a 10% chance to get an interview, which I think is fine. Then you say that you have to adjust for region, which I guess is fine (there's a small problem with this, but let's forget that for now). And then you go on to say that you have to adjust for internal candidates. Now you're double counting. The reason for the regional bias of many programs is because many of their spots are filled with their own med students and people from nearby schools who rotate there. So you're basically counting the same thing twice.

3. You further double count by then taking your 1/10*2/5*1/4 and multiply it by itself again. There's no reason for this. Once you've already got past the interview stage, you don't have to go through this same filtering process again. You also add some other factor of 4 which I can't understand after reading your explanation multiple times.

What you are suggesting is patently ridiculous.

What you're saying is that for this hypothetical regional candidate is the following:

Once this person has secured an interview, the chance of them matching is 1/400.

Ask any academic faculty member you want. We would never invite someone for an interview if the chance of their actually matching is 0.25%. That would be an absurd waste of everyone's time. With the possible exception of the courtesy interview to a med student or rotator, we only invite people who we think would have a decent shot of matching. And 0.25% is way too low.

You can also look at the absurdity another way. If we assume that we interview 10 candidates per slot (which is pretty close to average in my experience), then the average match rate of an interviewee is 10%. You are suggesting that the average interviewee is about 40 times more likely to match (once they have been invited for an interview) than this hypothetical non-regional candidate. That too is absurd.

With the exception of perhaps a rotator or med student who is given a courtesy interview (and clearly that's not what would be going on here for this hypothetical unconnected applicant), there is no way that anyone is invited to interview if they are 40 times less likely than the average candidate to match.

Generally speaking, and I can say this after having discussed this issue with many colleagues, once you secure an interview you are on roughly equal footing. Sure, the better applicants on paper will have a little bit of a leg up, but it's nowhere near 40x, which is the conclusion your assumptions would lead us to.


Hopefully, this will help you understand why you are wrong. I sincerely hope no one takes your advice seriously.
 

dermathalon

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The mumbo-jumbo that both of us are spouting is rooted in basic statistics. You can't just carry one calculation over to the next step without adjusting for the probability of the next step. There is no "double counting" in my calculation. If a selection happens twice (interviewing and then ranking) you have to account for it. Regional applicants are not the same as internal candidates and I'm accounting for this. These are estimates...just like your set of estimates. You have to carry the calculation through each step so that the probabilities are factored together to get an overall probability. The same biases that exist in the interview phase will again occur in the ranking phase because both steps are quite difficult decisions to make for the faculty when everyone really is pretty good. Furthermore, the very fact that many programs frequently select residents from their home medical school is not a matter of pure chance. There is inherent bias in the ranking process. The extra factor of 4 is again an ESTIMATE of extra bias toward the applicants ranked at the top...I'm pretty clear in my previous post. A chance of matching at 1/40,000 does not mean that you need 40,000 residents. I agree that if this is how you try to understand this number, then it truly does sound absurd. This shows that you are not understanding the idea of a weighted average. Like I said in my previous post, while one applicant may have 1/40,000, others will have a much higher chance (like say 1/5 or even higher). When you do a weighted average of all of the chances of all of the applicants to a particular Program X, this will even out to the ratio of "slots available at program X/number of total applicants to Program X." Your error was that you assumed that this weighted average is the actual chance for every applicant. That is just plain incorrect. My calculations account for why there are unfortunate people that go unmatched despite applying to all programs and why some people with only one interview can still match (although I presented only the numbers for the a person without connections and not the rosy side of having good connections). But we both know that it's not all pure statistics and there are a lot of subjective forces in play. We both seem to agree on the subjective forces at play, but my opinion is that you don't account for them adequately in your calculations.

Clearly, many programs do not have such a rigid regional bias (and I have been careful to refrain from overgeneralizing so please do not suggest otherwise). I'm giving you a justification for why an applicant might not apply to ALL programs and so present the case for why it can make sense to apply to less than the full count of possible applications. The law of diminishing returns is an important concept and it explains why people unfortunately still go unmatched, even when they apply to all programs. Sometimes there is a greater weakness in your application beyond simply applying to every program in the land. Realistically, everyone will still need to apply to an enormous number of places, especially when compared to our colleagues that are vying for other residencies. But that does not mean you HAVE to apply to every single program. It all depends and that's what I have been saying over and over again.

In any case, my advice from the start has been that applicants talk to an advisor to figure out the best plan of action. I think that's pretty solid advice. I don't believe in the one size fits all or the "vast majority." Again, if you feel that applying to all programs is best for you, then do it and no one will ever fault you for that. I do have friends that did apply to all programs (and I supported them whole-heartedly because it made sense for their situation) and they ultimately matched at a program where they had a strong connection...go figure..and they only had interviews at the places that they had strong connections...go figure again. I have others that applied everywhere with no connections and did not match at all. I have still other friends (the majority) who did not apply everywhere but still got a lot of interviews and matched...go figure yet again. There is no solid rule. Again, THERE IS NO ABSOLUTE RIGHT OR WRONG. Maybe it is this uncertainty that bothers you most about my posts but it is a part of life, even beyond dermatology.

We've gone back and forth a couple times and I don't want this to become too personal as I find myself agreeing with you more often than you might think (despite our disagreement here). It just happened that I piped up when I disagreed with you. I think we're going to have to agree to disagree. Again, I respect (but disagree this time) your position and obviously I have presented a different perspective. My biggest gripe with your position, above all, is that you label applicants as "simply stupid" if the "vast majority" of them are not applying to all programs and that is what impressed me to pipe up against you in the first place.
 
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RadOncDoc21

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To the OP,

Definitely accept every interview offer because you are in a very fortunate position and don't want to ruin any chances. There is no "magic number" and if you worked this hard you might as well go all out for it.

Now is not the time to slack off, especially since you had to have worked hard to get in this position. Every interview is a golden opportunity. Especially in a field like derm. Just my advice.

-R
 

reno911

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I'm pretty clear in my previous post. A chance of matching at 1/40,000 does not mean that you need 40,000 residents. I agree that if this is how you try to understand this number, then it truly does sound absurd. This shows that you are not understanding the idea of a weighted average. Like I said in my previous post, while one applicant may have 1/40,000, others will have a much higher chance (like say 1/5 or even higher).

I understood you fine, you're just wrong. The problem is that for any program there are probably not *any* prospective applicants (and certainly not a significant number) who have as low a chance as 1/40,000.

There's no way "regional bias" can take an average applicant and turn their chances in to 1/40,000. And it certainly can't for a significant number of people, which is why the vast majority should apply everywhere. The only way someone's chances are that low if they are a completely hopless applicant and shouldn't be applying for dermatology in the first place. But obviously we're not talking about that type of applicant. We're talking about the vast majority of applicants.

The patent absurdity of your claim is clear when you consider the fact that you're actually suggesting that programs would actually invite someone for an interview when they have a 0.25% chance of matching.

If you don't see the problem with your thinking I can't help you.
 

dermathalon

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The patent absurdity of your claim is clear when you consider the fact that you're actually suggesting that programs would actually invite someone for an interview when they have a 0.25% chance of matching.

If you don't see the problem with your thinking I can't help you.
Actually, those are your words and not mine. Please don't suggest otherwise.

The truth is that your estimate and my estimate are both incorrect because we have way oversimplified the process. And now you are hanging your hat on these estimated statistics (both yours and mine) as if they are fact. They are estimates that will have orders of differences with all of the other subjective factors involved. Despite your attempted disclaimers, the fact that courtesy interviews are given is proof that programs will invite someone for an interview that has a very low chance of matching...very close to zero in some cases. The programs also don't actively think "oh look here's someone that will have a 0.25% chance of matching, why don't we give this person an interview." No one would know these chances until after the fact. You can't perform an after-the-fact analysis and claim it to be prospective.

Although you started of with numbers to make your post seem impressive on the surface, you've repeatedly made mistakes in your statistics. You claimed "double counting" when you didn't understand the need for step by step probability, you erroneously referred to how to interpret the 1/40,000 by claiming that you needed 40,000 residents (sorry, but it's very clear that you didn't understand from your first post where you address this), and now you make other mistakes such as a post-hoc analysis that you try to use prospectively. You haven't even addressed the law of diminishing returns. You cling so fervently to the numbers and keep talking about the "patent absurdity" repeatedly of the same ESTIMATED statistic over and over again. You might be quite surprised of the statistics in the real world around you for anything that require several coordinated steps. My statistic is not absurd because it represents 1)an overall combined probability through two steps in the applications process and, more importantly, 2) part of the spectrum among all the applicants to a program and I have maintained this form the beginning. You are still missing these points.

To the OP, you should go to every darn interview you can get to and if this means you need to miss a few dinners, then do it. An interview not attended is a guaranteed "no match" to that program. I know that some of us took cross-country red eyes, just to land and barely make it to the next interview. Regardless of how many applications you submit, go to every interview and don't think twice about it unless you have to decide between two interviews on the same day. It may be worth asking if a program has a waiting list for an alternative date. In very rare cases a program can switch you to another date (very rare and happened to me once) but don't bet on this. My case was just a lucky unique situation where the program had just opened up an extra interview slot for the other date.

Unfortunately, some of you will be left with situations where you have to cancel as I also had to do...good luck!
 
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RadOncDoc21

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If you don't go to an interview just let me know so I can go in your place...:D... Don't let the name full you, I know a good opportunity when I see one.

My last 2 cents.

-R
 

Long Dong

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Dude! The watch is hot! However, I thought you were going to get this...

LOL, nah dog i can't mess with cars over 100K. Nothing screams small penis more then super expensive cars. I'm already tryin to fight that with the asian sterotype.
 

scumbagderm

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Take it from me and go on as many as you can.

I matched at #17 of 18 and am very happy now. Some of my interview offers had to be turned down due to scheduling conflicts but I went to each and every one that I was able to, regardless of cost. Had I been stupid and not gone on a few of those interviews then where would I be now? Probably on a 30 hour call on some medicine ward, eek! I know that spending loads of money can be stressful and may not feel "worth it" but trust me, it is!! Dermatology is awesome and worth every penny...and I'm just a resident, who hasn't seen most of the perks of derm yet. It truly is a fun and rewarding specialty.

And this sort of thing does not happen to only "cardboard box personality" people. You may be ranked quite high on a list but they just don't fall that far down. Any number of slip ups can occur because the derm match is largely a crap shoot.

I wish u all the best of luck but I advise you to not turn down interviews unless scheduling conflicts make it impossible for you to attend. Even if you can't make an interview dinner but can still make the interview, go for it!
 
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Iwy Em Hotep

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Some of these numbers are crazy.

There are ~100 programs in the US and ~300 positions every year. There also roughly ~600 applicants who rank at least one position in the match. These numbers are approximations from the NRMP data.

Most programs interview about 10 applicants per position (close enough from my experience) so on average, each program will interview 30 people.

With absolutely no biases, if you apply to any given program, your chance of being granted an interview is 30/600, or 1/20. Similarly, your chance of matching once granted an interview is 1/10.

In short, for any one program you apply to, you have a 1/200 chance of matching at that program, or 0.5%.
 

reno911

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Actually, those are your words and not mine. Please don't suggest otherwise.
They actually are your words, so I will suggest exactly that. Perhaps you didn't realize what you were saying. But, once again, I can't help you with that.

Here's a reminder in case you forgot:

So we're at 1/10x2/5x1/4 = 1/100 to just get an interview. then you go through the whole elimination process again so you have another 1/10x2/5x1/4...except that schools talk to their preferred applicants at the time of ranking...if done right this is also within the rules of the NRMP as long as they do not solicit. You have to account for this and I think that it is another factor of 4 (likely an underestimate) because it makes it that much harder to proceed down the rank list beyond the preferred candidates. So for the interview/ranking phase it is 1/10x2/5x1/4x1/4 which works out to 1/400.
So you have said AFTER this hypothetical candidate gets an interview they are 1/400 to match. That's what you said. No one gets invited if their chance to match is that low. Which is why your estimate is absurd.

I also found this part particularly amusing:

No one would know these chances until after the fact. You can't perform an after-the-fact analysis and claim it to be prospective.
No one would do that except for you. You do exactly that when you say it would have been a waste for you to have applied to more programs. You can only say this because you matched. Before you know whether you are going to match or not, applying to more programs would have been the smart thing to do. But of course with the benefit of hindsight, you suggest that it would have been a waste.


Finally, I just need to clear you up on a couple of things.

1. You're double counting. But I'm giving up explaining why to you. You're not going to get it.

2. I did understand what you were saying. I never said what you keep claiming that I said:

you erroneously referred to how to interpret the 1/40,000 by claiming that you needed 40,000 residents
I never said you needed 40,000 residents. According to your "analysis", the chance is 1/40,000 whether you are considering a group of 10 residents over a short period of time or 1 million residents over a period of many years (we would obviously have to be far in the future to be able to do this). Let's look at what I actually said.

First, the idea that there exists a significant population of applicant that have a 1/40,000 chance of matching at a given program (even with a regional bias) is just ridiculous on face. I guarantee if you look at every single derm program (even those with a strong regional bias), they will have in their history someone who wasn't in their region that had no connection. They simply had something on their application that attracted someone's attention and cause them to match. And no derm program has ever had anywhere near 40,000 residents, so it is very unlikely that the chance is 1/40,000.
I'm going to break down the bold sentences for you, because it was clearly too difficult for you to comprehend.

--Every program has, in its history, had a certain number of residents that matched that were non-regional applicants without connections. Let's call that number X.

--Every program has, in its history had a certain number of total residents. Let's call that number Y. We know that Y is far less than 40,000

--Therefore the observed rate of a non-regional applicant with no connections matching is X/Y.

--We know that X is at least equal to 1 ("they will have in their history someone who wasn't in their region that had no connection") and Y is less than 40,000 ("no program has had anywhere near 40,000 residents"). Therefore the observed rate, X/Y, is greater than 1/40,000.

--However it is possible that the observed rate is not the same as the actual rate because of variance related to small sample size, which is why I was careful to say, "so it is very unlikely that the chance is 1/40,000."

3. Your constant suggestion that we have no way of knowing what's right because "they're just estimates" is a cop out. There are reasonable estimates and unreasonable ones. Using the available information and deductive reasoning, you can judge the validity of an estimate. Your estimates, I'm afraid, are terrible for the reasons stated.
 
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N-Surge

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That is assuming all 600 apply to each program. This probably doesn't happen. In other words, apply to all to increase your odds, even if so slight.
 

reno911

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Some of these numbers are crazy.

There are ~100 programs in the US and ~300 positions every year. There also roughly ~600 applicants who rank at least one position in the match. These numbers are approximations from the NRMP data.

Most programs interview about 10 applicants per position (close enough from my experience) so on average, each program will interview 30 people.

With absolutely no biases, if you apply to any given program, your chance of being granted an interview is 30/600, or 1/20. Similarly, your chance of matching once granted an interview is 1/10.

In short, for any one program you apply to, you have a 1/200 chance of matching at that program, or 0.5%.
All of the above is completely reasonable, and I agree that's it's probably close. But dermathalon would have you believe that a significant number of applicants can predict a bias so strong that it will take that 1/200 and turn it into 1/40,000.
 

dermathalon

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All of the above is completely reasonable, and I agree that's it's probably close. But dermathalon would have you believe that a significant number of applicants can predict a bias so strong that it will take that 1/200 and turn it into 1/40,000.
This is a long one...skip it if you don't want to read...I apologize to the general reader:

Ok, now this is actually become amusing to me as well. I never said that a "significant" number of applicants would undergo the bias that I quoted. In fact, my estimate of 1/40,000 was for a totally unfortunate applicant...so that I could paint a worst-case scenario for you to show you one end of the spectrum.

My matching is inconsequential because I made these decisions before I applied. That's not pure luck, it's through the help of several very smart mentors who been in the field and on admissions committees for a long, long time...some likely longer than you. So I did my homework and did not happen into these viewpoints as hindsight. In the same vein, stack the cards in your favor and your chances of matching will be very high. Yes, there is always a chance that you might not match, but for SOME applicants the law of diminishing returns is a very real thing and adding one more application to a particular school will be marginally, if not insignificantly, helpful.

This whole process involves bias in addition to the important objective factors. You cannot make the whole process into a unbiased statistical analysis. It doesn't make sense. I'll give you an real-life example that will trump any theoretical statistics (and this is from people that are well connected in the admissions committee fields so I'm not making this up, and I personally know of several that do this):

Some schools will set a Step 1 cut-off prior to even LOOKING seriously at your application unless you have stellar research publications to convince them otherwise. If you do not have impressive research (ie. MD/PhD or MD who has published first author original research) on your CV and your Step 1 is less than the cut off, you are out. You chance of a match is ZERO in this case. For some schools, it's just too hard without a first pass filter to narrow down towards who they are going to interview. Wouldn't you focus on writing personalized personal statements to the other programs instead of wasting an application when you didn't have a chance of matching anyway. And no, this is not hindsight if you were privy to this information ahead of time. This is something that only a mentor might be able to tell you. And, this is ONE example so please don't jump on the generalization train again stating that "dermathalon states that everyone should find the cutoffs for every school." Another example is that some schools stick to the AOA cut-off pretty rigidly except for internal candidates and for well-published applicants...again another situation where the odds are severely stacked against you if you apply here and don't meet the criteria. There are many factors that are different examples and I'm not going to go into each one because that would be too detailed for this post. There is a reason that people say that your best chance of matching is at your home institution...the probabilities severely change with the subjective factors.

I went through several iterations like this with my mentors and eliminated several programs off my list and focused well on the remaining ones. In the end I still applied to many, many programs but not all. Instead I focused on stacking the cards in my favor with the remaining programs. That said, the right decision for some is to apply to all programs (and not this is not a contradiction to what I said earlier). And more importantly, you should attend every interview possible after you have committed with your applications.

In the end, Reno, I engaged you in this thread because I found your words to be quite arrogant with your post that it is "simply stupid" if the "vast majority" of applicants are not applying everywhere (and also, I disagreed with you). You can't just max out credit cards as you have suggested in other threads...what if you don't match? This is a very real possibility, even if you apply to all programs. Are you going to help their credit recover? Are you going to take care of their bank payments?

I think it's important to give advice but my pet peeve is when you insult others for not taking yours. Neither you or I will be able to determine right or wrong and if this feels like a "cop out," I'm sorry that you feel that way.
 

reno911

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1. With regard to this part:

Ok, now this is actually become amusing to me as well. I never said that a "significant" number of applicants would undergo the bias that I quoted. In fact, my estimate of 1/40,000 was for a totally unfortunate applicant...so that I could paint a worst-case scenario for you to show you one end of the spectrum
The case of the "totally unfortunate" applicant is irrelevant. What I was talking about was the vast majority of applicants (the vast majority of applicants are not "totally unfortunate"). Once again, refer to my prior posts if you have forgotten. If you are suggesting that what I am saying is false, then you are by definition saying that there have to be a significant number of applicants to which your calculation applies and therefore a significant number of applicants that should not apply everywhere.

If there are only a few, hopeless applicants for which this applies, then my advice (i.e., the vast majority should apply everywhere) still applies.

2. Obviously some schools stick to certain cut-offs, etc. But there is no way that anyone outside the program knows exactly what they all are, how they may change, and what exceptions may be possibly made. Any of your mentors who claimed to know this with enough certainty to discourage you from applying from programs likely gave you bad advice.

Every year on the this board, or just talking to applicants, you will find several applicants who get interviews and match at places that made absolutely no sense based on supposedly known biases. It happens frequently enough that one should definitely take a shot, even if the chance is low (of course it's rarely as low as 1/40,000)

3. With regard to this part:

You can't just max out credit cards as you have suggested in other threads...what if you don't match? This is a very real possibility, even if you apply to all programs. Are you going to help their credit recover? Are you going to take care of their bank payments?
It's just a simple case of risk/benefit analysis. Obviously sometimes things won't work out. But the reward absolutely justifies the risk. Besides we're not talking about a ton of cash here. If we're agreed that you should go to every interview possible, our only disagreement is the fees for the extra applications. I think at most we're talking about a difference of $5000 in application fees. One can easily get a loan for this amount with a monthly payment of around $100 a month. Now I realize that this is not insignificant for a med student or resident, but once again, the cost certainly justifies the benefit.

Also, I hope that no one took the suggestion to max out credit cards literally. There are plenty of better ways for presumptive physicians to secure more than enough credit to pay for this stuff at very low interest rates, that maxing out credit cards should be unnecessary. Of course, even if you had to max out your credit cards, it would still be the right thing to do.

4. Finally, with regard to your whole diminishing marginal returns argument. I guess you didn't realize that my analysis was of the marginal case. If you go back and reread my earlier post, you'll see that I'm talking about the cost of applying to one extra program (I assumed that was obvious, but apparently it wasn't). The entire analysis here is about adding an extra program. However, when you do the math, you will see that adding one extra program after that doesn't change things enough to make it a bad decision. There is a diminshment (obviously) but it doesn't change the risk/benefit calculation enough that one shouldn't apply to an apparently longshot program. If you repeat this marginal analysis, you end up concluding that the vast majority of people should apply everywhere.
 
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dermathalon

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Well, I feel for most applicants, the diminishing returns are significant at some point where the risk is not changed significantly by not applying to all the programs. Also, my mentors never discouraged from an application but we discussed risk/benefits and that's what led me to my final application strategy, which worked out very well. And programs do talk to each other.

As I had mentioned before, the majority of my friends that matched did not apply to all the programs and many of them had double digit interviews and matched. They did their own risk/benefit analysis and then went forward. However, I know of a few that didn't match and many of them did apply to all the programs (and one severely restricted their applications to only 20, which is really stacking the odds against success). In any case, there will be people that apply to all programs and don't match and will feel pretty upset about that too.

I will agree that both of us are talking about a simple case of risk/benefit at the end of the day. And I agree that we both feel the same way about attending interviews. We clearly have different perspectives on how to approach the application phase that's been aired out here to the Nth degree...people can decide for themselves. I think it's reasonable for most people to decide not to apply to all the programs but clearly you feel that the reasonable thing for most applicants is to apply to all programs.


You think I'm incorrect, and I think that you are incorrect...at least we've said everything and beat our heads together.

I'm ready to bury this hatchet.
 
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N-Surge

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Best thread in a long time! There's like 3 to 4 conversations going on. I highly encourage this, every so often. Gives us a great outlet. :)
 

opencomedo

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I agree, this thread has been quite interesting and fragmented, I'm gonna try to weigh in on a couple of different conversations:

1. I don't do statistics if I can't help it but I kinda feel the cost of applying to more programs is much less than the amount that medical school cost (for me almost 200K), so if that couple of extra thousand might increase your chances by even a couple of percentage points I sorta feel like it would be worth it in the long run.

2. I know several people who fell to the absolute bottom of their rank lists, one of whom interviewed at over 20 places and matched next-to-last on their rank list. Remember, all of the stats about "number needed to match" dont reflect the fact that you might match, but not in your top 5, 10, 15 (In other words, you dont know how many of those with lots of interviews wouldnt have matched if they had selectively applied and didnt get that one extra interview).

3. It is true that many programs choose to be regional or have selection criteria that may exclude you which would make your application worthless but bear in mind there is no way of knowing this and a lot of what you hear through the grapevine is completely unfounded, so you may actually get an interview somewhere that "doesnt interview people from the northeast" or "board scores under 250" or "blond hair and blue eyes"

4. I like where LD's head is... but....



and BMW >> M-B
 

Long Dong

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4. I like where LD's head is... but....



and BMW >> M-B
Yeah I was between the GMT and the Deep Sea, the deep sea in black was 10 grand maybe as my second rolex after my initial 2 year contract expires and the offer me a resigning bonus/partnership deal.

I also believe BMW>MB but the MB will do until this below comes out in the next few years in convertable.

 

N-Surge

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LD will be needing this Rolex for his new technique, DST, aka Deep Sea Therapy. :)

Will need this as well.