Was general surgery as competitive as ortho or ENT this year?

[Masonator]

General Surgery seemed very competitive this year. There were as many people who didn't match in Gen Surg as there were in ortho in my class. Do you think that Gen Surg has gotten as bad as ortho or ENT? I am asking simply to see what people thought based on their own experiences. I'm not asserting that one specialty is better then another.

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[dr.evil]

Definitely a tough question. I'm still assuming that board scores and grades are, on the average, higher for applicants to ENT/Ortho than General Surgery. This is of course partly do to the fact that there are so many more spots in GS but also do to the perception over the last few years that GS has become less competitive. This brings students who previously felt that they weren't competitive enough to do GS to now apply.

The problem was that, at least at our institution, the applicant pool as a whole had very strong numbers and looked good on paper therefore those who applied with less than stellar numbers may have gone unmatched. I know our medical school had at least 3 students go unmatched in GS. So it must be getting tougher.

One of our attendings laughed at the increased numbers of applicants. He says it's absolutely attributable to the 80 hour work week. His quote: "Everyone wants to be a surgeon. In the past though, people didn't want to spend that much time or energy to become one. Now they can do it in 5 years with only 80 hours per week."

Although this is somewhat conceited, I see his point. I know many people who loved the thought of surgery in medical school but hated the life in residency. Those people are now applying.

 

[apma77]

general surgery never has and never will be as competitive as the subs...lesss money and alot worse lifestyle

 

[hemoccult]

On the whole, regardless of specialty choice, the better/best programs in any specialty will always be competitive. That being said...at one interview I attended (...I honestly can't remember for the life of me where...), the chair mentioned the fact that the application numbers were indeed increased, however the quality of these applicants was not markedly increased.

After having said that though...I met a lot of bright folks along the interview trail. Sure, I applied to academic programs and maybe the quality at Wash U, UofWash, Pittsburgh, and some of the other more noted programs was different than that of a community program, but I thought there were some outstanding applicants out there.

As other posts have mentioned, ENT, Ortho, Radiology, Anesthesia, and the "lifestyle" specialties will often attract some of the "brighter" applicants as they feel that they have worked very hard for their great "reward" and oftentimes rightfully so. This is by no means to take away from their accomplishments.

In the end, it almost doesn't matter what folks say about how competitive a certain field is. I know folks who matched into ortho programs at academic institutions that have sub-mean board scores and were not the "best and brightest." Why did they match? Probably because ortho was exactly what they wanted to do and they were determined to find a spot. Sure they aren't going to top ten programs, but hey, in the end, they are going to be orthopaedic surgeons!

Don't let the comments of others telling you how difficult or competitive a specialty is discourage you. If you network like a crazy man, work like a dog, have a likeable and normal personality, along with some basic competence, you can match to almost any specialty you want. Granted some might be near impossible, but never completely out of the quesiton.

 

[NE_Cornhusker1]

Originally posted by dr.evil
One of our attendings laughed at the increased numbers of applicants. He says it's absolutely attributable to the 80 hour work week. His quote: "Everyone wants to be a surgeon. In the past though, people didn't want to spend that much time or energy to become one. Now they can do it in 5 years with only 80 hours per week."

Although this is somewhat conceited, I see his point. I know many people who loved the thought of surgery in medical school but hated the life in residency. Those people are now applying.

with that thought in mind do any of the current residents/pd's/attendings around here expect general surgery to be extended another year [or two]? what is a 'normal' week like now for a gen. surg. resident [please pardon my lack of knowledge-i'm just a lowly emt hoping to get into the class of 2005 (and i'm real interested in gs or ortho)].

 

[Masonator]

I guess I have a skewed view as all the gen surg programs I applied to were very competitive academic programs in California and New York. I feel like in that subset of programs, you needed ortho or ent stats to match. Gen Surg is definitely not "wide open" like I was told. However the match worked out for me and I am very thankful I matched where I did.

I thought is was interesting that someone said that money and lifestyle is the only thing making specialties competitive. I could see how one could infer that based on the current popular specialties. That doesn't explain the resurgent interest in gen surg though.

 

[Masonator]

Originally posted by NE_Cornhusker1
with that thought in mind do any of the current residents/pd's/attendings around here expect general surgery to be extended another year [or two]? what is a 'normal' week like now for a gen. surg. resident [please pardon my lack of knowledge-i'm just a lowly emt hoping to get into the class of 2005 (and i'm real interested in gs or ortho)].

You could start a whole thread with the day in the life of a resident question. Here is a rough idea in a nutshell

1: Floor work, hernias, lumps & bumps, abcesses

2: SICU, SICU, SICU and Gen Surg consults galore. Welcome to rough calls. Perhaps some more advanced lap cases.

3: More operative responsibility in bigger cases, exposure as a senior in some surgical specialties(depends on the program)

4: senior operative experience in specialties and chief responsibilities(leading a team) at away sites

5: Chief year, your pick of the cases, big whacks and only hardcore general surgery cases, minimal specialty exposure. You will supervise all of your teams and coordinate many patient, clinic and administrative responsibilities.

 

[RedBlanket]

Personal opinion is that g.surg competitiveness is way up, but still not up to ortho or the subs. Out of 15 applicants for g.surg from my school, 6 didn't match in a categorical spot. Ortho, OTOH matched 9 out of 11. The applicant pool was slightly suspect, but there were a few that I knew were solid candidates who fell through the cracks. I have heard rumors from other reputable, solid academic medical schools (including a top-10 school which will go unnamed) with significant numbers of unmatched g.surg applicants (4 unmatched from the big name school).

I would not want to be applying next year... Clearly it is becoming more competitive and there will apparently be a significant # of applicant who are re-applying after a year off or from a prelim spot. Rumor had it that all the prelim surg spots disappeared within the 1st hour of scramble, I would assume largely from unmatched g.surg applicants.

Going over the NRMP data, the most significant predictor of "competitiveness" seems to be % of US students matched.

Let's compare:
Anesthesia: 73/68
Derm: 97/79
EM: 78/83
GS: 85
Ortho: 93
Plastics: 94
Radiology: 96/81

(two #'s indicate programs with PGY1/PGY2 slots with significant numbers of each)

The derm PGY2 number suprises me, as does Radiology PGY2 (slightly, I'd have guessed 85-90). Other than that, I think that about covers my preconception of "competitiveness". I don't have the SF stats handy, but I'd be willing to bet the surgical subs all have >90% US student match.

If you track g.surg numbers over the last three years, you'll see: 85->79->75->83->85

We have now cycled back to the level of g.surg in 2000. I would suspect that the numbers will continue to climb.

Just some observations, not trying to say US students are "better", just that this statistic seems to be a reasonable marker of "prestige".

 

[droliver]

Originally posted by dr.evil
One of our attendings laughed at the increased numbers of applicants. He says it's absolutely attributable to the 80 hour work week. His quote: "Everyone wants to be a surgeon. In the past though, people didn't want to spend that much time or energy to become one. Now they can do it in 5 years with only 80 hours per week."

I agree 100% with these observations. I finished prior to the adoption this past July, but we'd been working on the changes for about 2 years prior to get into compliance by then. You have to draw a straight line connection b/w the new rules & the increased applications, nothing else has changed much. When they first proposed these changes I was pretty skeptical, but if that's what it takes to keep the next generation interested, then I'm all for it. Unfortunately I think it is introducing a different work ethic in future generations who view medicine as a job rather then a profession.

 

[Masonator]

Red Blanket, I checked out the 2004 stats looking at % US filled.
GS is around 85%. Neurosurg is around 85% Neurosurg didn't fill. ENT is around 85% with US grads and ENT didn't fill. PGY2 positions for urology was 85% US grads as well.

There were more unfilled spots in ENT and neurosurg then there were in GS. I know it is hard to adjust these percentages based on number applying, etc. But it looks like gen surg may have been as bad as ENT or Neuro. What is hard to know is a side by side comparison of the applicant pools.

Definitely GS was not as competitive as urology though. I was disgusted by how good urology candidates are.

 

[RedBlanket]

Originally posted by Masonator
Red Blanket, I checked out the 2004 stats looking at % US filled.
GS is around 85%. Neurosurg is around 85% Neurosurg didn't fill. ENT is around 85% with US grads and ENT didn't fill. PGY2 positions for urology was 85% US grads as well.

There were more unfilled spots in ENT and neurosurg then there were in GS. I know it is hard to adjust these percentages based on number applying, etc. But it looks like gen surg may have been as bad as ENT or Neuro. What is hard to know is a side by side comparison of the applicant pools.

Definitely GS was not as competitive as urology though. I was disgusted by how good urology candidates are.

Are you looking at the SF match stats? It seems like you're getting these specialties' numbers off of the NRMP table. Remember that very few ENT/NS/Urology programs participate in NRMP. The mainstream uses the SF match, which does not have these statistics on its web site.

 

[Masonator]

My bad, I was using NRMP. I thought they compiled the SF match statistics. I guess not. Do the low tier ENT and neurosurg programs use the NRMP rather then the SF match?

 

[Leforte]

There were no unfilled positions in this years ENT SFMatch.

My understanding is that the NRMP ENT positions are for people who have matched via SFMatch, then submit for their requisite PGY1 year. Some do this via NRMP ENT, some via NRMP Prelim Surgery and some neither as it is a position outside the match with nothing else required (as in the case where I matched).

Those programs that do offer their PGY1 positions through the NRMP match have the applicants rank the position #1 with no other programs listed. I assume that the unfilled NRMP positions may be due to lack of communication between programs and early-matched MSIVs.

 

[BOTB]

the best way to judge "competetiveness" is # of applicants vs # of positions available, and average USMLE for matched(since its the only score we all have in common).

surgical subspecialties usually fill every year, and if there is a spot or two open - they are scrambled into just as quickly

gen surg categorical fills just about every year, with a few spots open - not too much different.

the difference comes in average test score, and the percent of applicants that did not match in the desired field. I beleive that these both tend to be higher in subspecialties than general surg categorical.

and yes some gen surg categorical is very competetive, but we are talking about fields in general.

 

[aboo-ali-sina]

Originally posted by BOTB
the best way to judge "competetiveness" is # of applicants vs # of positions available, and average USMLE for matched(since its the only score we all have in common).

surgical subspecialties usually fill every year, and if there is a spot or two open - they are scrambled into just as quickly

gen surg categorical fills just about every year, with a few spots open - not too much different.

the difference comes in average test score, and the percent of applicants that did not match in the desired field. I beleive that these both tend to be higher in subspecialties than general surg categorical.

and yes some gen surg categorical is very competetive, but we are talking about fields in general.

while this is a good proxy for competitiveness, there is still a downfall. There are many many more GS programs than any of the subs. And while most sub spec. surgical training programs are at academic or large community centers, many small hospitals have GS programs. So the vanrience of applicants' qualifications is very large. You would need to do a matched comparision. Compare the GS applicants with Sub. Spec. applicants only at programs that had both GS and Sub. Spec. but even still that would not be a fair comparison

 

[kojack]

Here are the stats for ENT from sfmatch. Notice the match rate was 76% for US seniors.

Rank Lists: 359
Matched: 256
US Seniors: 241 (76%)
US Grads: 6 (43%)
IMGs: 9 (33%)

No unfilled spots

Avg USMLE matched : 237
Avg USMLE unmatched : 222
AOA matched: 35%

 

[Masonator]

Thanks for the SF info, how did you get it? How did you get the AOA in Step 1 scores? You wouldn't happen to have these stats for general surgery would you?

 

[ortho2003]

Originally posted by RedBlanket
Going over the NRMP data, the most significant predictor of "competitiveness" seems to be % of US students matched.

Let's compare:
Anesthesia: 73/68
Derm: 97/79
EM: 78/83
GS: 85
Ortho: 93
Plastics: 94
Radiology: 96/81

These numbers are not a predictor of competetiveness. These numbers show the percent of all students applying to that specialty who matched in some specialty, not a particular specialty. For example, there are aproximately 550 ortho spots available with nearly 1100 candidates that apply to at least one ortho program. Of those 1100 candidates, only 550 match ortho, but 93% match in some specialty. Whether that specialty is another sub, GS, or a pre-lim is not known. Plastics is the same story...almost half the candidates that apply for at least one plastics program, do not matchplastics. They end up matching in a back-up specialty though, whith is why you see the 94% The 6% of plastics unmatched and the 7 % of ortho unmatched are those that only applied plastics or ortho and didn't match.

 

[Pilot Doc]

Ortho2003,

You are misinterpreting the stats. The percentages given are the % of spots taken by US Seniors. For example, of the roughly 1000 GS spots, 850 were taken by US seniors (or maybe US grads, I'm not sure.) The stats posted give no information about how many people did not match.

 

[mpp]

Here are the 2004 neurosurg numbers from sfmatch if anyone is interested:

Registration 363
CAS Participants 311
Rank Lists 282
Ranked 237
Matched 149
US Seniors 140
US Grads 3
IMGs 6
Unmatched 97

Positions Offered 153
Positions Filled 149
Left 4

USMLE Matched 235
USMLE Unmatched 213

AOA 19%
PhD 10%

Avg Apps 35
Avg Interviews 9.7
Avg Offers 4.0

Pct Matching 53%
US Seniors 79%
US Grads 25%
IMGs 11%

Although it should be noted that these numbers don't quite add up. If there were 282 rank lists submitted and 149 matched, there should be 133 unmatched, not 97. Or if there were 237 people ranked and 149 matched, there should be 88 unmatched, not 97.

The unmatched+matched is 246...don't quite understand those numbers, but that's what they released.

 

[maxheadroom]

For example, there are aproximately 550 ortho spots available with nearly 1100 candidates that apply to at least one ortho program. Of those 1100 candidates, only 550 match ortho, but 93% match in some specialty. Whether that specialty is another sub, GS, or a pre-lim is not known. Plastics is the same story...almost half the candidates that apply for at least one plastics program, do not matchplastics. They end up matching in a back-up specialty though, whith is why you see the 94% The 6% of plastics unmatched and the 7 % of ortho unmatched are those that only applied plastics or ortho and didn't match.

I think the statistic actually reflects the percentage of the positions filled that went to US seniors. For example, 2 of the 78 PRS positions this year went to FMGs (very, very highly qualified FMGs who have spent lots of time in the US, usually at the programs where they matched). Thus, the 6% reflected in the stats.

 

[Who'sYourDaddy]

73 u.s. seniors into 78 plastics spots = 93.5% U.S. senior fill rate.
there were 77 spots filled total. 1 unmatched spot, which wasn't really unmatched because the program didn't fill their spot on purpose. therefore, the plastics match went 100% filled, 73/77 (94.8%) U.S. seniors, and 4/77 (5.1%) not U.S. seniors. Those 2 FMGs you refer to may not be accurate. rumor has it that one of those 2 went to harvard. the other was a student from puerto rico who is a U.S. medical student, not an FMG. therefore, there is only 1 fmg accounted for. where are the other 3 non-U.S. seniors from? are they FMGs? i think i heard that one of them is a student who graduated from Kentucky last year and matched back at kentucky. he would be a U.S. graduate, not U.S. senior, and would count towards that group of 4 non U.S. seniors. so now we have 2 of the 4 accounted for, the harvard FMG, and the kentucky u.s. graduate. where are the other two from??