Was it harder to match what you wanted in 2021? A closer look at the NRMP results.

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Lucca said:
why not? It's nothing more complicated than a series of linear equations and the NRMP is literally sitting on a treasure trove of data perfect for populating them. I would bet several hundred dollars that all of the factors people think of as "big" will not really shift the number of apps needed by very much, especially after a few cycles of working the algorithm and the only things that will really matter are 1) degree type, 2) failed board attempt, 3) academic LOA/repeat.

It's simple if we can all decide that our goal is to have the number of apps per applicant be as small as possible, and have caps be equitable across applicant type and specialty. The alternative, which is *now*, is obviously already super inequitable across these dimensions. Although rarely admitted on this site, it is 100% the case that students from more prestigious med schools for example can get away with applying to far, far fewer residencies compared to an average applicant in their specialty of choice for all but the hyper competitive specialties. this is precisely because, as you have already stated, increasing the app burden / interview slot leads to increasingly arbitrary decision making, i.e. using meaningless differentiators like school prestige or step 1 score.
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The interactive charting outcomes page does already show good data for pretty much every factor - degree type, step 1 and 2, research experiences and publications, work, volunteering, other grad degrees, AOA. "Here's your allotted number of applications, based on your factors, for a 97% or greater rate of matching"

Could work without disadvantaging one group for the sake of another
 
Dr.Cut.em.up said:
I'm hoping this doesn't happen to me, but I am prepared for this. In all honesty, I am just hoping to match given the circumstances
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Yeah I know he wasn't picky but he really loved ortho (typical type of "bro" MD you'd expect given their stereotype).

He ended up closer to where he grew up which is one of the major cities but far from where his family lives now.

It is odd though because I know someone who had below average ortho board scores as a DO student but networked super hard and did a ton of extra rotations at one particular program they really liked. Ended up matching at a program that's considered "average" but in their ideal location.
 
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After reading all of this the questions I’d like to ask are: is this just that applicants are better? Is everything just more competitive? Have expectations changed from students that they should be able to do something more competitive than in the past?

I guess I’m asking because anecdotally the Med students I see genuinely seem to work harder and know more than I and my friends did at a similar time. You can definitely look at the generation before me and they wouldn’t have had a snowballs chance in hell of perhaps even getting into medicine compared to kids now.

Does that have anything to do with any of this? Granted back the there was just less. Less applicant, less financial support to let people break into medicine, less diversity, less schools, less residencies.
 
Lem0nz said:
After reading all of this the questions I’d like to ask are: is this just that applicants are better? Is everything just more competitive? Have expectations changed from students that they should be able to do something more competitive than in the past?

I guess I’m asking because anecdotally the Med students I see genuinely seem to work harder and know more than I and my friends did at a similar time. You can definitely look at the generation before me and they wouldn’t have had a snowballs chance in hell of perhaps even getting into medicine compared to kids now.

Does that have anything to do with any of this? Granted back the there was just less. Less applicant, less financial support to let people break into medicine, less diversity, less schools, less residencies.
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This is interesting because a lot of attendings were saying the students today are crap who don't know basic clinical skills and were significantly worse than students few years ago
 
Lawpy said:
This is interesting because a lot of attendings were saying the students today are crap who don't know basic clinical skills and were significantly worse than students few years ago
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Well clinical skills yes but that’s a different set of pressures and a different liability world.

No, I’m asking about medical knowledge, research acumen, etc.
 
Lem0nz said:
Well clinical skills yes but that’s a different set of pressures and a different liability world.

No, I’m asking about medical knowledge, research acumen, etc.
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Oh. I'm not sure about that. I think we have an advantage with online boards prep materials and Anki premade decks that allow us to cram huge volumes of facts? But i feel that's a reversal of cause and effect because these board prep materials only happened as a consequence of Step 1 mania in past few years which occurred as consequence of overapplication fever.
 
Lem0nz said:
After reading all of this the questions I’d like to ask are: is this just that applicants are better? Is everything just more competitive? Have expectations changed from students that they should be able to do something more competitive than in the past?

I guess I’m asking because anecdotally the Med students I see genuinely seem to work harder and know more than I and my friends did at a similar time. You can definitely look at the generation before me and they wouldn’t have had a snowballs chance in hell of perhaps even getting into medicine compared to kids now.

Does that have anything to do with any of this? Granted back the there was just less. Less applicant, less financial support to let people break into medicine, less diversity, less schools, less residencies.
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There's been an arms race across all sorts of competitive admissions, from "top" colleges to med schools to competitive residencies. More and more ECs every year, higher median scores, higher median grades. Research is the biggest offender for med students. In the 2000s for matching something like neurosurgery, people had ~5 research entries, now that's closer to 20. Similar story for different metrics for each step - higher SAT score IQRs for colleges, more clinical exposure and volunteer hours for premeds, etc.
 
Lem0nz said:
After reading all of this the questions I’d like to ask are: is this just that applicants are better? Is everything just more competitive? Have expectations changed from students that they should be able to do something more competitive than in the past?

I guess I’m asking because anecdotally the Med students I see genuinely seem to work harder and know more than I and my friends did at a similar time. You can definitely look at the generation before me and they wouldn’t have had a snowballs chance in hell of perhaps even getting into medicine compared to kids now.

Does that have anything to do with any of this? Granted back the there was just less. Less applicant, less financial support to let people break into medicine, less diversity, less schools, less residencies.
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This is what I was getting at. Is it the number of interviews lower than what would be expected for the increase in apps because things are more competitive now, or is it really just the increased number of apps driving decreased yield?
 
Matthew9Thirtyfive said:
This is what I was getting at. Is it the number of interviews lower than what would be expected for the increase in apps because things are more competitive now, or is it really just the increased number of apps driving decreased yield?
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Number of interviews is up, the yield is only down because of app volume. Similar to the step average drifting ever upwards or the research entries drifting ever upwards, theres no net gain for us. Same proportion of people are above median and below median. It just keeps taking more time and more effort to reach that median. Compared to the students of 20 years ago were multiple deviations above as a group
 
I don't know it just looks like med students now are on average significantly worse than med students few years ago because the clinical acumen is generally garbage. The point of med school isn't to regurgitate Anki facts and churn out crappy papers but overapplication made both of these necessary at the cost of severely degrading the value of med students
 
efle said:
Number of interviews is up, the yield is only down because of app volume. Similar to the step average drifting ever upwards or the research entries drifting ever upwards, theres no net gain for us. Same proportion of people are above median and below median. It just keeps taking more time and more effort to reach that median. Compared to the students of 20 years ago were multiple deviations above as a group
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Yeah that’s what it seems like.
 
Lawpy said:
I don't know it just looks like med students now are on average significantly worse than med students few years ago because the clinical acumen is generally garbage. The point of med school isn't to regurgitate Anki facts and churn out crappy papers but overapplication made both of these necessary at the cost of severely degrading the value of med students
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This isn’t true at all. Medical students are much better. The volume of knowledge has increased exponentially and Med students have *kept up*. You may look at it and see a bunch of average students but I look at it and am amazed because it’s way more than I had to do. And people 10, 20, 30 years older than me? They have trouble fathoming it.

It was easier to be amazing once upon a time because there was less you had to be amazing at. Substantially less.
 
Lem0nz said:
This isn’t true at all. Medical students are much better. The volume of knowledge has increased exponentially and Med students have *kept up*. You may look at it and see a bunch of average students but I look at it and am amazed because it’s way more than I had to do. And people 10, 20, 30 years older than me? They have trouble fathoming it.

It was easier to be amazing once upon a time because there was less you had to be amazing at. Substantially less.
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My cousin says the same thing. He graduated medical school like 10 years ago and says he is blown away with how much more there is to know.
 
Lem0nz said:
This isn’t true at all. Medical students are much better. The volume of knowledge has increased exponentially and Med students have *kept up*. You may look at it and see a bunch of average students but I look at it and am amazed because it’s way more than I had to do. And people 10, 20, 30 years older than me? They have trouble fathoming it.

It was easier to be amazing once upon a time because there was less you had to be amazing at. Substantially less.
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But the thing is, we're only able to keep up with the sheer volume because of things like Anki that helps to memorize countless amounts of facts, when these things didn't exist few decades ago. And we're spending hundreds of hours memorizing these facts at the expense of many other important things (like skipping classes, not paying attention to case based discussions in PBLs even though those things are important etc).

I don't know. I think we're better off not memorizing these things and instead learn firsthand from strict on the job training with blunt honest feedback from residents and attendings
 
Lawpy said:
But the thing is, we're only able to keep up with the sheer volume because of things like Anki that helps to memorize countless amounts of facts, when these things didn't exist few decades ago. And we're spending hundreds of hours memorizing these facts at the expense of many other important things (like skipping classes, not paying attention to case based discussions in PBLs even though those things are important etc).

I don't know. I think we're better off not memorizing these things and instead learn firsthand from strict on the job training with blunt honest feedback from residents and attendings
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If lectures were better and a more efficient way of learning, people wouldn’t be skipping them. Who cares if people are skipping lecture? And I have yet to experience people doing anki during clinical reasoning sessions. If people are, then either the sessions are poorly run or the student has their priorities mixed up.
 
Matthew9Thirtyfive said:
If lectures were better and a more efficient way of learning, people wouldn’t be skipping them. Who cares if people are skipping lecture? And I have yet to experience people doing anki during clinical reasoning sessions. If people are, then either the sessions are poorly run or the student has their priorities mixed up.
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Yea I could care less if you go to class too. Having a better way to learn is not upsetting at the slightest. That’s medical students one upping us and it’s kind of rad. You freaking crowd sourced your education and the product was better. It’s pretty cool.

If Elon, Gates, and Reddit find a way to download that **** straight straight into your brains I’ll take that student over the one who did 3,000,000 anki hours and won’t even be mad.
 
I dug up the old charting outcomes to compare how much research folks did then vs now. It's pretty nuts

research comparison.png
 
DrStephenStrange said:
A majority of research done in med school nowadays are just fluff though. It would be nice to compare the significance of research done now vs then as well.
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Not so sure it would be that different. Yes we have more meta analyses and database studies which... yea ok whatever. But back then case reports were still cool. That wouldn't fly today.
 
Lawpy said:
But the thing is, we're only able to keep up with the sheer volume because of things like Anki that helps to memorize countless amounts of facts, when these things didn't exist few decades ago. And we're spending hundreds of hours memorizing these facts at the expense of many other important things (like skipping classes, not paying attention to case based discussions in PBLs even though those things are important etc).

I don't know. I think we're better off not memorizing these things and instead learn firsthand from strict on the job training with blunt honest feedback from residents and attendings
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I disagree with this strongly. Anki is an amazing tool for clinical questions too, it's literally just harnessing the best way for the brain to remember. I utilized anki extensively in 3rd year, my sub-i, and I plan to continue it in residency. I have anki decks which cover entire operations, with all relevant anatomy, indications, complications, steps, tips, and instruments used. That way I can review that specific deck prior to the operation to brush up on it, but I also keep it in my general decks that I'm reviewing so that I don't need to fully relearn it all every time. The important thing is understanding how anki works/how your brain works/how to make cards.
 
FindersFee5 said:
I disagree with this strongly. Anki is an amazing tool for clinical questions too, it's literally just harnessing the best way for the brain to remember. I utilized anki extensively in 3rd year, my sub-i, and I plan to continue it in residency. I have anki decks which cover entire operations, with all relevant anatomy, indications, complications, steps, tips, and instruments used. That way I can review that specific deck prior to the operation to brush up on it, but I also keep it in my general decks that I'm reviewing so that I don't need to fully relearn it all every time. The important thing is understanding how anki works/how your brain works/how to make cards.
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Did you make your own cards or was it premade decks?
 
Doubt that knowing more info, even obscure first aid factoids, has contributed to a decline in medical student clinical acumen. It’s likely due to a decrease in quality of clinical rotations.

It’s also likely overblown. I’m sure their experiences were on average more valuable. But that doesn’t mean they were so much better than today’s students.

Even today, med students seem to think they’re doing well or even crushing every rotation when in reality, more of us are similar than different. The only ones that stand out are the terrible ones and that rare one that actually is so awesome that they’re more helpful than hindrance.

So imagine that typical med student with an inflated ego who just knows they’re great clinically despite probably just being like everyone else. When they become an attending, they’ll tell their students how much better they were on rotations, too.
 
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Angus Avagadro said:
Students will soon figure out that the cost of becoming a physician is prohibitive. I'm not sneezing at $145/hr, but it doesn't go as far as you think. My estate lawyer gets $300 an hour and is not at a high price law firm.
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If the doctor is getting paid $145/hr they’re probably bringing in $290+/hr. Overhead - rent, ancillary staff, malpractice, health insurance, etc - is roughly half of revenue for a typical clinic.
 
I don't think students are just churning out fluffier research than before, they're just dumping more hours into it. Most of my friends were hustling research on the side since MS1 and many of them are doing full research gap years. It's ridiculous, especially for fields like derm and plastics and ortho where very few people will be at academic positions after their training. We're sort of paralleling how PhD students are used as teaching assistants during their training, except we pay $1,000/week for the privilege of watching Boards and Beyond and doing their chart reviewing, case report writeups, or database analysis.
 
efle said:
I don't think students are just churning out fluffier research than before, they're just dumping more hours into it. Most of my friends were hustling research on the side since MS1 and many of them are doing full research gap years. It's ridiculous, especially for fields like derm and plastics and ortho where very few people will be at academic positions after their training. We're sort of paralleling how PhD students are used as teaching assistants during their training, except we pay $1,000/week for the privilege of watching Boards and Beyond and doing their chart reviewing, case report writeups, or database analysis.
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I mean you're at a top school so publishing is actually something meaningful since its guaranteed your work will go to a good and def non predatory journal. For most other schools, the sheer volume is next to impossible without having to fight a horde of med students to get that rare productive attending
 
Lawpy said:
Did you make your own cards or was it premade decks?
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For my specialty specific stuff, I made my own cards. But I also used premade cards extensively in preclinical years and I think those gave me a really solid foundation in general medicine and in how to make effective cards.
 
Lawpy said:
Also why is rad onc research so high in 2020?? @medgator @elementaryschooleconomics help me out here. How much radonc research do you see from med students that are straight up garbage? Or is radonc itself unusually productively good by its nature?
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Lag time with applicants... Remember up until 2016-2017 or so, rad onc is still competitive and mainly requires research more than step scores or AOA so everyone is doing it to match. Med students in the know are literally starting projects at MS1, possibly even in pre med.

Pretty sure that will be much lower going forward. The magnitude of the drop in competitiveness of rad onc as specialty and the stats of residents matches will be one for the history books between 2000-2015 and-2020+. Many of us believe a chunk of rad onc graduates in 2025+ may be unemployable unless they're willing to end up in raging metropolises like Flint MI, evansville IN or Kearney NE
 
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Regarding the increased level of knowledge medical students need to know (it’s objectively true, just look at the size and content changes of FA over the years), I’ve always found this quote instructive (see photo). Tradeoffs are inevitable but hard decisions about med ed need made. That goes not only for curriculum, but also for app numbers.

Both of these trends are unsustainable, and doing nothing is not an option.
 

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BlackSquirrelMed said:
Regarding the increased level of knowledge medical students need to know (it’s objectively true, just look at the size and content changes of FA over the years), I’ve always found this quote instructive (see photo). Tradeoffs are inevitable but hard decisions about med ed need made. That goes not only for curriculum, but also for app numbers.

Both of these trends are unsustainable, and doing nothing is not an option.
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Great quote and entirely accurate.
 
efle said:
I dug up the old charting outcomes to compare how much research folks did then vs now. It's pretty nuts

View attachment 338163
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I do wonder what are the consequences in the field of research due to this. Obviously the research papers are mostly fluff, but case reports could be useful for gathering info on unicorns, and some people do publish semi-decent papers so I can see how this could be semi-useful. Or is this all just useless waste of time?
Lem0nz said:
This isn’t true at all. Medical students are much better. The volume of knowledge has increased exponentially and Med students have *kept up*. You may look at it and see a bunch of average students but I look at it and am amazed because it’s way more than I had to do. And people 10, 20, 30 years older than me? They have trouble fathoming it.

It was easier to be amazing once upon a time because there was less you had to be amazing at. Substantially less.
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Does it make any difference in patient care however? I remember an attending was presenting for my group during a physical examination clinical class and told us point blank that the minutiae details of anatomy/etc we're learning is not that important and will mostly be forgotten (to make a point that we should be paying more attention to the clinical, not to discredit other classes). What percent of the new info actually is maintained after we transition to attendinghood?
 
BuildingMyOwnLuck said:
I do wonder what are the consequences in the field of research due to this. Obviously the research papers are mostly fluff, but case reports could be useful for gathering info on unicorns, and some people do publish semi-decent papers so I can see how this could be semi-useful. Or is this all just useless waste of time?

Does it make any difference in patient care however? I remember an attending was presenting for my group during a physical examination clinical class and told us point blank that the minutiae details of anatomy/etc we're learning is not that important and will mostly be forgotten (to make a point that we should be paying more attention to the clinical, not to discredit other classes). What percent of the new info actually is maintained after we transition to attendinghood?
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It depends on what field you go in to, but a lot of it is good that you at least know the information exists, even if you forgot it.

If you’re not in neurology, ortho, or PMR, you’re unlikely to be able to pinpoint where on the brachial plexus many random injuries are. I certainly couldn’t draw it even if you paid me. But you see someone with an odd constellation of UE findings and maybe normal c-spine imaging, maybe it rings some bells regarding where else the lesion may be - and inspires further dedicated evaluation of the brachial plexus.

Does that require the initial efforts to memorize every random merger/split in the plexus? Probably not. I forgot that halfway through M1 year. But it’s still reasonable that we spent at least some time on it.
 
BuildingMyOwnLuck said:
I do wonder what are the consequences in the field of research due to this. Obviously the research papers are mostly fluff, but case reports could be useful for gathering info on unicorns, and some people do publish semi-decent papers so I can see how this could be semi-useful. Or is this all just useless waste of time?
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Very few are actually papers, the vast majority of the entries are abstracts and posters/presentations. It's much more about building a long list of ERAS entries than actual contribution to literature.
 
efle said:
Very few are actually papers, the vast majority of the entries are abstracts and posters/presentations. It's much more about building a long list of ERAS entries than actual contribution to literature.
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Of course its fluff. The vast majority of doctors do not care about publishing whatsoever, even at academic centers. Its just a rat race.
 
efle said:
Very few are actually papers, the vast majority of the entries are abstracts and posters/presentations. It's much more about building a long list of ERAS entries than actual contribution to literature.
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Agree with this. Some of those posters may spark some interesting conversations at the conference or something that contribute to the greater research endeavor, but most will just be completely lost to time, remembered only on a couple resumes (same is true for most of the low impact papers that will be buried in the depths of pubmed)

I think there is some small value in the fluff stuff in terms of learning how the research/publishing process works, but i really wish there was a lot less of it
 
efle said:
Very few are actually papers, the vast majority of the entries are abstracts and posters/presentations. It's much more about building a long list of ERAS entries than actual contribution to literature.
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Oh, that's much better than I expected, I genuinely thought most people were publishing actual articles even to get into nonsurgical/moderate competitiveness specialties. Good to hear it's not that ridiculous (yet, at least).
TelemarketingEnigma said:
Agree with this. Some of those posters may spark some interesting conversations at the conference or something that contribute to the greater research endeavor, but most will just be completely lost to time, remembered only on a couple resumes (same is true for most of the low impact papers that will be buried in the depths of pubmed)

I think there is some small value in the fluff stuff in terms of learning how the research/publishing process works, but i really wish there was a lot less of it
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It's like the whole volunteering thing to get into med school. I can't say that washing wheelchairs, doing laundry and making photocopies in my hospital I volunteered at will make me a better physician. I really do feel for my future peers as the rate race is exponentially getting worse both pre med school and during.
 
BuildingMyOwnLuck said:
Oh, that's much better than I expected, I genuinely thought most people were publishing actual articles even to get into nonsurgical/moderate competitiveness specialties. Good to hear it's not that ridiculous (yet, at least).

It's like the whole volunteering thing to get into med school. I can't say that washing wheelchairs, doing laundry and making photocopies in my hospital I volunteered at will make me a better physician. I really do feel for my future peers as the rate race is exponentially getting worse both pre med school and during.
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Agree, I don't envy the applicants of 2030 into....well anything competitive really. I have siblings much younger than me and even their highschool experience and trying to get into the colleges they want is a world different than mine 10 years ago. These poor kids are making straight A's and still getting rejected from their state schools.
 
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