Were "competitive" specialties also competive 20 years ago?

[rocketbooster]

ENT, ortho, plastics, ophthalmology, derm...were these also super competitive a long time ago, say 20 years ago? I'm guessing they were somewhat competitive but not like they are now?

I've been wondering this from a while. So, if you see a 50 year old dermatologist, can you assume he/she was at the top of their class?

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[mmmcdowe]

Derm used to be much less competitive apparently.

 

[isoquin]

I know during an ortho lecture, we were told by someone in the field that he could never get into an ortho residency program today.

 

[KinasePro]

I know during an ortho lecture, we were told by someone in the field that he could never get into an ortho residency program today.

Michael Collins (author of "Hot Lights, Cold Steel") was originally slated to do a Pediatrics residency at Mayo, but decided that he wanted to do ortho at the very last minute, on a whim. They let him "transfer" into their Ortho program without any problems whatsoever. According to him, the ortho stereotype was very accurate back then and literally anyone could get a spot if they wanted one.

There's a nice interview with him floating around on SDN's Radio Rounds (or w/e it's called) where he talks this over in detail.

 

[TheMan21]

Rads and Gas were also easier to get into back in the day (although I think Gas is starting to get a bit less competitive, perhaps due to the CRNA invasion.) I've read that rads is still considered a low tier specialty in some other countries.

 

[Jack is Back]

It's like comparing the NFL today to the 1930's:

It's a different game now.

 

[El Dooderino]

Rads and Gas were also easier to get into back in the day (although I think Gas is starting to get a bit less competitive, perhaps due to the CRNA invasion.) I've read that rads is still considered a low tier specialty in some other countries.

I just don't understand posts like this

 

[Morsetlis]

Top picture looks like a dance.

 

[BigRedBeta]

The competitiveness of residency fields is always changing.

New technologies, different market pressures, and emphasis by media and medical schools all combine to affect what people want to do. Some fields like Family Medicine weren't more competitive, but in the mid 90's there were significantly more residency spots. Certainly lifestyle is a newer force that has pushed fields like derm and urology into the upper echelons of competitiveness. Anesthesia probably has changed the most over the last 20 years, starting out popular, then tanking when the first round of CRNA expansion took place, then rebounding to it's current position.

It is definitely not safe to assume anything about where a person ended up in their medical school class based on specialty. While some things like derm may seem intuitive now, they weren't so in the past. More importantly, there are always people who scored 250+ on Step 1, were AOA and top of their class, and decided to go into pediatrics at their home institution in some flyover state. Just because some fields are easy to match into doesn't mean they don't attract the best and brightest.

 

[El Dooderino]

The competitiveness of residency fields is always changing.

New technologies, different market pressures, and emphasis by media and medical schools all combine to affect what people want to do. Some fields like Family Medicine weren't more competitive, but in the mid 90's there were significantly more residency spots. Certainly lifestyle is a newer force that has pushed fields like derm and urology into the upper echelons of competitiveness. Anesthesia probably has changed the most over the last 20 years, starting out popular, then tanking when the first round of CRNA expansion took place, then rebounding to it's current position.

It is definitely not safe to assume anything about where a person ended up in their medical school class based on specialty. While some things like derm may seem intuitive now, they weren't so in the past. More importantly, there are always people who scored 250+ on Step 1, were AOA and top of their class, and decided to go into pediatrics at their home institution in some flyover state. Just because some fields are easy to match into doesn't mean they don't attract the best and brightest.

I have friends who would adamantly disagree with urology being anything close to a lifestyle specialty

 

[Speed Kills]

I have friends who would adamantly disagree with urology being anything close to a lifestyle specialty

Sugery --> Lifestyle

 

[carml]

In the old days, derm only attracted folks who were all genuinely interested in derm, which isn't that many folks, which is why the specialty wasn't all that popular. Nowadays, it attracts those types too, but also too many folks attracted to the lifestyle only hence driving up the competitiveness. In most other countries, derm is a last choice resort for folks.

 

[astrocreep96]

I've heard that ortho wasn't always competitive (my family doc jokes that the bottom of his class went into ortho), but all of the old school orthopods at my hospital and others are AOA. WTF?

 

[Zuerst]

Sugery --> Lifestyle

during residency, probably...

ophthal and plastic can be pretty cush

 

[ccmonopolies]

GI didn't become the cash cow that it is until recently. Guess what? It became competitive.

If you go into a specialty just because it is hot now, don't be surprised if it isn't anymore 10 year down the road. Do what you are interested in.

 

[NeuroChris]

Good lord, why is everyone so interested in derm?

 

[naus]

I've heard that ortho wasn't always competitive (my family doc jokes that the bottom of his class went into ortho), but all of the old school orthopods at my hospital and others are AOA. WTF?

A lot of ortho in the 1960s was still fracture care, which had really horrible call (still do) and poor reimbursement (many drunk homeless people). Naturally ortho wasn't that competitive then. General surgery was much better reimbursed than ortho then.

It wasn't until a few decades later that joint replacements and scoping really took off. People weren't as gungho about school sports as they are today either.

But reimbursements can still change at any moment on the whim of CMS. ENT saw major reimbursement cuts in the early 2000s. Cards and rads are getting cut now. Ortho is probably next. Do what you really enjoy, or you'll be bitter when reimbursements get slashed, as they inevitably will.

 

[D elegans]

Good lord, why is everyone so interested in derm?

Seriously brah? $$$$/lifestyle talks. That being said, I (and presumably you) would be miserable doing Derm.

 

[DoctwoB]

I have friends who would adamantly disagree with urology being anything close to a lifestyle specialty

During residency, it's a surgical lifestyle, though easier then most (gensurg, neuro, ortho, etc.)

Afterwards, you can completely tailor your practice, but lifestyle tends to be very good. Outside of the occasional case of testicular torsion or fournier's gangrene, there just aren't very many urologic emergencies. You can do 10 hour cystectomies + neobladder reconstruction if you want, but those aren't the norm and tend to be concentrated in a few academic centers. Most will do a lot more 30 minute vasectomies, cystoscopies, etc. that are much easier to plan a nice schedule around.

 

[Dral]

Good lord, why is everyone so interested in derm?

http://www.medscape.com/features/slideshow/compensation/2011/

Slide 16. Doesn't really answer your question, but your question was rhetorical to begin with (I'm assuming).

 

[El Dooderino]

During residency, it's a surgical lifestyle, though easier then most (gensurg, neuro, ortho, etc.)

Afterwards, you can completely tailor your practice, but lifestyle tends to be very good. Outside of the occasional case of testicular torsion or fournier's gangrene, there just aren't very many urologic emergencies. You can do 10 hour cystectomies + neobladder reconstruction if you want, but those aren't the norm and tend to be concentrated in a few academic centers. Most will do a lot more 30 minute vasectomies, cystoscopies, etc. that are much easier to plan a nice schedule around.

I don't know, they grind in PP. It was a strange choice to put next to derm considering there are many other specialties that offer a better lifestyle

 

[NeuroChris]

http://www.medscape.com/features/slideshow/compensation/2011/

Slide 16. Doesn't really answer your question, but your question was rhetorical to begin with (I'm assuming).

Thanks for the link man👍, i guess im better off doing something else- more like neuro

 

[45408]

I know during an ortho lecture, we were told by someone in the field that he could never get into an ortho residency program today.

I worked with an orthopod in his 70s who said that all the smart kids in his class got top spots in internal medicine. He was literally very near the bottom of his class, and all they could get him was a spot in ortho.

 

[45408]

I have friends who would adamantly disagree with urology being anything close to a lifestyle specialty

Compared to other surgical specialties, it is.

 

[El Dooderino]

Compared to other surgical specialties, it is.

yes, and surgical specialties aren't lifestyle choices. Derm, ophtho, rad-onc, psych, em, anesthesia, radiology, pmr, and rheum all have better lifestyles than urology. I guess you can call anything a lifestyle specialty when you compare it to gen surg

 

[BigRedBeta]

For the record, the choice of urology was used as evidence of a field which was previously not competitive, and now, because of lifestyle concerns, now is competitive.

Yes, urology is not a pure lifestyle field, especially during residency. But it does offer a significantly better private practice lifestyle than most other surgical specialties.

And while it may seem like SDN heresy, there are a lot of people who choose fields because the work makes them happy, not based absolutely on how many hours they work. Choosing to get into the OR is a choice, and some people need to be there. That doesn't mean though they want to spend every moment there, hence the search for something like Urology, which does offer a better lifestyle compared to the other options. People choose urology for that reason.

 

[Dral]

Thanks for the link man👍, i guess im better off doing something else- more like neuro

Not true. It's not like there are any specialties where the percentage of satisfied physicians is zero.

Plenty of happy surgeons and OB/Gyns out there...except maybe not that poor OB/Gyn in CT that lost that gajillion dollar law suit.

 

[Smachadams]

Was plastics always as competitive as it is now??