What is good about the match?

Burrell College of Osteopathic Medicine
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Substance said:
We already do that. I don't see how the preclin and half a year of clin contribute any meaningful information to students.

The MD, like the DDS, should grant one the privilege of providing general medical care. Medical education is ineffective, medical school is a pointless exercise in futility and sucking-up, and the curriculum is based on a century-old recommendation paper.

The dentists are out day one post-graduation ready to practice. Their craft is not easier than ours. But their schools actually teach them how to do it, not how to suck-up and shadow people. Anyone who trumpets how medicine is so much more complicated and cannot be practiced without a residency in family medicine is delusional and hasn't thought this through.

Three years of medical school. Two years of "family medicine" residency right after. Everyone gets the MD and general practice privileges. No match required. Wanna specialize? Apply later on, just like every other job on the planet.
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So you're proposing extending general medical education and requiring everyone to do 5 years before they can go into a given specialty instead of 4? Interesting.
 
Substance said:
We already do that. I don't see how the preclin and half a year of clin contribute any meaningful information to students.

The MD, like the DDS, should grant one the privilege of providing general medical care. Medical education is ineffective, medical school is a pointless exercise in futility and sucking-up, and the curriculum is based on a century-old recommendation paper.

The dentists are out day one post-graduation ready to practice. Their craft is not easier than ours. But their schools actually teach them how to do it, not how to suck-up and shadow people. Anyone who trumpets how medicine is so much more complicated and cannot be practiced without a residency in family medicine is delusional and hasn't thought this through.

Three years of medical school. Two years of "family medicine" residency right after. Everyone gets the MD and general practice privileges. No match required. Wanna specialize? Apply later on, just like every other job on the planet.
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YES! The biggest disappointment of medical school was realizing at the end of M3 that, after $100,000 in tuition, I knew nothing about how to manage a patient independently. Really? I spent four years in med school dicking around trying to kill time until I could finally start learning how to be a doctor in residency? It is a crime that we come out of medical school unable to practice as generalists. I agree with you 100%, and what you say is completely logical. But what you advocate will never happen because it undermines the protected labor racket that artificially props up incomes through the BE/BC bottleneck. Take that away and the system swings back around to a free market like the dentists have, competing for patients and actually having to run a business to make a living. As it is now, being BE/BC virtually guarantees you a decent paying job somewhere as an employee.
 
The new Forbes articles make it very clear that under the current system, students have zero representation on the Match board. Any revision of the exemption law should include a provision that allows a federal labor judge to appoint a special master that will look out for the interests of the students and act as a clearing house/ombudsman for complaints.

ChEMD said:
So you're proposing extending general medical education and requiring everyone to do 5 years before they can go into a given specialty instead of 4? Interesting.
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Given what we have now, it doesn't seem like such a big change. This could be a option open to students.
 
ChEMD said:
So you're proposing extending general medical education and requiring everyone to do 5 years before they can go into a given specialty instead of 4? Interesting.
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It currently requires you to do 5-years in most states to get licensed. Many states require 3-years of post-doctoral training.

What really is troublesome, is that a physician fresh out of medical school can no get licensed/practice even in a supervised role. This, in essence, means that PA/NP training is better than MD training because they are allowed to have an independent license, and practice independently, without residency. Think about that one.
 
neusu said:
It currently requires you to do 5-years in most states to get licensed. Many states require 3-years of post-doctoral training.

What really is troublesome, is that a physician fresh out of medical school can no get licensed/practice even in a supervised role. This, in essence, means that PA/NP training is better than MD training because they are allowed to have an independent license, and practice independently, without residency. Think about that one.
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I get that, but many people don't want to practice family medicine, and I doubt completing a mandatory family medicine residency would reduce the number of years of residency for most specialties.

It does not mean that PA/NP training is better at all. It means that people argue that their training is better, and are damn good at making that argument.
 
luckrules said:
Just read this article: http://www.forbes.com/sites/theapot...dency-matching-system-for-newly-minted-m-d-s/

And I'm wondering what exactly is good about the match. For patients? For attending doctors? For hospitals/training programs? For the public?

Is it JUST an historical anachronism or are their ANY pros. Looking for both personal stories and well reasoned analysis out there.
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Party line: the match does mostly a good job with most programs and most applicants.

How I feel: The match is horrible. They neither publish their algorithm, nor their data on applicants to programs. We pay them way too much for them to not have a charting outcomes every year. It should be published concomitantly with the match results. Likewise, why does it take so long for them to do their analysis? How many iterations do they run? Their basic algorithm is explained on their website. How does couples match interface with this? I can assure you that I can write a "solution," meaning a computer program that does the same thing the match does, using their algorithm, and it would not take several weeks to run.

The reason we put up with it is because it is forced on us. No one has a better system yet. They have a government granted monopoly.

Was the previous system better? Perhaps not. Students signed contracts with hospitals during their early years and often didn't get the best end of the stick for fear of losing out. Perhaps a better system would be to allow interviews, have an offer embargo until a particular date, and go through a scramble. Programs that had candidates that they actually wanted, and the candidates actually wanted the program would be set. Programs that played up how great they were to too many applicants would be left holding the bag. The bottom applicants would still, nonetheless be left chasing what they wanted. Even so, it would be better than this current system wherein we spend an exorbitant amount of money for nothing.
 
plumazul said:
Exactly, that's my point.
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So what...because he's not writing letters urging us to burn the whole thing down and condemning the match, he must be a corrupt pawn of the system?

The NRMP board has a medical student representative. Yet you say med students have "zero" representation on the board. Kind of an obvious contradiction...
 
southernIM said:
Nice response letter on Forbes about this today:

http://www.forbes.com/sites/theapot...nts-but-youre-not-entitled-to-your-dream-job/

Although I have to wonder - is Forbes the one coming up with the ridiculously inflammatory titles for these articles? Because again the title of the article has little resemblance to the content therein.
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On par with that: http://www.ama-assn.org/ama/pub/edu...question-of-month/graduates-being-denied.page

The responses by some are quite childish IMHO.
 
southernIM said:
So what...because he's not writing letters urging us to burn the whole thing down and condemning the match, he must be a corrupt pawn of the system?

The NRMP board has a medical student representative. Yet you say med students have "zero" representation on the board. Kind of an obvious contradiction...
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He has as much power on that board, as medical students in med school govt. have on their medical schools: http://www.pandabearmd.com/2008/04/13/medical-school-pre-clinical-years-twenty-questions-part-3/
 
ChEMD said:
I get that, but many people don't want to practice family medicine, and I doubt completing a mandatory family medicine residency would reduce the number of years of residency for most specialties.

It does not mean that PA/NP training is better at all. It means that people argue that their training is better, and are damn good at making that argument.
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That's right. I would hate to be a family doctor. But my system would certainly make things more flexible and more in line with our patient-care mandate than what we have presently. 100% of graduating medical students would be able to provide primary care. Specialists would have more of an appreciation for primary care physicians, and more of an idea of what they get themselves into beyond the "I GOT 299 I WILL DO PRS! I MIGHT HATE IT BUT 299!" strategy as present. Plus, students with family and other life obligations would not have to pack up and move halfway across the country for a residency if they didn't want to. All communities are looking for primary care docs.

The aim would not be to force people into family medicine - On the contrary, I argue that my system would force people into things less often than our current one does.

The aim would be to provide a tangible use to the MD degree, give graduating students means by which they could pay off debts sooner, and also give them opportunities to specialize without the need for an all-encompassing match.

If you don't match now, you're basically obligated to do another field that you don't want to do. There are no second chances.

If an MD was actually a worthwhile designation, you'd apply, and if you didn't get in, you'd apply again next year and work in the mean time. Debt repayment wouldn't be so onerous, and careers wouldn't stagnate.
 
southernIM said:
So what...because he's not writing letters urging us to burn the whole thing down and condemning the match, he must be a corrupt pawn of the system?
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:uhno: I would hope that you'd be willing to concede that there is a little bit of daylight between "burning the whole thing down" and being a reflexive apologist? The Match was not chiseled in stone and handed down from some deity. There are problems to be solved, nothing should be sacrosanct.
 
neusu said:
Party line: the match does mostly a good job with most programs and most applicants.

How I feel: The match is horrible. They neither publish their algorithm, nor their data on applicants to programs. We pay them way too much for them to not have a charting outcomes every year. It should be published concomitantly with the match results. Likewise, why does it take so long for them to do their analysis? How many iterations do they run? Their basic algorithm is explained on their website. How does couples match interface with this? I can assure you that I can write a "solution," meaning a computer program that does the same thing the match does, using their algorithm, and it would not take several weeks to run.

The reason we put up with it is because it is forced on us. No one has a better system yet. They have a government granted monopoly.

Was the previous system better? Perhaps not. Students signed contracts with hospitals during their early years and often didn't get the best end of the stick for fear of losing out. Perhaps a better system would be to allow interviews, have an offer embargo until a particular date, and go through a scramble. Programs that had candidates that they actually wanted, and the candidates actually wanted the program would be set. Programs that played up how great they were to too many applicants would be left holding the bag. The bottom applicants would still, nonetheless be left chasing what they wanted. Even so, it would be better than this current system wherein we spend an exorbitant amount of money for nothing.
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Wait? You can do NRMP and charge less? How much do you charge?

Is this guy going to collect our info and give it to programs for > 20/program? That's awesome!
 
neusu said:
Wait? You can do NRMP and charge less? How much do you charge?

Is this guy going to collect our info and give it to programs for > 20/program? That's awesome!
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You realize you're replying to your own post, right?
 
Substance said:
We already do that. I don't see how the preclin and half a year of clin contribute any meaningful information to students.

The MD, like the DDS, should grant one the privilege of providing general medical care. Medical education is ineffective, medical school is a pointless exercise in futility and sucking-up, and the curriculum is based on a century-old recommendation paper.

The dentists are out day one post-graduation ready to practice. Their craft is not easier than ours. But their schools actually teach them how to do it, not how to suck-up and shadow people. Anyone who trumpets how medicine is so much more complicated and cannot be practiced without a residency in family medicine is delusional and hasn't thought this through.

Three years of medical school. Two years of "family medicine" residency right after. Everyone gets the MD and general practice privileges. No match required. Wanna specialize? Apply later on, just like every other job on the planet.
Click to expand...

Preach. And heck, I'll up the ante. Since 4th year is already pretty much a total joke anyway, perhaps you don't even need the 5th year. 2 years pre-clinical, and then 2 years of in-your-face clinical experience with the goal of becoming a good "General Practitioner". Split half the time between clinic and inpatient. Heck, my friend who is getting her FNP has done 1 full-time semester of general practice clinicals and is going to be licensed to practice next month, so it seems 2 full years of this would make you pretty darned competent to be licensed, no?

Then when you graduate, you can go practice as a GP, or apply to do specialty training. As you note, exactly like the dental model. You'd probably solve the primary care crisis overnight.

It is a travesty that FOUR YEARS of professional education is not preparing us to become even general providers.
 
Mr. Hat said:
Preach. And heck, I'll up the ante. Since 4th year is already pretty much a total joke anyway, perhaps you don't even need the 5th year. 2 years pre-clinical, and then 2 years of in-your-face clinical experience with the goal of becoming a good "General Practitioner". Split half the time between clinic and inpatient. Heck, my friend who is getting her FNP has done 1 full-time semester of general practice clinicals and is going to be licensed to practice next month, so it seems 2 full years of this would make you pretty darned competent to be licensed, no?

Then when you graduate, you can go practice as a GP, or apply to do specialty training. As you note, exactly like the dental model. You'd probably solve the primary care crisis overnight.

It is a travesty that FOUR YEARS of professional education is not preparing us to become even general providers.
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So by comparing our training to that of a NP, you are basically saying that you think they are receiving enough training to become competent, independent providers from day 1 after graduation. It seems to me like this is the exact opposite of what physicians actually believe.

You really can't compare dentistry and medicine. I'm not saying that dentistry is easy, and in fact I have no experience in it whatsoever, but it's a little ridiculous to compare the two fields. Medicine encompasses the entire body. Dentistry encompasses a tiny fraction of the body. It's much more reasonable to think a dentist can learn all he/she needs to know to practice in 4 years.
 
ChEMD said:
So by comparing our training to that of a NP, you are basically saying that you think they are receiving enough training to become competent, independent providers from day 1 after graduation. It seems to me like this is the exact opposite of what physicians actually believe.

You really can't compare dentistry and medicine. I'm not saying that dentistry is easy, and in fact I have no experience in it whatsoever, but it's a little ridiculous to compare the two fields. Medicine encompasses the entire body. Dentistry encompasses a tiny fraction of the body. It's much more reasonable to think a dentist can learn all he/she needs to know to practice in 4 years.
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I don't know about other schools except harvard but I heard that in my school it used to be a combined track where people would take the same preclinical classes and then choose whether they wanted to be a dentist or a doctor. It separated when medical school moved towards organ systems while dental school stuck with the pathology, pharmacology, physiology style classroom learning. They still do most of the organs and took the same anatomy class as we did (minus the pelvis and the legs) while doing all of the labs that they have to do like crowns, making molds of teeth, etc. I have a healthy respect for dental school and dentists in general. We learn more of the theoretical stuff in our preclinical years in medical school but they spend a lot of time actually doing things that dentists do.
 
Psai said:
I don't know about other schools except harvard but I heard that in my school it used to be a combined track where people would take the same preclinical classes and then choose whether they wanted to be a dentist or a doctor. It separated when medical school moved towards organ systems while dental school stuck with the pathology, pharmacology, physiology style classroom learning. They still do most of the organs and took the same anatomy class as we did (minus the pelvis and the legs) while doing all of the labs that they have to do like crowns, making molds of teeth, etc. I have a healthy respect for dental school and dentists in general. We learn more of the theoretical stuff in our preclinical years in medical school but they spend a lot of time actually doing things that dentists do.
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Yeah, I was surprised to find out they have extremely similar pre-clinical years. And they are able to practice things that dentists to because all general dentists do the same things. The same can't be said for medicine, in that there are so many different skills required for the various areas you can go into. The real difference is probably years 3 and 4, where they can be so much more focused on their craft on a small area of the body. That's what allows them to practice when they graduate.
 
neusu said:
Party line: the match does mostly a good job with most programs and most applicants.

How I feel: The match is horrible. They neither publish their algorithm, nor their data on applicants to programs. We pay them way too much for them to not have a charting outcomes every year. It should be published concomitantly with the match results. Likewise, why does it take so long for them to do their analysis? How many iterations do they run? Their basic algorithm is explained on their website. How does couples match interface with this? I can assure you that I can write a "solution," meaning a computer program that does the same thing the match does, using their algorithm, and it would not take several weeks to run.

The reason we put up with it is because it is forced on us. No one has a better system yet. They have a government granted monopoly.
Click to expand...

Agreed. This is how I also feel about the NBME. How do they come up with this ridiculous 3 digit number system for the steps? Is there a formula? Is it a standardized scale score like the MCAT, GMAT, and every other admissions test? Is it truly a licensing exam that is pass/fail? Nope. The only thing they provide is roughly the % right is to pass, but that is irrelevant. They describe vaguely a "statistical percentile measures" to "ensure" each score is the same. I don't understand what it is about medicine and the lack of transparency of their agencies. Everything has to be behind lock and key.
 
ChEMD said:
So by comparing our training to that of a NP, you are basically saying that you think they are receiving enough training to become competent, independent providers from day 1 after graduation. It seems to me like this is the exact opposite of what physicians actually believe.

You really can't compare dentistry and medicine. I'm not saying that dentistry is easy, and in fact I have no experience in it whatsoever, but it's a little ridiculous to compare the two fields. Medicine encompasses the entire body. Dentistry encompasses a tiny fraction of the body. It's much more reasonable to think a dentist can learn all he/she needs to know to practice in 4 years.
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I could be wrong, but Harvard Medical School and Harvard Dental School take all their basic sciences together. Dentists' basic science education are not just limited to one area - besides maybe, Pathology.
 
greg1184 said:
Agreed. This is how I also feel about the NBME. How do they come up with this ridiculous 3 digit number system for the steps? Is there a formula? Is it a standardized scale score like the MCAT, GMAT, and every other admissions test? Is it truly a licensing exam that is pass/fail? Nope. The only thing they provide is roughly the % right is to pass, but that is irrelevant. They describe vaguely a "statistical percentile measures" to "ensure" each score is the same. I don't understand what it is about medicine and the lack of transparency of their agencies. Everything has to be behind lock and key.
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Yup, lack of transparency, outright lying in some cases, and stubborn acceptance of glaring inefficiency of how things are - sounds exactly like the House of Medicine to me.
 
DermViser said:
I could be wrong, but Harvard Medical School and Harvard Dental School take all their basic sciences together. Dentists' basic science education are not just limited to one area - besides maybe, Pathology.
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This is true. HSDM students take the exact same courses as the HMS students during the first two years. In fact, the HSDM students have additional dental courses on top of the HMS coursework. Their first two years are harder; no question.
 
Seems that overwhelmingly, the ones complaining about the match are the very most competitive students.

I could be wrong, but it seems to me that their discontent might be primarily an ego thing. When almost 90% of their classmates get the exact same '1 job offer at essentially the same salary' that they got, well then, where's the validation for doing extraordinarily well? Where's the months-long public First World indecision lament of "Boston and San Francisco are so expensive. But then, Minnesota's so cold, and well, it's Baltimore..."

A system that works for almost 90% of the people almost all the time? Yeah, let's dismantle that.
 
southernIM said:
Nice response letter on Forbes about this today:

http://www.forbes.com/sites/theapot...nts-but-youre-not-entitled-to-your-dream-job/

Although I have to wonder - is Forbes the one coming up with the ridiculously inflammatory titles for these articles? Because again the title of the article has little resemblance to the content therein.
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Decent rebuttal. Like how in the comments, Ms. Ho responds. She sure has a lot of time on her hands to reply to her critics...wonder how she fits it into her schedule between the large sections of her day reserved for weeping at home over her match result? I can only assume this crusade has something to do with that.
 
Kaputt said:
Decent rebuttal. Like how in the comments, Ms. Ho responds. She sure has a lot of time on her hands to reply to her critics...wonder how she fits it into her schedule between the large sections of her day reserved for weeping at home over her match result? I can only assume this crusade has something to do with that.
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She's an MS-4 at UT-Southwestern who matched into Emergency Medicine, her chosen specialty, at The University of Chicago: http://www.utsouthwestern.edu/newsroom/center-times/year-2014/march/match-day-specialty.html. I highly doubt she's weeping.

The rebuttal is done by MS-2s at UT-Southwestern, who for all intents and purposes, are commenting on something they have absolutely no experience or knowledge of (not that this has ever stopped medical students before). They sound like utter fools with statements like, "Perhaps resident physicians should be grateful they receive any compensation at all". Makes me wonder what I kind of indoctrination occurs there, and if all students willingly drink the Kool-Aid.
 
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DermViser said:
She matched into Emergency Medicine, her chosen specialty at The University of Chicago: http://www.utsouthwestern.edu/newsroom/center-times/year-2014/march/match-day-specialty.html

I highly doubt she's weeping.

The rebuttal is done by MS-2s at her medical school, who for all intents and purposes, are commenting on something they have absolutely no experience or knowledge of (not that this has even stopped medical students in the past)
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I won't pretend to know how the EM world works, but I do know it doesn't work like the rest of the specialties. The dirtier your hospital is, the better it is for EM...hence why people claw to get into Cook County's EM program, but no one wants to touch their IM or radiology programs with a ten-foot-pole. I have no idea if she is happy with her match, but she seems extremely unhappy with the match process. In one of the comments, she admits that she didn't hate the match until she went through it (though there could be a number of reasons to explain why -- being unhappy with her own match result being the most obvious candidate).

I think it's unfair to say that anybody who hasn't gone through the match yet doesn't have the right to say anything about it. There's lots of literature on why the match is the way it is and lots of data to look at. The only thing that happens once you go through the match process is that you can get emotionally drained during the process...which doesn't make you a very objective critic about it. Ms. Ho's arguments are all crap, as has been discussed in this thread and else ware, and I'm just glad that something was posted on Forbes to rebut that horrible article. But Forbes is just click-bait these days anyway so who cares.
 
Kaputt said:
I won't pretend to know how the EM world works, but I do know it doesn't work like the rest of the specialties. The dirtier your hospital is, the better it is for EM...hence why people claw to get into Cook County's EM program, but no one wants to touch their IM or radiology programs with a ten-foot-pole. I have no idea if she is happy with her match, but she seems extremely unhappy with the match process. In one of the comments, she admits that she didn't hate the match until she went through it (though there could be a number of reasons to explain why -- being unhappy with her own match result being the most obvious candidate).

I think it's unfair to say that anybody who hasn't gone through the match yet doesn't have the right to say anything about it. There's lots of literature on why the match is the way it is and lots of data to look at. The only thing that happens once you go through the match process is that you can get emotionally drained during the process...which doesn't make you a very objective critic about it. Ms. Ho's arguments are all crap, as has been discussed in this thread and else ware, and I'm just glad that something was posted on Forbes to rebut that horrible article. But Forbes is just click-bait these days anyway so who cares.
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There are many reasons to hate the match, besides not getting your #1 choice. She goes into great detail WHY the system is so flawed in her comment rebuttals. I'll leave it to the EM folk to comment on whether the dirtier the facility, the better the training. 🙄 My point is that MS-2's who've been under the protection of a classroom, have no right to comment on how great the match is or how GME should work, bc they don't have any valid viewpoint on which to comment. They sound more like they're kissing ass, esp. with comments like, "Perhaps resident physicians should be grateful they receive any compensation at all." Will be curious if they feel the same way, once they become MS-4s.
 
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DermViser said:
They sound more like they're kissing ass, esp. with comments like, "Perhaps resident physicians should be grateful they receive any compensation at all." Will be curious if they feel the same way, once they become MS-4s.
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I see the save the world brigade is active at UT-Southwestern. At my med school, the most radical SWBs went for the most specialized fields once M4 rolled around.

Can we stop selecting for bleeding hearts in med school admissions?
 
maxxor said:
I see the save the world brigade is active at UT-Southwestern. At my med school, the most radical SWBs went for the most specialized fields once M4 rolled around.

Can we stop selecting for bleeding hearts in med school admissions?
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Considering UTSW seems to have the reputation on SDN and from those who have interviewed, of recruiting high-achieveing gunners, and they grade all 4 years, A/B+/B/C/F (seriously? Who letter grades anymore?) I wouldn't say those students are "save the world" but more experienced brownnosers (remember they still have to go through the match, gotta get those sweet LORs, and what better than to side with the establishment?)
 
DermViser said:
There are many reasons to hate the match, besides not getting your #1 choice. She goes into great detail WHY the system is so flawed in her comment rebuttals. I'll leave it to the EM folk to comment on whether the dirtier the facility, the better the training. 🙄 My point is that MS-2's who've been under the protection of a classroom, have no right to comment on how great the match is or how GME should work, bc they don't have any valid viewpoint on which to comment. They sound more like they're kissing ass, esp. with comments like, "Perhaps resident physicians should be grateful they receive any compensation at all." Will be curious if they feel the same way, once they become MS-4s.
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The rebuttal article I was actually referring to was from a guy at LSU, not the one from the UTSW underclassmen. I agree that their comments did seem like ass-kissing.
 
maxxor said:
I see the save the world brigade is active at UT-Southwestern. At my med school, the most radical SWBs went for the most specialized fields once M4 rolled around.

Can we stop selecting for bleeding hearts in med school admissions?
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Same here. These sorts of people will say anything to advance themselves.

Admissions would find better applicants if they didn't force everyone through the EC nuclear arms race...they shouldn't act surprised when they get students matriculating that would sell-out their grandma for a spot in med school.
 
maxxor said:
I see the save the world brigade is active at UT-Southwestern. At my med school, the most radical SWBs went for the most specialized fields once M4 rolled around.

Can we stop selecting for bleeding hearts in med school admissions?
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Yep. While I had to Google "SWB," it is sad that a large number of ugly personalities push out normal people from specialties in which they have a genuine interest and natural predisposition. People compete for derm, PRS, uro, optho, rads/rad-onc, and ENT not because they are passionate about the field or the patient population, but because they want want to win. Obviously this doesn't apply to everyone in these fields, but you have to admit that there are a large percentage of these kind of people who suddenly out of nowhere declare their intent to apply for an ultra-competitive specialty in M4 after doing every EC under the sun M1-M3 while keeping their derm research a secret. These people are always successful because it was their game plan since they were a premed. Med school admissions is partial to these severely unbalanced "winning-for-the-sake-of-winning" applicants. These people get into med school and result in the stratifying of different specialties, which unfortunately keeps otherwise well-suited individuals from pursuing or even considering certain careers because they "only got a 230 on step 1", and even more unfortunately causes others who would otherwise be fantastic specialists to be jobless at graduation.

A perfect system would have a solution to this problem where good students would have a decent shot at any specialty. By good I mean a medical student who never fails a class, gets average USMLE scores (220s), good grades (HP average), and has good LORs. In the current system, this good student barely even has a chance at any of the above specialties. Are the competitive specialties so much more difficult that a "good" student cannot be adequately trained and only excellent students could possibly ever excel in the field? Of course not. But that's the way it is when it comes to making rank lists.
 
greg1184 said:
Agreed. This is how I also feel about the NBME. How do they come up with this ridiculous 3 digit number system for the steps? Is there a formula? Is it a standardized scale score like the MCAT, GMAT, and every other admissions test? Is it truly a licensing exam that is pass/fail? Nope. The only thing they provide is roughly the % right is to pass, but that is irrelevant. They describe vaguely a "statistical percentile measures" to "ensure" each score is the same. I don't understand what it is about medicine and the lack of transparency of their agencies. Everything has to be behind lock and key.
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It's behind lock and key because the entire medical system self perpetuates itself based on the ridiculous job security and incomes of physicians and specialists in particular. Without said income and job security, the hyper competition for admissions would fade, job selection would become less about some stupid standardized pattern-recognition test and more about actual aptitude, and there would be no need to limit people to taking the test only once or to score a licensing examination as anything other than pass/fail. As it is now, everything is lock and key to ensure that only the fastest rabbit gets the carrot (specialist lifestyle and pay) lest we end up with students taking step 1 10 times and the average usmle for derm shooting up to 270 with thousands of applicants and nobody applying to family medicine. The fact that the system assumes this is the case for all students is part of the problem.

What a crime that a person's career comes down to a silly test taken on a single day at the age or 23 or 24, and that for the sake of fairness, that person is not allowed to improve and demonstrate such improvement in order to obtain his best fit in the medical field. But that wouldn't be fair! Better for American healthcare to force those who didn't ace the test into specialties that require more strenuous work for less pay. Brilliant! Lets allow the most neurotic and intellectually gifted workaholics with $$$ as their sole intent to occupy cushy specialty fields where they can work part-time while we force average, but still very capable and caring medical students, into demanding fields that don't align with their natural interests or personalities. Do we see a problem yet, America?
 
atomi said:
It's behind lock and key because the entire medical system self perpetuates itself based on the ridiculous job security and incomes of physicians and specialists in particular. Without said income and job security, the hyper competition for admissions would fade, job selection would become less about some stupid standardized pattern-recognition test and more about actual aptitude, and there would be no need to limit people to taking the test only once or to score a licensing examination as anything other than pass/fail. As it is now, everything is lock and key to ensure that only the fastest rabbit gets the carrot (specialist lifestyle and pay) lest we end up with students taking step 1 10 times and the average usmle for derm shooting up to 270 with thousands of applicants and nobody applying to family medicine. The fact that the system assumes this is the case for all students is part of the problem.

What a crime that a person's career comes down to a silly test taken on a single day at the age or 23 or 24, and that for the sake of fairness, that person is not allowed to improve and demonstrate such improvement in order to obtain his best fit in the medical field. But that wouldn't be fair! Better for American healthcare to force those who didn't ace the test into specialties that require more strenuous work for less pay. Brilliant! Lets allow the most neurotic and intellectually gifted workaholics with $$$ as their sole intent to occupy cushy specialty fields where they can work part-time while we force average, but still very capable and caring medical students, into demanding fields that don't align with their natural interests or personalities. Do we see a problem yet, America?
Click to expand...

I know plenty of average/below average classmates who have crappy personalities. On the other hand, all of our junior AOA members are awesome, well-balanced people, and they are passionate about their fields of interest. I don't really buy the whole argument that the high scorers are in it for the money while the average/below average students are somehow more caring and deserve to go into a more competitive specialty because they find it very, very interesting. What kind of argument is that?
 
atomi said:
What a crime that a person's career comes down to a silly test taken on a single day at the age or 23 or 24, and that for the sake of fairness, that person is not allowed to improve and demonstrate such improvement in order to obtain his best fit in the medical field. But that wouldn't be fair! Better for American healthcare to force those who didn't ace the test into specialties that require more strenuous work for less pay. Brilliant! Lets allow the most neurotic and intellectually gifted workaholics with $$$ as their sole intent to occupy cushy specialty fields where they can work part-time while we force average, but still very capable and caring medical students, into demanding fields that don't align with their natural interests or personalities. Do we see a problem yet, America?
Click to expand...

If you re-read your post, there is a lot of dissonance.
 
boogaloo said:
I know plenty of average/below average classmates who have crappy personalities. On the other hand, all of our junior AOA members are awesome, well-balanced people, and they are passionate about their fields of interest. I don't really buy the whole argument that the high scorers are in it for the money while the average/below average students are somehow more caring and deserve to go into a more competitive specialty because they find it very, very interesting. What kind of argument is that?
Click to expand...

This obviously does not apply to all students, and I did not say that all low scorers are "somehow more caring." My point was that there are those who would otherwise be a good fit with a genuine non-lifestyle non-monetary interest the field who are forced out either directly through the match or indirectly through pressure from their peers leading to self-selection. At the same time, having a high USMLE score does not automatically mean that the only reason the person is interested in the field is because of their score. Naturally there are "crappy personalities" across the whole range of USMLE scores.

My point was that competitive specialties are largely not interested in average and above average applicants and often feel entitled to only candidates excellent in every category on paper. This is what I find shameful about the process in general. These specialties are viewed, both by programs and applicants, as gold medals, only going to the best of the best. Specialty selection should be about interests and personality fit, not a trophy. You don't need to be any smarter to be a dermatologist, ophthalmologist, or radiation oncologist than you do to be an obstetrician, internist, or general surgeon. But the overwhelming message the system sends is that only a select elite are academically qualified and intellectually capable of succeeding in certain specialties, which just so happen to be the ones offering the highest income/work hours ratio, and we all know that is bogus.
 
boogaloo said:
I know plenty of average/below average classmates who have crappy personalities. On the other hand, all of our junior AOA members are awesome, well-balanced people, and they are passionate about their fields of interest. I don't really buy the whole argument that the high scorers are in it for the money while the average/below average students are somehow more caring and deserve to go into a more competitive specialty because they find it very, very interesting. What kind of argument is that?
Click to expand...

I felt like most of our Junior AOA members were legitimate all stars. Really - most of them were amazing people who happened to be whip smart. And several of them went into fields like peds, neurology, general surgery - not your typical "in it for the money" fields (although they did go to like CHOP, hopkins, MGH within those fields so they did pretty darn well for themselves). Maybe it's the selection criteria my school used for junior AOA...I don't really know.

Senior AOA on the other hand was most of the gunner douches in my class.
 
southernIM said:
I felt like most of our Junior AOA members were legitimate all stars. Really - most of them were amazing people who happened to be whip smart. And several of them went into fields like peds, neurology, general surgery - not your typical "in it for the money" fields (although they did go to like CHOP, hopkins, MGH within those fields so they did pretty darn well for themselves). Maybe it's the selection criteria my school used for junior AOA...I don't really know.

Senior AOA on the other hand was most of the gunner douches in my class.
Click to expand...
I think the thing is we've seen a huge shift in the specialties that those in AOA choose in general:

http://www.ncbi.nlm.nih.gov/pubmed/?term=2919933 (1989) vs. http://www.ncbi.nlm.nih.gov/pubmed/?term=21837375 (2011)

Of course, the way one is chosen for AOA varies a lot between medical schools to begin with, so it's a good thing we have the Gold Humanism Honor Society for that. 🙄
 
atomi said:
My point was that competitive specialties are largely not interested in average and above average applicants and often feel entitled to only candidates excellent in every category on paper. This is what I find shameful about the process in general. These specialties are viewed, both by programs and applicants, as gold medals, only going to the best of the best. Specialty selection should be about interests and personality fit, not a trophy. You don't need to be any smarter to be a dermatologist, ophthalmologist, or radiation oncologist than you do to be an obstetrician, internist, or general surgeon. But the overwhelming message the system sends is that only a select elite are academically qualified and intellectually capable of succeeding in certain specialties, which just so happen to be the ones offering the highest income/work hours ratio, and we all know that is bogus.
Click to expand...
Don't forget medical schools themselves. I always find it interesting those who said that decades ago, the top students in the class went into fields like Internal Medicine and Surgery. My how things have changed.
 
southernIM said:
I felt like most of our Junior AOA members were legitimate all stars. Really - most of them were amazing people who happened to be whip smart. And several of them went into fields like peds, neurology, general surgery - not your typical "in it for the money" fields (although they did go to like CHOP, hopkins, MGH within those fields so they did pretty darn well for themselves). Maybe it's the selection criteria my school used for junior AOA...I don't really know.

Senior AOA on the other hand was most of the gunner douches in my class.
Click to expand...

Agree 100%. Most (keyword most) of them were brilliant students who followed their passions and often went into uncompetitive fields to pursue academic careers. What we were talking about were the students who magically developed an interest in derm M4 after spending the first three years being total douches, telling their peds clerkship director they are 100% set on peds, being involved in every student government activity possible, and racking up every phony EC under the sun. These people are strategists and have an agenda to get what they want (I liked the "would sell out their own grandma" quote above). Still, it blows my mind that programs can't see through the pretense. Senior AOA went to two types of people. Those who were genuinely nice and couldn't care less if they were AOA or not, and the gunners who got it as a result of a popularity contest. The latter group almost exclusively went into the most competitive lifestyle specialties.
 
atomi said:
Agree 100%. Most (keyword most) of them were brilliant students who followed their passions and often went into uncompetitive fields to pursue academic careers. What we were talking about were the students who magically developed an interest in derm M4 after spending the first three years being total douches, telling their peds clerkship director they are 100% set on peds, being involved in every student government activity possible, and racking up every phony EC under the sun. These people are strategists and have an agenda to get what they want (I liked the "would sell out their own grandma" quote above). Still, it blows my mind that programs can't see through the pretense. Senior AOA went to two types of people. Those who were genuinely nice and couldn't care less if they were AOA or not, and the gunners who got it as a result of a popularity contest. The latter group almost exclusively went into the most competitive lifestyle specialties.
Click to expand...

wow, that's a lot of blanket statements you made right there.
 
atomi said:
It's behind lock and key because the entire medical system self perpetuates itself based on the ridiculous job security and incomes of physicians and specialists in particular. Without said income and job security, the hyper competition for admissions would fade, job selection would become less about some stupid standardized pattern-recognition test and more about actual aptitude, and there would be no need to limit people to taking the test only once or to score a licensing examination as anything other than pass/fail. As it is now, everything is lock and key to ensure that only the fastest rabbit gets the carrot (specialist lifestyle and pay) lest we end up with students taking step 1 10 times and the average usmle for derm shooting up to 270 with thousands of applicants and nobody applying to family medicine. The fact that the system assumes this is the case for all students is part of the problem.

What a crime that a person's career comes down to a silly test taken on a single day at the age or 23 or 24, and that for the sake of fairness, that person is not allowed to improve and demonstrate such improvement in order to obtain his best fit in the medical field. But that wouldn't be fair! Better for American healthcare to force those who didn't ace the test into specialties that require more strenuous work for less pay. Brilliant! Lets allow the most neurotic and intellectually gifted workaholics with $$$ as their sole intent to occupy cushy specialty fields where they can work part-time while we force average, but still very capable and caring medical students, into demanding fields that don't align with their natural interests or personalities. Do we see a problem yet, America?
Click to expand...

I'm happy to say I overcame those obsacles to end up in the specialty I genuinely wanted. It was a difficult road, and it wasn't a program the ivory tower hierarchy people on this board would like, but its in the field I wanted to pursue since the beginning of third year.
 
greg1184 said:
I'm happy to say I overcame those obsacles to end up in the specialty I genuinely wanted. It was a difficult road, and it wasn't a program the ivory tower hierarchy people on this board would like, but its in the field I wanted to pursue since the beginning of third year.
Click to expand...
I agree, the level of hierarchy that SDN perpetuates in an already great specialty is crazy. I understand not wanting to go to a "trash-dump" (how you define this can vary) residency that mistreats residents, but there are tons of so-called "middle-tier" residencies that are perfect to training good residents in their specialty. Not to mention, they might not have their head so far up their ***, either.
 
Meh, it's simple supply and demand really. If you're a program director in a competitive specialty, why wouldn't you want the students with the best CV? Also, people in every other career outside of medicine take jobs based on things like money and lifestyle, I don't see why it's such a taboo topic in medicine. Because somehow we're supposed to be better than everyone else and not care about our lives outside of work?

Many of the most competitive specialties are not at all these lifestyle specialties that you're describing. PRS, ortho, neurosurgery? I don't think anyone considers those to be lifestyle specialties, yet they are all "competitive specialties".

In life, if there aren't enough spots for everyone, the person with the most qualifications will get the job 9/10 times. It doesn't matter if someone else wanted it more (however you judge that).
 
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