What the heck happened with the urology match this year? Match rates of competitive specialties are scaring me and deterring me from them.

[CuriousMDStudent]

I was bored and decided to head over to r/medicalschool and I learned that the urology match rate was 65% this year?? Apparently plastic surgery is looking even scarier this year potentially because 400 people are applying for 185 spots. I'm interested in ortho and historically it's an 80% match rate.

This is not really what I thought it would be like after getting into medical school. I was always told that getting into medical school would be the hardest part but it seems like I'm not even guaranteed a job after residency?! This is so scary. I'm sorry if I'm being irrational. I don't know if I should just aim for a noncompetitive specialty just to guarantee myself a position after residency.

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[AlteredScale]

I was bored and decided to head over to r/medicalschool and I learned that the urology match rate was 65% this year?? Apparently plastic surgery is looking even scarier this year potentially because 400 people are applying for 185 spots. I'm interested in ortho and historically it's an 80% match rate.

This is not really what I thought it would be like after getting into medical school. I was always told that getting into medical school would be the hardest part but it seems like I'm not even guaranteed a job after residency?! This is so scary. I'm sorry if I'm being irrational. I don't know if I should just aim for a noncompetitive specialty just to guarantee myself a position after residency.

It's the perpetual "things will get easier/better" but it's honestly a huge rat race, and it's normal to feel somewhat blindsided with the whole process. If you have a strong application you should do shoot your shot and pursue the speciality you want with a good contingency plan in order.

 

[Darrow O'Lykos]

By percentages, you're still more likely to match than get accepted to medical school. One school I interviewed at had 8,000 applications for 200 spots. National acceptance %s are still like in the 30s-40s.

The difference now is that you are competing against all the top people that med school admissions teams deemed sufficient. So you really have to dedicate yourself early on to matching into an extremely competitive field. Every couple of years there's always concern about a particular field's future job market, and that may lead others to apply to a completely different field which may make a given field(s) significantly more competitive than even a year prior. Look at that ~20% decline in people applying to EM last year. You have to think those people decided to flock to other fields.

Match rates for most good schools exceed 97%. You'll match if you apply yourself, it just may not be the speciality you thought you'd be as a pre-med or in your pre-clinical years.

Work hard now and it'll pay off when you apply to match.

Also, I'm jamming some lo-fi now in prep for my exam this afternoon.

 

[GoSpursGo]

it seems like I'm not even guaranteed a job after residency?!

You are guaranteed a job after residency, and a good and well-paying job at that.

You just aren't guaranteed a job in your preferred specialty. If you choose to aim for a highly competitive specialty, that is 100% on you and you are responsible for ensuring that you perform to the level required to get into that specialty. A match rate isn't the end-all-be-all, so you have to be aware of where you lie on the bell-curve for a given specialty before you apply.

 

[Dral]

My guess is this trend will continue, for at least a year or a few, since Step I is going pass fail. Once programs figure out new criteria (likely Step II, but who knows), it could revert back a bit.

Anything can happen. I interviewed for a competitive specialty and didn't match with 15 interviews. Luckily I scrambled into one of the only (maybe the only) spots left that year in the specialty I was going for. Scrambled...that shows my age a bit heh.

Anyway, nothing is promised for sure. However, if you feel strongly about applying for what you want to really do and you have a reasonable application, my thoughts are you still have to go for it while having a good Plan B in place (whatever that may be).

 

[mrbreakfast]

Getting into medical school is the hardest part. The percentage of college freshmen interested in premed who actually get accepted to med school is supposedly in the single digits. Heck, the acceptance rate for people who make it far enough to take the MCAT is something like 40%.

You may be incorrectly assuming that people who don't match into "surgical subspecialty X" don't match at all; in reality, probably 95% of those people match into something else (probably general surgery). You can apply to as many specialties as you want. When I was a medical student, it was extremely common for people applying to competitive specialties to apply to a "back-up" specialty as well.

 

[Lawpy]

Getting into medical school is the hardest part. The percentage of college freshmen interested in premed who actually get accepted to med school is supposedly in the single digits. Heck, the acceptance rate for people who make it far enough to take the MCAT is something like 40%.

You may be incorrectly assuming that people who don't match into "surgical subspecialty X" don't match at all; in reality, probably 95% of those people match into something else (probably general surgery). You can apply to as many specialties as you want. When I was a medical student, it was extremely common for people applying to competitive specialties to apply to a "back-up" specialty as well.

Ok but a 65% match rate among a very highly selected pool of applicants is a problem. Med students are generally far superior to premeds so we can’t just compare those statistics directly like that. A 65% match rate among urology applicants, which itself is heavily self selecting and involves usually the best med students competing against each other, is a problem.

 

[GoSpursGo]

Ok but a 65% match rate among a very highly selected pool of applicants is a problem. Med students are generally far superior to premeds so we can’t just compare those statistics directly like that. A 65% match rate among urology applicants, which itself is heavily self selecting and involves usually the best med students competing against each other, is a problem.

I actually disagree, clearly if 35% are applying and going unmatched, they are not sufficiently self-selecting.

Not that I have any particularly bright ideas on how to help med students weed themselves out from applying to competitive specialties. But it just sort of is a reality that you have to accept if you choose to go for a specialty that you know receives more applicants than has spots.

 

[Dral]

I think we have two discussion points here.

1. We can take all comers applying to med school. Then yes, for any applicants, the numbers say it is more difficult to get into medical school than a urology residency. Now take a superstar in undergrad. It may be more difficult for THAT person to match urology than it was for them to get into medical school. My personal experience was matching residency being the tougher of the two.

2. The self selection issue. I agree that enough self selection isn't happening (again, could be a subacute issue with Step I going P/F around now). How to fix this? Well, it may be difficult for an applicant to know the number of people applying the year they apply. Assuming not much variance from year to year? Well, maybe advisors need to be better informed about numbers and help students adjust expectations accordingly/formulate contingency plans. The disappointing truth is that not everyone who wants to be a urologist gets to be one.

 

[Darrow O'Lykos]

I actually disagree, clearly if 35% are applying and going unmatched, they are not sufficiently self-selecting.

Do you think if they moved to capping # of applications that applicants would be more hesitant to applying to the competitive specialties, or would they more selectively hedge their bets between desired field X and backup field Y?

Not that this matters considering how much money ERA$ makes.

P.S.: Dejounte should've been first-team, but alas he gets his due. #GSG

 

[Wordead]

I was bored and decided to head over to r/medicalschool and I learned that the urology match rate was 65% this year?? Apparently plastic surgery is looking even scarier this year potentially because 400 people are applying for 185 spots. I'm interested in ortho and historically it's an 80% match rate.

This is not really what I thought it would be like after getting into medical school. I was always told that getting into medical school would be the hardest part but it seems like I'm not even guaranteed a job after residency?! This is so scary. I'm sorry if I'm being irrational. I don't know if I should just aim for a noncompetitive specialty just to guarantee myself a position after residency.

Medical schools opening at a very high rate + residency spots expanding very slowly = obvious outcome is obvious

 

[GoSpursGo]

Do you think if they moved to capping # of applications that applicants would be more hesitant to applying to the competitive specialties, or would they more selectively hedge their bets between desired field X and backup field Y?

Not that this matters considering how much money ERA$ makes.

P.S.: Dejounte should've been first-team, but alas he gets his due. #GSG

Idunno about capping apps and honestly haven’t given it a ton of thought. Personally, I have always thought that schools need to do a better job of being honest with students about their competitiveness, maybe even cap the number of students they will support applying to a specific specialty. Of course it sucks to be the gatekeeper that dashes dreams, but it just moves the disappointment up from match day and gives students a chance to avoid SOAPing.

And I hadn’t seen that news—that’s great!

 

[NegativeMargin]

Comparing pre-meds to med students is silly for the reasons mentioned, but in so far as describing the general strategy used which is reflected in the statistics, aren't there obvious trends towards people ranking 20+ programs where that didn't actually used to be the norm? And that being the same with people applying to 20+ med schools and that not being the norm years ago either? And aren't these the strategies being advertised by basically everyone to the students? It's certainly what I'm hearing from everyone.


Isn't this just the result of the culture that's been built up by everyone over the last decade? People talk about educating students on the effectiveness of their self-selection, but just compare an applicant this year to one 10-15 years ago.. An applicant now might rank 15 programs in their dream specialty and 15 more at a less competitive specialty. Compare that to someone 10 years ago who is more "educated" on self selection and only ranks 15 programs for the safe specialty. Even if only 1 or 2 of the 300 surplus applicants for the positions of that residency type end up getting matched there, isn't it worth that extra $1000 for those students? Especially with SOAP now having 4 rounds, and more applicants going unmatched across the board anyway.. why not?

If you wanna talk about self-selection, is there any other group of people in academia more willing to take the long way to living out their dream than these people? Gap years and transitional years are a normalized thing now. Doesn't seem all that crazy that in the midst of all this ambiguity they reach for the same justifications that likely got them into med school to begin with. "I can eventually do what I want to do as long as I am willing to work longer than anyone else."

 

[Dr G Oogle]

Ok but a 65% match rate among a very highly selected pool of applicants is a problem. Med students are generally far superior to premeds so we can’t just compare those statistics directly like that. A 65% match rate among urology applicants, which itself is heavily self selecting and involves usually the best med students competing against each other, is a problem.

I am not sure how much this has to do with issue, but virtual interviews probably are playing a big role. Those unmatched 35% maybe testing the waters in urology since it’s much easier to do interviews at home. Do you have stats from the march? How many interviews did the unmatched folks have? How many other specialties did they apply to? How many interviews per applicant this year compared to 2019?

 

[operaman]

I think it’s obvious what happened to the Urology match: a lot more people applied than the number of positions available. Pretty straightforward if you ask me. Surely some solid applicants are in the unmatched bunch as well as some duds who don’t have any self awareness, but they all knew the odds going in. Sounds like plastics will have a similar experience this year. ENT had a similar rate last year.

Yeah OP if you want competitive fields then be prepared to compete. The increase in Med students overall means more people vying for slots, though many new schools are not going to have any competitive applicants since they lack home programs and other resources needed to match well.

There’s also an ebb and flow to this stuff. When I matched the ent match rate was like 70% or so and I knew people with 260s and solid research who went unmatched. A couple years later our match rates were nearly 100% with a few programs having to soap. Then last year we were back to <70% again. My theory is that after bad years you’ll see faculty steering weaker students away so rates go up, then people think the field is less competitive so they tell students to go for it and then rates plummet again.

 

[DOVinciRobot]

A 65% match rate among urology applicants, which itself is heavily self selecting and involves usually the best med students competing against each other, is a problem.

Why is that a problem? Competitive specialties are, well, competitive. People should expect to compete. As med schools continue to open these numbers will inevitably continue to go down as more and more people think they are competitive for X specialty.. this will help made even worse by P/F Step 1.

OP I advise every applicant to even moderately competitive specialties to have a back up plan, or at least plan for the possibility of not matching.

 

[doctorsharukhan]

By percentages, you're still more likely to match than get accepted to medical school. One school I interviewed at had 8,000 applications for 200 spots. National acceptance %s are still like in the 30s-40s.

The difference now is that you are competing against all the top people that med school admissions teams deemed sufficient. So you really have to dedicate yourself early on to matching into an extremely competitive field. Every couple of years there's always concern about a particular field's future job market, and that may lead others to apply to a completely different field which may make a given field(s) significantly more competitive than even a year prior. Look at that ~20% decline in people applying to EM last year. You have to think those people decided to flock to other fields.

Match rates for most good schools exceed 97%. You'll match if you apply yourself, it just may not be the speciality you thought you'd be as a pre-med or in your pre-clinical years.

Work hard now and it'll pay off when you apply to match.

Also, I'm jamming some lo-fi now in prep for my exam this afternoon.

Med school admissions is very different than applying to residency. Not all med school applicants are worthy/capable (some have the grades but fall short in other areas or vice versa). On the other hand, you could say 85%+ of all ERAS applicants are competent. Some schools receive 8000 applications but only 5500 complete a secondary (some just shoot their shot cuz it's only $150 and that's peanuts to some people).

It's better to look at interviews offered vs matriculant # or look at post-interview acceptance. There was a spreadsheet somewhere and some schools had 20% rate, most seemed to be in the 45-70% range (which is why people say 3 interviews will likely lead to 1 A) and my buddy's DO school at the time had like a 90% post-interview acceptance rate. Some people bail last minute to better schools and in some cases # accepted vs # matriculants may be a better gauge.

My point is that the right applicant (good grades, theme/story aligns with their target med school) is very likely to gain acceptance to that med school. Some med schools have special programs like early decision, and other programs similar to early decision where you essentially "shadow" their med school starting your sophomore or junior year, meet minimal stats (typically cutoffs are lower than their averages) and essentially multiplies your chances. On the other hand curating your med school profile to align with one particular residencies theme doesn't yield the same results.

 

[mrbreakfast]

A 65% match rate among urology applicants, which itself is heavily self selecting and involves usually the best med students competing against each other, is a problem.

How, exactly, is this a problem? Keeping in mind that competitive specialties are competitive because they open the door to scarce jobs - and thus high pay - and keeping in mind that that job market saturation directly influences specialty desirability, and thus how competitive they are (e.g. radiation oncology), what specific problem do you see here?

You say "self-selecting." I don't have good data on the urology match, but among US MDs, the majority of unmatched neurosurgical or orthopedic surgery applicant had Step 1 scores below 240. The idea that only the "best and brightest" apply for these specialties doesn't actually play out in the data.

My point is that the right applicant (good grades, theme/story aligns with their target med school) is very likely to gain acceptance to that med school.

Of course, the exact same argument can be applied to the resident match. The mean ortho matched applicant's Step 1 percentile is a lower percentile than the average med school matriculant's MCAT percentile. I think there's some bias here because every poster here got into medical school, but an enormous number of excellent undergrad students do exactly what you suggest and get into zero med schools. But this is beside the point.


As others here have said: the issue probably rests with medical schools not being straightforward enough with their students about the odds of matching. Looking back, I didn't get a ton of advising about how to pick a specialty, let alone what to expect after matching/graduating from residency. This should probably be a bigger part of med school curricula.

 

[NotAProgDirector]

Other than the weird years of 2018 and 2019, this year was no different than 2015-2017:

App inflation like all other specialties. Interview counts unchanged, match percentage in 2015 was the same 67%.

More people applied for spots than the number available. Just like in musical chairs, someone is always left without a chair.

 

[NotAProgDirector]

I was bored and decided to head over to r/medicalschool and I learned that the urology match rate was 65% this year?? Apparently plastic surgery is looking even scarier this year potentially because 400 people are applying for 185 spots. I'm interested in ortho and historically it's an 80% match rate.

This is not really what I thought it would be like after getting into medical school. I was always told that getting into medical school would be the hardest part but it seems like I'm not even guaranteed a job after residency?! This is so scary. I'm sorry if I'm being irrational. I don't know if I should just aim for a noncompetitive specialty just to guarantee myself a position after residency.

If you go to medical school with the idea that you're going to be ortho/NS/Uro/Plastics etc and it's all-or-none -- if you don't get that field, you don't want to be a physician at all -- then yes, it's a risk. Because there's no guarantee that you'll get one of those fields. But if you go to a US MD/DO program and don't run into major problems, you will get a residency in something. It may not be your first choice, but it can be a great career.

Many people applying to those competitive fields assess their chances, and consider applying to a second field as a back up. Or some decide that if they don't match they will complete a research year and then apply again (usually with a backup the second time).

And I think you misspoke -- you mean a position after medical school in residency. After residency, you're very, very likely to get a position working as a physician. There are a few specialties with issues at present, but those are the exception.

 

[NotAProgDirector]

Looking more deeply at the AUA match results, my summary above is not correct. You need to click into the match report to get the full details.

The data in table above show that the problem isn't interview hoarding or anything like that. The number of interviews seems to be stable. The main problem is the massive increase in MD/DO applicants. Over the last 2 years, there has been an increase of ~100 MD/DO applicants. The past grads and IMG's have stayed about the same. This has made the MD/DO match rate drop from the 90% range to the 70% range. Whether this is from "more of the best candidates picking Uro over other fields" (i.e. increased apps with the same quality) or "more people who previously would not have applied to Uro giving it a go" (i.e. increased apps with a spread in quality, hoping for holistic review) is unknown from the data published.

OK, I'm done talking to myself.

 

[doctorsharukhan]

IMO one should go into med school with the idea that they'll be happy being a general internist, then try for other (more competitive) fields depending on your capabilities. I say that because sometimes people (even smart ones in undergrad) will struggle in med school due to many reasons (mental, distractions, etc), or change their mind about certain specialties down the line.

Lots of derm apps end up IM (just look at IG and the many wanna-be internists with their little botox spas), and many ortho apps turn into anesthesia/rads.

 

[GeneralStCloud]

But if you go to a US MD/DO program and don't run into major problems, you will get a residency in something. It may not be your first choice, but it can be a great career.

This is very encouraging to me. I don't want anything competitive but the large increase in total medical student enrollment has been worrying me. It has been making me second guess starting a DO program this fall due to concern of over saturation when I am up for match in 2026,

 

[Iamnew2]

By percentages, you're still more likely to match than get accepted to medical school. One school I interviewed at had 8,000 applications for 200 spots. National acceptance %s are still like in the 30s-40s.

The difference now is that you are competing against all the top people that med school admissions teams deemed sufficient. So you really have to dedicate yourself early on to matching into an extremely competitive field. Every couple of years there's always concern about a particular field's future job market, and that may lead others to apply to a completely different field which may make a given field(s) significantly more competitive than even a year prior. Look at that ~20% decline in people applying to EM last year. You have to think those people decided to flock to other fields.

Match rates for most good schools exceed 97%. You'll match if you apply yourself, it just may not be the speciality you thought you'd be as a pre-med or in your pre-clinical years.

Work hard now and it'll pay off when you apply to match.

Also, I'm jamming some lo-fi now in prep for my exam this afternoon.

That sounds about right in terms of med school, year I applied to med school had about 7,000 plus applications for about 200 or slightly less spots. Getting in med school is rough but matching super competitive specialties is just as rough just different

 

[NotAProgDirector]

This is very encouraging to me. I don't want anything competitive but the large increase in total medical student enrollment has been worrying me. It has been making me second guess starting a DO program this fall due to concern of over saturation when I am up for match in 2026,

If we look at last year's data:

From Table 7, There were 35194 PGY-1 positions. We remove the PGY-1 only spots (IM, GS, OB, and TY) of which there were 4484 = 30710 categorical positions.

Now add the PGY-2 Advanced positions (since those people would match a prelim and and advanced) = 30710 + 2699 = 33409 positions in the match that are "complete training".

Looking at table 4, we can see the number of applicants:
MD Seniors - 20425
DO Seniors - 7332
Total = 27757

The difference is 5652 more spots than total MD+DO seniors. Even if everyone gets a spot, there are lots left over. There are another ~2500 prior grads - presumably most didn't match into something complete the prior year so we should not count them twice (a small number are swicthing fields, but even then that opens spots for someone else). This also doesn't include postions in other matches (Military, SF, AUA, etc).

The remainder are filled by IMG's. There's plenty of room for DO school growth, you're not going to get squeezed out.

If we got to a situation that MD or DO students were regularly being excluded by IMG's, I expect that there would be widespread outcry and concern, and someone would change the system. We are a very long way from that.

 

[GeneralStCloud]

There's plenty of room for DO school growth, you're not going to get squeezed out.

I hope you understand how much you are appreciated by people in my position.

 

[SlitLampExam]

Personally, I have always thought that schools need to do a better job of being honest with students about their competitiveness, maybe even cap the number of students they will support applying to a specific specialty. Of course it sucks to be the gatekeeper that dashes dreams, but it just moves the disappointment up from match day and gives students a chance to avoid SOAPing.

And I hadn’t seen that news—that’s great!

I disagree. My chairman was totally unhelpful. If I listened to his staff, I would take the 4th year elective in February or March, after the match because there wasn't room for me, selecting the elective late (start of 4th year). If I listened to the chair, I would have no recommendation letters because he refused to write one after my elective, saying he didn't see patients with me on a daily basis.

My back up specialty had a vice chairman that was good and bad. Good in that he showed me his proposed recommendation letter. Bad in that the letter was a bad letter. It said that I don't have the personality of a surgeon. What is that supposed to mean? Not a bully? After all, I showed up very early and pre-rounded the patients, wrote notes, volunteered to do stuff for patient care (like getting labs, etc.). So gatekeeper setups are not necessarily good.

The bottom line is to self evaluate your competitiveness, do the best you can (like know the material and the patients' data), seek mentors, have a back up specialty, don't sell yourself short.

(The positive part of the story was that 2 part time faculty agreed to let me do a 4th year specialty rotation in August of the 4th year, one of them writing a good recommendation and that I got into a decent residency in a competitive specialty).

 

[AnesthesMD]

I was bored and decided to head over to r/medicalschool and I learned that the urology match rate was 65% this year?? Apparently plastic surgery is looking even scarier this year potentially because 400 people are applying for 185 spots. I'm interested in ortho and historically it's an 80% match rate.

This is not really what I thought it would be like after getting into medical school. I was always told that getting into medical school would be the hardest part but it seems like I'm not even guaranteed a job after residency?! This is so scary. I'm sorry if I'm being irrational. I don't know if I should just aim for a noncompetitive specialty just to guarantee myself a position after residency.

Don’t forget about the tough road to get board certified either… some specialty boards are much more greedy and malignant than others. Being a doctor nowadays is tough. I retired my license in TN because of the extra $400/year privilege tax despite me never practicing in that state… and they’re still demanding their money… I gotta pay it because it’s the IRS. I wish we would unionize. I don’t know what the future of medicine holds but as more and more insurance companies demand and reimburse more for corporately managed practices over self-employed doctors and doctor groups the future really looks bleak.

 

[notretired]

How, exactly, is this a problem? Keeping in mind that competitive specialties are competitive because they open the door to scarce jobs - and thus high pay - and keeping in mind that that job market saturation directly influences specialty desirability, and thus how competitive they are (e.g. radiation oncology), what specific problem do you see here?

I'll bite. It's a problem because the only people who win in the competitive matching bubble are the folks profiting off med student neuroticism and free labor. Research years, qbanks, practice exams, away rotations ~ all cost time and money but where's the evidence that it produces better doctors? There shouldn't be a scarcity of good/well-paying jobs in highly needed fields like primary care, yet here we are with pediatricians making annually what a neurosurgeon makes quarterly. This isn't an argument to doc the pay of highly specialized fields, but rather establish better pay parity overall, and drastically reduce tuition. I can't think of many specialties that are overpaid, but plenty that are underpaid.

The sad thing is, med students and physicians alike are too busy competing amongst each other to realize how much they're losing to the system. So sure, bust your a** to go into uro, ortho, derm, or whatever the flavor of the month is right now, but atleast acknowledge what a ridiculous/artificial competition it is to begin with. Tell your non-medicine friends being a d*** doctor is the most competitive field in medicine and they'll look at you sideways.

 

[mrbreakfast]

There shouldn't be a scarcity of good/well-paying jobs in highly needed fields like primary care, yet here we are with pediatricians making annually what a neurosurgeon makes quarterly.

Neurosurgeons always will - and should - get paid many times what a PCP does. There is no system where they'd be remotely close, because there are plenty of people (including non-physicians) who can tell you to eat healthy, stop smoking, and help control your blood pressure and blood sugar, but very, very few people who can remove a tumor from your spine without killing you, let alone paralyzing you. Ask yourself how much money you'd be willing to pay, cash, for an annual PCP visit, keeping in mind that the average SDN poster is probably many times more affluent than the average American. How much in cash would you be willing to pay for a life-saving operation?

You can argue that PCPs ought to get paid more, yet no one's actually willing to pay them more for their services. You can argue that that's a fundamental issue with our healthcare system, but - to my knowledge - no one's found a better solution as of yet than replacing FM docs with NPs, and at this point of the conversation, we're pretty far from the original topic of specialty competitiveness.

 

[NegativeMargin]

Meandering into specialty specific threads reveals there is plenty to be made in rvu compensation systems when approached from the goal of making more money, regardless of where one works, but I certainly can't speak to that in any informed way. It just seems obvious that with the way our healthcare system is set-up, the nature of the physician-making pipeline, and pressures already pushing for more midlevel providers, the cards are just not in PCPs favor, especially in urban areas.

I do think there are parallels to draw between this issue and specialty competitiveness, however.

What's being discussed are pipelines that lead people to tend toward certain behaviors. With so many for-profit med schools springing up, and competitiveness rising in the match, it may not benefit the rats running the race, but it does seem like a self-limiting concern. The answer to needing more PCPs and more physicians is to continue watching more mid-levels push, continue to watch the trend of med-schools gathering more students, and continue watching as residencies cannot rise to meet that need. The excess students, especially from low level DO schools and Caribbean's, who are not competitive anyway, will have to go primary care; the pressure in general will (and already is) causing physicians to speak their case backed by statistics about how unsupervised mid-levels do not benefit any party, and my guess: PCPs who already manage 20+ patients a day will now have to manage 5x that amount and 5 mid-levels who they oversee, squeezing PCPs even further, but providing the space needed for everyone else to breathe?

I must be too naïve to get this, but I don't really see the problem with that picture. Given the circumstances, I will get my shot to compete and end up where that performance leads me, making enough money to support my family in the process. I do not have total freedom in any of these choices, but that is the bill of goods as it was described before I made this investment. To draw the line to the OP even more clearly, the answer is not that we are deterred, it is that we know the odds are ever against us. For those of us with enough life-perspective to be cognizant of these factors, we'll apply more broadly, take out more loans, and brace for impact.

 

[notretired]

Neurosurgeons always will - and should - get paid many times what a PCP does.

Ok, but should a pediatric neurosurgeon make less than adult per RVU? Should a pediatric cardiologist make less than an adult cardiologist? Should a derm make more than a pathologist? My point is that a lot of it is fairly arbitrary, and specialty competitiveness is similarly arbitrary. The "competitive specialties" in the early 2000's didn't require 20 research experiences to match into, and the mean step 1 in the early 2000's was around ~215, are these doctors not as good as the doctors who are graduating today? I doubt it. The only people winning are those requiring others to do more fluff and busy work to get to the same endpoint.

 

[DOVinciRobot]

The "competitive specialties" in the early 2000's didn't require 20 research experiences to match into, and the mean step 1 in the early 2000's was around ~215, are these doctors not as good as the doctors who are graduating today? I doubt it. The only people winning are those requiring others to do more fluff and busy work to get to the same endpoint.

The only reason those numbers have increased is the ever increasing number of medical students. The rapid expansion of medical schools has bloated the application pool.

Ok, but should a pediatric neurosurgeon make less than adult per RVU? Should a pediatric cardiologist make less than an adult cardiologist? Should a derm make more than a pathologist?

Honestly this is irrelevant.

 

[notretired]

The only reason those numbers have increased is the ever increasing number of medical students. The rapid expansion of medical schools has bloated the application pool.

Agreed; although factors inherent to the match like over application, and drastic differences in lifestyle and pay between specialties likely exacerbate them.

Honestly this is irrelevant.

My point was the arbitrary nature of reimbursement, and how it is subject to change w/minimal recourse from physicians. Do pediatric surgeons feel like they should be paid less than their adult counterparts? I doubt it, but the powers that be make the rules, and if they decide to slash reimbursements across the board, physicians in general seem far too preoccupied with justifying why they should make more than Joe from pediatrics than mounting an offense against everyone getting screwed.

 

[DOVinciRobot]

physicians in general seem far too preoccupied with justifying why they should make more than Joe from pediatrics than mounting an offense against everyone getting screwed.

I don’t know a single physician in real life preoccupied with that. Everyone is preoccupied with how corporate healthcare is screwing over physicians everywhere.

Agreed; although factors inherent to the match like over application, and drastic differences in lifestyle and pay between specialties likely exacerbate them.

Again, that comes back to ever increasing numbers of applicants. The differences in lifestyle and pay are inherent to the nature of different specialties.

Competitive specialties are competitive. No one is owed a spot in any specialty and this idea that the level of competition in certain specialties is “a problem” is frankly absurd.

 

[notretired]

Competitive specialties are competitive. No one is owed a spot in any specialty and this idea that the level of competition in certain specialties is “a problem” is frankly absurd.

At a certain point it does become pretty absurd, because the "competition" in this case is who is willing to waste the most time on fluff EC's, churning out tons of low quality research, and doing 10k MCQ's, which doesn't make better doctors, but makes people good at doing monotonous tasks of limited relevance. If someone has evidence that # of pubs and volunteerism is associated with better resident performance and patient outcomes I'd love to see it.

 

[DOVinciRobot]

At a certain point it does become pretty absurd, because the "competition" in this case is who is willing to waste the most time on fluff EC's, churning out tons of low quality research, and doing 10k MCQ's, which doesn't make better doctors, but makes people good at doing monotonous tasks of limited relevance. If someone has evidence that # of pubs and volunteerism is associated with better resident performance and patient outcomes I'd love to see it.

Red herring. No one said those things make better residents/doctors. You have to cull the ever increasing application herd somehow.

One may argue those things simply represent dedication to a specialty, which IS important to residency programs.

But for the 3rd time, all of this is driven by the simple factor of applicants/# of spots in these specialties. The numerator in that equation is constantly increasing. And no one is owed anything, so if programs want you to publish more for them to consider you competitive then, instead of squawking about how it doesn't lead to better doctors, then I suggest you publish (general "you")

 

[notretired]

And no one is owed anything, so if programs want you to publish more for them to consider you competitive then, instead of squawking about how it doesn't lead to better doctors, then I suggest you publish

In 5yrs when you're done with residency this could very well be:

And no one is owed anything, so if admin wants you to work more to consider giving you the same salary, instead of squawking about it, I suggest you just do it

 

[Lem0nz]

In 5yrs when you're done with residency this could very well be:

And no one is owed anything, so if admin wants you to work more to consider giving you the same salary, instead of squawking about it, I suggest you just do it

Not even remotely related, lol. If admin wants you to work more for the same amount of money you walk and find a new job. Though I guess it may be an apt analogy - if you don't want to do the work to get into a competitive specialty, walk and find a different specialty.

 

[mrbreakfast]

Ok, but should a pediatric neurosurgeon make less than adult per RVU? Should a pediatric cardiologist make less than an adult cardiologist? Should a derm make more than a pathologist? My point is that a lot of it is fairly arbitrary

Yes to all, for the same reasons mentioned above. Doctors don't get their salaries for being knowledgeable, they get it based on what they can bill for; they're effectively mechanics for the body. None of this is arbitrary. That answers every question that asks "why does X make more than Y?"

For the med students reading this, I'd strongly recommend learning as much as you can about the actual "job" of being a doctor as you can before picking a specialty, because being able to bill for services that other medical professionals can't is the entire reason people will hire you.

In 5yrs when you're done with residency this could very well be:

And no one is owed anything, so if admin wants you to work more to consider giving you the same salary, instead of squawking about it, I suggest you just do it

Though unrelated, this statement serves as an excellent point as to why in-demand specialties are competitive: the "hot" specialties can just walk out the door and into a new job that'll pay them what they want.

 

[Ho0v-man]

At a certain point it does become pretty absurd, because the "competition" in this case is who is willing to waste the most time on fluff EC's, churning out tons of low quality research, and doing 10k MCQ's, which doesn't make better doctors, but makes people good at doing monotonous tasks of limited relevance. If someone has evidence that # of pubs and volunteerism is associated with better resident performance and patient outcomes I'd love to see it.

Your point seems to be a little different from post to post. But overall you seem upset with using our current metrics for resident selection. I don’t necessarily disagree with you.

Do you have a suggestion for how we should better stratify applicants? Because taking this “fluff” away just makes these specialties go to people from the most prestigious schools.

 

[notretired]

Your point seems to be a little different from post to post. But overall you seem upset with using our current metrics for resident selection. I don’t necessarily disagree with you.

Do you have a suggestion for how we should better stratify applicants? Because taking this “fluff” away just makes these specialties go to people from the most prestigious schools.

Yeah I think you caught the drift, I think it's general frustration with feeling like the things I'm putting my time into are not really benefiting my development in becoming a physician.There's a couple of great doctors who I've shadowed who encourage interviewing pts, coming up w/differentials/plans, and presenting them for feedback w/o the pressure of third yr grades etc. It's been immensely helpful in solidifying pre-clinical didactics but there's only so much time and it comes at the expense of building up an ERAS app.

I think the fluff should be largely replaced w/performance on Sub-I's + SLOE type system like what is used in EM. I think people should understand that maybe with the exception of derm, med school prestige plays more of a role in dictating where you match as opposed to what specialty you can match into. Even prior to the step 1 change incest amongst the top 20 programs was readily apparent. As someone who wouldn't have gotten into med school w/o the benefit of a high mcat, I was pretty against the p/f change, until I saw what made up a significant portion of the material on step1.

Now that step1 is p/f I think students will just shift that time into EC's and research, which doesn't really change anything because it still means time away from actually learning medicine. I think selection for the job should most heavily weight performance of the job itself, and the SLOE system seems to be a reasonably objective way of doing this.

 

[Lawpy]

You have to cull the ever increasing application herd somehow.

The answer is enforcing caps, whether application or interview caps

 

[NotAProgDirector]

Yeah I think you caught the drift, I think it's general frustration with feeling like the things I'm putting my time into are not really benefiting my development in becoming a physician.There's a couple of great doctors who I've shadowed who encourage interviewing pts, coming up w/differentials/plans, and presenting them for feedback w/o the pressure of third yr grades etc. It's been immensely helpful in solidifying pre-clinical didactics but there's only so much time and it comes at the expense of building up an ERAS app.

I think the fluff should be largely replaced w/performance on Sub-I's + SLOE type system like what is used in EM. I think people should understand that maybe with the exception of derm, med school prestige plays more of a role in dictating where you match as opposed to what specialty you can match into. Even prior to the step 1 change incest amongst the top 20 programs was readily apparent. As someone who wouldn't have gotten into med school w/o the benefit of a high mcat, I was pretty against the p/f change, until I saw what made up a significant portion of the material on step1.

Now that step1 is p/f I think students will just shift that time into EC's and research, which doesn't really change anything because it still means time away from actually learning medicine. I think selection for the job should most heavily weight performance of the job itself, and the SLOE system seems to be a reasonably objective way of doing this.

Do you really think that SubI / SLOE is objective? If we're going to use them to stratify, then you need a spectrum of performance -- if everyone is labeled "exceptional" or "top 10%" then that's not helpful at all. And there's lots of evidence that being evaluated by someone else is often highly biased by that person's preconceived notions, or by the evaluatee's extroversion. And if we take the prominence of the person making the recommendation into account, then we're back to "prestige".

Not to mention that if you complete your SubI and get an "average" performance back, it's much too late to do anything about that now.

 

[notretired]

You'd know more than me, but wasn't the point to attempt to objectify an inherently subjective thing? And if it's all bunk anyway because everyone is "exceptional" then why use it all?

And there's lots of evidence that being evaluated by someone else is often highly biased by that person's preconceived notions, or by the evaluatee's extroversion.

Wouldn't these same issues present in interviews?

 

[solitarius]

Average and below-average medical students can get into EM/IM/FM/Peds.

Above average medical students cannot necessarily get into surgical specialties.

 

[mrbreakfast]

I think the fluff should be largely replaced w/performance on Sub-I's + SLOE type system like what is used in EM

I mean, this already exists in all the competitive specialties (as effectively-mandatory away rotations).

And sub-I is more of a rite of passage - everyone is expected to "perform near/at the level of an intern." Most people can't do this, but they typically get a generic rubber-stamped pass anyway. What program would take someone who performed "below average" on their sub-i? There was a person in my med school class who did their sub-I as an away rotation. Their single evaluator evaluated them as an intern, and thus roasted them on their evaluation. They had to withdraw from the match.

There's no easy solution, but short of implementing a national standardized something for each specialty, I think we're stuck with what we've got for now.

 

[jstwannagraduaaate!!!]

No one is entitled to any field, but to say that is has not become insane to match into one of these "competitive" fields is living in denial. It is a norm now to do a research year for derm and other surgical subspecialties lol, thats crazy imo. The only way this is fixed would be to reimburse the "less" competitive fields more. We are seeing this sort of with psyc, as thats a field where you can set up shop and charge $ only. The disparity between high paying fields (surg subs, derm, and rads) is just going to grow even more unless reimbursement structure is changed (which I doubt happens).

 

[DOVinciRobot]

No one is entitled to any field, but to say that is has not become insane to match into one of these "competitive" fields is living in denial.

No one has said it’s not extremely competitive to match one of these specialties. Many (most?) of us just don’t see it as a problem. Med school is only a guarantee to becoming a doctor, it’s not a guarantee to which type. That’s completely on you.

Again, none of those things would be expected of applicants if there wasn’t an ever increasing pool of applicants from med school seat inflation.

 

[jstwannagraduaaate!!!]

No one has said it’s not extremely competitive to match one of these specialties. Many (most?) of us just don’t see it as a problem. Med school is only a guarantee to becoming a doctor, it’s not a guarantee to which type. That’s completely on you.

Again, none of those things would be expected of applicants if there wasn’t an ever increasing pool of applicants from med school seat inflation.

It is not beneficial at all to the medical system to have students take a year off to get one of these competitive fields, but if that's what it takes then so be it. You can make the same $ in other less sought-after fields with a good business sense. I do think that it highlights the problem of med school class expansion and the fact that primary care fields are becoming less desirable.