MD & DO When do you think STEP1 grading changes will take effect?

[deleted870424]

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Hi all! Alot of people that I know (including me) are taking STEP1 this Spring. Do you think there is any way the grade changes that they recommend this Winter will take effect by then? My head says no, but my anxious medical student mind is nagging me. Thoughts?

 

[efle]

This is total speculation, but my guess would be formal recommendation this winter, USMLE response will take months and would precede any actual change by at least an entire year, so the ERAS of late 2021 at the soonest. The earliest anybody should care about this would be the current MS1s that just started school

 

[Prince090]

Nothing is gonna happen. They had similar meeting a decade back and nothing happened..

Unless these guys bring a better and objective system , they can't replace the current system.

 

[efle]

Nothing is gonna happen. They had similar meeting a decade back and nothing happened..

In the 2000s, competitive things like surgical subspecialties still had average step scores in the 230s and people only applied to a couple dozen programs. The modern environment with a ~250 target score, 70+ programs applied to, and step screening as a major way to weed down the applicant pool, is all a positive feedback loop that has only popped up in the time since their last evaluation of scoring. Not to mention the whole preclinical hijacking that is also newer, with resources like Boards and Beyond, Pathoma, or Zanki coming out in the last ~5 years and essentially supplanting the whole curriculum for a lot of students who realize their priority in life now has to be board scores.

I doubt they'll make the full jump to Pass/Fail, but something like a shift to reporting quartiles is going to have a lot better chance now than a decade ago

 

[Prince090]

In the 2000s, competitive things like surgical subspecialties still had average step scores in the 230s and people only applied to a couple dozen programs. The modern environment with a ~250 target score, 70+ programs applied to, and step screening as a major way to weed down the applicant pool, is all a positive feedback loop that has only popped up in the time since their last evaluation of scoring. Not to mention the whole preclinical hijacking that is also newer, with resources like Boards and Beyond, Pathoma, or Zanki coming out in the last ~5 years and essentially supplanting the whole curriculum for a lot of students who realize their priority in life now has to be board scores.

I doubt they'll make the full jump to Pass/Fail, but something like a shift to reporting quartiles is going to have a lot better chance now than a decade ago

That is the key thing. Scoring system might change but there will be ways to differentiate low , medium and high performance. Pass/Fail system doesn't work.

 

[Lawpy]

This is total speculation, but my guess would be formal recommendation this winter, USMLE response will take months and would precede any actual change by at least an entire year, so the ERAS of late 2021 at the soonest. The earliest anybody should care about this would be the current MS1s that just started school

Could I get tagged when the formal recommendation gets announced? Because until then, the discussions are pointless with usual arguments as to why Step should or shouldn't be pass/fail. The formal recommendation is critical as it could be game-changing

 

[ace_inhibitor111]

In the 2000s, competitive things like surgical subspecialties still had average step scores in the 230s and people only applied to a couple dozen programs. The modern environment with a ~250 target score, 70+ programs applied to, and step screening as a major way to weed down the applicant pool, is all a positive feedback loop that has only popped up in the time since their last evaluation of scoring. Not to mention the whole preclinical hijacking that is also newer, with resources like Boards and Beyond, Pathoma, or Zanki coming out in the last ~5 years and essentially supplanting the whole curriculum for a lot of students who realize their priority in life now has to be board scores.

I doubt they'll make the full jump to Pass/Fail, but something like a shift to reporting quartiles is going to have a lot better chance now than a decade ago

Back in 2000, the average step score was 215 with a standard deviation of 20, today its 230 with a standard deviation of 20. So a 235 would be about equal to a 250 in terms of percentile based on that.

The ‘positive feedback loop’ is due mainly to increased numbers of medical students, not board scores. Think about why certain specialties are so highly desired. Ortho and ENT are by all accounts better rewarded and have better lifestyle than Gen Surgery. Derm is also just better than IM in terms of lifestyle and pay. Why do they have such an advantage? Because they historically limited the amount of residencies. Any increase in number of competitors results in a substantial decrease in reward and lifestyle. The emphasis on boards is just a symptom, not the problem.

 

[Chibucks15]

Back in 2000, the average step score was 215 with a standard deviation of 20, today its 230 with a standard deviation of 20. So a 235 would be about equal to a 250 in terms of percentile based on that.

The ‘positive feedback loop’ is due mainly to increased numbers of medical students, not board scores. It’s also driven by how much better certain specialties are. Ortho and ENT are by all accounts better than Gen Surgery with less BS involved. Derm is just better than IM in terms of lifestyle and money. Why are they better? Because they historically limited the amount of residencies. Any increase in number of competitors results in a substantial decrease in reward and lifestyle, end of story.

Yes but there’s a reason the residencies were limited. Is there really THAT huge of a need for a massive expansion of dermatologists? (Just an example not dumping on them). There’s inherently more of a need for IM, hence more spots, hence less competition and less pay.

 

[efle]

Back in 2000, the average step score was 215 with a standard deviation of 20, today its 230 with a standard deviation of 20. So a 235 would be about equal to a 250 in terms of percentile based on that.

It was the late 2000s the last time they considered this topic, when the USMLE distribution was much closer to now (average of like 221-222 vs 228), but specialties like Ortho still only had averages of ~235. Percentile wise, it's been a huge shift, from needing top ~1/3rd to hit the average a decade ago to top ~1/8th now.

 

[mistafab]

I hope for all ya'lls sake that it never changes. More pressure on step 2CK will just make life more stressful.

 

[ScreamingInternally]

I hope for all ya'lls sake that it never changes. More pressure on step 2CK will just make life more stressful.

Seriously this. If they get rid of one thing which residencies across the nation use to compare students, there will simply be another things that pops up to replace it. In this case, CK is already becoming increasingly important but at least it provides a way out for people with bad Step1 to redeem themselves. If they take away S1, itll put a huge amount of importance on Step2. Beyond that, itll make things like pubs, reputation of med schools, maybe even taking an early step3 more important across the board so as to create a better metric on how to compare applicants. There are too many people applying for them to not somehow filter this stuff, S1 is an easy way to filter, simple as that.

 

[BorderlineQueen]

Yes but there’s a reason the residencies were limited. Is there really THAT huge of a need for a massive expansion of dermatologists? (Just an example not dumping on them). There’s inherently more of a need for IM, hence more spots, hence less competition and less pay.

In terms of derm they limit the number of residences to keep pay high. Even though some people have to wait 4-6 months to see a dermatologist . It’s supply and demand the fewer the dermatologist the better for dermatologists in terms of pay. Around 8,000 dermatologists in the USA compared to 209,000 pcps. It’s all about lifestyle and money also derm is M-F 9-5 no call and around 450-500k per year. Compared to IM where lifestyle and pay aren’t that great. If IM had pay and life style like derm it would become more competitive. Also in general the residency bottleneck benefits every specialty if we had more physicians pay would go down.

 

[Dr. Doctor MD]

In terms of derm they limit the number of residences to keep pay high. Even though some people have to wait 4-6 months to see a dermatologist . It’s supply and demand the fewer the dermatologist the better for dermatologists in terms of pay. Around 8,000 dermatologists in the USA compared to 209,000 pcps. It’s all about lifestyle and money also derm is M-F 9-5 no call and around 450-500k per year. Compared to IM where lifestyle and pay aren’t that great. If IM had pay and life style like derm it would become more competitive. Also in general the residency bottleneck benefits every specialty if we had more physicians pay would go down.

You are literally wrong in so many regards.

1) Very few people wait 4-6 months except in BF nowhere
2) Numerous large cities are saturated with dermatologists and you can get next day appointments
3) There has been no effort to restrict derm residencies
4) There has been massive dermatology expansion of residencies
5) This expansion of residencies has been the same pace as Rad Onc one of the most notorious specialties for over-expansion
6) Derms absolutely have call, period. Not bad call, but definitely still call.
7) Average derm is nowhere near 450k-500k unless you are in the midwest where it actually does take 3 months to get an appointment.
8) We need 20x more PCPs than dermatologists since EVERY patient should have a PCP while only a small portion of the population needs dermatological care. Expecting the number of derms to come anywhere close to the number of PCPs is ridiculous.
9) FM has a much more robust job market than dermatology as you can work primary care even in the most saturated of cities. Good luck getting a dermatology job in Boston, San Francisco, NYC.

Your post is misinformed in it's entirety.

 

[BorderlineQueen]

You are literally wrong in so many regards.

1) Very few people wait 4-6 months except in BF nowhere
2) Numerous large cities are saturated with dermatologists and you can get next day appointments
3) There has been no effort to restrict derm residencies
4) There has been massive dermatology expansion of residencies
5) This expansion of residencies has been the same pace as Rad Onc one of the most notorious specialties for over-expansion
6) Derms absolutely have call, period. Not bad call, but definitely still call.
7) Average derm is nowhere near 450k-500k unless you are in the midwest where it actually does take 3 months to get an appointment.
8) We need 20x more PCPs than dermatologists since EVERY patient should have a PCP while only a small portion of the population needs dermatological care. Expecting the number of derms to come anywhere close to the number of PCPs is ridiculous.
9) FM has a much more robust job market than dermatology as you can work primary care even in the most saturated of cities. Good luck getting a dermatology job in Boston, San Francisco, NYC.

Your post is misinformed in it's entirety.

You didn't realize at all what I'm arguing
1. People with poor insurance have to wait months to see dermatologist. 40% of patients reported waiting 1-6 months to see a dermatologist Long Wait Times in Dermatology Harm Patient Experience, Safety
2. Large cities are different than the suburbs and rural areas.
3. Yes corporate places can open residencies but the residency bottleneck still exists.
4. Still only around 9,600 dermatologists in the USA. https://www.harriswilliams.com/system/files/industry_update/dermatology_market_overview.pdf
6. Maybe in academic but in PP you can choose if you want call or not.
7. Medscape puts derm at 419k Medscape: Medscape Access.
8. I never said we need 209,000 dermatologists. I only said that's why derm salary is high because of supply and demand.
9. Supply and demand everyone wants to live in cities. Same thing in EM doctors can't find jobs in cities but need to find jobs in the suburbs. Everyone and their mother wants to live and work in a city.