Why are some residencies more competitive than others?

[xnfs93hy]

The title is pretty much my question. And lets say someone really wants to match into NS or Orthopedic Surgery and they don't match, can they just apply next year or is that it? I just don't understand why some of these residencies are so competitive, or why there are so few slots.

What if you want to have a sub-specialty in spine? I imagine that is even more difficult...?

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[tennisball80]

There are a number of other factors too.

But Jeff, you should know this. You are good at this.

M O N E Y

Orthopedic surgeons make $296,200 to $488,966 a year on average.

http://www.aamc.org/students/cim/pub_orthopaedicsurgery.htm

 

[MilkmanAl]

True. Lifestyle also plays a big role.

 

[yaah]

You can get at competitiveness partially with the "supply and demand" data. Some residencies have fewer training programs, thus low supply. These are often more competitive, if only because there are fewer spots. Some residencies have few spots but proportionally fewer applicants, so the competitiveness is the same.

In other cases, there are simply more applicants who want to do it. If 1000 people want to do dermatology and 1000 people want to do family medicine, but there are only 100 dermatology spots and 600 family medicine spots (these are made up numbers), then dermatology will be more competitive. Competitive applicants also often self-select for more competitive residencies, so that increases it more.

As to why certain specialties get more competitive and greater numbers of people applying to them, it generally comes down to 1) potential compensation and/or 2) lifestyle. There are other factors which play a role, a lot of it depends on the individual. Many people will say that their interest in a certain specialty transcends certain lifestyle concerns like money and lifestyle, but alas, that makes little difference because EVERYONE will say that their interest transcends money and lifestyle concerns.

 

[Law2Doc]

There are a number of other factors too.

But Jeff, you should know this. You are good at this.

M O N E Y

Orthopedic surgeons make 600k+ a year on average.

The average salary you quote for ortho is not close to accurate (your figure is way too high for the average), but the basic concept is right. Some combo of salary, lifestyle and number of slots available dictates how competitive a residency is. Dermatology has fewer slots but offers a nice income and high salary. Hence it is competitive. Primary care fields have a ton of spots and the lifestyle and salary are not so impressive so it they tend not to be competitive.

 

[tennisball80]

The average salary you quote for ortho is not close to accurate (your figure is way too high for the average), but the basic concept is right. Some combo of salary, lifestyle and number of slots available dictates how competitive a residency is. Dermatology has fewer slots but offers a nice income and high salary. Hence it is competitive. Primary care fields have a ton of spots and the lifestyle and salary are not so impressive so it they tend not to be competitive.

Thanks for correcting me.

 

[Law2Doc]

... And lets say someone really wants to match into NS or Orthopedic Surgery and they don't match, can they just apply next year or is that it? I just don't understand why some of these residencies are so competitive, or why there are so few slots.

There is a stigma to not matching, and it makes it a lot harder to get what you want in subsequent matches. So if you aren't competitive, you are often advised to hold off on entering the match and make yourself more competitive, typically spend a year doing targetted research in something specialty specific, maybe get another advanced degree (MPH), and then try the match at a later date. It's best to take one shot and make it count, rather than not match and reapply. Also once you do enter the match, if you didn't get what you applied for, you more typically would try to scramble into something preliminary/transitional (or actually rank these things lower on your list and hopefully not scramble at all) and then try again thereafter with some residency experience. But no, you don't say I'm going to do ortho or neurosurg and keep entering the match until I get it. The match should be a one time thing unless you seriously miscalculate.

 

[Law2Doc]

Thanks for correcting me.

The average for ortho listed in JAMA a few years back was about $320k. http://www.medfriends.org/specialty_hours_worked.htm . And physician incomes have been flat and lagged behind inflation since then so that number should still be in the ballpark (most of the figures listed there are within $50k of accurate).

 

[xnfs93hy]

There is a stigma to not matching, and it makes it a lot harder to get what you want in subsequent matches. So if you aren't competitive, you are often advised to hold off on entering the match and make yourself more competitive, typically spend a year doing targetted research in something specialty specific, maybe get another advanced degree (MPH), and then try the match at a later date. It's best to take one shot and make it count, rather than not match and reapply. Also once you do enter the match, if you didn't get what you applied for, you more typically would try to scramble into something preliminary/transitional (or actually rank these things lower on your list and hopefully not scramble at all) and then try again thereafter with some residency experience. But no, you don't say I'm going to do ortho or neurosurg and keep entering the match until I get it. The match should be a one time thing unless you seriously miscalculate.

Are all surgical specialties competitive (I hope I said that correctly)? What makes someone a competitive candidate for competitive slots?

 

[PeepshowJohnny]

Are all surgical specialties competitive (I hope I said that correctly)? What makes someone a competitive candidate for competitive slots?

Yep, pretty much every surgical subspeciality range from either very competitive (Ortho, Urology, Ophtho, Neurosurgery) to extremely competitive (Catergorical Plastics and ENT).

Even Gen Surg is far from a slam dunk to match into.

The same things make you competitive for surgery residencies as others (High Step 1, good clerkship grades/Deans letter). However, surgery fields seem to value feedback from surgeons especially so strong LORs from people in the field (or chairman/pds) help a great deal.

 

[Law2Doc]

Yep, pretty much every surgical subspeciality range from either very competitive (Ortho, Urology, Ophtho, Neurosurgery) to extremely competitive (Catergorical Plastics and ENT).

Even Gen Surg is far from a slam dunk to match into.

The same things make you competitive for surgery residencies as others (High Step 1, good clerkship grades/Deans letter). However, surgery fields seem to value feedback from surgeons especially so strong LORs from people in the field (or chairman/pds) help a great deal.

If you do "ok" in a US allo med school and the boards, and the surgeons like you, you will likely get a general surgery residency someplace. There are a lot of slots, and a lot of med students are put off by the lifestyle. By contrast some of the specialties that PSJ mentioned above require you to be a superstar.

 

[xnfs93hy]

If you do "ok" in a US allo med school and the boards, and the surgeons like you, you will likely get a general surgery residency someplace. There are a lot of slots, and a lot of med students are put off by the lifestyle. By contrast some of the specialties that PSJ mentioned above require you to be a superstar.

What do you mean by superstar, and what specialties in particular?

EDIT: But don't general surgeons get compensated pretty well though? Why does the lifestyle suck so bad?

 

[PeepshowJohnny]

What do you mean by superstar, and what specialties in particular?

EDIT: But don't general surgeons get compensated pretty well though? Why does the lifestyle suck so bad?

Superstar is a common term med students bat around for some reason. Usually means someone who excells in pretty much every area that people care about in medicine: Great grades/boards scores, attendings/residents love him so he's got glowing recommendations, has strong research background, great patient manner, has connections/comes from a name program. And no blemishes on their record.

I'd say that Categorical plastic surgery and ENT like to recruit superstars. You don't have to be one, but you're going to be competing against them.

General surgeons do get compensated "well" but if you ratio it to the time they put in, they do worse than fields like Radiology, Derm, Emergency med, anesthesiology. I think their lifestyle is so bad because that's how the field wants it. They've been very resistant to changes toward shift work seen in fields like Internal Medicine with hospitalists. It takes a very specific kind of person to be a general surgeon, something the field prides itself on very much.