"Why doing a PhD is often a waste of time"

[Neuronix]

Also, I just skimmed the thread and I'm not sure if taken into account, but the rate of 1 in 20 not matching, at least in my program, correlates about to the number that choose not to do residency because they'd much rather do a postdoc than ever do clinical again.

Please read before posting.

That table and my extrapolated data counts only match applicants from their senior year in medical school/combined degree program.

Though your observation may correlate to one of my favorite quotes:

From my own experience (and others at my MSTP program), "Post-doc" is code for "did not match" in most cases.

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[Watson104]

:
Originally Posted by calvinNhobbes
From my own experience (and others at my MSTP program), "Post-doc" is code for "did not match" in most cases.

I used to think so. Now that I've been around for awhile and actually know the last 3-4 in my program that go "post-doc," they never wanted to do clinics again, never did an interview or entered the match, and one had to be talked out of not completing the MD.

What I now see as code for "did not match" are those orphan prelim years that people usually scramble into in obscure locations or even home locations.

 

[Neuronix]

That's true. I do know some people who could have easily matched into pathology, but hated clinical medicine enough that they didn't even want to do path. That's reasonable. My favorite was the one graduate who went straight into industry. He was still listed as post-doc on the match list

 

[Neuronix]

In every medical school, you're going to have the bottom 5% who have fulfilled the graduation requirements, but not attractive to residency programs. Is this the case? Or does it have more to do with strategy in the match e.g. applying only to top-tier competitive residencies with below average scores/grades?

This is a misunderstanding I hear commonly. Of course there is a bottom 5%, 10%, 20% tier of your medical school class and of step 1 takers. But those students realize they are not competitive for many specialties, and instead apply for residencies they are competitive for. Since many of the traditional MD/PhD specialties are not that competitive, they still do fine matching into say pediatrics and nobody is ever the wiser. In my experience, these students have NOT comprised those who have failed to match.

The people who don't match in my experience tend to be average to above average medical students based on step scores and class rank. They tend to believe their MD/PhD will help get them a residency position. They may be borderline for the specialty based on objective stats (say 220-230, around middle of medical school class), but are still applying for a competitive specialty with step 1 average around 240. They would be borderline MD applicants, but believe their PhD will push them through. Sometimes it does. Probably more often than not it does. But sometimes it doesn't. Part of the problem is the MD/PhD trap I have written extensively about. Essentially, you are restricted to matching to academic programs as community programs won't look at you since they have no research opportunities, but the academic programs still have higher step 1 and clinical grade requirements they expect of MD-only applicants. To quote my blog:

The MD/PhD Trap

Caveat: The MD/PhD trap section is merely a guideline/thought process and should not be taken as gospel.

Academic programs in competitive specialties often have Step I cutoff scores for interview. Even if not a strict cutoff, step I scores, clinical grades, and LORs are examined closely. These factors are almost always far more important to programs than the research you have done. Thus even with a merely average medical school performance, you may not get the specialty you want.

It goes without saying that many programs will automatically cut students who have serious academic issues ranging from failing a course to failing a year to a bad LOR. I am not talking about these students with serious "red flags". What I mean is that to match to strong academic programs, you need to be a strong medical student in addition to having a solid PhD.

So MD/PhDs need to be strong medical students to match to competitive academic residency programs that have the research opportunities we need to persue academic careers. Conversely, MD/PhDs are essentially excluded from categorical community programs. These are the programs that usually match MD-only students with lower step scores and grades than the average for a specialty. These are your standard "backup" programs. But these programs know they don't have research to offer and assume an MD/PhD is going to go elsewhere. Even if an MD/PhD student tries to spin otherwise by downplaying their research experience, they will likely not be interviewed or match there. I've heard some stories of antagonistic interviewers along these lines--"What are you doing here? We don't have research!"--"Where else did you apply? You'd never come here." I've seen several applicants get burned either by thinking community would be a backup, or by applying to mostly community programs in some specific geographic region for family/relationship reasons.

Thus it is possible to be caught in the middle. If you have a merely average medical school performance, you will often be shut out of research heavy academic training programs for lack of competitive statistics such as step scores and AOA. Yet if you are an MD/PhD, the community programs don't want you. This is the trap which can lead to you not matching. If one wasn't so research-heavy there would be a chance to match community where your MD-only classmate with similar stats matched. But you can't match at those community programs. In these situations lower-tier academic is the best bet, but still risky.

There are also graduates who are location restricted due to family concerns, limiting how many programs they apply to. I applied to 46 residency programs all around the country and matched into a totally random location outside my desired areas. But that's what you have to do for competitive residencies. Since MD/PhDs essentially are restricted to academic programs, you have to figure out the minimum number of programs you need to apply to, and find all the academic programs in your area of desire. If you're applying in medicine, that might not be an issue. If you're applying in a smaller specialty or one with fewer academic programs, it becomes a major issue if you have location needs.

This tends to be a particular issue for students with families. If anything, female residents with children or who are planning children tend to be considered liabilities to residency programs, which makes it even harder to stay close to spouse/parents and/or couples match. This is yet another difficulty for women MD/PhDs to have families that is not being addressed.