Why don't people match into residency?

[infectiousdisease101]

Knowing their other misleading practices, I wouldn't doubt that this is the case.

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

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[begoood95]

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

Other people have also done their research and came to the opposite conclusion.

...And just like that, another SDN thread has made it's way to the Caribbean!

 

[mariposas905]

Theoretically you can. Realistically - no. Many programs (including primary care ones) will filter out applications from people who graduated more than 3-5 years before. Unless you did something very heavily clinical during those 3-5 years (i.e. another residency, medical missions, volunteering in a free clinic), the belief is that you are too far removed from clinical medicine to successfully re-adjust to internship.

- Sure, you're eligible to apply. The chances that you will match, though, are pretty low. Fair or not, there is a bias against people who could not match, and the generally accepted advice is that your chances drop precipitously the farther out from school you are.

- Step 3 is exceptionally easy IF you're doing general clinical medicine everyday.

The number of unfilled seats is getting lower, though, and will likely continue to get lower as the number of people in the residency match increases.

Is this true for off-shore grads as well? I hear of a lot of IMGs getting their medical degree and then coming to the States to study for their USMLEs. They then apply for US based residencies 2-3 years later. Since they already have a 50% acceptance rate as well, does taking time off after they graduate to prep for a residency further lower their chances?

 

[infectiousdisease101]

Then again, they most likely matched into a surplus residency like internal, so it explains it.

 

[PreMedMissteps]

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

What research is that?

 

[Matthew9Thirtyfive]

What research is that?

YouTube videos and blogs from former Carib students.

 

[PreMedMissteps]

YouTube videos and blogs from former Carib students.

Now there's some notable research right there!

 

[PreMedMissteps]

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

Are you fine with unknown community programs? Really, there's some fancy double-talk going on. I hear Caribb people talk about NY residencies, as if they're at NYU or similar...when they're really at some unknown community program somewhere in the state.

 

[gonnif]

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

Research my A$$!! see spreadsheet

I am not a big fan of off-shore schools but by no means do I rule them out (see my standard advisement in item #8). However, I want to make sure people go into this with eyes wide open. So know what the hell you are talking about before you post

1) actual rates are way below there reported numbers
(data from www.nrmp.org/wp-content/uploads/2014/01/NRMP-and-ECFMG-Publish-Charting-Outcomes-in-the-Match-for-International-Medical-Graduates-Revised.PDF-File.pdf#page=28)

2) There was and still is minor SOAP post-match placement for IMG so : chart from 2013 (to match spreadsheet)
(see www.nrmp.org/wp-content/uploads/2013/08/resultsanddata2013.pdf#page=55)
(for similar 2017 data see http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf#page=57)

3) 2013 had the "all-in" policy for NRMP so minor amount of pre-match which appears now to account for less than 100 slots

4) we have no individual data on both NRMP withdrawals and no ranks, both of which drop from NRMP data rates. My last calculations of that showed US MD Senior with about 8% overall residency failure (no match, withdraw from match, did not rank in match) while over US-IMG from all school showed about 61% in overall residency failure (for data see http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf#page=23)

5) Just to be clear, reports from off-shore includes any all post graduate "placements" not match. SGU reports about 29% are non-NRMP placements (they may even count the few SOAPs in this) This would be Match, Post-Match SOAP, formal off-match residency (prematch), substitute/open contracts which can be for other residents who drop position. This also appears to include non-residency post graduate contracts. In other words, they get a job in facility under physician and in some states, a year of this can get your license). I will not get into the nitty gritty of prelim spots for them. So their numbers show graduates who get into ANY kind of post-grad slot, be it residency or not. For comparison, US MD Seniors get into one of the their top three programs about 78%. That is not simply the specialty they want but the actual hospital/school program in the location they chose.

6) SGU reports a total of 5,654 in four year programs, so there should be about 1414 enrollment per year. They also report their 5-7 year program which should include about 56 enrollment per year. So 1470 estimated class size. They state over 900+ placements. Lets say 950 divided by 1470 and that is 61%. Where are the other 40%?
SGU states "93% OBTAINED POSTGRAD POSITION Of our eligible 2016 US graduates who applied for a postgraduate position, 93 percent obtained one within one year." With 950 as estimated number for 93% that would mean about 1020 as eligible US grads, where are the other 450 who started the school? How many either withdrew or didnt rank? Are they just not US Citizens and didnt apply to NRMP? How many never graduated so they dropped out? The spreadsheet above shows a 67% match rate for US citizens. Now which number am I gonna trust?

7) we have no verifiable and therefore reliable data on the schools attrition rates and therefore cannot tell a prospective student their "success" chances. That is starting medical school, earning a degree, and actually getting any residency slot. With US students, we know 97% will ultimately graduate and over 99% will get a residency slot, for both MD and DO. Using SGU as an example, even with something as low as 10% attrition, that means maybe 90% of people graduate and 67% match, that means 60% success rate.

8) I am not a big fan of Off-shore schools but by no means do I rule them out (see my standard advice below):
as I've said often, before considering any offshore school applicant must go through at least two application cycles for both MD and DO with at least a year break in between (ie skip a cycle) for application repair and/or enhancement. the break is necessary to analyze and understand the weaknesses in an application. Repair may be as simple as reorganizing rewriting application or it may require postbacc, SMP, MCAT, or additional extracurricular such as clinical volunteering and other items. I strongly advise that no student should consider off shore schools until the above has been done

 

[infectiousdisease101]

You got me. My apologies.

 

[gonnif]

True. A US MD resident recently told me that a Caribb grad only got a pre-lim surg position, which ended several months ago...and now that student has nothing.

I often wonder when the Caribbs report their match successes if they're counting single-year prelim/trans matches when that's all their students get when they were going for an advanced residency.

Knowing their other misleading practices, I wouldn't doubt that this is the case.

They would add:
All categorical matches
All prelim matches
All SOAP (post match) placements
All pre-match (non NRMP) placements
Likely add any contract fills (ie replace resident who dropped out)
Likely add any clinical contract (non residency) of any kind which would be a post-graduate spot

In short, any position that any graduate gets where they even remotely touch a patient can be counted

Also note that schools may say their placement rate is XX% for eligible applicants. Does this include those who applied for residency but then either withdraw or not rank as these numbers are dropped out? And what about attrition? I do not trust their numbers (see my previous post with spreadsheet)

 

[TypeADissection]

In my short experience having participated in the interview and selection process for general surgery residents last year, I think the reason why many fail to match is:
1. Not necessarily overestimating the strength of their own application, but rather, underestimating how strong the field is.
- Our average incoming Step 1 was 245 last year. My buddy at one of the UC programs in Cali told me his program's was 255 last year. Kind of a shock to me, but it's been steadily creeping up each year. So when Student A with a 225 applies with solid but not great grades, and standard form LORs; it becomes very easy to move past that application and look to the next one. And please please please keep your personal statement to 1-page. This really is for you. Anything longer just doesn't get read, there are just too many.
2. Not being savvy with the match. As stated over and over, you should rank programs in accordance with where you want to go and not how you think they're going to rank you, but we've had students not rank our program and then not match. Then they come calling during the SOAP hoping for a prelim spot. The crazy thing is, they would've 100% matched as a categorical if they just ranked us based on our rank list. So you've got to decide, would I rather be a general surgeon (or whatever you're applying to) versus not going to a certain program?

Hope this helps. Good luck to everybody. It's a stressful time and there may be a lot drinking involved to help cope, but it will come to pass. Having matched personally for the last time into fellowship, just remember to be yourself and try to have fun along the way. Cheers.

 

[PreMedMissteps]

They would add:
All categorical matches
All prelim matches
All SOAP (post match) placements
All pre-match (non NRMP) placements
Likely add any contract fills (ie replace resident who dropped out)
Likely add any clinical contract (non residency) of any kind which would be a post-graduate spot

In short, any position that any graduate gets where they even remotely touch a patient can be counted

Also note that schools may say their placement rate is XX% for eligible applicants. Does this include those who applied for residency but then either withdraw or not rank as these numbers are dropped out? And what about attrition? I do not trust their numbers (see my previous post with spreadsheet)

The Caribbs also like to imply that many of their students get their "first choice match," which is very misleading to those who don't understand the process. A student can only realistically rank programs where they were interviewed, so if they only interviewed at community programs that desperately interview nearly anyone they can, then likely the student is going to match at his #1 choice. No one explains that the student's #1 was less-likely any US MD student's #1.

 

[RogueUnicorn]

Pretty certain that 5% is pre-SOAP. I've actually never heard of a us md not even being able to get something like a pre-lim surgery year through soap

A lot of us would probably have chosen not matching over prelim surgery.... [shudder]

True. A US MD resident recently told me that a Caribb grad only got a pre-lim surg position, which ended several months ago...and now that student has nothing.

Technically not nothing; after a year of residency/internship in most states you're eligible to be an independently licensed physician. Without BE/BC you can't do much with it but you're at least employable in urgent care (even in urban areas) or as a straight up pricare somewhere rural

I did my research and as long as you attend a big 4 and don't mess up, you'll be fine.

yikes.

Our average incoming Step 1 was 245 last year. My buddy at one of the UC programs in Cali told me his program's was 255 last year. Kind of a shock to me, but it's been steadily creeping up each year.

The interns keep coming in with higher scores but lower ability to get anything done, wtf!

 

[mcloaf]

The interns keep coming in with higher scores but lower ability to get anything done, wtf!

There's an arms race in test prep and Step 1 scores, while administrators battle to see who can limit liability the most by not letting students do anything.

 

[gonnif]

A lot of us would probably have chosen not matching over prelim surgery.... [shudder]


Technically not nothing; after a year of residency/internship in most states you're eligible to be an independently licensed physician. Without BE/BC you can't do much with it but you're at least employable in urgent care (even in urban areas) or as a straight up pricare somewhere rural

Well its a tad more than that. Virtually any institutional setting where the institution takes on insurance burden, can use a licensed physician with only 1 year post grad. This is how some resident moonlight in ER, urgent care, walk in clinics, etc. This can also be in jails, colleges, VA, military, etc. I certainly know some docs who, for whatever reason, either didnt go beyong intern or dropped residency and soend their career doing this work. I would guess It is a very small minority today or perhaps those after prelim or traditional year go this route rather than go into a specialty. Then there are some who spend career as a locum tenens (temp doc).

 

[RogueUnicorn]

There's an arms race in test prep and Step 1 scores, while administrators battle to see who can limit liability the most by not letting students do anything.

I'm kidding bro the interns are fine; moreover I'd counter that most med students in my experience are hampered more by their unwillingness to work harder than any barrier put up by administrators.

Well its a tad more than that. Virtually any institutional setting where the institution takes on insurance burden, can use a licensed physician with only 1 year post grad. This is how some resident moonlight in ER, urgent care, walk in clinics, etc. This can also be in jails, colleges, VA, military, etc. I certainly know some docs who, for whatever reason, either didnt go beyong intern or dropped residency and soend their career doing this work. I would guess It is a very small minority today or perhaps those after prelim or traditional year go this route rather than go into a specialty. Then there are some who spend career as a locum tenens (temp doc).

Locum positions as far as I'm aware are more often than not BE/BC positions

 

[Dr.J.D]

"Truly, truly, I say to you, unless one is born again he cannot see the kingdom of God."- Jesus

 

[darkjedi]

"Truly, truly, I say to you, unless one is born again he cannot see the kingdom of God."- Jesus

lol wut

 

[21Rush12]

"She got a big booty, so I call her big booty."
-2 Chainz


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[el_duderino]

"She got a big booty, so I call her big booty."
-2 Chainz

Tru.

 

[Lucca]

Closing thread.