Why is IM getting more competitive?

[Carbocation1]

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Sounds like the IM match was more competitive this year. What can it be due to? The rise of hospitalist medicine? Uncertainty in Gas/Rads? An increase in the amount of students who are interested in chronic care management of gomers?

 

[tiedyeddog]

I doubt it was more competitive as a whole. I bet when the numbers come out it will end up being very similar to past years.

Maybe getting into top level programs was more competitive, I dunno. You just end up seeing the bad outcomes on here and not the good ones. And Lol at the gomers jab there. I matched into a surgical subspecialty but I am smart enough to know IM is a ton more than just the care of gomers.

 

[maxxor]

I matched into a surgical subspecialty but I am smart enough to know IM is a ton more than just the care of gomers.

Outpatient, sure. Inpatient? It's getting harder to believe when my last 5 admissions' average age was greater than 80, with 3 being greater than 90.

 

[tiedyeddog]

Outpatient, sure. Inpatient? It's getting harder to believe when my last 5 admissions' average age was greater than 80, with 3 being greater than 90.

that is going to be highly dependent on where you practice. Plus, IM is the gateway to a bunch of different medicine subspecialties....

The entire population is aging. ALL fields are seeing increases in the average age of the patients they are treating (minus peds, of course....)

 

[ACSurgeon]

Outpatient, sure. Inpatient? It's getting harder to believe when my last 5 admissions' average age was greater than 80, with 3 being greater than 90.

And those under the age of 80 certainly have a physiologic age above 80. Nothing like your 40 year olds with renal failure, heart failure, copd who are admitted with copd or chf exacerbation or pna... The birthday says one thing, but their medical chart says another.

 

[Carbocation1]

My sense is that even community IM programs are getting more competitive, relative to previous years. In these turbulent times, could it be the perception that a specialty rooted in internal medicine is more stable than ROAD fields? Or perhaps a rise in students who are unsure of what they want to do so they like the flexibility that IM offers?

 

[maxxor]

My sense is that even community IM programs are getting more competitive, relative to previous years. In these turbulent times, could it be the perception that a specialty rooted in internal medicine is more stable than ROAD fields? Or perhaps a rise in students who are unsure of what they want to do so they like the flexibility that IM offers?

Or the fact that we are running short of residency spots is actually coming to fruition. DO school expansion has been rampant and MD + DO graduates in 2016 will exceed residency spots (last time I checked).

 

[Carbocation1]

Or the fact that we are running short of residency spots is actually coming to fruition. DO school expansion has been rampant and MD + DO graduates in 2016 will exceed residency spots (last time I checked).

It seemed like rads and gas were less competitive this year though.

 

[jw3600]

Or the fact that we are running short of residency spots is actually coming to fruition. DO school expansion has been rampant and MD + DO graduates in 2016 will exceed residency spots (last time I checked).

Hmm. Last time I heard we were still several years away from this. 5-7?

 

[maxxor]

It seemed like rads and gas were less competitive this year though.

They are, and have been for some time. Med students fundamentally are extremely risk averse. When you hear that good jobs are becoming more scarce in the Rads/Gas, they move to fields that have lots of job postings. IM/FM/Psych always have tons of jobs posted.

All specialties have a worsening job market right now, not just rads/gas. Cardiology market is saturated and recently slashed reimbursement is not helping things. HemeOnc, like Ophtho, is getting lots of negative press from the Medicare data release because they bill chemo infusions as cost+plus. GI is relatively safe as they have kept positions low, but they have 1 cash cow, and that's screening endoscopy. If that gets slashed, they're in hot water too. Primary care/General IM has the volume for sure, but not anything specialized. They need to be in a larger city to derive the referral base needed to see enough patients to pay the bills. That's the big unfortunate secret of specialization. Yes you can make more money than primary care, but you have to live in an area that has the referral base so you have the luxury of limiting your practice. Not every area can sustain that.

 

[tiedyeddog]

It seemed like rads and gas were less competitive this year though.

What are you basing this off of?

 

[maxxor]

What are you basing this off of?

He's probably referring to open spots. Rads had something like 140 positions in SOAP. Even the number of AMGs applying to Rads is down a lot.

 

[tiedyeddog]

He's probably referring to open spots. Rads had something like 140 positions in SOAP. Even the number of AMGs applying to Rads is down a lot.

Yes but that has been an ongoing trend for a couple years now, nothing new.

 

[tiedyeddog]

According to the match website, in the 2015 match only 49% of the IM spots were filled by US seniors... If you are a US senior who didn't bomb step 1 and you have no red flags matching somewhere in IM should be pretty easy still...

 

[maxxor]

Hmm. Last time I heard we were still several years away from this. 5-7?

Just looking at NRMP match table (http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf), page 1, bottom of table:

Total Positions 27,293
US Seniors 25,931
Total Applicants 52,860

Granted, I'm post call, and it's near midnight where I am, but suuuuure looks like we're pretty close with the US Seniors and Total PGY-1 positions available. I assume US Seniors includes DO applicants, but there's a lot of DO schools coming online in the next few years. In 2016 there's 6000 projected DO grads, up 1500 from 2014 (when I last looked at the data). That's pretty dang close to 1:1 for available PGY-1 positions and US Seniors applying for spots.

 

[Mad Jack]

Or the fact that we are running short of residency spots is actually coming to fruition. DO school expansion has been rampant and MD + DO graduates in 2016 will exceed residency spots (last time I checked).

DO+MD grads won't surpass the number of residencies until 2024 at the earliest. Where the hell are you digging your numbers up from? Keep in mind there are AOA, SF, and milmatch positions out there that add well over 3k positions each year.

 

[Mad Jack]

Just looking at NRMP match table (http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf), page 1, bottom of table:

Total Positions 27,293
US Seniors 25,931
Total Applicants 52,860

Granted, I'm post call, and it's near midnight where I am, but suuuuure looks like we're pretty close with the US Seniors and Total PGY-1 positions available. I assume US Seniors includes DO applicants, but there's a lot of DO schools coming online in the next few years. In 2016 there's 6000 projected DO grads, up 1500 from 2014 (when I last looked at the data). That's pretty dang close to 1:1 for available PGY-1 positions and US Seniors applying for spots.

Your numbers are completely disconnected from your own sources.

 

[Pacna]

It seemed like rads and gas were less competitive this year though.

That's because people are realizing that we won't have somebody in their basement looking at MRI results in 50 years. For gas, I think it's mostly ~public/political sentiment that the job could be done nearly as well without so many MDs.

 

[maxxor]

DO+MD grads won't surpass the number of residencies until 2024 at the earliest. Where the hell are you digging your numbers up from? Keep in mind there are AOA, SF, and milmatch positions out there that add well over 3k positions each year.

Those numbers came from NRMP document.
Predicted DO graduation numbers came from http://www.aacom.org/docs/default-source/data-and-trends/2014-trends-COM-AEG-PDF.pdf?sfvrsn=26
Figures 6 and 8.
AOA has ~3000 spots a year, but historically, 30% goes unfilled. AOA is weird to consider, because ACGME folks can't apply to them.
SF Match = a few hundred spots in ophtho and urology.

 

[maxxor]

Your numbers are completely disconnected from your own sources.

please help my post-call brain connect the dots in that table.

Seems fairly simple:

Total Positions 27,293
US Seniors 25,931
Total Applicants 52,860

If you increase # of US Seniors while keeping total positions the same, you will have more US seniors than positions.

 

[the argus]

Just looking at NRMP match table (http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf), page 1, bottom of table:

Total Positions 27,293
US Seniors 25,931
Total Applicants 52,860

Granted, I'm post call, and it's near midnight where I am, but suuuuure looks like we're pretty close with the US Seniors and Total PGY-1 positions available. I assume US Seniors includes DO applicants, but there's a lot of DO schools coming online in the next few years. In 2016 there's 6000 projected DO grads, up 1500 from 2014 (when I last looked at the data). That's pretty dang close to 1:1 for available PGY-1 positions and US Seniors applying for spots.

Not sure where 25,931 comes from on page 1, but if you go further down to page 5 you'll see that the actual number of US seniors was 18,025, and DO applicants was 2,949.

6,000+ US-IMGs/foreign-IMGs matched in 2015. We are still many years from 1:1 AMGs to PGY-1 positions.

 

[Postictal Raiden]

please help my post-call brain connect the dots in that table.

Seems fairly simple:

Total Positions 27,293
US Seniors 25,931
Total Applicants 52,860

If you increase # of US Seniors while keeping total positions the same, you will have more US seniors than positions.

Table 4 has a better breakdown of applicants/matched/unmatched data

 

[Mad Jack]

There were 18,447 US MD seniors and around 3,000 DO applicants in the NRMP match for over 27,000 NRMP positions, excluding the additional >3,000 AOA, milmatch, and SF match positions.

Please, show me in which page there are over 25k US seniors lol.

 

[maxxor]

looks like table 1 "applicants" double count people who apply to multiple specialties, which could actually explain the forum question at hand. More people applying with IM as backup?

 

[Mad Jack]

looks like table 1 "applicants" double count people who apply to multiple specialties, which could actually explain the forum question at hand. More people applying with IM as backup?

This is very likely, but is not a new trend.

 

[maxxor]

I think he doesn't know how to interpret data. He's just pulling numbers out of his rear end.

Are you just being an ass at this point? Look at the bottom of table 1, that's where those numbers came from.

 

[maxxor]

This is very likely, but is not a new trend.

We never said it was a new trend; just the magnification of ongoing trends. The residency crunch is coming and will be uncomfortable. It's already getting tough in the prelim market with more and more people matching advanced without PGY-1.

 

[Siggy]

And those under the age of 80 certainly have a physiologic age above 80. Nothing like your 40 year olds with renal failure, heart failure, copd who are admitted with copd or chf exacerbation or pna... The birthday says one thing, but their medical chart says another.

...and the drug screen shows [drum roll] METH!

 

[midweststudent1]

Could a moderator sometime in the future sticky and lock the real numbers of the applicants and residency spots based on the current data we have? 8 think it could be really helpful.....That way we don't have to have this sky is falling discussion every week ....

 

[Mad Jack]

Are you just being an ass at this point? Look at the bottom of table 1, that's where those numbers came from.

It's a cute number but it is horribly wrong if you compare it to literally every other part of the report.

 

[notbobtrustme]

IM is the only specialty with crazy stratification.

There are programs that just need bodies to fill their class out so they can have scutmonkeys to move the meat. And then you have programs in which even amazing superstars have a difficult time matching into. It creates this impression, especially on SDN, that IM is competitive everywhere because you see these great stats getting rejected at many places. However, in the grand scheme of things, a mid-tier university IM program is within reach for most US MD students.

 

[tiedyeddog]

IM is the only specialty with crazy stratification.

There are programs that just need bodies to fill their class out so they can have scutmonkeys to move the meat. And then you have programs in which even amazing superstars have a difficult time matching into. It creates this impression, especially on SDN, that IM is competitive everywhere because you see these great stats getting rejected at many places. However, in the grand scheme of things, a mid-tier university IM program is within reach for most US MD students.

This is exactly my point above. It is well known SDN is frequented by more "competitive" people and only the ones who are disappointed are vocal enough to post about it. I really, really doubt IM as a whole is more competitive compared to last year or the year before. This is right from the press release from this years match on the match website:

"Internal Medicine programs offered 6,770 positions, 246 more than in 2014; 98.9 percent of positions filled, and 49.0 percent filled with U.S. seniors"

That is over 3,300 spots filled by people other that US seniors.... If it is more competitive it is by an ever more minuscule amount. Maybe average matched step 1 will end up increasing BUT the average step 1 of everyone who took it last year also increased, the numbers are both increasing concordantly.

 

[Slack3r]

I doubt it was more competitive as a whole. I bet when the numbers come out it will end up being very similar to past years.

Maybe getting into top level programs was more competitive, I dunno. You just end up seeing the bad outcomes on here and not the good ones. And Lol at the gomers jab there. I matched into a surgical subspecialty but I am smart enough to know IM is a ton more than just the care of gomers.

You're right, it's a lot of social work too!

 

[kuuj3307]

It's competitive in the sense that if you want to go to a big dog(top 20), you're going to have to be as competitive as your friends going into ENT, Ortho, Derm, etc.

If you want to go to a community program up to about mid tier program, it's the same as always. If you apply intelligently and you're an AMG, you will match in internal medicine.

 

[MattSmith45]

As long as an MD student does decent, he/she can waltz into a mid tier IM program. So in that respect, it's not that competitive from a USMD standpoint. Probably more competitive at the higher end though.

For DOs, you need to do extremely well in class and on your boards to have a shot at mid tier programs. Same for IMGs. That's where I think the competitiveness is.

 

[MadRadLad]

looks like table 1 "applicants" double count people who apply to multiple specialties, which could actually explain the forum question at hand. More people applying with IM as backup?

That would make sense. Curious though, what sort of things dictate what your backups could (effectively) be? I know some people will apply to Plastics/ENT/Ortho with Gen Surg as a backup. But what if you wanted to do something like Gas or Neuro or Rads. Could you dual apply Gas/Neuro or Rads/Rad Onc or Neuro/Psych? Is it possible/feasible?

 

[Morsetlis]

I dual applied gas and EM as an IMG from SGU, with a healthy amount of IM backup. Certainly doable to get a good amount of interviews, but at places USMDs may not want to match to 😉 ... it was also a huge headache setting up electives, getting LORs (and SLOEs).

IM as a specialty is fine, no need to say the sky is falling. The ABIM/MOC thing is more hilarious than any CRNA or VRAD shenanigans, though.

 

[67552931811]

As long as an MD student does decent, he/she can waltz into a mid tier IM program. So in that respect, it's not that competitive from a USMD standpoint. Probably more competitive at the higher end though.

For DOs, you need to do extremely well in class and on your boards to have a shot at mid tier programs. Same for IMGs. That's where I think the competitiveness is.

False. Class rank is pretty much irrelevant and you need to do average on boards.

 

[Jumanji2015]

False. Class rank is pretty much irrelevant and you need to do average on boards.

In reference to a DO student just needing to do average on their boards to get a mid tier IM residency? I just want to be sure I'm not misunderstanding you. Thanks.

 

[midweststudent1]

In reference to a DO student just needing to do average on their boards to get a mid tier IM residency? I just want to be sure I'm not misunderstanding you. Thanks.

Average on USMLE is ~230....if you're slightly above average 235-240 you would be competitive I think

 

[TwinsFan]

False. Class rank is pretty much irrelevant and you need to do average on boards.

I think it depends a lot on what people consider "mid tier"

Most would say it means a university program that is better than many other university programs but not a top one. Going to a random schools university IM program is probably not mid tier. If u want to go to a mid tier u will need to be average as an MD student and usually better than this as a DO as some places have bias.

 

[Jumanji2015]

Average on USMLE is ~230....if you're slightly above average 235-240 you would be competitive I think

Cool. I still haven't decided which program I'm going to attend yet, I've still got a little while before the deadline on multiple acceptances, but it's good to know that attending a DO school wouldn't preclude me from getting IM at a decent MD hospital. Thanks for your insight.

 

[meister]

Three year residency with hospitalist jobs all over the place offering good money, same reason EM is popular. Why do rads (as an example) for twice the number of training years for only a marginal pay increase? I mean other than the fact that you should probably specialize in what you enjoy and not base your decision largely on logistical reasons. People do anyway though.

Plus IM has tons of subspecialty options which offer either good pay or good lifestyles, though not really both outside of allergy.

 

[Pinkleton]

I think it depends a lot on what people consider "mid tier"

Most would say it means a university program that is better than many other university programs but not a top one. Going to a random schools university IM program is probably not mid tier. If u want to go to a mid tier u will need to be average as an MD student and usually better than this as a DO as some places have bias.

This. I'm DO and interviewed at 4 mid-tier programs, and did not match into any of those. Low tier university program instead. I had 240s/250s, all but 1 honors on clerkships (IM honors), above avg class rank. Interviewers acted like I was a shoe in. I think when it comes down to the ranking process, being a DO matters more than I anticipated

 

[username456789]

I think when it comes down to the ranking process, being a DO matters more than I anticipated

I certainly don't mean for this to come across as any type of "kicking you while you're down", but I really do wish more premedical students (and DO students) would strongly take this into consideration. The SDN groupthink has morphed from "There is a bias against DOs" --> "There is a slight bias against DOs" --> "There is really hardly any bias against DOs except in Derm/Plastics/etc" --> DO=MD and in 10 years they will be the same degree."

 

[Pinkleton]

I certainly don't mean for this to come across as any type of "kicking you while you're down", but I really do wish more premedical students (and DO students) would strongly take this into consideration. The SDN groupthink has morphed from "There is a bias against DOs" --> "There is a slight bias against DOs" --> "There is really hardly any bias against DOs except in Derm/Plastics/etc" --> DO=MD and in 10 years they will be the same degree."

There is a certainly a solid amount of bias, and I'm not saying that there shouldn't be a small degree of it. With 2 similar applicants, I would choose the MD myself. But when you've clearly shown that you can excel as a DO, it makes no sense to be discriminated against. Other than your program being seen as undesirable because of the DO bias. A complete circle of bull****.

I'm not worked up about it anymore. At first I was shocked because I was sure I would get my #1 spot. But now I'm just happy I matched at a university program in my favorite city. Maybe I'm better off than at a midtier in a location I didn't like. Regardless, it's the perfect motivation to thoroughly crush it during residency

 

[Wordead]

There is a certainly a solid amount of bias, and I'm not saying that there shouldn't be a small degree of it. With 2 similar applicants, I would choose the MD myself. But when you've clearly shown that you can excel as a DO, it makes no sense to be discriminated against. Other than your program being seen as undesirable because of the DO bias. A complete circle of bull****.

I'm not worked up about it anymore. At first I was shocked because I was sure I would get my #1 spot. But now I'm just happy I matched at a university program in my favorite city. Maybe I'm better off than at a midtier in a location I didn't like. Regardless, it's the perfect motivation to thoroughly crush it during residency

Unfortunately, the program being seen as undesirable is a real thing - I heard from my IM classmates, more than is necessary, that X program must have problems because there were too many DOs or IMGs there. I think PDs are very aware of this.

 

[TwinsFan]

One other thing to consider about being a DO or maybe new unknown MD school is that your clinical training is an unknown commodity that is suspect to many in academic medicine. Also class rank means less and less when the average competition in the class is less and less. This is one reason why where you go to school matters to some programs, and especially top and mid-tier ones. If they can see how you measure up in something they know and respect (school xyz) then you become more of a safe bet.

The top of the class at random satellite DO school may have been able to be at or near the top at another school. But when the avg is 3.5/27 from random UGs vs. 3.8/33+ from brand name UGs at brand name school, the measuring stick is different. Add in the clinical training and it is easy to see why there can be bias, even if it has nothing to do with title or history of the degree itself.

 

[KinasePro]

It's competitive in the sense that if you want to go to a big dog(top 20), you're going to have to be as competitive as your friends going into ENT, Ortho, Derm, etc.

I see this on SDN all the time, but this just isn't true... Top tier IM has always been accessible with decent stats and grades, can't say the same for the others listed at all.

 

[kuuj3307]

I see this on SDN all the time, but this just isn't true... Top tier IM has always been accessible with decent stats and grades, can't say the same for the others listed at all.

Define decent? Is the top twenty in derm more competitive than the top twenty in medicine? Of course.

But an applicant matching in IM at a top program must have numbers that would be competitive in the run of the mill derm, ortho. ENT programs. I've experienced it, as have others this cycle. Even with 250/260/AOA, getting interviews from only about half of the top 20 is common.