Why MD/PhDs do well in the Match

[Instant Noodles]

Glad to see that MD/PhDs do really well in the Match each year. Lots of competitive specialties and places (proportionally) compared to MD only seniors. Just wondering, what main reasons why?

http://homepage.uab.edu/paik/match.html
http://www.aamc.org/programs/cim/chartingoutcomes.pdf
http://www.nrmp.org/data/index.html

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[Neuronix]

The PhD does help one match, however, it does not help as much as many people assume. Every year a small percentage of MD/PhDs, even from top programs, go unmatched. Competitive specialties still care highly about Step 1 scores, clinical grades, and to some extent your grad school performance--i.e. not publishing could negate your PhD entirely.

Match lists are advertisements. They are misleading. See:

http://forums.studentdoctor.net/blog.php?b=3111

 

[xanthines]

I had a related question. What's everyone's opinion on how much being MSTP helps you during a scramble? Of the MD/PhD'ers I've known, I've been surprised at how well they've done after not matching and then going through the scramble. They were obviously disappointed at not matching, but they still went to decent places for reasonably desirable residencies (neuro, surg, etc as opposed to IM, FM, peds). Just a limited observation, of course!

-X

 

[QofQuimica]

I voted other, because you're talking about apples versus oranges. MD/PhD programs attract a certain type of applicant, whereas med schools in general draw from a much broader pool. So it's not fair to ask why many MD-only students at schools that are not research-oriented don't end up at top academic centers for residencies like many MD/PhD students do. My guess is that if you restricted your pool of MD-only students to those who have similar training and interests (minus the PhD) and come from the same set of research-oriented schools, the difference you see would disappear.

To answer xanthines's question, I wonder how much it has to do with having an extra support system. Most of the best open residency slots are taken within hours or even minutes after the scramble begins. So what people in the scramble really need if they want to get a good spot is to have a whole team of helpers who can start making phone calls and faxes as soon as the clock strikes noon. My guess is that it might be less likely for a large MD program to give their scrambling students the kind of individualized attention and manpower resources that an MD/PhD program would provide.

 

[Neuronix]

My guess is that it might be less likely for a large MD program to give their scrambling students the kind of individualized attention and manpower resources that an MD/PhD program would provide.

My experience in talking with MD/PhDs who have attempted to scramble (successfully and unsuccessfully) is that this is nonsense. Sorry Q.

 

[QofQuimica]

My experience in talking with MD/PhDs who have attempted to scramble (successfully and unsuccessfully) is that this is nonsense. Sorry Q.

Your experience is something that you and I can both acknowledge is extremely biased. Sorry back at ya. 😉

 

[Neuronix]

Your experience is something that you and I can both acknowledge is extremely biased. Sorry back at ya. 😉

It's not so much a matter of the school as it is: what is the program going to do for you in the scramble? It's up to you to fax out applications and make phone calls very quickly. The medical school has nothing to do with that process.

The best your medical school could do for you is make a phone call or two. That's up to the department chair in the department you're applying to at your program. This is very specialty/program dependent and has nothing to do with school size or your status as an MD/PhD student. A phone call from the dean or the MD/PhD director doesn't mean anything if they're not in the specialty to which you're applying.

 

[echod]

Perhaps a better title would be:

Graduates of MD/PhD programs, how did having a PhD help you in the match?

 

[QofQuimica]

It's not so much a matter of the school as it is: what is the program going to do for you in the scramble? It's up to you to fax out applications and make phone calls very quickly. The medical school has nothing to do with that process.

That's my point. At my school, the administration *does* help scramblers make calls/send faxes, and it's *not* only up to the student. And this is an MD-only school that is much larger than an MD/PhD program. So, I was hypothesizing that in a small, intimate program like an MD/PhD where everyone knows everyone, that kind of help would be seen more commonly compared to a large school with 200+ students where the dean probably barely knows the scrambling students' names. Theoretically, it seems reasonable that an MD/PhD program director would be more vested in their students' success compared to most med school deans just based on how involved they are with their students. But if I'm wrong, well, then I'm wrong.

 

[gbwillner]

Perhaps a better title would be:

Graduates of MD/PhD programs, how did having a PhD help you in the match?

I agree this is a better question. MD/PhDs will have different goals and their training will help them in different ways. If your goal is the traditional "physician-scientist" goal- and you want to become faculty at your institution, having the PhD and being dependable/respected are extremely important. If you don't want to do research anymore and go into private practice, being hard-working is likely more important and your PhD is likely irrelevant.

For me, having the PhD, being experienced in a "hot" and relevant field, and being able to sell myself as the future of the field were the key to landing my residency.

My resident class has 2 other MSTPs- but neither are currently in the same career path as me, and I can't say for sure what helped them. One wants to do clinical research in a competitive sub-specialty of Path (and didn't get the fellowship in-house and will be going to Hopkins after training) and the other wants to do private practice and hasn't found a fellowship yet. I let everyone know early on about my plans and never waivered- and I've essentially been given everything I've asked for. I can't say for sure this will continue indefinitely, but I was given this position to become a physician scientist and as long as I continue on that path I will be supported by my institution.

 

[smq123]

I find it laughable that the most popular answer so far is that MD/PhDs do better in the match because they are intrinisically smarter and hard working. To many purely-clinical MDs, especially those from the old school, MD/PhDs are less appealing as applicants because of the stereotype that they are too cerebral, too hung up on details, and make for inefficient clinicians. The stereotype that they are arrogant, egotistical, and hung up on their status as an MD/PhD (as, um, evidenced by this poll) makes them further unpopular, since it is felt that they will be poor team members.

This wouldn't be such a big deal if those purely-clinical MDs weren't responsible for evaluating you, both as students and as residents.

That's my point. At my school, the administration *does* help scramblers make calls/send faxes, and it's *not* only up to the student. And this is an MD-only school that is much larger than an MD/PhD program. So, I was hypothesizing that in a small, intimate program like an MD/PhD where everyone knows everyone, that kind of help would be seen more commonly compared to a large school with 200+ students where the dean probably barely knows the scrambling students' names. Theoretically, it seems reasonable that an MD/PhD program director would be more vested in their students' success compared to most med school deans just based on how involved they are with their students. But if I'm wrong, well, then I'm wrong.

I think you're missing Neuronix's point.

Helping scramblers make calls/send faxes is nice, but in the long run, doesn't really matter. It doesn't matter if it's the vice-dean of students, or your MD/PhD program director, or your roommate who is frantically pushing the send button on the fax machine.

What DOES matter is someone in the specialty that you applied to is making phone calls on your behalf - i.e., "This person would be a great resident, you really should take them, they would add to this field." Unless your MD/PhD program director happens to be a well known clinician in the field that you're applying to, his word doesn't mean anything to a residency PD. Your MD/PhD program director can't comment on your clinical capabilities, or how hard you work on the floors, which is really all that a residency director cares about.

 

[URHere]

I find it laughable that the most popular answer so far is that MD/PhDs do better in the match because they are intrinisically smarter and hard working.

The stereotype that they are arrogant, egotistical, and hung up on their status as an MD/PhD (as, um, evidenced by this poll) makes them further unpopular, since it is felt that they will be poor team members.

I don't think that the poll results here are necessarily a sign of the humongous collective MD/PhD ego coming out to play.

I must admit that, although I didn't vote in this poll, I can understand why someone would choose that answer. It's kind of like the classic pre-allo question of why Harvard and other highly ranked schools generally have the highest average step 1 scores. Sure, you could try to argue that those schools provide better preparation, but you still have to consider that the top-tier students were generally the ones with the highest stats and most competitive applications before even entering medical school. This same argument could be applied to the MD/PhD subset. If MD/PhD applicants come to medical school equipped with better stats than the general MD-only pool, wouldn't you expect that to manifest itself in some way? It might be through grades or higher step 1 scores, but I think that this idea does have something to do with match success.

As I said before, I didn't vote on this poll - mainly because I don't know enough about MD/PhD match success to form a complete opinion about this. Regardless, I don't think that the 'smarter and more hardworking' choice is entirely appalling".

 

[QofQuimica]

I think you're missing Neuronix's point.

Helping scramblers make calls/send faxes is nice, but in the long run, doesn't really matter. It doesn't matter if it's the vice-dean of students, or your MD/PhD program director, or your roommate who is frantically pushing the send button on the fax machine.

What DOES matter is someone in the specialty that you applied to is making phone calls on your behalf - i.e., "This person would be a great resident, you really should take them, they would add to this field." Unless your MD/PhD program director happens to be a well known clinician in the field that you're applying to, his word doesn't mean anything to a residency PD. Your MD/PhD program director can't comment on your clinical capabilities, or how hard you work on the floors, which is really all that a residency director cares about.

No, we're talking past one another here. Even if the PD isn't in the same field, no doubt s/he knows someone who is, and the PD could ask that person to make calls. They do that at my MD-only program. Again, my hypothesis is that MD/PhD PDs should be more likely to do that for their students than a medical school dean who is responsible for many more students and probably doesn't know them as well. Now granted that my school may not be representative of most MD schools, but at the same time, I don't think Neuro's experience is necessarily representative of most MD/PhD programs, either.

 

[smq123]

No, we're talking past one another here. Even if the PD isn't in the same field, no doubt s/he knows someone who is, and the PD could ask that person to make calls. They do that at my MD-only program. Again, my hypothesis is that MD/PhD PDs should be more likely to do that for their students than a medical school dean who is responsible for many more students and probably doesn't know them as well. Now granted that my school may not be representative of most MD schools, but at the same time, I don't think Neuro's experience is necessarily representative of most MD/PhD programs, either.

Maybe. I don't know, I just feel like you're making a lot of assumptions here.

- You're assuming that a higher-up in your desired field at your school actually knows or cares who your MD/PhD director is. If that higher-up is in something like, say, ortho, I can tell you that they rarely care about anyone outside of ortho, regardless of their job title.

- You're assuming that many MD/PhD directors know people in a variety of different fields. I would argue that this is LESS likely to be the case. The only way that most attendings know other chairmen or residency PDs is if they sit on university or hospital wide committees....something that an MD/PhD director is unlikely to have time for.

- You're assuming that an MD/PhD director is going to make time in his schedule for scramble day. I would bank against that, to be honest. Scrambling takes a whole day, sometimes TWO whole days, and I find it really hard to believe that an MD/PhD director, no matter how intimate the program is or how fatherly he tends to be, is going to set aside two whole days for the students in his program.

I mean, I feel that it's more likely that the MD/PhD director, given how chaotic and stressful the scramble is, would say "This is not my problem; go talk to your student dean," and go back to his usual daily routine. When you can so easily dump the problem on someone else, why would you take on the stress of helping people scramble?

The ONLY advantage I can see an MD/PhD having in the scramble is, possibly, having more specialty/department connections, after having done research in that field. If your PI knows people in your desired field, he may ask them to make phone calls for you, or even be willing to take time out of his schedule and make a few phone calls for you. But this has more to do with the research that you have done (which could also be the case if you did a few summer research projects), and less to do with being an MD/PhD.

 

[gstrub]

- You're assuming that an MD/PhD director is going to make time in his schedule for scramble day. I would bank against that, to be honest. Scrambling takes a whole day, sometimes TWO whole days, and I find it really hard to believe that an MD/PhD director, no matter how intimate the program is or how fatherly he tends to be, is going to set aside two whole days for the students in his program.

I mean, I feel that it's more likely that the MD/PhD director, given how chaotic and stressful the scramble is, would say "This is not my problem; go talk to your student dean," and go back to his usual daily routine. When you can so easily dump the problem on someone else, why would you take on the stress of helping people scramble?

Dude...you are COMPLETELY wrong, at least at my program. One of the most important days for MD/PhD directors is seeing their students match after 7+ years. I won't explain the reasons for this as your previous posts indicate that you either don't care, or simply won't understand.
-G

 

[Neuronix]

Dude...you are COMPLETELY wrong, at least at my program. One of the most important days for MD/PhD directors is seeing their students match after 7+ years. I won't explain the reasons for this as your previous posts indicate that you either don't care, or simply won't understand.
-G

Please do explain. I'm curious what your MD/PhD program director does for students who didn't match in the scramble.

 

[xanthines]

On the one hand, I agree that a MSTP director isn't likely to block out a lot of time to help with scrambling students. Given how busy directors tend to be, it doesn't seem like a good use of their time, since it's also the med school's responsibility (supposedly) to ensure their students get into a residency somewhere. Isn't it kind of hard for a director to actually prepare for a scramble since you don't know beforehand which students need to scramble, where they want to go, and what field they want to be in? The more likely scenario is that they go on with their day and in the fairly rare event that an MSTP doesn't match, they'll do what they can to help. Otherwise, it's up to the student to figure out who to ask for help, ie a ortho for a ortho program, etc. Reasonable?

-X

 

[calvinNhobbes]

My MD/PhD admin was helpful as long as you were going into IM/Path/Neuro/Pysch/and maybe Peds. Anything else and you were on your own. They just didn't know anyone in other fields enough to make any difference.

 

[QofQuimica]

Maybe. I don't know, I just feel like you're making a lot of assumptions here.

Well, of course I am--we both are. But, to be fair, some of the arguments you're making are exaggerating my position. For example, a med school dean isn't going to take an entire day or two off to help scrambling students either, so it's not a very fair standard to hold an MD/PhD program director to. As another example, the majority of MD/PhD students only apply in a few fields such as path, IM, peds; it's not like there are tons of people applying to all of the less traditional specialties. And for those who are, odds are good that they're going to be scrambling into one of the more traditional MD/PhD specialties where the PD *does* have connections. Lots of students who scramble end up in a different specialty than what they originally applied in, so it's not like the PD is limited to only helping the students try to get spots in that outside specialty. I'm also not convinced that MD/PhD program directors are as little connected as you're suggesting. The academic medical world is incredibly incestuous.

Dude...you are COMPLETELY wrong, at least at my program. One of the most important days for MD/PhD directors is seeing their students match after 7+ years.

That's all I'm trying to get at.

I won't explain the reasons for this as your previous posts indicate that you either don't care, or simply won't understand.
-G

Hey, easy there, G! She wasn't saying your mom wears army boots or anything like that. Along with Neuro, I would like to hear more about what your PD does, and I'm sure some of the younger students would also be interested.

 

[Neuronix]

My MD/PhD admin was helpful as long as you were going into IM/Path/Neuro/Pysch/and maybe Peds. Anything else and you were on your own. They just didn't know anyone in other fields enough to make any difference.

Roughly my and my buddy's experiences as well, except make it IM/Peds/Path and maybe Neuro/Psych.

Common denominator there: unless you have a TERRIBLE record, you will match fairly well in one of those specialties as an MD/PhD. So the scramble isn't much of an issue for those students to begin with.

 

[smq123]

Well, of course I am--we both are. But, to be fair, some of the arguments you're making are exaggerating my position. For example, a med school dean isn't going to take an entire day or two off to help scrambling students either, so it's not a very fair standard to hold an MD/PhD program director to.

Actually, they do. At many schools, they do. Perhaps not *THE* dean, the guy who's picture is on the front of every alumni newsletter, but very often, the student deans *do* take the whole day off. The statistical likelihood that absolutely everyone from that school is going to match is low, so there's going to be at least a handful of people who will need advice/help with scrambling. It makes sense, from a probability standpoint, for them to block their whole schedules off.

In a smaller MD/PhD subset, that's less likely to happen - there very well may be years when no one in the program needs to scramble. If there is 1 or 2, they might as well just rely on the student deans, like anyone else. I just find it hard to believe that an MD/PhD would voluntarily close off a day for something that might not happen. As an intern, my PD blocked off scramble day (no clinic, no patients, no meetings after 11 AM, etc.) because, in previous years, he had not filled. This year, he DID fill, so he was relieved, but also kind of peeved at the waste of a day.

As another example, the majority of MD/PhD students only apply in a few fields such as path, IM, peds; it's not like there are tons of people applying to all of the less traditional specialties.

Well, I think this partly comes back to an issue that I know Neuronix has alluded to in previous posts - what kind of specialties are MD/PhDs encouraged to pursue, and which ones are they *actually* pursuing? And it also seems to reflect the culture of one specialty versus another.

From what I've seen of the scramble, people in certain specialties (IM, path, peds, FP, anesthesia) were very willing to help out students from that school who hadn't matched. When called upon by deans or other faculty, they were willing to make influential phone calls to PDs at other programs. This, however, was definitely not true for many of the more competitive specialties, particularly the surgical ones. Unless they had a personal interest in you, they did not seem willing to help. The "cold shoulder" from ortho is fairly common, just as one example. Radiology, which is already notorious for not caring at all about research, is probably another.

The point I'm trying to make is, do not assume that the fact that you are an MD/PhD in an MSTP program is going to give you a big boost in the scramble, or even the Match, if match results from the last 2 years can be believed. The only thing that can help you is having deep connections in either your home department, or in other fields that you would be willing to scramble into.

 

[Doctor&Geek]

Moral of the story:

DO NOT BE STUPID. YOU ARE NOT INVINCIBLE.
INTERVIEW AT SAFETIES. RANK MORE PROGRAMS.

 

[Neuronix]

Moral of the story:

DO NOT BE STUPID. YOU ARE NOT INVINCIBLE.
INTERVIEW AT SAFETIES. RANK MORE PROGRAMS.

Also: consider applying to a backup specialty.

 

[QofQuimica]

The point I'm trying to make is, do not assume that the fact that you are an MD/PhD in an MSTP program is going to give you a big boost in the scramble, or even the Match.

And here is a take-home message we can all agree with. 🙂

 

[echod]

Also: consider applying to a backup specialty.

Is having a backup specialty frowned upon by program directors in the preferred specialty? What would you tell the interviewers when they ask you which specialty you're actually more interested in? Wouldn't that come off as being insincere about one's specialty choice?

 

[QofQuimica]

Is having a backup specialty frowned upon by program directors in the preferred specialty? What would you tell the interviewers when they ask you which specialty you're actually more interested in? Wouldn't that come off as being insincere about one's specialty choice?

If you're smart, you don't tell them at all. If you're applying to more than one specialty, you can write separate PSes, assign separate LORs, etc. And if you don't apply to both specialties at the same hospital, odds are that they won't find out you're applying in two specialties unless you tell them.

 

[gstrub]

Please do explain. I'm curious what your MD/PhD program director does for students who didn't match in the scramble.

Our director (with our deans support of course) created an additional preliminary spot for our one unmatched (after scramble) student at our home program. This student was the first in our program to go unmatched in the scramble, and to be honest, it was likely their own fault (for not applying to both medicine and surg prelim programs). Anyway, problem was solved and the student will go onto PGY-2 radiology after finishing the prelim year, all thanks to our program director.

It sounds like at other, bigger name programs, the PD could care less, and that sucks.

For me the bottom line is not to count on the MD/PhD making up for a major deficiency (poor step I or clinical grades), but it should open some doors at more research orientated programs that you may have otherwise not gotten interviews at. At least that's what I've heard, and continue to hope for.

 

[smq123]

Our director (with our deans support of course) created an additional preliminary spot for our one unmatched (after scramble) student at our home program. This student was the first in our program to go unmatched in the scramble, and to be honest, it was likely their own fault (for not applying to both medicine and surg prelim programs). Anyway, problem was solved and the student will go onto PGY-2 radiology after finishing the prelim year, all thanks to our program director.

This is really confusing. At your school, is the director of the MSTP program also the Internal Medicine residency director? 😕 Because, usually, the only people who can "approve" additional residency spots are residency PDs, and not MSTP program directors.

And the dean's approval often has nothing to do with it - the medical school deans are generally not affiliated with the ACGME administration at the hospital. The hospital, technically, has to ask for ACGME approval of additional spots, because of Medicare funding of resident salaries, maximum number of residents allowed in the hospital per year (which is ACGME controlled) blah blah blah.

 

[gstrub]

I don't know how they did it. He is not the IM director either. One day there were X prelim surgery spots, the next day there were X+1. This was a very rare occurrence as no student had ever not scrambled from our MD/PhD program before. In fact, I know of only one other student who had to scramble, and that was because they applied to PRS and ranked only 4 programs (ended up scrambling into a top 5 rad onc program). And we've had many people match into fields other than IM/Peds/Path etc (several NSG, derm, plastics, radiology), in the last 7 years.

I guess I am just not seeing the matching/scrambling difficulties on my end...perhaps it's from good career advising throughout our training (i.e. don't apply to ortho if you aren't competitive without the PhD, etc).
-G

 

[Neuronix]

it was likely their own fault (for not applying to both medicine and surg prelim programs).

You're blaming the person for not applying to surgical prelims? I mean, are medicine prelims usually THAT competitive? The answer is no, and I imagine they just didn't apply to enough prelim programs or only all competitive ones. Very few applicants in radiology apply to both medicine and surgical prelims (more common: medicine and TY or medicine or TY alone), so I would not at all place the blame on this student.

This strikes a bit of sore spot for me, because when a student fails to match the student is almost always blamed. I view this a bit as blaming the victim. Yes, it could be their fault, but often the reasons given for blaming them don't hold water with me.

I will say that this hasn't been much problem here in this case. Our surgical prelim is aka hell (I can point you to numerous threads on SDN in the residency forums that will confirm that fact) and never fills anyway. One of the MD/PhDs who didn't match a few years ago scrambled into one of those spots and failed to match out of again when he reapplied. I can only hope that never happens to me.

As for the advising at our school, it has changed dramtically. Long gone are the days when "All you need to do is pass" or "you're MD/PhD you'll get whatever you want" was common advice. Even when I took step 1 the MD/PhDs weren't given as much time to study for the exam as were the MD students. The advisors are very firm with us now if they think we'll have any difficulty matching and the advice is definitely to perform exceptionally on the steps and in the clinics. Still, this doesn't help the students who scored 220 on their Step 1 5 years ago. It's somewhat hard to blame the advisors or students. It's amazing how much further a 220 went 5 years than a 220 does now. And for the students who are simply average performers in this school of extreme overachievers who have to compete for honors after being out of clinics for 4 years, it's really sad to see them have to pick different specialties. But that's life I guess.

 

[QofQuimica]

This strikes a bit of sore spot for me, because when a student fails to match the student is almost always blamed. I view this a bit as blaming the victim. Yes, it could be their fault, but often the reasons given for blaming them don't hold water with me.

I agree that in many cases this is true. Yes, people do stupid stuff sometimes, but I doubt they're in the majority. The job of the dean's office is to ensure that students come up with a match strategy that has a reasonably strong chance of success. If a student is on the low end of being competitive for their preferred specialty, any dean that's worth their salt will tell that student to have a backup plan like a prelim year, post doc, second specialty that is less competitive, etc. Assuming that most people follow the advice they get from the dean's office, if they still fail to match, it is more likely to be a result of factors outside of their control. The match is a kind of giant game of musical chairs; every year, a few people end up not getting a chair when the music stops.

Basically, what it comes down to is this: no one wants to believe that the scramble could happen to them. We are all type As--we wouldn't be where we are if we weren't. But there aren't enough spots in derm for everyone who wants them, and so unfortunately, some perfectly qualified people aren't going to start dermatology residencies come June. The take-home lessons for all of us should be that we need to A) listen when people in the dean's office are honest enough to say that we should have a backup plan, and B) not be hubristic.

 

[strangeglove]

I'm sure this has been mentioned already here, but there are some specialties, e.g. IM, neuro, psych, path, peds, where a PhD really does help, as long as you are you are applying to a research-oriented program and you are convincing in your ongoing interests in research. That said, the most competitive among these programs do not offer every MD-PhD an interview. Often, these are programs that see themselves not only as research powerhouses, but also strong in clinical training. They do not want someone who has merely passed all of their clinical rotations. For this reason, if your clinical grades aren't strong, despite having a Science or Nature paper, then you should consider applying to somewhat less competitive programs as backups.

 

[gstrub]

You're blaming the person for not applying to surgical prelims?

I guess I am. If you need to apply to a prelim program, and your deans office says "hey you're record it pretty crappy...you'd better apply to both surgery and medicine programs" and you say "well, I'm only going to apply to 5 medicine prelims because I am MD/PhD and should be a shoo-in" then yes, it is YOUR fault if you fail to match. Perhaps it would be better to say "your choice."

Agree with Q. The deans office shares the responsibility in advising you what you are competitive for. But in the end, you get to choose how many programs and what fields to rank.

 

[smq123]

I guess I am. If you need to apply to a prelim program, and your deans office says "hey you're record it pretty crappy...you'd better apply to both surgery and medicine programs" and you say "well, I'm only going to apply to 5 medicine prelims because I am MD/PhD and should be a shoo-in" then yes, it is YOUR fault if you fail to match. Perhaps it would be better to say "your choice."

Agree with Q. The deans office shares the responsibility in advising you what you are competitive for. But in the end, you get to choose how many programs and what fields to rank.

The thing with the Match is, though, that there are surprises every year. I think the thinking before going through the Match is, "Well, if someone fails to match, it's probably because they did something wrong, like not apply broadly enough, or they were really socially inept," etc. The thinking after the Match, from what I've seen, is "Wow. Can you believe Mary, Miss AOA-top 3-four publications-everyone loves her, didn't match??" Like I said, there are surprises every year, and as it has become more competitive, it's harder to pinpoint reasons for why people didn't match. I've met a lot of people who were amazing candidates not match in urology, ortho, ENT, and radiology. There's definitely a "crapshoot" component in the process.

 

[Gfunk6]

It's amazing how much further a 220 went 5 years than a 220 does now.

Why do you suppose this is? Is there any hard evidence that this is true?

If true, I suppose saturation of MD-PhDs in competitive residencies and/or upward creep of Step I scores may have contributed.

 

[Neuronix]

Why do you suppose this is? Is there any hard evidence that this is true?

Can I say for sure that had I applied with my exact same application 5 years ago would I do better than I will do applying now? No. But here's the circumstantial data for just the past 2 years... There is a charting outcomes 2006 which is a little more dramatic, but the Step 1 scores reported there are medians and not means.
Sources:
http://www.nrmp.org/data/chartingoutcomes2007.pdf
and
http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

If true, I suppose saturation of MD-PhDs in competitive residencies and/or upward creep of Step I scores may have contributed.

I've heard both of these explanations. Also there are overall more applicants applying for approximately the same number of positions.

From: http://www.nrmp.org/data/resultsanddata2010.pdf

I saw the director of the ACGME speak recently and he claimed there won't be enough residency positions for US medical graduates in about 2013. Of course there's already way too many applicants for the total number of positions due to FMGs, but that's a discussion for elsewhere.

The number of MD/PhDs is also growing.
From the same sources
2007: 530 matched, 32 unmatched MD/PhDs
2009: 573 matched, 51 unmatched MD/PhDs