Applications for Psych

[pingumd]

Can current residents and attendings speak to the trend for applications in psych for 2008 compared to the previous few years?
I heard a few rumors that applications were up for 2008 but not sure by how much or even if the rumor is true.
Any info much appreciated since it NRMP takes it's sweet time in putting together the application stats for each field.

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[HCE]

Can current residents and attendings speak to the trend for applications in psych for 2008 compared to the previous few years?
I heard a few rumors that applications were up for 2008 but not sure by how much or even if the rumor is true.
Any info much appreciated since it NRMP takes it's sweet time in putting together the application stats for each field.

http://pn.psychiatryonline.org/cgi/content/full/43/9/1-a

 

[colleezfascia]

Can current residents and attendings speak to the trend for applications in psych for 2008 compared to the previous few years?
I heard a few rumors that applications were up for 2008 but not sure by how much or even if the rumor is true.
Any info much appreciated since it NRMP takes it's sweet time in putting together the application stats for each field.

With regard to this year's apps, all I know is from what a department coordinator in the Northeast told me. She said that "the applications were way up this year." And she lifted her eyebrows as she said it (dramatic effect is always key). As far as what consitutes "way up," I'm not sure. Would be interesting to find out, though.

 

[peppy]

Yes, I'll be very interested in what the 2009 statistics are. I too heard at one of the programs I interviewed with (in the midwest) that they had received more applications this year. It also appeared to me that more of my fellow classmates were interested in psych this year (one person in last year's class, whereas in this year's class there are at least 4 of us that I know of).
Once I know I have matched somewhere, I can start trying to recruit future applicants to our field.

 

[cattledog]

I can't speak either way about whether there's an increase in applicants for psych positions this year or not. But in reading several specialties' threads on the subject, I can say that I've never seen a comment like "Anesthesia keeps getting easier to get into every year" or "PM&R - could the applicant pool get any smaller?" In my experience, everyone with an opinion on the matter believes his or her specialty (declared or actual) is harder to get into this year than last.

 

[dianamd]

Someone at one of my interviews told me that applications were up at Harvard and Columbia med schools this year. Something to do with, 1) a loan reimbursement at Harvard for going into psychiatry and 2) who knows at Columbia, but something like 15 students applying.

No idea if there is truth to this rumor, though.

Doesn't make me happy, but at this point, we are closer to finding out our match than submitting our lists, so who cares! Just tell me!!!

 

[NJWxMan]

Numerous program coordinators at mid to upper tier Psychiatry programs told me that they had unprecedented numbers this year including one that received over 1,500 applications for only 60 interview slots and another in which the PD found 400 new applications after a weekend in November. Fact is this: psych numbers were definitely up this year, and in many cases, significantly so. Let's face it; lifestyle is nearly never a problem for a psychiatrist and the intricacy of daily practice is much less enduring. Being swamped with new labs everyday, annoying phone calls, and better yet, laundry list patients (the ones that save all of their problems for their yearly visit so that they only had to pay the one visit copay of $20 instead of the $60) are no fun.

 

[chameleonknight]

"

But the number of graduates from U.S. medical schools choosing psychiatry has dropped slowly but steadily for several years; this year's number—595—represents a drop of 6 percent from last year and 8.8 percent from 2005 (see chart)

"


---From the above article

 

[pingumd]

Well, I would be surprised if psychiatry doesn't get a lot more popular in the future since it is a good lifestyle and is getting increasingly "sciency".

I wonder if the possible increase in applications is due to the economy. Ie, someone who had decided to take a few years off to work at a company, to raise children, or people who trained in family med who are now deciding to retrain in a different field.

 

[billypilgrim37]

I think it's pretty clear that the number of FMG applications to EVERYTHING is increasing every year, while the number of AMG applications to psychiatry is randomly going up and down every year with no clear evidence of any sort of up or down trend whatsoever. As long as programs are systematically biased against FMGs (which they clearly are), there is little evidence that psychiatry is becoming a lick more competitive for AMGs in the past 5-10 years.

I've also seen stats that people simply apply to more programs than they used to, for whatever reason.

 

[cleareyedguy]

One reason for the perception is not just absolute overall numbers but the fact that several medical schools that also have strong residencies produced >10 applicants each. My understanding is that would include Columbia, Cornell, and UCSF, but there may be others.

In general, however, I wouldn't get too bent out of shape about the numbers of applicants. They're generally fairly meaningless unless you are interested in national policy issues, and even then one year does not a trend make.

 

[janisjoplin]

One reason for the perception is not just absolute overall numbers but the fact that several medical schools that also have strong residencies produced >10 applicants each. My understanding is that would include Columbia, Cornell, and UCSF, but there may be others.

In general, however, I wouldn't get too bent out of shape about the numbers of applicants. They're generally fairly meaningless unless you are interested in national policy issues, and even then one year does not a trend make.

What do you think about this now, after there ended up being shockingly few scramble spots? On Match day itself a lot of people I know matched at places they were just totally surprised by, often pretty far down on their lists. You're not going to see this reflected in the "Where did I match" threads, of course, because people who are shocked won't post there. But even some applicants from those "strong" programs seem to be in that position. This may not be a matter of national policy, but it sure has an impact on those people's lives, careers, and at least their short term happiness.

 

[billypilgrim37]

The few small number of scramble slots probably doesn't mean anything. If you don't get what you want, it sucks. I doubt that the small number of scramble slots can be used as any sort of evidence to suggest that on the whole applicant X would have been less happy this year than in the past. Of course, some individuals are always victims of probability, and that really sucks. But it doesn't make a trend.

There are many ways to explain the lack of scramble slots based on applicant and program behavior rather than an increase in applicant quality or number. If applicants interview and rank more programs, and programs interview and rank more applicants for fear of not matching or filling (which would be the case based on the previous years' number of slots going unfilled), that would readily explain this trend.

 

[heyjack70]

Are the number of psychiatry residency spots stable year to year? Has there been a decrease?

 

[janisjoplin]

The few small number of scramble slots probably doesn't mean anything. If you don't get what you want, it sucks. I doubt that the small number of scramble slots can be used as any sort of evidence to suggest that on the whole applicant X would have been less happy this year than in the past. Of course, some individuals are always victims of probability, and that really sucks. But it doesn't make a trend.

There are many ways to explain the lack of scramble slots based on applicant and program behavior rather than an increase in applicant quality or number. If applicants interview and rank more programs, and programs interview and rank more applicants for fear of not matching or filling (which would be the case based on the previous years' number of slots going unfilled), that would readily explain this trend.

But that would require a coordinated or at least coincidental effort across a lot of programs as well the presence of a remarkably similar style of ranking behavior by multitudes of applicants--i.e. a trend. And no less a mysterious trend at that.

 

[billypilgrim37]

But that would require a coordinated or at least coincidental effort across a lot of programs as well the presence of a remarkably similar style of ranking behavior by multitudes of applicants--i.e. a trend. And no less a mysterious trend at that.

I wouldn't call it a mysterious trend, but a simple change in behavior based on an incentive. If your previous behavior results in less matching, which is undesirable, you do things differently. I'm sure Longwood and NYU's rank lists were much longer than last year, and they were surely no worse off for it. And I'm sure plenty of other programs were nervous knowing that even top programs can get burned for having rank lists that are too short.

As far as applicants, well, they all talk to each other and they all read this website and they all keep getting told "hey, psych is getting more competitive, you better interview at more places!"

 

[janisjoplin]

The few small number of scramble slots probably doesn't mean anything.

But there was a five fold decrease in scramble spots from the year before, and even more if you look at which spots actually were real. How do you know that isn't meaningful? I would think it could either be just a blip, or possibly part of something larger.

 

[notdeadyet]

But there was a five fold decrease in scramble spots from the year before, and even more if you look at which spots actually were real. How do you know that isn't meaningful? I would think it could either be just a blip, or possibly part of something larger.

It could just be an indication that people are interviewing more programs (which would account for the residency programs indicating more volume).

But also, med schools have been increasing enrollments for the last couple years without a matching increase in residency slots. This could provide a more challenging application environment for international med school grads. If it continues, it could start to pinch osteopaths (though I'd think at a much lesser level).

At the end of the day, I'm not sure we've seen any indication yet that we have more than the 2-3% of unmatched U.S. grad med students than we've had in years passed. Until the data comes back, we don't know much.b

 

[heyjack70]

Are the number of psychiatry residency spots stable year to year? Has there been a decrease?

To answer my own quote, total spots this year were only 6 fewer than last year.

http://www.nrmp.org/data/advancedatatables2009.pdf

Compared to last year,
61 more US seniors matched into psych.
22 fewer "other" applicants matched.

US senior matches are up, and there were 39 more matches this year with 6 fewer residency spots (not including 4 in Puerto Rico)

In past years There have been about 50 scramble spots. But those dwindled to "11" with the increased number of matches.

 

[BobA]

To answer my own quote, total spots this year were only 6 fewer than last year.

http://www.nrmp.org/data/advancedatatables2009.pdf

Compared to last year,
61 more US seniors matched into psych.
22 fewer "other" applicants matched.

US senior matches are up, and there were 39 more matches this year with 6 fewer residency spots (not including 4 in Puerto Rico)

In past years There have been about 50 scramble spots. But those dwindled to "11" with the increased number of matches.

Great post. While psych was slightly more competitive this year, the 4.5% increase in applicants seems to be within the normal range of variation. Some years %of AMG applicants to psych is up 4.5% some years it's down 4.5%. (see page six of link above) I think it's just hovering around the mean.

Other 2009 analysis:

1063 psychiatry spots for 732 AMG applicants, or 1.45 spots per AMG.

76 AMG's ranked psych but didn't match (some might have listed multiple specialties).

Compare to peds (1.28 spots per applicant), IM (1.61), Neuro PGY-2 (1.16), EM (1.11), Ortho (0.85), Plastics (0.57), Derm PGY2 (0.73), Rads (0.85)

I didn't realize how few neuro spots there were. If you add the PGY1 and PGY2 there are only 581 spots. Almost half as many neuro spots as psych spots.

 

[nancysinatra]

Great post. While psych was slightly more competitive this year, the 4.5% increase in applicants seems to be within the normal range of variation. Some years %of AMG applicants to psych is up 4.5% some years it's down 4.5%. (see page six of link above) I think it's just hovering around the mean.

Other 2009 analysis:

1063 psychiatry spots for 732 AMG applicants, or 1.45 spots per AMG.

76 AMG's ranked psych but didn't match (some might have listed multiple specialties).

Compare to peds (1.28 spots per applicant), IM (1.61), Neuro PGY-2 (1.16), EM (1.11), Ortho (0.85), Plastics (0.57), Derm PGY2 (0.73), Rads (0.85)

I didn't realize how few neuro spots there were. If you add the PGY1 and PGY2 there are only 581 spots. Almost half as many neuro spots as psych spots.

BobA--I think that 4.5% refers to the percentage of US seniors who matched into psych this year, not to an increase over last year, and yes it is similar to recent years. If you notice, 18.1% is listed for internal medicine, which makes sense that that's the percentage of grads going into IM, not a percentage increase for IM.

Anyway, it won't matter much what percent apply in psych if the overall applicant pool increases and all fields become more competitive. In one of the threads before the match I posted a link to an article about how overall US med schools are increasing enrollments. The purpose of increasing enrollments is ostensibly to create more primary care doctors. If it's true I'd think it would actually just put more pressure on competitive fields first and then fields like psych, and finally, in the end, produce disgruntled people who are forced to go into primary care because they can't match in anything else. Someone should compare the number of unmatched US seniors in all the fields this year to previous years. In other forums they are saying all fields were "really competitive."

Or maybe people always just say their annual match was "really competitive." No one (besides anesthesiarocks and his notorious thread) ever says how "easy" it is to get into something.

 

[BobA]

BobA--I think that 4.5% refers to the percentage of US seniors who matched into psych this year, not to an increase over last year, and yes it is similar to recent years. If you notice, 18.1% is listed for internal medicine, which makes sense that that's the percentage of grads going into IM, not a percentage increase for IM.

Anyway, it won't matter much what percent apply in psych if the overall applicant pool increases and all fields become more competitive. In one of the threads before the match I posted a link to an article about how overall US med schools are increasing enrollments. The purpose of increasing enrollments is ostensibly to create more primary care doctors. If it's true I'd think it would actually just put more pressure on competitive fields first and then fields like psych, and finally, in the end, produce disgruntled people who are forced to go into primary care because they can't match in anything else. Someone should compare the number of unmatched US seniors in all the fields this year to previous years. In other forums they are saying all fields were "really competitive."

Or maybe people always just say their annual match was "really competitive." No one (besides anesthesiarocks and his notorious thread) ever says how "easy" it is to get into something.

You're right - thanks for the clarification.

I think the purpose of increasing the number of us medical school spots is really just a way of recognizing the huge gap between supply and demand is potentially hurting patients by not supplying enough quality physicians.

As long as the number of residency slots stays constant, there won't be that many more PCP's. Just more USAMG's going into primary care. The overall number of PCP's will stay constant with the number of residency spots.

I agree that increasing competition is going to result in more disgruntled physicians (12 people from my school didn't match into their chosen field - a record!)

 

[nancysinatra]

As long as the number of residency slots stays constant, there won't be that many more PCP's. Just more USAMG's going into primary care. The overall number of PCP's will stay constant with the number of residency spots.

Actually in primary care aren't there so many unfilled positions each year that unmatched applicants from other fields would in fact be forced to default to this field which is otherwise avoided like the plague? That's why in this earlier thread I wanted to compare FP scramble slots with the measly "11" that were posted in psych. This is a proportional problem before it is a sheer numbers problem. However, if that is the wisdom of increasing US med student enrollments without increasing residency slots in specialty fields, then I guess it is ONE way to create more PCPs, but I can't imagine it is the best way. People will work until they've paid off their loans and then quit.

 

[notdeadyet]

However, if that is the wisdom of increasing US med student enrollments without increasing residency slots in specialty fields, then I guess it is ONE way to create more PCPs, but I can't imagine it is the best way. People will work until they've paid off their loans and then quit.

I think you might underestimate people's ability to work at a job they dislike. There are a whole lot of disgruntled doctors out there (over-represented in primary care and surgery, from what I've seen) and they aren't quitting anytime soon.

For all the talk about all the great opportunities for physicians, once you've been residency trained in a specialty, board certified, and work the 10-15 years it takes to pay off your loans, it's going to be hard to make a career leap to selling pharm or consulting for D&T.

 

[peppy]

Some people may get fed up enough to quit once their loan debt is gone, but I wouldn't expect most people to do that. Even the worst medical job is still much better (and far more secure) than a lot of other career paths. Can you imagine going into the current economy and trying to break into a new industry with no qualifications or hands on experience related to the industry? When I found out I didn't match (yes, I cringe at the foreshadowing of my earlier post in this thread now), I thought for a few seconds about trying to find a job outside of medicine for the year, but I wouldn't even know where to start. For all the years we spend in school, we sure don't have much to show for it without a residency.

There are also those who might learn to love primary care if they're forced into it. Many of the problems with primary care are more to do with the current political climate, not because everything about being a PCP is so horrible.
I've worked with some primary care docs who were making great money and/or seemed to enjoy their work (sure, those two things don't always go hand in hand). The relationship a PCP can form with a patient they've known for years can be very meaningful. We've all probably seen those patients who bring their PCP Christmas cookies and such. I'd be very surprised if most psychiatrists would accept Christmas cookies from someone they had involuntarily hospitalized.

When I was looking for open positions, I seriously thought about going for one of the open FM positions. However, I remember reading the cautionary tale of Panda Bear about switching fields in haste, so I've decided to hold off and give myself an internship year to think over my next move instead.

 

[BobA]

Actually in primary care aren't there so many unfilled positions each year that unmatched applicants from other fields would in fact be forced to default to this field which is otherwise avoided like the plague? That's why in this earlier thread I wanted to compare FP scramble slots with the measly "11" that were posted in psych. This is a proportional problem before it is a sheer numbers problem. However, if that is the wisdom of increasing US med student enrollments without increasing residency slots in specialty fields, then I guess it is ONE way to create more PCPs, but I can't imagine it is the best way. People will work until they've paid off their loans and then quit.

Presently most of those IM/FM spots that go unfilled in that match do eventually get filled with IMG's/FMG's. So increasing the enrollment of US medical school just means that they'll get filled with AMG's.

 

[nancysinatra]

Presently most of those IM/FM spots that go unfilled in that match do eventually get filled with IMG's/FMG's. So increasing the enrollment of US medical school just means that they'll get filled with AMG's.

Unhappy would-be plastic surgeon, would-be radiologist, and would-be psychiatrist AMGs. Is this really a policy? Some might end up liking it but a lot will remember that they failed at something else first and become bitter, and maybe not provide the best care, either.

 

[BobA]

Unhappy would-be plastic surgeon, would-be radiologist, and would-be psychiatrist AMGs. Is this really a policy? Some might end up liking it but a lot will remember that they failed at something else first and become bitter, and maybe not provide the best care, either.

That assumes that the FMG's/IMG's going into those primary care spots now have some undying desire to adjust BP meds and counsel smoking cessation.

Unless primary care salaries increase NP's, and PA's are the future of primary care anyway.

 

[notdeadyet]

Unhappy would-be plastic surgeon, would-be radiologist, and would-be psychiatrist AMGs. Is this really a policy? Some might end up liking it but a lot will remember that they failed at something else first and become bitter, and maybe not provide the best care, either.

This isn't a new phenomenon. And if not matching into your specialty of choice is enough of a setback to make you a lifelong bitter failure, you never really had a shot of happiness coming out of the gate.

Most algorithms look something like:
Radiology > Emergency Medicine > Anesthesia >>>>>> Banking.

Plug in your specialties of choice. But at the end of the day, even if you don't match into your program of choice, or even your specialty of choice, spending your life as a physician still beats counting and moving widgets for the rest of your days.

 

[nancysinatra]

That assumes that the FMG's/IMG's going into those primary care spots now have some undying desire to adjust BP meds and counsel smoking cessation.

I don't see how I was assuming that. FMGs/IMGs who take those spots may be bitter too. Or simply desperate. What looks like it will happen now is that we will have even more bitter and desperate people. I don't see how that furthers the cause of primary care.

And if not matching into your specialty of choice is enough of a setback to make you a lifelong bitter failure, you never really had a shot of happiness coming out of the gate.

I disagree. A person could have several specialties they're happy with, but by a landslide have no interest in a primary care career. And counting widgets is not the only thing outside of medicine that people do.

Would you be making the same argument if the US had a shortage of surgeons? Or better yet cosmetic plastic surgeons? Would you think it was ok to force people into those fields if the slots routinely went unfilled?

 

[BobA]

I don't see how I was assuming that. FMGs/IMGs who take those spots may be bitter too. Or simply desperate. What looks like it will happen now is that we will have even more bitter and desperate people. I don't see how that furthers the cause of primary care.

My point was just that there won't be more desperate or bitter people working in primary care because the number of primary care residency spots will stay the same. The bitter people will be AMG's instead of IMG's, but the absolute number won't change.

 

[nancysinatra]

My point was just that there won't be more desperate or bitter people working in primary care because the number of primary care residency spots will stay the same. The bitter people will be AMG's instead of IMG's, but the absolute number won't change.

Oh, I see what you mean. However I would think that the net amount of bitterness in the profession will increase because AMGs, unlike FMGs, are not bettering their plight by coming here, and AMGs will also owe up to $250,000 for the privilege of matching in a field they initially scorned. I'm only saying it seems like there might be better ways to address the shortage of PCPs than increasing the number of unmatched or unhappily matched AMGs. But again I don't know if this is even real.

I'm sorry about the people at your school who didn't match in what they wanted. I hope they got spots they're happy with.

Peppy--your posts are really inspiring and I'm glad things are looking up. I think you will do amazingly well in the next year! I'm kind of jealous that you get to do a real intern year!

 

[notdeadyet]

A person could have several specialties they're happy with, but by a landslide have no interest in a primary care career.

I think you're seeing an injustice in the system that I'm not.

If you have no interest in specialties that make up 50% of the opportunities out there, and they make up the least competitive 50% of the opportunities, then you should pursue medical school with the understanding that you'd better be $hit hot or you will end up miserable. If you are not going to be safely amongst the best 30% or so medical students in the country, you shouldn't apply, as you run the risk of winding up in the field you have no interest in.

At the end of the day, there are more total allopathic residency spots than there are allopathic medical school graduates. Literally, there is enough room that everyone could potentially get a spot somewhere if they apply broadly enough. That's a great and rare thing.

But there are X amount of spots in Radiology and Y amount of applicants. If Y>X, some won't get radiology and need to try their hand at another specialty. If someone wants to be a Radiologist but would be unhappy in any other field in medicine should probably not attend medical school. If someone has an open mind as to medical specialties and is more concerned with just being a physician, they will find a home.

I find the whole medical residency thing to be MUCH more egalitarian than any other profession than I've worked in.

And counting widgets is not the only thing outside of medicine that people do.

That was meant to be facetious. It apparently didn't come across. My bad.

 

[notdeadyet]

Would you be making the same argument if the US had a shortage of surgeons? Or better yet cosmetic plastic surgeons?

If the US had a shortage of plastic surgeons, and plastic surgeon slots is where half of all medical school graduates would eventually end up, I'd have to be either incredibly confident or incredibly foolish to go to medical school if I couldn't stomach going into cosmetic plastic surgery.

You can dream of being an astronaut, but only so many folks go up in space. Some of us end up flying for UPS. If that doesn't gel with someone, they shouldn't go to flight school. Make sense?

Would you think it was ok to force people into those fields if the slots routinely went unfilled?

No one's getting forced into anything. There are a set number of slots for each specialty. You're either a strong enough applicant to get a slot or you aren't. If you aren't, you need to look at Plan B.

I've never gone into a job interview where I was the only applicant. I either got the job or I didn't. No one "forced" me to take another job. I just didn't get it because there were more qualified applicants. Such is life. In every field.

Medicine is a much better gig than in the outside world. In medicine, you will get a residency if you're open-minded enough. That ain't true in most fields.

 

[nancysinatra]

notdeadyet, I wonder if you misunderstand me a bit? I'm not complaining about the current status quo. I'm talking about the situation where med school enrollments would be annually increasing to the point that the match is flooded, where psych has no scramble spots, where competitive specialties have far, far more applicants than they have spots, and where currently open FP spots will be filled by those unmatched people who have no other choice. This is a dynamics problem, not a static "injustice" I am seeing. That's why I keep saying I don't know if it's real or not.

I have no trouble with the competitive nature of medical specialties or with expecting people to default to primary care. But schools vary in how they evaluate students. If you're ok with the concept of increasing competitiveness indefinitely, then I at least think someone should assess the measures we compete on. At my school, shelf exams are it. They accounted for close to 100% of our surgery grade. You could be an absolute loser on the floor and get honors, or an absolute star and get a pass, because the shelf, and only the shelf, mattered. Indeed, if you LEAVE the floor to STUDY for the shelf, that is the best strategy. Now, with the system becoming more Darwinian than ever, we will see even more of this mentality.

I can understand a more ruthlessly competitive match system if you TELL premeds at their interview "It costs 250,000 to come to our school, we will grade you on shelf exams entirely, and you will likely not be able to match into a specialty besides FP." I would be more comfortable with that, I guess.

If enrollments are not increasing I take back my point. I posted a link last week to an article saying they were from the Chicago Tribune.

 

[OldPsychDoc]

notdeadyet, I wonder if you misunderstand me a bit? I'm not complaining about the current status quo. I'm talking about the situation where med school enrollments would be annually increasing to the point that the match is flooded, where psych has no scramble spots, where competitive specialties have far, far more applicants than they have spots, and where currently open FP spots will be filled by those unmatched people who have no other choice. This is a dynamics problem, not a static "injustice" I am seeing. That's why I keep saying I don't know if it's real or not.

I have no trouble with the competitive nature of medical specialties or with expecting people to default to primary care. But schools vary in how they evaluate students. If you're ok with the concept of increasing competitiveness indefinitely, then I at least think someone should assess the measures we compete on. At my school, shelf exams are it. They accounted for close to 100% of our surgery grade. You could be an absolute loser on the floor and get honors, or an absolute star and get a pass, because the shelf, and only the shelf, mattered. Indeed, if you LEAVE the floor to STUDY for the shelf, that is the best strategy. Now, with the system becoming more Darwinian than ever, we will see even more of this mentality.

I can understand a more ruthlessly competitive match system if you TELL premeds at their interview "It costs 250,000 to come to our school, we will grade you on shelf exams entirely, and you will likely not be able to match into a specialty besides FP." I would be more comfortable with that, I guess.

If enrollments are not increasing I take back my point. I posted a link last week to an article saying they were from the Chicago Tribune.

So in other words, "what if medicine were more like law school?"

 

[notdeadyet]

notdeadyet, I wonder if you misunderstand me a bit? I'm not complaining about the current status quo. I'm talking about the situation where med school enrollments would be annually increasing to the point that the match is flooded, where psych has no scramble spots, where competitive specialties have far, far more applicants than they have spots, and where currently open FP spots will be filled by those unmatched people who have no other choice.

Gotcha. Apparently I misread what you were saying. I thought your gripes was with the injustice of how things are right now.

Enrollments in medical schools have been bumped up a fair bit starting three years ago a fair bit (10-15% at some schools, a handful of students at others). I don't think residency seats were increased significantly to match this increase.

If med school enrollments are dramatically raised, things could get ugly like the situation you describe above. But I think they've been pretty judicious about it.

If you're ok with the concept of increasing competitiveness indefinitely, then I at least think someone should assess the measures we compete on. At my school, shelf exams are it.

I don't think competitiveness will increase indefinitely. Unlike law or business, medical schools are restricted from increasing enrollments. It's not a matter of how many seats the market will bear.

As for changing the metric of evaluation, I'm not too pushed in that. I LIKE the fact that different schools do it differently. I intentionally avoided going to schools that used evaluation criteria I didn't like and a fair part of my decision was based on how a particular school evaluated and motivated students. I'd hate to see any standardization, because it would force schools to all become more alike.

And residency directors have a good handle on the differences amongst the different medical schools. This is a bonus of having so relatively few medical schools. If you're the neurology program director at OHSU, you have a pretty good handle on what an Honors in Neuro means at Emory.

 

[notdeadyet]

I can understand a more ruthlessly competitive match system if you TELL premeds at their interview "It costs 250,000 to come to our school, we will grade you on shelf exams entirely, and you will likely not be able to match into a specialty besides FP." I would be more comfortable with that, I guess.

This is really up to the STUDENT. When you decide to go to medical school, you are signing up for a $250,000 house. That's more than a house in most places.

I wish medical students would take their med school investment at least as seriously as they'd take purchasing a house. There are questions you need to ask and things you need to look into and the responsibility lies with YOU, the buyer.

In what you describe above, it's the equivalent of wishing that brokers would TELL prospective buyers at interviews that the rate they are charging is high and the area's crime is growing and they're more than likely going to have a tough time selling their new home at a profit.

I think most med schools have some clerkships that are more shelf based and others that are more subjectively based. Some students are like you and decry rotations that are heavily or entirely shelf-based (I'm with you) as they say it doesn't factor in floor performance. Some students decry rotations that are heavily subjective, as it lends itself more to ***** kissing and students being graded on how their personality gels with a particular faculty member. The trick is to choosing a med school that evaluates students in the way you feel is more fair.

If enrollments are not increasing I take back my point. I posted a link last week to an article saying they were from the Chicago Tribune.

The country has a shortage of primary care docs. The solution to that has been to increase the number of doctors until those seats are filled. This will make the competitive residencies more competitive. I don't think there's a way around this, unless something is done to make primary care more attractive.

 

[nancysinatra]

So in other words, "what if medicine were more like law school?"

Is that how law school works out for people? There are a lot of unemployed lawyers, it's true...

Notdeadyet, how were you able to assess, as a premed, how med schools evaluated their students? I was just showered with phony chipper propaganda about how great the first 2 years were at every school. Looking back it had to be 99.99% false. There should be a truth in advertising law that applies to medical schools, just like there is for pharmaceuticals. Med schools should not say they are "cooperative learning environments" when in fact they are hotbeds of competition. This should be no less than federal statute. I'm impressed you were able to see through the facade.

Ugh I need something to do other than complain! I know, I need a shelf exam to study for.

 

[nancysinatra]

This is really up to the STUDENT. When you decide to go to medical school, you are signing up for a $250,000 house. That's more than a house in most places.

I wish medical students would take their med school investment at least as seriously as they'd take purchasing a house. There are questions you need to ask and things you need to look into and the responsibility lies with YOU, the buyer.

I totally disagree. Buying a home and being educated are different things. It is one thing to aspire to improve one's mind and devote one's life to the cause of health care, and another to covet a bigger house or a more illustrious address. The cost of medical education is simply prohibitive which I think is sad. It's great to encourage responsibility, but you can only go so far; our system is very unfair in many ways, and the burden of change should be placed on the system, not the students.

 

[notdeadyet]

notdeadyet, how were you able to assess, as a premed, how med schools evaluated their students?

I asked for copies of their curriculum plans and the syllabi for the courses (these are usually on file with the office of academic affairs, or some other local flavor). I also asked for the grading criteria for the 3rd year required clerkships. I also asked for how the Dean's letter was written, if students were ranked (and if so, how).

I asked a lot of specific questions and asked for a a little of documentation, but only documentation that should be readily available and public access. I didn't get pushback, other than the occassional sigh from the occassional office staffperson.

I was just showered with phony chipper propaganda about how great the first 2 years were at every school. Looking back it had to be 99.99% false.

The one question I avoided asking is if schools fostered a cooperative learning environment. Soft questions like these, that don't have any data to back it, is wasted breath. I did ask if the first two years were graded or pass/fail. If they were pass/fail, I asked if the actual percentages were later used for class ranking or the dean's letter. I asked if there was a student-run note service and asked to peek at the student-run file sharing. These sort of questions let ME judge if the school's learning environment for the first two years.

There should be a truth in advertising law that applies to medical schools, just like there is for pharmaceuticals. Med schools should not say they are "cooperative learning environments" when in fact they are hotbeds of competition.

It's all a shade of gray though, right?" There will ALWAYS be gunners at schools and always be those who help their classmates. The trick is to ask questions to find out if the school has policies that actively support student collaboration and cooperation.

 

[notdeadyet]

I totally disagree. Buying a home and being educated are different things.

They are exactly the same in one way: they cost $250K. Treating that money as anything less than one of the largest investments in your life is being very financially irresponsible.

Whether you're dropping $250K to get a place with a pool or dropping $250K to become a pediatrician for the underserved in Nicaragua is irrelevant. It's a lot of money. It shouldn't be spent without asking a lot of questions.

The cost of medical education is simply prohibitive which I think is sad.

It's a great investment, so I don't think it's too prohibitive long term. If you asked students if they'd be willing to have their salaries dropped by 30% for the sake of free medical education, I'll bet a majority would say "no". The $250K spent getting entry to a $150k/year job with great job security seems like money well spent to most.

It's great to encourage responsibility, but you can only go so far; our system is very unfair in many ways, and the burden of change should be placed on the system, not the students.

The system seems very unfair compared to theory. The med school education system seems incredibly fair compared to any experience I've had with any actual professional system in the real world. The bias, snap judgment, and prejudice in med school admission and residency selection pales in comparison to your average job interview. The transparency of medical schools you are thinking of attending is much greater than the transparency of a private company you are thinking of going to work for.

If something seems unfair, I think it's usually best to ask "compared to what?"

Anyway, we'll just have to respectfully agree to disagree. I didn't find med schools to be shy about answering any question I had. If students don't care enough about investigating what questions to ask, that's their call, but caveat emptor.

Disclosure: I was raised working class and am old. I realize that this makes my viewpoint very different from your average medical student.

 

[peppy]

Peppy--your posts are really inspiring and I'm glad things are looking up. I think you will do amazingly well in the next year! I'm kind of jealous that you get to do a real intern year!

Thanks for the well wishes. I hope your prediction for next year is more accurate than the interviewer I had this year who assured me that he thought I'd do well in the match.
There are some rotations that I am not looking forward to reliving in my internship year, but when I hear from people who aren't in medical careers about the misery of looking for a job nowadays or working long hours for much less money than residents make, it puts things in perspective.

 

[VMSmith]

notdeadyet's posts make a lot of sense to me.

Too many people go into medical schools with no idea about what they're actually signing up for - not knowing the evaluation systems (or knowing them but not really understanding what they mean, or how the systems will affect them), or just not having any choice about it if they only get into schools with similar evaluation systems.

Everyone gets different advice from different people about what to pay attention to when selecting medical schools, and it's difficult for someone who hasn't actually been through the process to recognize good advice from...less good advice. Some people say to pay attention to Step 1 scores, others to pay attention to match lists, still others to pay attention to evaluation methods.

The same holds true for residencies - I honestly still don't know what I should have based my decision on, because I'm not totally sure what specific aspects of each program will turn out to be the most important for me as I go through residency. I gathered advice from dozens of people but ultimately it was based on their priorities, and ranged from "just go with your gut" to specific advice regarding everything from call/night float systems to mentoring. And I'm sure everyone will find things they love about their program and things they hate whether they matched at their #1 or their #10 program.

And so I feel like part of what makes people feel that the process is unfair is that they feel, rightly or wrongly, that they go into it not really knowing what is important in terms of securing a "good" position and not really knowing how to decide what a "good" position is compared to a "bad" one. Especially when they look at their own record and know that their application is a strong one based on the advice they got (good Step 1 score, good grades, good recs as far as they know, etc) and they still didn't get the position they felt they deserved. And knowing that it's a computer algorithm that decides where they're going and having no control over it beyond Feb 25th makes it feel all the more unfair.

You can argue that the same holds true in the "real world", where they just wouldn't get a job offer if there were others more qualified (or with better connections), but the perception is that in the real world you at least get to decide between 2 or 3 offers (maybe), and I think that ability to make a choice is very alluring.

 

[nancysinatra]

It's a great investment, so I don't think it's too prohibitive long term. If you asked students if they'd be willing to have their salaries dropped by 30% for the sake of free medical education, I'll bet a majority would say "no". The $250K spent getting entry to a $150k/year job with great job security seems like money well spent to most.

It's not such a great investment if you get sick or injured during your medical school years at a point where you have accumulated a staggering amount of debt but cannot go to residency or otherwise use the training you've gotten so far. Then that partial MD will not look so much like a house or the land it's built on. Even going back to finish the MD later may be pointless as residency programs are rumored to shy away from applicants with gaps in their CV. There are lots of threads on this.

What other industrialized countries require students to take on a quarter of a million dollars in debt in order to pursue an uncertain education in a changing field where there are no guarantees? You may not think it's prohibitive but I would guess that statistically, people of working class background are underrepresented in medicine.

The system seems very unfair compared to theory. The med school education system seems incredibly fair compared to any experience I've had with any actual professional system in the real world. The bias, snap judgment, and prejudice in med school admission and residency selection pales in comparison to your average job interview. The transparency of medical schools you are thinking of attending is much greater than the transparency of a private company you are thinking of going to work for.

I would compare it to the academic arts and sciences, not to the business world. Whatever YOUR last experience was, that's what YOU'LL compare it to, I guess...

By the way, how did you know to look for all those things that you did in choosing a medical school? Age would not give you that insight. You must have known a recent medical student! To know to check whether they kept a hidden class rank??

 

[notdeadyet]

What other industrialized countries require students to take on a quarter of a million dollars in debt

None. But what other industrialized countries have folks starting out at $150K-$400K/year immediately out of residency? We have huge student debt after medical school, but our salaries are the highest in the world.

There's a solid debate about whether we should follow most of the rest of the world and have significantly lower student debt but also significantly lower salaries. But you can't compare our student debt with most countries, as our doctors also make a lot more money.

in order to pursue an uncertain education in a changing field where there are no guarantees?

Medicine may be a changing field, but it's one of the most stable job paths out there. I can't really think of any professional fields where your path is so well marked. The face of medicine may change and so might reimbursements, but I don't think anyone in their right mind is arguing that doctors are going to see their salaries fall out of the top 5%.

Have you ever met doctors who couldn't find jobs? Medicine is incredibly tightly controlled, from the number of folks in each residency down to the number of medical students allowed to go to school each year. It's really one of the most stable fields out there. Literally.

You may not think it's prohibitive but I would guess that statistically, people of working class background are underrepresented in medicine.

I'd agree. But I'm not paying for med school as I go. Neither are most of the rich kids. Most everyone I know is taking out the same student loans.

The reason you probably find less working class kids is that the rich kids tend to have parents who pay for SAT prep classes, send them to good schools, give them money so they aren't working in college, and other things that make them more primed to med school. There's also the issue of the fact that when your parents are a doctor and a lawyer, the idea of going to law and medical school seem more realistic and attainable.

But rich or poor, no one is turned away from med school because they can't afford it. None of us can. We all take out the loans.

 

[notdeadyet]

I would compare it to the academic arts and sciences, not to the business world.

When I say "professional", I'm not talking about the business world. My point stands for anything in the actual working world where you get paid. It's not industry specific.

I'm not really sure what "academic arts and sciences" means to you, but much of my professional background was in education, some at the college level. Hiring practices in academia is FAR less "fair" than med school and residency admissions.

Again, it ain't the business world I'm talking about. It's the working world. Med school/residency is egalitarian, transparent, and just by comparison. If you have an industry that you think this isn't the case, I'd be curious to hear about it, because I'd be pretty surprised.

By the way, how did you know to look for all those things that you did in choosing a medical school? Age would not give you that insight. You must have known a recent medical student! To know to check whether they kept a hidden class rank??

Going to med school was a big leap for me. I didn't know any doctors. I had no idea what residency was, let along how to get one.

I researched the idea of going to med school in a big way. Mostly online. SDN was a great resource to find out what students were complaining about. This is where I learned about the importance of the Dean's Letter, how some schools grade and others don't, who does class rank, etc.

I'm also cheap. If I'm dropping $250K on an education, I wanted to make sure that education got me where I wanted to go.

The only insight age has given me that helps in this process is that I have an extremely healthy respect for the money I'm spending on my education. I also realize that of all the unjustices I've seen and experienced in life, the injustice of med school/residency admissions is probably somewhere in the bottom quartile.

 

[notdeadyet]

Especially when they look at their own record and know that their application is a strong one based on the advice they got (good Step 1 score, good grades, good recs as far as they know, etc) and they still didn't get the position they felt they deserved. And knowing that it's a computer algorithm that decides where they're going and having no control over it beyond Feb 25th makes it feel all the more unfair.

Yeah, the Match is an odd bird.

The Match is set up so that as many people are placed into residencies as possible and as many residency seats end up being occupied as possible.

The alternative would be to set up the system as each residency program offering job interviews and then sending the offers out to the candidate they want. What you'd see there is a HUGE amount of Scramble, the top 20% would be more likely to get their perfect slot, the middle 60% would have to do way more interviews, and the bottom 20% would be much more likely to not find a home.

There's probably a much more egalitarian, efficient, and reduced-stress way of doing it, but wracking my brain, I can't think of one that doesn't create a whole new can of worms.

 

[nancysinatra]

I'm not really sure what "academic arts and sciences" means to you, but much of my professional background was in education, some at the college level. Hiring practices in academia is FAR less "fair" than med school and residency admissions.

Again, it ain't the business world I'm talking about. It's the working world. Med school/residency is egalitarian, transparent, and just by comparison. If you have an industry that you think this isn't the case, I'd be curious to hear about it, because I'd be pretty surprised.

Well, I have friends who are physicists. They get jobs and tenure based on their publishing and breakthroughs in the field of physics. It is hardly unfair. The smartest physicists with the best ideas are, for the most part, very obvious to everyone, and sought after.

By contrast, you will get a medical residency based on your step 1 score (which is entirely regurgitation), a few but not all of your clerkship grades (6 weeks - 3 months and very subjective) and maybe some other small aspects of your application, along with your LORs and PS. These are smaller and more trivial measures of what a person has to offer, I would argue, than what my physics friends are judged on when they are offered or not offered jobs. And during med school you are rushing around waiting for things to happen; at least that has been my experience. 2/3 of the time on my medicine rotation we were not being enraptured by some attending or resident teaching something or by being engaged in patient care... Some learned quickly to play the game by LEAVING to study for the shelf. Others took longer. That lag time is what separates people in terms of where they'll go from now on. If medicine considers this crucial to patient care, that's great! I'm not complaining!

In fact I can see exactly why it is this way. Programs want people who work well in the existing system and that's what good grades, etc. assures them, I imagine. It is a conservative system and I suppose it works quite well overall. I am happy for how it has worked out for myself as well. But it is not a deep or "fair" system, no, I would not say that.

Anyway, you didn't answer my question about what happens if someone gets sick while carrying substantial medical student debt. What if they flunk out? That will happen to a percentage of people.

 

[notdeadyet]

Well, I have friends who are physicists. They get jobs and tenure based on their publishing and breakthroughs in the field of physics. It is hardly unfair. The smartest physicists with the best ideas are, for the most part, very obvious to everyone, and sought after.

I'm not a physicist, so I can't comment on that niche field, but in general, academia is an incredibly ugly field. There is a lot of nepotism, favoritism, political jockying, backstabbing, etc. And this is to get an assistant professorship at a non-name university somewhere you don't want to live.

Academia is a great job once you have tenure, but the drive to get tenure is usually an ugly one. Maybe physics is a bright shining beacon, but talk to folks who've worked in academics about how "fair" it is and I think you might get a lot of laughs. I'd toss academia as pretty high on the list of "unfair" fields in terms of selection and promotion.

Maybe others with experience in academia can refute this, but I found it a pretty ugly and cutthroat environment, at least at the lower levels.