1. I'm not in a position to make any changes. You are. Where's your solution?
Not being in a position hasn't stopped you in the past from voicing your opinion.
My solution? To have a solution means there's a problem to correct. A three year downward trend (preceded by 10 years of steady increase) does not necessarily mean the future, left unaltered, is bleak. Nevertheless, were I called upon to give a solution, my solution would be as grassroots as it has been for the past 10 years. It has been to work with medical students both in person and on forums. Coaching students who want to apply. Attracting students who might be interested in ENT. I've been mentoring residents and fellows for 10 years now. This is short by many standards, but it is longer than most. I work with the program director. I work with the dean. I attend SUO meetings. I work on our society's fellowship training committee. I've long been an advocate of calling for understanding why medical students choose places to do residency and steering them away from simply checking boxes to personalizing applications. I'd like to go back to the early match. I'd like to scrap Step II and CS scores. I'd like to end the unwritten point system that has plagued our application process for the last 5 years. People say having the personality test in the application is a horrible idea. What do you think the interview is? It's a personality test. The rejoinder is that we should save the personality test for the interview, but then that leaves the application were it was -- strictly a numbers and points game. And that's what created the trend. The process is evolving, and we've experienced a flat tire. I don't understand why there is a nationwide smoke signal and panic now. So, the solution is working with each other to figure out where we want the field to head. That's not always tangible and even harder to translate into an application.
2. You think nobody else realizes that it's a lot of work to go through applications? Or is this a phenomenon unique to ENT and no other specialty has to do the same thing?
No, my comment was directed toward
you and
your statement. Your "arsed" statement.
Why is ENT so special that no other field feels it's necessary to inject a personality test and program specific paragraphs into the process?
I don't know how that came about, but it is there. I suspect it was because the trajectory and student unmatch (not program) was getting out of control and the numbers of applications were far exceeding the number of spots. The personality test phone call was an idiotic idea, but I don't think it was unreasonable to personalize the application. The trend started well before the personalized application process, and with one year of having programs go unmatched, well that's hardly a reason to panic. A reason to rethink? Yes. A reason to panic? No. The average USLME when I matched was 232. The average USMLE score in 2014 was 248. AOA percentage has gone up. The average numbers of scientific publications has gone WAY up since 2002. If a students looks at the trends, the logical conclusion is that a student has to at least meet that benchmark and to be competitive, exceed it. This drove competition; all this happened well before the program-specific requirements. And, yes, we loved it because we were getting high rollers -- at least academic high rollers. The newer requirements did reverse the trend of applications, and it at least appears that the downward trend is -- for the moment -- slowing. We will see what 2018 looks like.
I'm sure you'll find attendings who see no problem whatsoever in this process. Most of us are well-aware that 10 (?) programs went unmatched this past year. Most of us are trying to make our field competitive and attractive, and it still is. I, like many, are not yelling "fire" just yet.
What these publications track is the top 4 most applied to specialities. It doesn't talk about increasing program trends in medicine, pediatrics, family medicine, emergency medicine and others. People talk about the 35% swing in applicants, but that's compared to 3 years ago, when it was already 20% up from years before. It's not great to be in a volatile state; we'd much rather be where ortho is -- predictable and stable. Unfortunately, there's a momentum to everything and the pendulum is hopefully swinging.
But even I can see that people are being turned away from the field and it's laughable to say it's just because of how competitive it is.
What are the other reasons?
Why else would research suggest that 80% of current medical students cite matching into ENT as "nearly impossible" or "impossible?" Impossible to write a paragraph? Or impossible to meet the de facto standards of competitiveness? Why would anyone say it's impossible to match into ENT because of the residency, the career outlook, the people who run the programs, the application process or anything else about ENT other than the
perception that it's too competitive? Because it
is competitive -- too competitive. That is the most important reason why students are turned away.
So, most of us don't have our heads in the sand. We see an over-run competitive field and are trying to normalize the process. It's a work in process.
