NRMP March 2021 Discussions & Results

[Neopolymath]

It's not perfect but some requirement for programs to tell the truth about their program requirements/applicant selection process would help greatly, especially for DO and IMGs. Indirectly, this also helps USMD students because less IMGs and DOs send apps to places that don't actually give them a look which results in programs theoretically having more time to review the apps they do care about.

On a separate note, this year was a tragedy of the commons. I'm a great applicant for my field but I'm a dirty ****ing DO so I'm out at top programs (fair for several OT reasons) but I also got ghosted by some ****ty programs because they automatically think I don't want to go to some community program in an "undesirable" location (I actually do lol). This was wildly irritating. I think strong DO applicants got affected by this greatly with Covid but could see it happening every year to some extent. I think application caps actually makes this problem worse. Caps don't prevent this yield protection by programs!!! They are still going to think you don't want to go there.

I went to some bad interviews this year to fill out my list and ensure good geography for my personal life should it come down to it. I was interviewing with students from top med schools at these. During social time some of them even mentioned that they had no ties to the area or really any reason to apply there in the first place. Covid/Virtual interviews obviously made this happen and neither of us would be there in a normal year.

With application caps, you prevent some of this from top school students but you don't prevent it from good DOs or average MDs. I would still have to apply to that program to be safe as a DO but then I would feel even more obligated to attend the interview as I used one of my 20 (or whatever asinine #) apps on it. In a normal year, I would apply to that program and then drop it when the expected better interviews rolled in. This movement would happen with app caps and wouldn't happen ever again if we continue virtual interviews.

My initial proposal from stream of conscious rambling is:
1. Make programs actually be real about their process. This makes it easier for everyone but ERAS making $$$
2. LOOSE app caps to help prevent it from being insane to kill off the outliers doing just egregious amounts.
3. 20 same specialty interview cap if we continue virtual interviews.

I could probably polish this up better but basically I think you need some kind of very loose app cap for completely obvious reasons. I think it's obtuse to say it should be a constricting number because it clearly hurts a big group of applicants without having tons of utility. I think the key is not letting some people go on 25 same specialty interviews though because it's just stupid, frankly. That's far more important. A noticeable thing this year with virtuals was waitlists not moving. This prevented applicants from receiving the typical number and quality of interviews. We will have that again if we don't make some minor adjustments. There is no reason that myself or a JHU/Stanford/Harvard grad should be at a truly bottom tier interview. That interview should have gone to someone who needed it during a normal year. Hell, I've seen talk of not ranking some of these places by strong applicants. That's even worse! We were at the interview due to different ramifications but both could be fixed if we learn from this year.

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[ohmanwaddup]

This is the best compromise IMO. although I think for less competitive specialties, maybe something like 30 is more reasonable.

Is there any merit to the idea of rounds with caps? such as the first round you can apply to 50 programs, after that and interviews take place it becomes fully open? Idk if there is enough time to do two sets of interviews, but presumably if people got enough in the first round, they would not go on many in the second round.

 

[MICKY MANTLE]

I've seen a small-but-not-insignificant number of fellows (and attendings) from "top tier" residency programs who I wouldn't want touching my mother because they don't know how operate, and I've worked with attendings who went to a not-brand-name residency whose hands I would put my life in because they know what they're doing. Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate.

I'm sorry, but you are mistaken when you make such comments. Go look at top programs and see who comes out. Only on SDN would someone make a comment that is factually not true. Are there people that come out of "ranked" and "prestigious "programs" that are not spectacular, of course, but to say that "Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate" is just incorrect.

 

[FindersFee5]

But the thing is, you can't project what interviews you got in a not-capped world to the interviews you would have gotten in a capped world. It sounds like those first 20 programs you listed likely thought you were too competitive to be serious about applying there. In an app capped world, though, programs have less incentive to yield protect with interview invites. Instead of what seems to be happening now, where high tier applicants are almost "not competitive" for lower tier programs, a higher tier applicant would be competitive at any program they applied to.

 

[DrZoidbergDO]

Is there any merit to the idea of rounds with caps? such as the first round you can apply to 50 programs, after that and interviews take place it becomes fully open? Idk if there is enough time to do two sets of interviews, but presumably if people got enough in the first round, they would not go on many in the second round.

kind of a soap-lite? it's an interesting concept.

 

[ohmanwaddup]

kind of a soap-lite? it's an interesting concept.

yeah, my only worry with caps is, what happens when you apply to 50 programs and end up with less than 10 interviews? this idea would maybe alleviate that
?

 

[Jack Donaghy]

But the thing is, you can't project what interviews you got in a not-capped world to the interviews you would have gotten in a capped world. It sounds like those first 20 programs you listed likely thought you were too competitive to be serious about applying there. In an app capped world, though, programs have less incentive to yield protect with interview invites. Instead of what seems to be happening now, where high tier applicants are almost "not competitive" for lower tier programs, a higher tier applicant would be competitive at any program they applied to.

This is the part people seem not to be getting. Whatever your perception of "reach" programs are now, would not be consistent with the reality of an app cap system.

 

[AnatomyGrey12]

But the thing is, you can't project what interviews you got in a not-capped world to the interviews you would have gotten in a capped world. It sounds like those first 20 programs you listed likely thought you were too competitive to be serious about applying there. In an app capped world, though, programs have less incentive to yield protect with interview invites. Instead of what seems to be happening now, where high tier applicants are almost "not competitive" for lower tier programs, a higher tier applicant would be competitive at any program they applied to.

I have seen zero actual evidence this would be the case. It seems really idealistic and not based on any actual evidence.

And no, they were not places that I was obviously too competitive for. I actually got very few true community invites and I am fairly certain it’s for that reason, the programs in my first quartile apps were not of that ilk.

 

[AnatomyGrey12]

This is the part people seem not to be getting. Whatever your perception of "reach" programs are now, would not be consistent with the reality of an app cap system.

Please tell me how “reach” programs would change.

 

[Jack Donaghy]

Please tell me how “reach” programs would change.

You seem to think 8 out of your top 10 wouldn't have interviewed you in an app cap world. My assumption, then, is that these are reach programs for you. In a world where 45,000 people aren't applying for the same 3 spots, however, you have absolutely no way of knowing how many of those top 10 never would have interviewed you. I.e. your perception of "reach" programs is grounded in the current reality of our stupid and insane system.

Your idea of keeping things the way they are in order to help the underdog is indeed noble, but what I'm saying is that the underdog would have a way better shot if he or she were one of, say, 100 people applying to that program as opposed to the current system of them being one of 2,000 people.

 

[AnatomyGrey12]

Your idea of keeping things the way they are in order to help the underdog is indeed noble, but what I'm saying is that the underdog would have a way better shot if he or she were one of, say, 100 people applying to that program as opposed to the current system of them being one of 2,000 people.

I never said we need to keep things the way they are. But there is literally zero actual evidence that a cap of 20 will help the underdog. It’s idealistic. There are real consequences to hundreds (if not thousands) of students careers that will happen if a diminutive cap of 20 apps is implemented.

There will always be winners and losers, and changing the current paradigm simply shifts around who wins and who loses, same as a P/F Step 1. Changes need to be well thought out and realistic, not reactionary.

You seem to think 8 out of your top 10 wouldn't have interviewed you in an app cap world. My assumption, then, is that these are reach programs for you. In a world where 45,000 people aren't applying for the same 3 spots, however, you have absolutely no way of knowing how many of those top 10 never would have interviewed you. I.e. your perception of "reach" programs is grounded in the current reality of our stupid and insane system.

Go read my posts again. I never would have APPLIED to these programs, and for various reasons. Not the least of which being that as a DO I would have been forced to hedge my bets and apply in the immediate geographic region and to a much higher percentage of DO programs than I did. Programs that are objectively weaker.

If I drop past 14 on my rank list next week I’ll shut up, but what people are proposing in this thread would drastically alter my career trajectory and personal satisfaction with my training opportunities. I am far from alone on this.

 

[NotAProgDirector]

It's not so easy to tell you what our "app review process" is. It's rather nebulous, since we actually try to do a holistic review.

An app cap of 50 won't change much, I'm afraid. Getting an app tells me I'm in your top 50. i can't make any decision with that.

Rounds of apps won't work as described here. If I'm not in your top 50, then I'm really not interested in looking at your application. Rather than rounds of apps, suggestions of Gold/Silver/Bronze apps has been floated -- everyone gets 10 gold, 10 silver, and as many bronze as you want. But even that is going to tie students in knots, trying to figure out which programs to send Gold and Silver apps. Some programs will only look at Gold apps -- making a defacto cap of 10.

If the app cap was low enough, it's (probably) true that programs would take each app more seriously and applicants might increase their yield. But as already mentioned here it could end very badly for some students also. And app caps won't work well in the couple's match.

 

[Lem0nz]

I think there is zero leverage to change this and that the difference between $1,000 to apply vs $3,000 to apply is unfortunately negligible in the long run. It sure as hell doesn’t feel negligible as a Med student (I applied to 100+ for gen surg) but it was small potatoes.

We saved applicants exponentially more money by moving to virtual applications. It wasn’t as fun, you get to know people about 25% less well (but not that bad), and it’s challenging to get a feel for a place but the important questions can generally still be answered.

I think the crusade is currently targeting the wrong goal. Keeping interviews virtual is more beneficial. Even if it felt like it really sucked to do it that way it isn’t that bad. I was in the unique position that we had only two fellowship interview dates (was on the faculty side interviewing incoming candidates) where one was in person and one was not. We felt almost no difference between the two days when we sat down to make our rank list.

 

[libertyyne]

The only rational thing to do as an applicant is to essentially apply to every single program in your specialty where you would be willing to go , the greater the number the better.

Think about that above statement, and then think about insane it is to defend the current system.

There are two things that get conflated in this thread.
1. Competitiveness match of an applicant vs program.
2. Actual preference of an applicant and program.

1. should essentially be the easier part of this question, but programs dont do anyone any service by not publishing hard limits, or medians of the past 5 years of the program. I get it you want to be able to review applicants that may not fit those hard limits, but instead of muddying the water, why not just ask those applicants to directly contact the program.

2. The current system just assumes you have a regional bias to the location where you went to medical school. Which I guess works a large number of the times. but is not really true either.


Imagine a world where you apply to 20 programs, interview at 5 and match at your top 3 90% of the time. I suppose when you think about it ~75% of usmd applicants match at their top 3 ranks currently. But those top 3 programs are a function of post interview top 3 not true preference top 3. But decreasing application numbers would allow applicants to focus on programs they really would like to attend and programs to vet applicants more closely for fit.

 

[Med Ed]

An app cap of 50 won't change much, I'm afraid. Getting an app tells me I'm in your top 50. i can't make any decision with that.

Since the average US MD senior applies to over 60 programs now, a cap of 50 would reduce the total number of applications from this cohort by half or more. You would not receive applications from students who would not even place your program in their top 50.

For the record, I am not in favor of caps. Not that the Coalition cares what I think.

 

[Lem0nz]

The only rational thing to do as an applicant is to essentially apply to every single program in your specialty where you would be willing to go , the greater the number the better.

Think about that above statement, and then think about insane it is to defend the current system.

There are two things that get conflated in this thread.
1. Competitiveness match of an applicant vs program.
2. Actual preference of an applicant and program.

1. should essentially be the easier part of this question, but programs dont do anyone any service by not publishing hard limits, or medians of the past 5 years of the program. I get it you want to be able to review applicants that may not fit those hard limits, but instead of muddying the water, why not just ask those applicants to directly contact the program.

2. The current system just assumes you have a regional bias to the location where you went to medical school. Which I guess works a large number of the times. but is not really true either.


Imagine a world where you apply to 20 programs, interview at 5 and match at your top 3 90% of the time. I suppose when you think about it ~75% of usmd applicants match at their top 3 ranks currently. But those top 3 programs are a function of post interview top 3 not true preference top 3. But decreasing application numbers would allow applicants to focus on programs they really would like to attend and programs to vet applicants more closely for fit.

This is kind of cute to say if you're certain you're going to match. But there are a great deal of people who will be happy to match *at all*. If you're in the later category you aren't going to get ten interviews, or even five maybe, applying to 20 programs.

 

[Lawpy]

I never said we need to keep things the way they are. But there is literally zero actual evidence that a cap of 20 will help the underdog. It’s idealistic. There are real consequences to hundreds (if not thousands) of students careers that will happen if a diminutive cap of 20 apps is implemented.

There will always be winners and losers, and changing the current paradigm simply shifts around who wins and who loses, same as a P/F Step 1. Changes need to be well thought out and realistic, not reactionary.

Go read my posts again. I never would have APPLIED to these programs, and for various reasons. Not the least of which being that as a DO I would have been forced to hedge my bets and apply in the immediate geographic region and to a much higher percentage of DO programs than I did. Programs that are objectively weaker.

If I drop past 14 on my rank list next week I’ll shut up, but what people are proposing in this thread would drastically alter my career trajectory and personal satisfaction with my training opportunities. I am far from alone on this.

Are you disagreeing with the cap being low or the cap existing? Because like you said in your earlier post, a cap of like 50 or higher in competitive specialties would help and imo it'd seriously cut down the flood while demonstrating serious interest to programs. It doesn't make sense to think of reaches in this system because their apps they have to review are cut dramatically and someone less competitive would have a much better chance getting the interview

 

[libertyyne]

This is kind of cute to say if you're certain you're going to match. But there are a great deal of people who will be happy to match *at all*. If you're in the later category you aren't going to get ten interviews, or even five maybe, applying to 20 programs.

That is the point. It shouldnt have to be like that. If you know what programs you are competitive for
and you apply to those programs. You dont need to apply to 300 programs. 19/20 USMDs are relatively certain they will match at the end of the day. Plus going to more interviews, and ranking more places does not alleviate the likelihood that you may not match, there are diminishing returns in terms of interviews and ranks especially if you are an applicant that is not competitive or has a red flag.


The entire med ED community should be ashamed to be associated with programs that send out interview invites like best buy sells door buster TVs, to the first come first serve. 4 years of medical school , hundreds of thousands in debt, hundreds of hours of evaluations, MSPE, etc and the ability to obtain an interview is dependent on me sitting infront of computer clicking the refersh button faster that the next guy? Please, that is not a meritocracy, even worse its not even a real lottery.


There is soo much randomness associated with the way programs evaluate applicants and zero transparency. The system is designed to get these exact results.

 

[Lawpy]

The entire med ED community should be ashamed to be associated with programs that send out interview invites like best buy sells door buster TVs, to the first come first serve. 4 years of medical school , hundreds of thousands in debt, hundreds of hours of evaluations, MSPE, etc and the ability to obtain an interview is dependent on me sitting infront of computer clicking the refersh button faster that the next guy? Please, that is not a meritocracy, even worse its not even a real lottery.

It's crazy that that's even the thing. It makes no sense and it's a completely idiotic and unnecessarily stressful way to give interviews and i have no idea why programs do this year after year after year. It's so freaking absurd. Like what, are PDs expecting MS4s to ditch Sub Is halfway or park in the side of the road to quickly accept an invite? Are they insane?

 

[Maimonides1]

Just to calm your nerves this eve..!!

 

[ohmanwaddup]

Just to calm your nerves this eve..!!

View attachment 332489

wish this chart had a DO side. Hard to gauge how I should feel when it’s so heavily slanted by the IMG FMG applicants

 

[bigindian4891]

Just to calm your nerves this eve..!!

View attachment 332489

Its nice but also is very specialty dependent. I wish we had more of a break down for the future.

 

[Neopolymath]

wish this chart had a DO side. Hard to gauge how I should feel when it’s so heavily slanted by the IMG FMG applicants

There is one in a separate document

 

[ohmanwaddup]

There is one in a separate document

Link ?

 

[Qwerty122]

Maybe we can stratify the application cap based on your quantitative metrics? Like 260s get 20 apps, 250s get 35, 240s get 50, etc. DOs and IMGs can get more since they're less likely to match at "top" programs than MDs, but this way it still doesn't restrict the vertical advancement for them.

But still, it's unfair to limit career mobility of the 260s simply because they did well in medical school. That's some backwards logic then, to not reward those that actually try hard and do well for the sake of rewarding those who did not try as hard (230s).

And this still hasn't taken into account how your medical school prestige plays a role into this, as this assumes the only important metric for candidacy are steps, which we all know is not true.

 

[Neopolymath]

Link ?

Residency Data & Reports

The latest Match results and data for the Main Residency Match.

www.nrmp.org

Like page 40 of the first document on this page.

 

[Maimonides1]

wish this chart had a DO side. Hard to gauge how I should feel when it’s so heavily slanted by the IMG FMG applicants

Here we go.. Chill !

 

[efle]

Caps have to happen eventually. We can argue about the right number but it doesn't help anyone to let it keep trending up forever. I don't understand how it helps the underdogs to have ridiculous numbers of apps to review. Too many to read is exactly why heuristics like your step 1 or school are screens. If you're punching up don't you want everyone to actually read your application?

 

[Maimonides1]

Warning ⚠️

In this crazy academic year of delays, cancelations and website crashes..,
I will not be surprised for possible technical difficulties tomorrow due to the massive influx of data traffic in a limited time even though AAMC had tried to address these issues in advance..!

 

[Internist_Sandman]

I'm trying to stay occupied before the Match email tomorrow, so I am going to weigh in on this.

I am not in favor of application caps, because I favor the free market of applications. It lets rockstar DOs elevate themselves if they can afford to apply to reach schools and in normal years does not lead to rockstar MDs hoarding all the interviews. Traveling is too expensive that there is a functional cap of 15 or so interviews, if you're lucky.

I think the only change that needs to happen in normal years (because this year was funky with COVID), is open data about who matches at programs. You can anonymize it so no applicant is doxxed and no FERPA violations happen. But saying that you "prefer USMLE > 240 is not helpful" because everyone knows some MDs will match with scores lower than that and some DOs with 260s will be ghosted. That's just the name of the game, med school prestige matters.

Residency Explorer sort of started publicizing this data, but it does not seem to be completely accurate or up to date.

I think if there was more openness, programs would not have to sift through a million applicants who have no shot, but threw out an application because they were close enough to a vague cutoff score recommended on a website that is rarely updated.

 

[NotAProgDirector]

It's crazy that that's even the thing. It makes no sense and it's a completely idiotic and unnecessarily stressful way to give interviews and i have no idea why programs do this year after year after year. It's so freaking absurd. Like what, are PDs expecting MS4s to ditch Sub Is halfway or park in the side of the road to quickly accept an invite? Are they insane?

Full disclosure: We have an interview slot for everyone we invite. I agree this is ridiculous.

But PD's are not insane. If you want all of your interview slots full, you just invite 110% of the number of slots for interviews. Then have a waitlist. Although the experience may be miserable for applicants, it serves it's purpose for programs.

Warning ⚠️

In this crazy academic year of delays, cancelations and website crashes..,
I will not be surprised for possible technical difficulties tomorrow due to the massive influx of data traffic in a limited time even though AAMC had tried to address these issues in advance..!

NRMP unlikely to have any problems.

ERAS often has problems. Last year went much smoother than prior years, so there's hope of a gltch free process. But I agree I'd plan for glitches and celebrate if they don't happen.

 

[Banco]

Kind of a niche comment, but I was thinking about Letters of Intent and how some applicants send them to too many places disingenuously, causing PD's to not believe them much.


Would a token like system work well there? For example, you can send an official "intent" token to 1 program only, officially through ERAS. And then you are done. Other communication of that nature isn't allowed.


Or maybe it isn't enough of a problem to implement such a measure, idk.

 

[Matthew9Thirtyfive]

Kind of a niche comment, but I was thinking about Letters of Intent and how some applicants send them to too many places disingenuously, causing PD's to not believe them much.


Would a token like system work well there? For example, you can send an official "intent" token to 1 program only, officially through ERAS. And then you are done. Other communication of that nature isn't allowed.


Or maybe it isn't enough of a problem to implement such a measure, idk.

Didn’t ENT use this? I don’t remember how it has turned out.

 

[Banco]

Didn’t ENT use this? I don’t remember how it has turned out.

I believe they did it for letters of “interest” but yeah, not sure.

 

[3member]

Great study article about addressing ERAS FEVER explained by behavioral psychology behind GAME THEORY!

Just in IM and GS alone, 12% of applicants holds 50% of the interviews!

Possible solutions:
- Informative: programs publish cut off criteria.
- Marketplace: increase costs and put limits on interviews if not applications all together!
- Early Result Acceptance Program “ERAP”

Application Fever: Reviewing the Causes, Costs, and Cures for Residency Application Inflation

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of “Application Fever” is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of...

www.cureus.com

So does this indicate that we are more likely to match our top choices? .... Just holding out hope here haha

 

[Maimonides1]

So does this indicate that we are more likely to match our top choices? .... Just holding out hope here haha

To your Top FOUR CHOICES 94% of times !!

 

[Lost in Translation]

Except you pigeonhole people into their own region.

Not true. You should apply to places you want to go to. I'm sure you can find 3 or 4 programs in your immediate 100 mile radius that you don't want to go to. But you still apply there in the current system because you have to maximize your chances of interviewing since you know everyone else (who isn't a 0.1% applicant) is applying to practically everywhere as well.

Your reasons for wanting to go to XYZ program should be formulated before you submit ERAS, not after you get an interview and have to google that school and city.

You pigeonhole people into programs that might be DO or MD only only because of the programs historical data.

Implying that with application caps there won't also be reform on the part of programs to pull their residents from a wider applicant pool?

You prevent people from punching up and breaking ceilings.

Stop parroting what other people say; competitive applicants from "no-name" schools will always be competitive. If anything, the situation now is that applicants from brand name programs are the ones that match at "brand name" residencies because when everyone top tier looks the same on paper their only differentiator becomes where they got their degree.

You force people to only apply to programs they think they’re competitive for.

Isn't that the point? If your application would be a reach for X program, chances are VERY high that you would get filtered out by whatever random metric they use to cut down the number of applications they need to review. Inversely, if your application is clearly way above and beyond the typical resident for Y program, you might either be filtered out because the PD may think you're just shotgunning your application (which is the reality these days anyway) and not offer you an interview even if you actually were interested in training there. Or let's say they offer you an interview, but you have no real intention on going there anyway. Because of the current Match climate you have to take that interview and rank that place (barring any red flags), thus taking that interview away from an applicant who is more typical of the resident that Matches there and/or really wants to go to that program however doesn't have your 0.1% stats and therefore did not get an interview.

It's always nice to get that "oh, I didn't think I would get an interview with them" interview, but realistically how many times does someone in that situation end up actually Matching at that program?

I also got ghosted by some ****ty programs because they automatically think I don't want to go to some community program in an "undesirable" location (I actually do lol). This was wildly irritating. I think strong DO applicants got affected by this greatly with Covid but could see it happening every year to some extent. I think application caps actually makes this problem worse. Caps don't prevent this yield protection by programs!!! They are still going to think you don't want to go there.

Caps would fix this because programs will then implicitly know that you're applying there because you want to go there, because you're spending a limited resource (an application towards your cap) on them.

 

[deleted645092]

Not true. You should apply to places you want to go to. I'm sure you can find 3 or 4 programs in your immediate 100 mile radius that you don't want to go to. But you still apply there in the current system because you have to maximize your chances of interviewing since you know everyone else (who isn't a 0.1% applicant) is applying to practically everywhere as well.

Your reasons for wanting to go to XYZ program should be formulated before you submit ERAS, not after you get an interview and have to google that school and city.



Implying that with application caps there won't also be reform on the part of programs to pull their residents from a wider applicant pool?



Stop parroting what other people say; competitive applicants from "no-name" schools will always be competitive. If anything, the situation now is that applicants from brand name programs are the ones that match at "brand name" residencies because when everyone top tier looks the same on paper their only differentiator becomes where they got their degree.



Isn't that the point? If your application would be a reach for X program, chances are VERY high that you would get filtered out by whatever random metric they use to cut down the number of applications they need to review. Inversely, if your application is clearly way above and beyond the typical resident for Y program, you might either be filtered out because the PD may think you're just shotgunning your application (which is the reality these days anyway) and not offer you an interview even if you actually were interested in training there. Or let's say they offer you an interview, but you have no real intention on going there anyway. Because of the current Match climate you have to take that interview and rank that place (barring any red flags), thus taking that interview away from an applicant who is more typical of the resident that Matches there and/or really wants to go to that program however doesn't have your 0.1% stats and therefore did not get an interview.



Caps would fix this because programs will then implicitly know that you're applying there because you want to go there, because you're spending a limited resource (an application towards your cap) to send an application your way.

I don’t know how to reply to specific parts of your post so I’m just gonna list them;

- assumption that everyone applied to every program in the vicinity. There were 4-5 programs within 100 miles that I purposely didn’t apply to. Because I did research my list.

-Brand name schools don’t necessarily hog all the brand name residency spots. I got interviews at 2 top-10 programs on the unified release date this year, from a no-name school. There are also residents from my no name school at two separate top 10 programs , who I very much doubt would’ve applied there if there was a gap because no matter our performance it’s a huge reach.

 

[Maimonides1]

Full disclosure: We have an interview slot for everyone we invite. I agree this is ridiculous.

But PD's are not insane. If you want all of your interview slots full, you just invite 110% of the number of slots for interviews. Then have a waitlist. Although the experience may be miserable for applicants, it serves it's purpose for programs.


NRMP unlikely to have any problems.

ERAS often has problems. Last year went much smoother than prior years, so there's hope of a gltch free process. But I agree I'd plan for glitches and celebrate if they don't happen.

So far so good.., even-though there are reports of SOAP website is down as expected..!

Will wait for forthcoming reports to compare how this year MATCH fared compared to averages ?

 

[Maimonides1]

The deck has been shuffled.., let the chips fall.. wherever it may..!!

 

[ace_inhibitor111]

Not true. You should apply to places you want to go to. I'm sure you can find 3 or 4 programs in your immediate 100 mile radius that you don't want to go to. But you still apply there in the current system because you have to maximize your chances of interviewing since you know everyone else (who isn't a 0.1% applicant) is applying to practically everywhere as well.

Your reasons for wanting to go to XYZ program should be formulated before you submit ERAS, not after you get an interview and have to google that school and city.



Implying that with application caps there won't also be reform on the part of programs to pull their residents from a wider applicant pool?



Stop parroting what other people say; competitive applicants from "no-name" schools will always be competitive. If anything, the situation now is that applicants from brand name programs are the ones that match at "brand name" residencies because when everyone top tier looks the same on paper their only differentiator becomes where they got their degree.



Isn't that the point? If your application would be a reach for X program, chances are VERY high that you would get filtered out by whatever random metric they use to cut down the number of applications they need to review. Inversely, if your application is clearly way above and beyond the typical resident for Y program, you might either be filtered out because the PD may think you're just shotgunning your application (which is the reality these days anyway) and not offer you an interview even if you actually were interested in training there. Or let's say they offer you an interview, but you have no real intention on going there anyway. Because of the current Match climate you have to take that interview and rank that place (barring any red flags), thus taking that interview away from an applicant who is more typical of the resident that Matches there and/or really wants to go to that program however doesn't have your 0.1% stats and therefore did not get an interview.

It's always nice to get that "oh, I didn't think I would get an interview with them" interview, but realistically how many times does someone in that situation end up actually Matching at that program?



Caps would fix this because programs will then implicitly know that you're applying there because you want to go there, because you're spending a limited resource (an application towards your cap) on them.

The issue with caps is that the more popular residencies will still get a ton of applications, more than they can handle anyway. And guess who the most popular residencies will be? Mid-tier ones because most applicants fall near average. Meanwhile, lesser known residencies and those in rural locations will be more prone to SOAPing, because few would waste their tokens on Pinnacle, Lilitz, Shreveport etc. The end result will actually be more people SOAPing, both applicants and programs alike.

I think the current SOAP provides an extreme example of what would happen with caps. There is a limit of 45 tokens applicants can use. The majority of people end up trying to scramble for the same programs in decent locations, with the majority avoiding the same programs including prelim surgery. The end result is a success rate of ~50% of MDs receiving positions via the SOAP, even though the number of open positions technically exceeds the number of participants

 

[esob]

No. I will advocate against this my entire career. It keeps people from trying to “punch up” and have mobility above their current level.

Of my top 10 ranks I would have only applied to 2 of them if application caps were instituted.

This is actually a really solid point that I hadn't considered before voting for a cap on apps.

 

[Lost in Translation]

The issue with caps is that the more popular residencies will still get a ton of applications, more than they can handle anyway. And guess who the most popular residencies will be? Mid-tier ones because most applicants fall near average. Meanwhile, lesser known residencies and those in rural locations will be more prone to SOAPing, because few would waste their tokens on Pinnacle, Lilitz, Shreveport etc. The end result will actually be more people SOAPing, both applicants and programs alike.

This is actually a good point, and the first that I've seen in this thread, against capping applications.

I agree, lesser known programs or programs in not-super-desirable locations will likely receive fewer applications. However, I don't know if we can predict exactly how many fewer applications they'll receive unless all programs publish their application numbers, interviews offered, and geographical data of applicants and someone does statistical magic with machine learning to predict who would apply where depending on med school location/original state of residence/board scores/class rank/research/average stats of current residents at XYZ program/etc. Even so, I find it hard to imagine that they would receive fewer applications than interview spots simply because of how many medical students there are and how few residency positions are available. And people will still apply to places they want to go. When I applied to Match, of the 140-some places I sent my application to there were really only about 30 I would have really considered going to, or in other words only 30 that I really wanted an interview from. Of course, I didn't get an interview from all 30 of them (I don't even think I got 10 interviews from that personally desirable list). However, if I was limited to only 30 applications that cycle I might have gotten more from that list because they (likely) wouldn't have auto-filtered me out by a numerical metric and would (hopefully) have been able to review my application with their own eyes, now having fewer to manually go through, before making a decision on interview or not.

In a perfect world with application caps:

- Bottom 1/3rd sends 2/3rds of their application to lower-ranked programs and 1/3rd to mid-ranked with 1 or 2 reach in the top-ranked
- Middle 1/3rd sends 1/3rd spread somewhat evenly across all 3 rank tiers
- Top 1/3rd sends 2/3rds of their application to top-ranked programs and 1/3rd to mid-ranked

Certainly this still leaves mid-ranked programs with more applications as a group than the other 2, but there are also way more programs that would be considered mid-ranked than any one applicant can send applications to so that further stratifies who is applying to where. The trick is not making the cap so high that people can apply to just about every mid-ranked program anyway, but not making it so low that people are severely restricted in their options. I don't necessarily agree with a flat cap (i.e. 50) either, and I do like the specialty-specific cap suggestion but as a function of number of programs and not of the perceived competitiveness of that field.

 

[Lawpy]

We need to control the continuing flood of applications especially with the recent news of more people going unmatched this year. App caps with a reasonable cap set for each specialty are the way to go

 

[Lost in Translation]

I'm sorry, but you are mistaken when you make such comments. Go look at top programs and see who comes out. Only on SDN would someone make a comment that is factually not true. Are there people that come out of "ranked" and "prestigious "programs" that are not spectacular, of course, but to say that "Program rank and prestige is more associated with the quality and quantity of research put out by those institutions, not the quality of the residents they graduate" is just incorrect.

One of my mentors in med school tells of his experience as an ortho resident. He went to a top-ranked "brand-name" program for residency and later went somewhere else for fellowship. One of his co-fellows was a guy from a "no-name" program in Texas or some southern state. However, my mentor told me that that guy from Texas or wherever was the most surgically adept in the OR out of any fellow in that program, and better than many residents that he had worked with. Remember, my mentor went to a "brand-name" program that's one of the powerhouses for ortho research.

The point of my story is that just because USWNR or Doximity says XYZ program is top-tier doesn't automatically mean the best physicians come out of those programs. Quality of training is just one aspect, and NIH/T32 grant money/publications per faculty member per year are other aspects that go into those ranking lists. Hell, I've had some people tell me not to have my child delivered at a big-name university and go to the community hospital across the street (that has their own residency) instead because the quality of the care they get is better at that hospital. But when you look at the rankings, that big-name university program is several programs above that community program.

 

[Med Ed]

We need to control the continuing flood of applications especially with the recent news of more people going unmatched this year. App caps with a reasonable cap set for each specialty are the way to go

Let us not forget the historical data we have available.

The year was 1990. 13,980 active US seniors filed a combined 93,873 applications and had a match rate of 93.3%. The ratio of applications to active US seniors was 6.7.

The year was 2020. 22,250 active US seniors filed a combined 1,416,061 applications and had a match rate of 93.7%. The ratio of applications to active US senior was 63.6.

Increase in active US seniors: 59%
Increase in total applications: 1,408%
Increase in applications/US senior: 849%

 

[Redpancreas]

Let us not forget the historical data we have available.

The year was 1990. 13,980 active US seniors filed a combined 93,873 applications and had a match rate of 93.3%. The ratio of applications to active US seniors was 6.7.

The year was 2020. 22,250 active US seniors filed a combined 1,416,061 applications and had a match rate of 93.7%. The ratio of applications to active US senior was 63.6.

Increase in active US seniors: 59%
Increase in total applications: 1,408%
Increase in applications/US senior: 849%

By 2020, are you talking this season about to finish up or last season? How about a season like 2019?

 

[The Med-Peds Dude]

On a separate note, this year was a tragedy of the commons. I'm a great applicant for my field but I'm a dirty ****ing DO so I'm out at top programs (fair for several OT reasons) but I also got ghosted by some ****ty programs because they automatically think I don't want to go to some community program in an "undesirable" location (I actually do lol). This was wildly irritating. I think strong DO applicants got affected by this greatly with Covid but could see it happening every year to some extent. I think application caps actually makes this problem worse. Caps don't prevent this yield protection by programs!!! They are still going to think you don't want to go there.

I'm trying to figure out how you know/why you think these community programs ghosted you because you are too good for them. I've been doing this for a long time, and I'm not familiar with this concept.

 

[Chibucks15]

I'm trying to figure out how you know/why you think these community programs ghosted you because you are too good for them. I've been doing this for a long time, and I'm not familiar with this concept.

I see that all over here people thinking “yield protection” is a widespread thing. It just makes no sense. Why do they think you sent an app in if you’re “too good for them”? Much more likely you overestimated your desirability or you don’t meet their mold of who they are looking for due to a myriad of reasons. But god forbid anybody accepts that fact...it’s gotta be that “I’m just too good for them and they know it”

 

[Lost in Translation]

I'm trying to figure out how you know/why you think these community programs ghosted you because you are too good for them. I've been doing this for a long time, and I'm not familiar with this concept.

It's almost certainly yield protection.

A program that is typically filled with IMGs/Caribbean students won't think that an applicant with a 260 Step and AOA/GHHS would want to go there. Whether that's true or not is not taken into account when the program still needs to sort through 800 applications to interview 80. The data would suggest the former, though in @Chibucks15's case it sounds like the latter (e.g. they do want to go there but the program doesn't believe that).

Why do they think you sent an app in if you’re “too good for them”?

Because with how easy ERAS is, the likelihood everyone just sends apps everywhere is statistically more probable than someone has carefully curated a small list of 20 programs they really want to attend and only applied to them. I think it's a generational thing to be honest; my chair when I was applying was an older fellow and said I only needed to apply to 20-30 programs to match. I was told by the clerkship director and the PD to apply to at least twice that many because that's what everyone else is going to do (and obviously did). I ended up sending 140.

And that's one of the problems the application cap is trying to solve: now, by sending an application there, it's implied that the applicant truly does want to go there and their app should be taken seriously.