NRMP March 2021 Discussions & Results

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Which one of these possible steps.. could address the current problems with NRMP?

  • Caps on Apps

    Votes: 57 22.1%
  • Caps on Interviews

    Votes: 91 35.3%
  • Increase Tax

    Votes: 1 0.4%
  • Publish clear program cut offs

    Votes: 75 29.1%
  • ERAP: Early Residency Acceptance Program

    Votes: 26 10.1%
  • Other: Elaborate below

    Votes: 8 3.1%

  • Total voters
    258
  • Poll closed .
Will they though? CT surgery is a fellowship of GS unlike ENT, ortho, or urology which I could see GS being salty about. Maybe some uneducated PD that doesn’t know I6 CT has a match rate of like <50% but even that seems unlikely since basically every GS program has CT surgeons involved that will know about the I6 programs at least vaguely.

Also, an I6 CT applicant that ends up in GS is most likely going to be dedicated to their general surgery residency because they want to match into a CT fellowship, unlike a failed ortho applicant who is probably going to try to transfer to an ortho program or eventually drop out.
Yes. GS doesn’t like being the back up choice. GS programs have been known to pass on applicants who’s apps are too obviously geared towards I6

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No I'm saying if you are applying to ENT as your top choice and you apply to lets say IM as a back up the ENT folks will question your dedication to the field and IM will think you are using them as a backup. Seems like a lose lose
I think you’ll be very hard pressed to find someone who applied to ENT without a backup and then failed to match the second year into something. Doesn’t matter if they took a research year or SOAPed into a prelim spot.

I mean 3 DO students applied to ENT in 2020 with Step 1 scores of 190-210, so it’s not like we don’t have 100% rational people applying to these competitive specialities either.
 
Will they though? CT surgery is a fellowship of GS unlike ENT, ortho, or urology which I could see GS being salty about. Maybe some uneducated PD that doesn’t know I6 CT has a match rate of like <50% but even that seems unlikely since basically every GS program has CT surgeons involved that will know about the I6 programs at least vaguely.

Also, an I6 CT applicant that ends up in GS is most likely going to be dedicated to their general surgery residency because they want to match into a CT fellowship, unlike a failed ortho applicant who is probably going to try to transfer to an ortho program or eventually drop out.

That's actually what I thought before, but apparently it's actually an issue:

The Bias Against Integrated Thoracic Surgery Residency Applicants During General Surgery Interviews
 
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Yes. GS doesn’t like being the back up choice. GS programs have been known to pass on applicants who’s apps are too obviously geared towards I6
Have you talked to PD’s about this? Seems far fetched but sounds like you know someghing I don’t. I wonder what @ThoracicGuy @ACSurgeon think (only two general surgeons I remember usernames off the top of my head haha)
 
Yes. GS doesn’t like being the back up choice. GS programs have been known to pass on applicants who’s apps are too obviously geared towards I6
Why though? They should understand I6 is ultra competitive and difficult to match to so a gen surg --> fellowship pathway is reasonable alternative
 
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That's actually what I thought before, but apparently it's actually an issue:
The Bias Against Integrated Thoracic Surgery Residency Applicants During General Surgery Interviews
That is interesting for a number of reasons, but especially that barely half of the respondents had a step 1 over 230??? And only 76% published research in CT surgery?! Maybe these CT I6 programs are less competitive than I thought. Then again maybe not since the response rate was only 90 out of 180 and it was an online survey. Not super reliable but thanks for linking it. Still very interesting and I might post something in the surgery forum about this. Relevant quote below…

“Fifty-seven percent (49 of 86) scored above 230 on the USMLE Step 1 examination. Ninety-two percent (80 of 87) performed research during medical school, and 78% (62 of 80), specifically within cardiothoracic surgery; 76% (61 of 80) published their work.”
 
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Also are there plans to have an integrated pathway for IM fellowships like cards, GI, heme/onc? @NotAProgDirector
Fun fact, Denmark got rid of general internal medicine in the 1970s. They only have specialized residencies now…
 
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Does GS do the same for those applying to integrated vascular or integrated plastics?
From what I've seen plastics yes, but vascular less so for some reason. Maybe because vascular Is more of a general surgery field than cardiac or plastics.

Have you talked to PD’s about this? Seems far fetched but sounds like you know someghing I don’t. I wonder what @ThoracicGuy @ACSurgeon think (only two general surgeons I remember usernames off the top of my head haha)
From what I've seen with other applicants, statements I've seen attending surgeons make on these forums, faculty at my own school, that survey above, etc. I had a few publications in a subspecialty and was straight up asked at multiple interviews if I was using GS as a back up even though my app was pretty geared toward GS in every other way. GS people really get rubbed the wrong way if they think someone truly has no interest in general surgery at all.
 
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From what I've seen plastics yes, but vascular less so for some reason. Maybe because vascular Is more of a general surgery field than cardiac or plastics.


From what I've seen with other applicants, statements I've seen attending surgeons make on these forums, faculty at my own school, that survey above, etc. I had a few publications in a subspecialty and was straight up asked at multiple interviews if I was using GS as a back up even though my app was pretty geared toward GS in every other way. GS people really get rubbed the wrong way if they think someone truly has no interest in general surgery at all.
Gotcha, I believe you, just curious. Sorry if it sounded like I was completely doubting you. Kinda depressing to learn this though.
 
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That is interesting for a number of reasons, but especially that barely half of the respondents had a step 1 over 230??? And only 76% published research in CT surgery?! Maybe these CT I6 programs are less competitive than I thought. Then again maybe not since the response rate was only 90 out of 180 and it was an online survey. Not super reliable but thanks for linking it. Still very interesting and I might post something in the surgery forum about this. Relevant quote below…

“Fifty-seven percent (49 of 86) scored above 230 on the USMLE Step 1 examination. Ninety-two percent (80 of 87) performed research during medical school, and 78% (62 of 80), specifically within cardiothoracic surgery; 76% (61 of 80) published their work.”

I thought that was interesting as well. I think a similar phenomenon occurs in vascular. The average step has been around 235 if I recall correctly.
 
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From what I've seen plastics yes, but vascular less so for some reason. Maybe because vascular Is more of a general surgery field than cardiac or plastics.


From what I've seen with other applicants, statements I've seen attending surgeons make on these forums, faculty at my own school, that survey above, etc. I had a few publications in a subspecialty and was straight up asked at multiple interviews if I was using GS as a back up even though my app was pretty geared toward GS in every other way. GS people really get rubbed the wrong way if they think someone truly has no interest in general surgery at all.

Geez salty PDs are a problem and just made surgical sub matching even more stressful
 
I think you’ll be very hard pressed to find someone who applied to ENT without a backup and then failed to match the second year into something. Doesn’t matter if they took a research year or SOAPed into a prelim spot.

I mean 3 DO students applied to ENT in 2020 with Step 1 scores of 190-210, so it’s not like we don’t have 100% rational people applying to these competitive specialities either.
Lmao, who is advising those DO students.....
 
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Have you talked to PD’s about this? Seems far fetched but sounds like you know someghing I don’t. I wonder what @ThoracicGuy @ACSurgeon think (only two general surgeons I remember usernames off the top of my head haha)
Most solid general surgery programs have 3-4x more qualified candidates than they have spots. Sure some of these candidates will rank this program lower, but in general, strong GS programs will get their pick of applicants fairly high on their list. So, they have no incentive to take a resident who’s not going to be happy in general surgery, or worse leave the moment a PS or CTS position opens elsewhere.

now, I’m sure some PDs have different motives and will rank an i6 candidate high just because of their resume. No rule is 100% applicable. Also, plenty of integrated plastics/CT/Vascular dual apply every year and they pull it off so take what I’m saying with a grain of salt.
 
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From what I've seen plastics yes, but vascular less so for some reason. Maybe because vascular Is more of a general surgery field than cardiac or plastics.


From what I've seen with other applicants, statements I've seen attending surgeons make on these forums, faculty at my own school, that survey above, etc. I had a few publications in a subspecialty and was straight up asked at multiple interviews if I was using GS as a back up even though my app was pretty geared toward GS in every other way. GS people really get rubbed the wrong way if they think someone truly has no interest in general surgery at all.
You are correct. The vast majority of cardiothoracic surgery and plastics surgery work has been done by surgeons who ONLY do that work for the last several decades. As far as I know, plastics and cardiothoracic diverged a long time ago.

A lot of vascular surgery in America is still done by general surgeons who are not fellowship trained. Similarly, many old school private practice vascular surgeons still do general surgery.

Finally, in residency we did 1-2 months of vascular every year. We had ZERO plastics and cardiothoracic rotations (I did an elective in thoracic surgery, most didn’t).
 
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You are correct. The vast majority of cardiothoracic surgery and plastics surgery work has been done by surgeons who ONLY do that work for the last several decades. As far as I know, plastics and cardiothoracic diverged a long time ago.

A lot of vascular surgery in America is still done by general surgeons who are not fellowship trained. Similarly, many old school private practice vascular surgeons still do general surgery.

Finally, in residency we did 1-2 months of vascular every year. We had ZERO plastics and cardiothoracic rotations (I did an elective in thoracic surgery, most didn’t).
Were the ACGME minimum numbers different when you were training? This says minimum of 20 thoracic operations including 5 thoracotomies. I thought all general surgery programs required at least a month of thoracic surgery, that’s what the ACS/trauma attending at my school made it sound like at least. Maybe he got more thoracic training in ACS/SCC fellowship and I am misremembering.
 
Edit: Didn't see the part about IM being a backup. I don't think they really care. Everyone knows IM/FM are often used as backups. Rads is another example that I know for a fact doesn't care.
While it's very well known that people do this, most IM PDs absolutely care and try to avoid these people. Why would an IM program want someone that doesn't really want to do IM any more than a GS program wanting someone that doesn't actually want to do GS?

My residency PD would not invite someone to interview if he thought IM was their backup. And if they did get interviewed and it became apparent IM was a backup they were immediately DNR'd (do no rank).

Residency is hard, even more so if you don't actual enjoy the work. Having people around that are miserable brings the whole program down. I'm sure the majority of PDs across all specialties would prefer someone with lower stats and a less impressive resume who is passionate about the specialty over someone who looks great on paper but actually wants to do something else.
 
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Were the ACGME minimum numbers different when you were training? This says minimum of 20 thoracic operations including 5 thoracotomies. I thought all general surgery programs required at least a month of thoracic surgery, that’s what the ACS/trauma attending at my school made it sound like at least. Maybe he got more thoracic training in ACS/SCC fellowship and I am misremembering.
We got all of our thoracic numbers on trauma... we did vats, open thoracotomies sternotomies, and rib plating. I had an extra 60 cases more than most of our chiefs usually have.
 
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Have you talked to PD’s about this? Seems far fetched but sounds like you know someghing I don’t. I wonder what @ThoracicGuy @ACSurgeon think (only two general surgeons I remember usernames off the top of my head haha)

I agree with @ACSurgeon's response. General Surgery programs have many great applicants. They would generally rather have someone that wants that field rather than someone that might leave if they find a better opportunity.
 
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I understand that's what you're saying, but I'm saying that that doesn't/wouldn't happen. You're using another field as a backup, not ENT. Dedication to the field is demonstrated by doing research and away rotations.

Edit: Didn't see the part about IM being a backup. I don't think they really care. Everyone knows IM/FM are often used as backups. Rads is another example that I know for a fact doesn't care.

I’ve heard from some people involved with programs that some of them will question your dedication if you apply to a back up specialty and that it’s better to apply to a TY or something.
 
You are correct. The vast majority of cardiothoracic surgery and plastics surgery work has been done by surgeons who ONLY do that work for the last several decades. As far as I know, plastics and cardiothoracic diverged a long time ago.

A lot of vascular surgery in America is still done by general surgeons who are not fellowship trained. Similarly, many old school private practice vascular surgeons still do general surgery.

Finally, in residency we did 1-2 months of vascular every year. We had ZERO plastics and cardiothoracic rotations (I did an elective in thoracic surgery, most didn’t).

Wait in that case, why not make CT and plastics completely independent specialties with their own residencies? Why do CT and plastics fellowships after gen surg even exist?
 
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Wait in that case, why not make CT and plastics completely independent specialties with their own residencies? Why do CT and plastics fellowships after gen surg even exist?
Not enough integrated programs exist at the moment and the vast, vast majority of attendings in those two fields trained through GS. So some attendings want to keep that option open since they 1) think the GS background is important because that’s how they did it 2) want to leave the path open for people who discover the speciality later and are extremely qualified. Just my guess though.

Also just from looking at where I6 programs have been started, you need a pretty big CT surgery department to support an I6 program. But maybe that’s correlation not causation. I’ll again to defer to @ThoracicGuy. Also curious about how this plays out in vascular @TypeADissection
 
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Being "salty" about CT surgery applicants using GS as a backup is kind of silly honestly. CT surgery I6 is such a small field at the moment - every single person I know that has applied I6 used GS as a backup, and about 1/3 of them ended up matching GS anyway and were completely content with it. Also many people mix and match their ROL when they dual apply like this. I.E. someone might put I6 at X #1, then GS at Y #2 etc.

Wait in that case, why not make CT and plastics completely independent specialties with their own residencies? Why do CT and plastics fellowships after gen surg even exist?

Because not everyone knows they want to do that as an M3 in medical school. The fellowships still also provide a huge chunk (majority?) of the those specialty surgeons in the country.
 
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Being "salty" about CT surgery applicants using GS as a backup is kind of silly honestly. CT surgery I6 is such a small field at the moment - every single person I know that has applied I6 used GS as a backup, and about 1/3 of them ended up matching GS anyway and were completely content with it. Also many people mix and match their ROL when they dual apply like this. I.E. someone might put I6 at X #1, then GS at Y #2 etc.



Because not everyone knows they want to do that as an M3 in medical school. The fellowships still also provide a huge chunk (majority?) of the those specialty surgeons in the country.
What about someone who had no idea they wanted to do nsgy, ent, ortho etc until by MS3? The research year strategy would still apply. The fellowship may become outdated over time once the popularity of integrated pathway grows
 
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Not enough integrated programs exist at the moment and the vast, vast majority of attendings in those two fields trained through GS. So some attendings want to keep that option open since they 1) think the GS background is important because that’s how they did it 2) want to leave the path open for people who discover the speciality later and are extremely qualified. Just my guess though.

Also just from looking at where I6 programs have been started, you need a pretty big CT surgery department to support an I6 program. But maybe that’s correlation not causation. I’ll again to defer to @ThoracicGuy. Also curious about how this plays out in vascular @TypeADissection
I guess i'd need to look into the history of surgery subs more because i'm not sure whether nsgy, ortho, ent etc started out as gen surg fellowships --> integrated pathway --> fully independent residencies or whether they completely branched away from gen surg from start
 
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I’ve heard from some people involved with programs that some of them will question your dedication if you apply to a back up specialty and that it’s better to apply to a TY or something.

That's bizarre. Which specialties?
 
I guess i'd need to look into the history of surgery subs more because i'm not sure whether nsgy, ortho, ent etc started out as gen surg fellowships --> integrated pathway --> fully independent residencies or whether they completely branched away from gen surg from start
I was wondering the exact same thing. Obviously at one point you were either a non-surgeon or a surgeon and those are the two specialities in medicine, but that was a loooong time ago. I wonder when ENT for example became it’s own residency and ENT categorical residency was the ONLY way to become board certified in ENT.
 
Wait in that case, why not make CT and plastics completely independent specialties with their own residencies? Why do CT and plastics fellowships after gen surg even exist?
Plastics is for sure moving that direction. Personally, I would not feel safe that plastics fellowship matches will still be a reliable option after 7 years of GS residency.
 
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I have heard rumors, so take this with some massive salt, that the I6 programs might not take off like they have in plastics and some are pushing to stop opening more integrated spots. Because there is a question if the graduates are weaker coming out than the ones coming out of fellowship.

Perhaps @ThoracicGuy knows if there is any merit to this.
 
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I was wondering the exact same thing. Obviously at one point you were either a non-surgeon or a surgeon and those are the two specialities in medicine, but that was a loooong time ago. I wonder when ENT for example became it’s own residency and ENT categorical residency was the ONLY way to become board certified in ENT.

Optho and ENT were some of the first official residencies actually back in the ~1920s. The thing is though, that "general surgeons" operated on the neck and all over the body anyway (and to some extent still do).

This article gives a brief background on how residencies really began:

img_0851.jpg
 
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I have heard rumors, so take this with some massive salt, that the I6 programs might not take off like they have in plastics and some are pushing to stop opening more integrated spots. Because there is a question if the graduates are weaker coming out than the ones coming out of fellowship.

Perhaps @ThoracicGuy knows if there is any merit to this.
Would this only be in CT surgery? Since vascular is I5
 
Optho and ENT were some of the first official residencies actually back in the ~1920s. The thing is though, that "general surgeons" operated on the neck and all over the body anyway (and to some extent still do).

This article gives a brief background on how residencies really began:

img_0851.jpg
Ah interesting. I wonder when some of those became full integrated residencies though. For whatever reason thoracic surgery training after general surgery is technically called a “residency” by programs even today, I always just say fellowship because that’s what almost every other training program after a surgical residency is called m. And I don’t think integrated thoracic programs started until the early 2010s so thoracic residency approved in 1970 in that document must the the fellowship/residency after general surgery. I wonder if the dates for other surgical fields is their fellowships, not their integrated residencies.
 
Plastics is for sure moving that direction. Personally, I would not feel safe that plastics fellowship matches will still be a reliable option after 7 years of GS residency.
it is moving that direction but the fear mongering around plastics residencies disappearing has largely been that. fear mongering. it jumped down for a bit in 2-3 years but otherwise is stable. it continues to be one of the less competitive fellowships and more programs are adding spots (IU is planning on adding another plastics fellow spots) and new programs (I believe Tucson was planning) on now adding fellowships as well.
There were 64 spots this year compared to 63 the prior year and 70 5 years ago. The biggest jump was from 2014 to 2015 when this integrated path got introduced.
 
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I have heard rumors, so take this with some massive salt, that the I6 programs might not take off like they have in plastics and some are pushing to stop opening more integrated spots. Because there is a question if the graduates are weaker coming out than the ones coming out of fellowship.

Perhaps @ThoracicGuy knows if there is any merit to this.

I6 programs didn't really start until I was towards the end of my general surgery, so I don't have much experience with it. I went the traditional pathway and think it is a good one to do. I would hope they would keep traditional fellowship options available to catch those who become interested during their time in general surgery.
 
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Man all this I5/I6 whatever is jibberish to most of us. You guys wanna make your own thread? Haha
 
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ENT and neurosurgery lol

Wow. That's surprising. So I guess they expect people to take multiple research years/prelims to attempt to get in with dwindling chances every round. Well if they've got a research fellowship that hasn't been filling, that's a great way to pump up their numbers, lol
 
Also are there plans to have an integrated pathway for IM fellowships like cards, GI, heme/onc? @NotAProgDirector
No. Although I personally think it would be very reasonable to start fellowship after 2 years, there's no interest in this. It would make running a residency program very complicated not knowing how many PGY-3's you have (and programs with large numbers of residents going on to fellowships would be greatly impacted), and the ABIM has been very strict about starting fellowships early.

Regarding applying to backups, I agree with what's already been said. Programs don't want to be "backups" -- its inefficient for interviewing (since you know you'll be low on the RoL already), and we don't want people who are not really happy. I see this all the time with Derm applicants, we try not to interview them. I realize that's not best for that candidate -- but there are only a limited number of interview spots, every one I save on a backup applicant goes to a more interested applicant.

Regarding competitive fields considering candidates who apply to a backup field "less dedicated" and rank them lower -- that's just petty.
 
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No. Although I personally think it would be very reasonable to start fellowship after 2 years, there's no interest in this. It would make running a residency program very complicated not knowing how many PGY-3's you have (and programs with large numbers of residents going on to fellowships would be greatly impacted), and the ABIM has been very strict about starting fellowships early.

Regarding applying to backups, I agree with what's already been said. Programs don't want to be "backups" -- its inefficient for interviewing (since you know you'll be low on the RoL already), and we don't want people who are not really happy. I see this all the time with Derm applicants, we try not to interview them. I realize that's not best for that candidate -- but there are only a limited number of interview spots, every one I save on a backup applicant goes to a more interested applicant.

Regarding competitive fields considering candidates who apply to a backup field "less dedicated" and rank them lower -- that's just petty.
If someone failed to match derm in year 1 and then reapplied to only IM in year 2, would you look down on that? On one hand I can see how they appear not as dedicated to IM, but on the other hand they probably have great scores and are a hard worker, assuming they were actually competitive for derm.
 
Wow. That's surprising. So I guess they expect people to take multiple research years/prelims to attempt to get in with dwindling chances every round. Well if they've got a research fellowship that hasn't been filling, that's a great way to pump up their numbers, lol

It’s a small n, so it might not be universal.
 
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Also are there plans to have an integrated pathway for IM fellowships like cards, GI, heme/onc? @NotAProgDirector
There are pilots and some places have them that you apply for your first year. I don't see them being the future anytime soon. There are also short tracks for MD/PhDs. Like IMPD said amongst the field of IM, they're really no push for this.
 
If someone failed to match derm in year 1 and then reapplied to only IM in year 2, would you look down on that? On one hand I can see how they appear not as dedicated to IM, but on the other hand they probably have great scores and are a hard worker, assuming they were actually competitive for derm.
Absolutely. But it depends upon what they did with the gap year and their application. If they have changed their mind and are now interested in IM -- great. Ideally what I'd like to see is an LOR from their Derm mentor stating that they have changed their mind and are applying to IM now. If instead their gap year is a year of Derm research and their LOR's are all from random rotations from medical school, and/or their research mentor says they would be a great fit for "your program", then not so much.
 
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Not enough integrated programs exist at the moment and the vast, vast majority of attendings in those two fields trained through GS. So some attendings want to keep that option open since they 1) think the GS background is important because that’s how they did it 2) want to leave the path open for people who discover the speciality later and are extremely qualified. Just my guess though.

Also just from looking at where I6 programs have been started, you need a pretty big CT surgery department to support an I6 program. But maybe that’s correlation not causation. I’ll again to defer to @ThoracicGuy. Also curious about how this plays out in vascular @TypeADissection
I had heard that in order to have a vascular surgery residency, you need to have 1+ attendings than trainees. That's a major limitation to some departments that may only have 3-4 attendings. Also looking at the overall case volume, it's important to make sure that everyone can still get their case numbers. Right now, the open aortic cases are the hardest to get and there are a lot of places that don't even come close to getting there. So I don't know how more programs pop up or replace the traditional fellowships and then get approval without being able to backup the case minimums. There are also a lot of really good people that discover vascular surgery in their residency and then go on to do great things in the field. Not sure if this helps. Good luck though. Cheers.
 
That is interesting for a number of reasons, but especially that barely half of the respondents had a step 1 over 230??? And only 76% published research in CT surgery?! Maybe these CT I6 programs are less competitive than I thought. Then again maybe not since the response rate was only 90 out of 180 and it was an online survey. Not super reliable but thanks for linking it. Still very interesting and I might post something in the surgery forum about this. Relevant quote below…

“Fifty-seven percent (49 of 86) scored above 230 on the USMLE Step 1 examination. Ninety-two percent (80 of 87) performed research during medical school, and 78% (62 of 80), specifically within cardiothoracic surgery; 76% (61 of 80) published their work.”
You can match CT surgery w/o research? ( Assuming that 92 percent stat is accurate).
Here I am at a DO school, trying to get research so I can match mid tier IM or peds so I can specialize in endocrinology.
 
You can match CT surgery w/o research? ( Assuming that 92 percent stat is accurate).
Here I am at a DO school, trying to get research so I can match mid tier IM or peds so I can specialize in endocrinology.
I can't speak for IM, but you realize that a vast majority of peds applicants don't have published research.

I'm not suggesting you shouldn't pursue it, I mean, you totally should to everything to boost your Work/Research/Volunteer Experiences sections of the ERAS application, but generally speaking, the Research Experience section of many peds applicants isn't very robust.

Even more so speaking to pediatric endocrinology, the match rate for fellowship spots in 2020 (starting 2021) was 98.4% (ie only 1 applicant did not match) BUT 38% of the spots were left unfilled.

Just FYI.
 
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I can't speak for IM, but you realize that a vast majority of peds applicants don't have published research.

I'm not suggesting you shouldn't pursue it, I mean, you totally should to everything to boost your Work/Research/Volunteer Experiences sections of the ERAS application, but generally speaking, the Research Experience section of many peds applicants isn't very robust.

Even more so speaking to pediatric endocrinology, the match rate for fellowship spots in 2020 (starting 2021) was 98.4% (ie only 1 applicant did not match) BUT 38% of the spots were left unfilled.

Just FYI.
What about the 92 percent of CT surgery folks had research? Does that mean 8 percent of them didn't? How can you match CT w/o research? Is the question maybe asking directly about Bench research , perhaps?
 
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