"Welcome, ladies and gentleman, to the 2023 Internet Message Board Nuance Olympics. I'm your host Bob Costas sitting alongside my partner, Ric Flair. The games open tonight with Elementary School Economics attempting what is widely considered to be the most difficult routine in all of internet wordsmithing, namely, talking about USMLE scores and degrees and being a good doctor and the definition of competitiveness. Many people counseled him against this. He himself told himself not to attempt this. But at the end of the day, the people want the show, and he wants to give it to them."
Jokes aside -
I fundamentally believe certain things about our existence on this planet:
- There are multiple different types of intelligence. If you can draw a photorealistic sketch of the ocean but are illiterate, I would still consider you "smart".
- Modern-era, Western academics rewards and place value on a certain type of skill and behavior.
- Modern-era, Western society and culture reveres certain roles and achievements over others.
- There is no singular definition of a "good doctor".
I could go on. You get the point.
I would define "competitiveness" as something that only exists within the arena you are assessing, and hold to the rules that arena has deemed "important" in that time.
Classically, a "competitive" medical student entering the American Match was measured on metrics such as class rank/grades, USMLE scores (specifically Step 1), number and quality (and type) of publications, prestige of medical school, and so on.
Again, we all know what I'm talking about.
For almost 20 years, Radiation Oncology was one of the most competitive specialties in the Match, as defined by the measured parameters at the time.
Those parameters may or may not influence skill as a doctor. Those parameters have not always been of critical importance, will not always be of critical importance, and in fact have already shifted in the last 5-10 years.
I Matched during peak competitiveness. I know where I stood, as measured by the metrics considered important at the time. I know the general measures of my cohort as well.
I can't comment on if I'm a good doctor or not, in independent practice. I'd like to think I am, but - what does that mean? Maybe something I'm doing that I think is "good" is thought of as "bad" by my patient: who is right? Is anyone right? Other than actively murdering people definitely being "wrong"...I don't know.
Every year this always goes down the same spiral. I would frame it as such:
If you are trying to assess the "health" of the RadOnc Match, you need to hold your variables constant. If you think just the raw number of applicants matters, fine, you can do that.
But if you try to drill down further, you HAVE to make some uncomfortable judgements. And personally, I think that's OK - because ultimately, none of the metrics we have EVER devised have ever been able to concretely define if a person is a "good doctor" or not.
I know I'm talking into the wind. I know how this plays out, and I know it will play out again and again.
For me, I can definitely say I don't care about the preliminary total number of applicants. When I see the breakdown of that number, with MD/DO/IMG, I view that breakdown through the lens of the rules of the arena. It tells me something about JUST the Match. It tells me nothing about those individual people or what kind of Radiation Oncologist they may or may not be - depending on how many dual- and triple-applicants there are.
And you can lie to me and say you don't. But I know the truth.
"WOOOOOO"
"Well there you have it folks, Ric Flair certainly was impressed by the technical nature of the routine. But what will the judges think? Let's go to our floor reporter, Bill Nye the Science Guy..."
