So 15 people in my class are planning on applying ortho in the next match

[bonecrushersanon]

My school has a top-10 home orthopaedic program, but we usually send less than 5 people into orthopaedics each year. For some reason, my freak of nature class all decided they were interested in orthopaedics with 5-months to go until apps are due, so we went from 8 applicants to 15. Its a strong 15 too, most have Step-1 250+, great grades, and extra-curriculars. It honestly might be 15 out of the top 25 medical students in our entire class of >200 medical students, which just shows how awesome orthopaedics is as a specialty.

I'm a strong applicant; Step-1 250+, almost all honors clinically, should end up being AOA, and have pretty good extracurriculars. However, I've got to be honest, I'm just worried this level of competition is going to lead to a worse match than a typical year, especially with regional competition. As a group we are doing a good job, spreading out our away rotations across the country and trying not to do more than one student per away rotation.

Any advice on this unique situation for me, or our applicant class as a whole?

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[bonecrushersanon]

Thanks for the advice, I really appreciate it. I figure it will be the same out in the civilian world.

I don't think me or my class will get screened out prior to the interview stage, the real issue will be making it onto the "ranked to match" portion of the match list which comes down to aways and interviews. I might be biased, but I think my class as a whole has super awesome personalities and would all be fun to work with, thus why they are going into ortho. So I don't know if that will differentiate us much either.

 

[waitlist22]

I honestly wouldn't worry too much about it. Georgetown historically has like 20+ people apply each year, granted not all of them match but a good majority usually do. If you are competitive, which it sounds like you are, your chance of matching doesn't change based on how many in your class are applying. It will certainly make it more difficult to match at your home program, as there is more internal competition but overall shouldn't be a problem. There were about 10 in my class and that seemed about the same (10-12) at other schools from talking to people on the interview trail. Heck, I even went on a few interviews where two of my classmates were also there in an interview group of about 30-35. At that point it is about your interview skills and your fit, not how many are applying to ortho in your class. Each of you will bring something unique in your ECs, personal statement, LORs, etc.

 

[MDDoubleD]

The important thing is standing out, do horrible on all your Steps and fail classes. That will make you a unique candidate.

 

[MDDoubleD]

In all seriousness, in competitive specialties, most notably my field (NS) and ortho, you see quite a few applicants who aren't really wanting to do it but apply anyway, neuro because it's "cool" high powered and well paying and prestigious, ortho because it also pays well with a fair lifestyle, the best way to stand out is to establish yourself as someone who is genuinely interested in doing ortho. I won't give you the BS line about doing what you love but you need to make it look like you're doing what you love if you want to match.

 

[massmocha]

Do aways where you want to match!! A strong applicant like yourself will likely get a number of interviews, so you are past the "paper screen" phase of the process. At this point, your reputation and who vouches for you will get you in the door. Do aways at the 3 places you most want to match at, then put those at the top of your list. You can't tell too much from 1 day of drinks and interviews with attendings, so hope you wind up somewhere you rotated at and get advice about where a good spot would be for you from residents and mentors.

 

[waitlist22]

Do aways where you want to match!! A strong applicant like yourself will likely get a number of interviews, so you are past the "paper screen" phase of the process. At this point, your reputation and who vouches for you will get you in the door. Do aways at the 3 places you most want to match at, then put those at the top of your list. You can't tell too much from 1 day of drinks and interviews with attendings, so hope you wind up somewhere you rotated at and get advice about where a good spot would be for you from residents and mentors.

Definitely do aways at the 3 places you most want to match, with your step1 score I don't think you need to do an away at a "safety" program (in quotes b/c there really aren't any true safety programs) but I also wouldn't do all 2 or 3 aways at the top 10 places in the country. As far as the bolded above I tend to disagree. 2 of my aways ended up in the middle of my rank list for various reasons. Spending a month somewhere definitely gives you a more accurate view of the program than one day but I don't think that necessitates you putting them at the top of your list. 1 day of drinks and interviews certainly doesn't tell the whole story but you can definitely get a good feel for the attitude of the residents, how happy they are, how well they get along with faculty, a general idea about how much independence they get in the OR, how call is, etc.

You really do get a feel for fit at the interview dinners, believe it or not. And before anyone argues that residents will lie and say everything is great at their program when it isn't, I have not found that to be the case. Most places I interviewed were very honest about shortcomings of the program, things they didn't like, things they wish were better. They were honest about how brutal call was, how little independence they had during certain sub-specialty rotations, etc. It is important for you to figure out what you are looking for in a program and what strengths you value because each program is going to have some weakness (some worse than others). I'm not particularly interested in sports, so I didn't care if a program covered pro or college teams whereas that may have been really important for someone else. It took me a few interviews to really find out what I wanted in a program and it helped gear my questions in interviews later in the season. My point being that you can still get a general idea and feel for a program on interview day and at the dinners, not as good as a whole month of course, but you have to figure out what is important and if those things weren't present at your away rotations you shouldn't hesitate to put them lower on your list.

 

[massmocha]

Definitely do aways at the 3 places you most want to match, with your step1 score I don't think you need to do an away at a "safety" program (in quotes b/c there really aren't any true safety programs) but I also wouldn't do all 2 or 3 aways at the top 10 places in the country. As far as the bolded above I tend to disagree. 2 of my aways ended up in the middle of my rank list for various reasons. Spending a month somewhere definitely gives you a more accurate view of the program than one day but I don't think that necessitates you putting them at the top of your list. 1 day of drinks and interviews certainly doesn't tell the whole story but you can definitely get a good feel for the attitude of the residents, how happy they are, how well they get along with faculty, a general idea about how much independence they get in the OR, how call is, etc.

You really do get a feel for fit at the interview dinners, believe it or not. And before anyone argues that residents will lie and say everything is great at their program when it isn't, I have not found that to be the case. Most places I interviewed were very honest about shortcomings of the program, things they didn't like, things they wish were better. They were honest about how brutal call was, how little independence they had during certain sub-specialty rotations, etc. It is important for you to figure out what you are looking for in a program and what strengths you value because each program is going to have some weakness (some worse than others). I'm not particularly interested in sports, so I didn't care if a program covered pro or college teams whereas that may have been really important for someone else. It took me a few interviews to really find out what I wanted in a program and it helped gear my questions in interviews later in the season. My point being that you can still get a general idea and feel for a program on interview day and at the dinners, not as good as a whole month of course, but you have to figure out what is important and if those things weren't present at your away rotations you shouldn't hesitate to put them lower on your list.

I agree, sorry I worded that incorrectly. I meant rank the places you rotate at highly if you end up liking them. If you rotate somewhere and don't love it, or get a better vibe on an interview, you should always fill out your rank list according to your true preferences. Sorry for misspeaking.

 

[RueTay]

In your situation it will be very helpful to have a good letter from your chairman and good letters from your home institution in general. When a residency program gets 10+ aplocants from from the same med school that all seem qualified they will use LORs to help figure out who to interview. This is why some programs require a chairmanship letter. It's impossible for all of you to have glowing letters from your home institution. The ones who do will get more interviews... All else being equal.

Or just bail and do family med

 

[MDDoubleD]

In your situation it will be very helpful to have a good letter from your chairman and good letters from your home institution in general. When a residency program gets 10+ aplocants from from the same med school that all seem qualified they will use LORs to help figure out who to interview. This is why some programs require a chairmanship letter. It's impossible for all of you to have glowing letters from your home institution. The ones who do will get more interviews... All else being equal.

Or just bail and do family med

There's a middle ground between orho and FM, in all seriousness, if you want to do surgery but can't get it, ER is a good bet.

 

[KinasePro]

And before anyone argues that residents will lie and say everything is great at their program when it isn't, I have not found that to be the case. Most places I interviewed were very honest about shortcomings of the program, things they didn't like, things they wish were better. They were honest about how brutal call was, how little independence they had during certain sub-specialty rotations, etc.

Just posting purely to provide counterpoint-- but I found certain programs to be very dishonest about their experiences. In my experience this happens mostly at high-powered academic places... Residents would very often paint a totally different picture than the rotators/home students. "Naw, the fellows don't impact training at all--rather they enhance the experience!... Of course the majority of attendings let us go skin-to-skin! We totally get enough trauma exposure and autonomy to be comfortable on call..." Probably my favorite line is "we can pick whatever fellowship we want..." when I know specific examples of that not being true...

One thing that seemed to be true nearly everywhere is that the chiefs are your best friends when interviewing... to me, they always seemed more candid and honest than anyone else at the interview day. Rotators are great sources of information too, just be cautious of the occasionally manipulative ones (thankfully there aren't many of these at all, because our field is awesome.)

 

[waitlist22]

Just posting purely to provide counterpoint-- but I found certain programs to be very dishonest about their experiences. In my experience this happens mostly at high-powered academic places... Residents would very often paint a totally different picture than the rotators/home students. "Naw, the fellows don't impact training at all--rather they enhance the experience!... Of course the majority of attendings let us go skin-to-skin! We totally get enough trauma exposure and autonomy to be comfortable on call..." Probably my favorite line is "we can pick whatever fellowship we want..." when I know specific examples of that not being true...

Oh, no doubt, residents definitely lie about those 2 things and pretty much at every program. I guess I just knew that going into it and seemed like most applicants knew that. Fellows are almost always a hindrance to resident training and will get the better cases, that's why I never fell for that bull****. At one of my aways I was talking to one of the chiefs heading to a fellowship next year and he basically said what we will pretty much all say by the time we get to our fellowships: that he was out to get his own and learn what he needed to learn to practice competently. He wasn't going to know any of the residents when he got there so it didn't much matter to him if they didn't like that he got to pick his cases. Like it or not its true.

Same with the big academic programs. They definitely have a rep of not getting to operate much and pretty much have to do a fellowship to get adequate operative experience. They for sure stretch how much they get to do in the OR because of this known reputation. Rotators and fellow applicants on the trail are almost always your friend when it comes to finding out this stuff. Obviously this is all generalizing and is not true of every single program. Not every single high-powered academic place gets a poor operative experience but the majority of them don't get as much as the less rigorous academic programs and community programs.

All goes back to what you want in a program. Do you want the name, the fellowship opportunities, and future career possibilities that come by going to a top academic program where you may, or may not, operate less than other programs and have to learn a lot of skills during your fellowship? Or do you want to go to a solid blue collar program where you operate a lot, see a good bit of trauma, finish chief year competent and ready to enter private practice or fellowship while potentially sacrificing didactic and research prestige and the name/reputation of a top program? There are definitely a few programs where you can have all of those things but they are few and far between.

 

[massmocha]

Oh, no doubt, residents definitely lie about those 2 things and pretty much at every program. I guess I just knew that going into it and seemed like most applicants knew that. Fellows are almost always a hindrance to resident training and will get the better cases, that's why I never fell for that bull****. At one of my aways I was talking to one of the chiefs heading to a fellowship next year and he basically said what we will pretty much all say by the time we get to our fellowships: that he was out to get his own and learn what he needed to learn to practice competently. He wasn't going to know any of the residents when he got there so it didn't much matter to him if they didn't like that he got to pick his cases. Like it or not its true.

Same with the big academic programs. They definitely have a rep of not getting to operate much and pretty much have to do a fellowship to get adequate operative experience. They for sure stretch how much they get to do in the OR because of this known reputation. Rotators and fellow applicants on the trail are almost always your friend when it comes to finding out this stuff. Obviously this is all generalizing and is not true of every single program. Not every single high-powered academic place gets a poor operative experience but the majority of them don't get as much as the less rigorous academic programs and community programs.

All goes back to what you want in a program. Do you want the name, the fellowship opportunities, and future career possibilities that come by going to a top academic program where you may, or may not, operate less than other programs and have to learn a lot of skills during your fellowship? Or do you want to go to a solid blue collar program where you operate a lot, see a good bit of trauma, finish chief year competent and ready to enter private practice or fellowship while potentially sacrificing didactic and research prestige and the name/reputation of a top program? There are definitely a few programs where you can have all of those things but they are few and far between.

Your thoughts on top programs with no/few fellows? I know Wash U and Hopkins seemed to push that at their interviews.

 

[KinasePro]

Your thoughts on top programs with no/few fellows? I know Wash U and Hopkins seemed to push that at their interviews.

I think Wash U has got to be one of the best in the "academic" league, but during the interview day, the program director said he grants the most autonomy of any surgeon in the program, which is allowing residents to do 90% of the case. He emphasized that he was on the extreme end of the spectrum. Heard from many that fellows are a real force there, though you can certainly still end up with a decent operative experience. Didactics and research couldn't be better, though.

I think vanderbilt, iowa, case western, and pitt are among the best with little-to-no fellow interference. Also heard great things about USC but I personally did not interview there.

The program that provides the best experience despite fellows is probably Mayo, because you rarely work on the same service as the fellow there. Then again, the problem with Mayo is that a large proportion of the attendings are known to be handsy (rotators said it was 50/50). You exchange one problem for another in this case. Despite this, I still loved Mayo. Would've been very happy there if it weren't for the location.

 

[waitlist22]

I have the exact same thoughts about Mayo. Would have been thrilled to end up there but couldn't rank it number one because of the mentorship model. Too much possibility you would spend 3 months with an attending that didn't let you do anything or you didn't get along with. World class program no doubt but not right for me personally. Also the whole deal about never really being off call and having to have your pager 24/7 didn't do it for me. But KinasePro is right, the fellows here definitely won't be in your way because you will never be on service with them and you are very rarely double scrubbed at Mayo because of the mentorship model and having more attendings to cover than there are residents.

Can't speak to Hopkins or WashU in regards to fellows as I didn't interview there. I have heard nothing but good things about WashU from rotators and people who interviewed there. But as someone once said to me, "patients don't come from around the world to Mayo (HSS, Hopkins, WashU, etc.) to get operated on by a PGY3". Obviously these programs adequately train their residents and they must get enough operative experience but I wanted a place that gave me plenty of OR time so I felt comfortable once I was out on my own.

As far as fellows go it also depends on how many attendings there are in that specialty. I would imagine a place like Indiana Hand has a ton of fellows but they probably have a lot of attendings and a huge case load where your experience is not significantly affected other than the extremely rare cases that the fellow will get to do and not you. A place with 2 attendings and 1 fellow, your experience is probably affected. A place with 15 attendings and 2 fellows, probably not going to affect you too much.

 

[MDDoubleD]

I have the exact same thoughts about Mayo. Would have been thrilled to end up there but couldn't rank it number one because of the mentorship model. Too much possibility you would spend 3 months with an attending that didn't let you do anything or you didn't get along with. World class program no doubt but not right for me personally. Also the whole deal about never really being off call and having to have your pager 24/7 didn't do it for me. But KinasePro is right, the fellows here definitely won't be in your way because you will never be on service with them and you are very rarely double scrubbed at Mayo because of the mentorship model and having more attendings to cover than there are residents.

Can't speak to Hopkins or WashU in regards to fellows as I didn't interview there. I have heard nothing but good things about WashU from rotators and people who interviewed there. But as someone once said to me, "patients don't come from around the world to Mayo (HSS, Hopkins, WashU, etc.) to get operated on by a PGY3". Obviously these programs adequately train their residents and they must get enough operative experience but I wanted a place that gave me plenty of OR time so I felt comfortable once I was out on my own.

As far as fellows go it also depends on how many attendings there are in that specialty. I would imagine a place like Indiana Hand has a ton of fellows but they probably have a lot of attendings and a huge case load where your experience is not significantly affected other than the extremely rare cases that the fellow will get to do and not you. A place with 2 attendings and 1 fellow, your experience is probably affected. A place with 15 attendings and 2 fellows, probably not going to affect you too much.

Bingo.
Bear that in mind about any prestigious program (especially in surgery). Conventional wisdom had it "The bigger the name, the worse the residency."

 

[4thQTHailMary]

Oh, no doubt, residents definitely lie about those 2 things and pretty much at every program. I guess I just knew that going into it and seemed like most applicants knew that. Fellows are almost always a hindrance to resident training and will get the better cases, that's why I never fell for that bull****. At one of my aways I was talking to one of the chiefs heading to a fellowship next year and he basically said what we will pretty much all say by the time we get to our fellowships: that he was out to get his own and learn what he needed to learn to practice competently. He wasn't going to know any of the residents when he got there so it didn't much matter to him if they didn't like that he got to pick his cases. Like it or not its true.

Same with the big academic programs. They definitely have a rep of not getting to operate much and pretty much have to do a fellowship to get adequate operative experience. They for sure stretch how much they get to do in the OR because of this known reputation. Rotators and fellow applicants on the trail are almost always your friend when it comes to finding out this stuff. Obviously this is all generalizing and is not true of every single program. Not every single high-powered academic place gets a poor operative experience but the majority of them don't get as much as the less rigorous academic programs and community programs.

All goes back to what you want in a program. Do you want the name, the fellowship opportunities, and future career possibilities that come by going to a top academic program where you may, or may not, operate less than other programs and have to learn a lot of skills during your fellowship? Or do you want to go to a solid blue collar program where you operate a lot, see a good bit of trauma, finish chief year competent and ready to enter private practice or fellowship while potentially sacrificing didactic and research prestige and the name/reputation of a top program? There are definitely a few programs where you can have all of those things but they are few and far between.

Like everyone else, this is what I'm looking for. I believe Campbell Clinic to reasonably fit this description. Are there any others that come to mind?

The Ortho game has truly gotten to be ridiculous when it comes to applicants. I mean, I'm 260+ Step 1, AOA, etc., yet I feel "average" for Ortho. That's absurd.

 

[Handinhand]

Like everyone else, this is what I'm looking for. I believe Campbell Clinic to reasonably fit this description. Are there any others that come to mind?

The Ortho game has truly gotten to be ridiculous when it comes to applicants. I mean, I'm 260+ Step 1, AOA, etc., yet I feel "average" for Ortho. That's absurd.

Slight exaggeration. As an m3 who's getting ready for sub-is and applying this next year, I share your sentiment, but the average Step 1 on the last charting outcomes was 245, and only 58 people had higher than a 260 out of 840 applicants. AOA is still in the minority, also.

 

[massmocha]

Like everyone else, this is what I'm looking for. I believe Campbell Clinic to reasonably fit this description. Are there any others that come to mind?

The Ortho game has truly gotten to be ridiculous when it comes to applicants. I mean, I'm 260+ Step 1, AOA, etc., yet I feel "average" for Ortho. That's absurd.

Despite your feelings, you are not an average applicant. Your match chance is over 90% by every indicator in Charting Outcomes

 

[lodestar]

Despite your feelings, you are not an average applicant. Your match chance is over 90% by every indicator in Charting Outcomes

~~~~~~~~~

Gotta' agree. Personality can torpedo any candidate, but otherwise a Step score > 260 is a near lock for matching somewhere.

Good, credible posts elsewhere suggest that at the top programs it finally gets down to (while spitting hairs among the best candidates): Who do you like and see yourself working closely with for 5 years?

When PD's suggest that the Step 1 "is just one of a number of factors we consider," that is a bit obtuse. If you did a regression and correlation analysis, Step 1 would correlate VERY highly, and certainly be the number 1 criterion...you cannot even get to the interview in Derm, Ortho, ENT, etc., without a well-above-average Step 1 (90%+).

 

[4thQTHailMary]

Despite your feelings, you are not an average applicant. Your match chance is over 90% by every indicator in Charting Outcomes

Fair enough. Just seems that way when you read this site and other forums, not to mention people that I know in IRL that stack up similarly. I guess that's a good thing as it prevents me from getting complacent.

 

[Bancrofti]

Despite your feelings, you are not an average applicant. Your match chance is over 90% by every indicator in Charting Outcomes

Fair enough. Just seems that way when you read this site and other forums, not to mention people that I know in IRL that stack up similarly. I guess that's a good thing as it prevents me from getting complacent.

It's definitely understandable. It's easy to get lost with how competitive you are after reading SDN; it'll seem like everyone was 250+, AOA, and has research. Likewise, successful people tend to surround themselves with other successful people, so if you did well, it is more likely that a majority of the people you acquaint yourself with did well also.

It didn't calm me too much, but just to helped to put things in perspective a little: there are about ~86 PGY1 positions at the programs listed by doximity as being top 10 ortho programs (whether this is an accurate list is a different story, it's just for the sake of the argument). If you consider that there were 50 something people that scored above 260 last year, only 1 of whom didn't match, you kind of just have to assume that you're automatically competitive enough for most programs in the country if you know that your step 1 score is higher than almost everyone applying even when only considering top 10 programs. From the NRMP data, it seems that the most important things are your numbers, how well you perform during an interview, and how interpersonal you are.

What worried me is not having enough research if it turns out that I want to be at an academic program. I feel like I've seen people post on orthogate/SDN or heard stories of people with multiple 1st author publications. Almost every single person I've asked both on SDN and people who have matched before me have said that at the least all you need to make sure to do is get on some kind of project so that you have something to talk about to show your interest and that should be good enough if your step score is solid enough. I'm just going to go on their word, since they obviously the people who have matched know what they're talking about and stop stressing and hopefully I'll just kill whatever aways I'm on.

 

[lodestar]

re:
From the NRMP data, it seems that the most important things are your numbers, how well you perform during an interview, and how interpersonal you are.

~~~~~~~~

Spot on correct!

There are always a few top scorers who simply do not know how to interview...and it is a learned skill. But you cannot even get into/among the candidate pool without getting thru the minimum higher Step 1 score litmus test screen.

Once you get the interview, dress the part, maintain eye contact, have a few intelligent questions, be obviously interested without becoming an obsequious sycophant, watch your manners, remember the little people (residents or even support staff can torpedo you), and make yourself real/likable/engaging enough.

These basic, common sense rules apply in ANY interviews...for bank management slots, whatever. You DO get only one chance to make a first impression. Studies show that the interviewers form their impressions of you during the first 2 minutes. And comely, affable, engaged people simply ALWAYS win out once at the interview point.

 

[KinasePro]

I believe Campbell Clinic to reasonably fit this description. Are there any others that come to mind?

Campbell is an outstanding program. You would emerge from that program with excellent operative training, though most applicants agree that research/didactics are a weakness there.

I personally think the most balanced program in the country is probably Iowa. Great academics, outstanding operative experience, great tradition within orthopaedics. Just my $0.02.

 

[YankeeJeterMD]

Don't worry about it. We had about the same amount of people applying and I matched with a 240 step 1 to a GREAT program. In fact, the two people who didn't end up matching had much better scores than me. The fact of the matter is that programs are looking for a particular candidate, and if that's you, you'll get the interview. If that's not you, you won't get the interview and maybe your classmates will, but you probably wouldn't be happy there anyway. Since you cannot be the same person as your other classmates, just be yourself, and you'll end up at the right program for you. Matching is a two way process--not only are you looking for a program that is a good fit, the program is looking for residents who will be a good fit, too.