Too Many ORL Applicants From Home Institution?

[soonereng]

So this year it looks like there are more people who are going to apply ORL from my school than we've ever had before. I was looking at match lists for my home institution from the last 7 years and the most that we matched into ORL in a single match was 4 (don't know how many applied that cycle) but usually only match 1-2 (with only 1-2 applying per year).

There are probably 7-8 of my classmates including myself who are going to apply this year. It seems that we may have several left out in the cold come next March as our program only takes 3 and it appears that they like to get at least 1 resident per match from other schools.

Given that we are a midwestern state school with ~170 class size, do we have any chance of matching 7-8? What is the most that anyone has heard of matching in a year from a similar size school?

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[Leforte]

It does not matter how many people apply from any one school. Most people end up at another institution, anyway.

What is more important is that YOU work hard, develop a research project, score well on your exams, interview well and leave a good impression.

Don't worry about the other 7 applicants from your school.

If you have a particular interest on staying at your home institution, let your PD know - be visible but not intrusive, be interested but not obnoxious, get along well with others and don't bad mouth your fellow students.

BUT, to answer your question, I do recall that there were 7 matched people from one school a few years ago. Can't remember which one, but I am sure it is somewhere in the lists of "where did you match" threads at otomatch.com

 

[Ableton]

I agree with Leforte in that it really doesn't matter a whole lot how many people apply from your institution. My school has a relatively small ENT department (only take 1-2 residents per year) and a total of 7 students matched this year, almost all at other programs.

 

[resxn]

I agree with the above with one caveat. You are at risk of getting a letter of recomendation diluted with so many other applicants. I would do what you can to know your chairman, but so will everyone else. I would then pick one other attending who is student friendly and just work your tail off for them in particular to get your 2nd letter from that person. If you shine for that attending in whatever way is best for them in particular, you can get a letter that says something like, "Of the 7-8 students rotating through our department this year, soonereng demonstrated superior qualities unrivaled by his peers."

Probably not going to get something that glowing, but that should be your goal. Even if it's not coming from a Chairman it's going to standout like crazy.

 

[ExtraAverage]

Having just finished the process this year, I will say that it really changes year to year for every school on how many will apply and get in. My class size is a touch smaller than yours and we have an average size home ENT program (also located in the Midwest.) In 2009 we had 7 people apply to ENT and all 7 were accepted. This last year 5 of us applied through the match and only 3 of us got in. So success can vary wildly. I think the most important stats are those in your application folder, though I do agree that having many applicants can water down your recommendation letters. I made sure to target two ENT's early in medical school and worked with them extensively before my Sub-I month so they already knew me. This definitely helped in my letters.

 

[soonereng]

Thanks for the replies everyone. At least I now know it is possible (though not necessarily probable) for us all to match.

 

[GoLytely]

Do you really want to be an ENT that badly? I considered it initially, until I realized that most people I knew who were applying were doing so because they wanted to be a surgeon without the horrible hours (and because urology would put them on the wrong end of some cruel jokes, forever). Most of them have deceived themselves into believing they truly love the inner ear, throat, nose, snot, etc.

I bring this up not to be inflammatory, but to preface how shocked I was at how competitive this field really is. Based on my graduating class alone, I'd call this potentially the most competitive field in medicine right now. We had about EIGHT people apply (I'm at a USNews ranked 30-40 school in the NE). Of those, four matched. Of those four, 3 matched at below 5th on their rank list, and one matched his #1 presumably only because it was our home program. Of the four that failed, one scrambled into anesthesia, one into a preliminary general surgery year, and the other two are doing research for a year.

The question to ask yourself may be: Do I reaaaaaaally want to do this, or are there more superficial reasons driving me to it? If it's the latter, it may not be worth the huge risk involved. I can't imagine graduating after 4 years of being a great student and being an unemployed reject.

 

[medstylee]

Do you really want to be an ENT that badly? I considered it initially, until I realized that most people I knew who were applying were doing so because they wanted to be a surgeon without the horrible hours (and because urology would put them on the wrong end of some cruel jokes, forever). Most of them have deceived themselves into believing they truly love the inner ear, throat, nose, snot, etc.

I bring this up not to be inflammatory, but to preface how shocked I was at how competitive this field really is. Based on my graduating class alone, I'd call this potentially the most competitive field in medicine right now. We had about EIGHT people apply (I'm at a USNews ranked 30-40 school in the NE). Of those, four matched. Of those four, 3 matched at below 5th on their rank list, and one matched his #1 presumably only because it was our home program. Of the four that failed, one scrambled into anesthesia, one into a preliminary general surgery year, and the other two are doing research for a year.

The question to ask yourself may be: Do I reaaaaaaally want to do this, or are there more superficial reasons driving me to it? If it's the latter, it may not be worth the huge risk involved. I can't imagine graduating after 4 years of being a great student and being an unemployed reject.

I would guess that almost no one does ENT just so s/he can be a "surgeon." I applied this year and thus have gotten to know many med students who chose this route. I would say about half did rotations in ENT during their third year and realized then and there that they liked everything about the field - the people, the cases, the variety, the fact that people in ENT really like their jobs, etc... Then there are also many people - myself included - who in one way or another developed a curiosity about ENT early in medical school and then shadowed residents, did research, etc. All in all, I would guess the majority of people who apply to ENT have very good reasons for doing so and their decisions are well thought out.

As for it being competitive, sure it is, but it's definitely not the most. Knowing excellent candidates in my class who did not match in plastic surgery and dermatology, I believe ENT is a few notches below those two in competition. GoLytely, I think your school's experience this year is pretty atypical. Our school - which is definitely NOT a top school - had 7/8 match this year and every one of us matched at either our #1 or #2 programs. Again, that is pretty atypical as well, but I think it's more realistic than having < half match and all low on their lists. Sure, ~30% of applicants don't match (many international) and the avg step 1 is probably >240 now... but, like I said, most people who are applying to ENT have things well planned out and know why they want to go into this field.

Best of luck, it's truly a fantastic field and I cannot wait to start my residency.

 

[forbin]

I heart snot. And earwax.

Do you really want to be an ENT that badly? I considered it initially, until I realized that most people I knew who were applying were doing so because they wanted to be a surgeon without the horrible hours (and because urology would put them on the wrong end of some cruel jokes, forever). Most of them have deceived themselves into believing they truly love the inner ear, throat, nose, snot, etc.

I bring this up not to be inflammatory, but to preface how shocked I was at how competitive this field really is. Based on my graduating class alone, I'd call this potentially the most competitive field in medicine right now. We had about EIGHT people apply (I'm at a USNews ranked 30-40 school in the NE). Of those, four matched. Of those four, 3 matched at below 5th on their rank list, and one matched his #1 presumably only because it was our home program. Of the four that failed, one scrambled into anesthesia, one into a preliminary general surgery year, and the other two are doing research for a year.

The question to ask yourself may be: Do I reaaaaaaally want to do this, or are there more superficial reasons driving me to it? If it's the latter, it may not be worth the huge risk involved. I can't imagine graduating after 4 years of being a great student and being an unemployed reject.

 

[resxn]

Do you really want to be an ENT that badly? I considered it initially, until I realized that most people I knew who were applying were doing so because they wanted to be a surgeon without the horrible hours (and because urology would put them on the wrong end of some cruel jokes, forever). Most of them have deceived themselves into believing they truly love the inner ear, throat, nose, snot, etc.

You're kidding right? Not to be inflammatory? And you say MOST have deceived themselves. Most choose ENT to be a surgeon without the hours but to avoid jokes about urology?

How seriously immature are you. That's not a question.

 

[GoLytely]

You're kidding right? Not to be inflammatory? And you say MOST have deceived themselves. Most choose ENT to be a surgeon without the hours but to avoid jokes about urology?

How seriously immature are you. That's not a question.

How is what I posted immature? It's possible that I worded it carelessly. Most of the people I know who are going into ENT do it because they love the OR, but the thought of suffering through a general surgery residency and brutal, unrewarding career is too much for them. I don't think that's way too hard to believe. Many of us fall in love with our OR experiences but decide that the lifestyle of the typical general, vascular, transplant, or other surgeon would leave us little time to pursue...well...a life outside of the hospital (for those who want that, which admittedly is not everybody).

Then a billion and one threads come along, on this site and others, assuring us that ENT and Uro offer this great lifestyle after residency and you STILL get to work in the OR your whole career. How cool is that? At this point, Uro has lost out among some of my friends because, yeah, you deal with a lot of penises. I don't know whether NOT wanting to work so extensively with penises is immature, but it seems to be a bit of a stretch from what most med students dreamt of doing in highschool and college.

With due respect (which is hefty, given how helpful you are to folks around here), do you really think that otolaryngology is so exciting in theory to have catapulted in competitiveness far beyond general surgery and hence its subspecialties, with the lifestyle issue playing a minimal role? I would have to argue, based on my experiences with a just-matched group of students, that, given a love of the OR, ENT often wins out due to lifestyle concerns.

 

[resxn]

With due respect (which is hefty, given how helpful you are to folks around here), do you really think that otolaryngology is so exciting in theory to have catapulted in competitiveness far beyond general surgery and hence its subspecialties, with the lifestyle issue playing a minimal role?

Yeah, actually I do. And I find it immature to think that someone is going to make a life decision based on a perceived easiness in my specialty. It royally pisses me off that I hear residents whine about how hard they work and they have a whopping 80hrs/wk. Heck, I do that now sometimes 6 years into private practice. I'm not so naive to think that lifestyle doesn't play a role, as I'm sure it does, but not to the point that supposedly intelligent (and perhaps the most intelligent given the competitiveness) med students "deceive" themselves into liking an otherwise unlikeable field.

ENT is better (to those who believe it) than General Slavery (yes I can acknowledge it's a harder lifestyle) for several reasons:
1 - combination of clinical and surgical care. No other surgical specialty except for ophtho has the same luxury as to provide the complete range of care for a pt's medical condition. Some derms come close. For urologists, there's nephrologists. For general surgeons, there's internists/GI/Oncologists. For neurosurgeons, there's neurologists. For Cardiothoracic surgeons, there's cardiologists.
2 - variety. In ENT you have ortho, plastics, trauma, derm, endoscopic, pediatric, airway, endocrine, and neuro surgical components. Tell me a field in any surgical realm which comes close to that range of options any of which you could specialize in or generalize in all. Plastics probably comes closest. Certainly general surgery does not.
3 - protection. At least on the near horizon, this field is very well-protected. There is no forseeable threat from NP's or PA's taking over this specialty as there is for PCP fields.
4 - salary. It's a lucrative field for sure with options for ancillary services to bring in further income including allergy and audiology.
5 - lifestyle. I work 60hrs/wk avg. I see 24-28 people/day in clinic. I operate 2 full days a week. I'm not the busiest because I take time to actually talk with my patients. I see them for f/u and don't use NP's or PA's. I take all my own call for my own patients--not sharing with my partners--so as to provide personalized care. I perform 95% of all the trachs in my 300 bed hospital and about 40% of the inpt consults despite 8 on-call ENT's. Ask my wife if my lifestyle seems great. I was in the USAF as an ENT for 3 years and I guarantee you that was a better lifestyle in terms of time for my family than is private practice and I guarantee you that I work as hard if not harder than my good general surgery friends. They will freely admit as much. I don't have to work that hard, I choose to so that I can build a successful practice and prevent other hungry ENT's from setting up shop in my geographic location and eating away at my referrals. I serve as the chair of surgery in my largest hospital and on two other medical executive committees. I am a paid speaker for Ciprodex and Acclarent with several commitments due to my relationships there.

I think your assumption that lifestyle is why people choose ENT is immature. Any med student worth their salt is going to find out what life is like outside academia. Just because general surgery residents get the crap kicked out of them doesn't mean that we all don't work our tails off post-residency. Is it better than residency? Heck yes. Is it better than general surgery? I think so. Certainly call for ENT is better than it is for general surgery. But overall lifestyle being dramatically easier? No way. And I stand by my assertion that it's immature to think so.

I would have to argue, based on my experiences with a just-matched group of students, that, given a love of the OR, ENT often wins out due to lifestyle concerns.

Then you have associated with some seriously flawed students.

 

[Leforte]

While lifestyle is a factor in many medical students career choice, I do think that most who choose ENT do realize that they are embarking on a surgical career. The hours are those of a surgeon. You will be in rounding early as a resident, your cases can be longer than most other surgeons, you will take call like any other surgeon and you'll be coming in at night for the tonsil bleed, airway emergency, etc.

During my residency, we worked longer hours than any other surgical resident, with the exception of the neurosurgeons.

As an attending, my days are more predictable, but there are still nights where I'm in late operating or seeing consults with the residents.

Am I working as hard as the general surgeons? Harder than some, less than others. But, again, once you finish your training, you can choose how hard you want to work, regardless of specialty.

In addition to the excellent reasons Resxn detailed about our specialty, I would also add that unlike many other surgical specialties (except Urology and Optho perhaps), ENT also allows you to change your practice as you get older or as your priorities in life change.

You can start out gung-ho and operate like mad in the beginning. As you get more senior, and perhaps want more stable hours, you can give up the H&N cases and focus more on the shorter cases. While all surgeons can do this, what ENT also offers is that should you decide to give up operating all together, you can have a very successful clinic only practice with a wide variety of conditions treated. I believe that it would be very difficult, although not impossible, for a general surgeon to do the same.

Personally, I like the fact that there is a strong medical management component to ENT. As Resxn pointed out, there is no "medicine" specialty that manages the clinical side of ENT.

While I have seen many students express interest in ENT because of the perceived lifestyle, in my experience, many have chosen other specialties if lifestyle is a major factor in the career choice.

As for not choosing ENT because you may not match and be an "unemployed reject" - I don't even know where to begin with that one. If fear of rejection is a guiding factor in a persons career choice, I would probably advise them to seek help through the student health clinic for psychotherapy to gain coping skills in dealing with the unknown. If a person is a poor candidate, they will likely have a backup plan. If they are a good candidate who, for whatever reason, does not match - they'll have to decide what path to pursue next on un-match day. But these outcomes are not "competitive specialty" specific. They occur frequently in less competitive fields for a variety of reasons which is beyond the scope of this thread.

 

[Substance]

The voice of reason appears!

Medical students are forced far too early to make career decisions. How the hell can a medical student know what field is the one he wants to spend the rest of his life practicing? Medical students know nothing about any field aside from competitiveness, prestige, income, and whether its surgical or not. The actual science and practice of the field is beyond their experience.

Solution: common rotating internship year with the option to practice general practice afterwards and apply for another residency in the future should one desire.

 

[SouthernSurgeon]

It does not matter how many people apply from any one school. Most people end up at another institution, anyway.

I don't know that I completely agree. My school sent a ton of people into general surgery this year (kind of a flukey year as we usually only have 4 or 5 and had >10 this year), and as applicants we were all feeling the crunch - lots of us who were in a similar cohort seemed to be competing against each other for interviews and ultimately for positions. We each got (seemingly) passed up in favor for the others at a few schools and one PD admitted to me that he was having a hard time "choosing" from amongst all the candidates at my school - I got the impression he liked a number of us but couldn't justify a rank list that would give him 4 or 5 students from the same school. And at my home school it was a HUGE issue - people got left out in the cold who in any other year would have been very strong candidates for the home program.

Now all that said, ultimately it does come down to you and if you are a strong candidate on your own it should work out. But I would argue that things like this can have an effect on the process - there just isn't much to do about it except (as you say) suck it up and do your best.

As for sending tons of people into competitive fields - I'm pretty sure northwestern had a dozen people match in urology last year - so it can certainly be done.

 

[Leforte]

Solution: common rotating internship year with the option to practice general practice afterwards and apply for another residency in the future should one desire.

You can do this via a transitional year. The problem comes with funding through Medicare for the program that you eventually do your residency with. My understanding is that your funding is dependent upon the first place you match. So if you match into FM and decide to switch to surgery after PGY1, you only have 2 years of Medicare funding for your GS residency. That means the program/hospital would be out the additional 3 years of nearly $100k per year for your residency. I'm not sure what the rules are for a transitional year I suppose I could ask our GME office.

Also, I think that while many student do arrive at a decision late in their medical school curriculum, the alternative is the European/Australian model where, as you indicate, you do a rotating internship, then choose either the physician/surgeon/other pathway. You are not guaranteed a residency and you could spend years in limbo waiting for a position. Training would, of course, be extended far beyond the times we have now in residency. Interestingly, with the talk of limiting resident hours to 55 or so per week there has been an open discussion that training times may have to be extended regardless, which many students/residents are finding less palatable than working the hours as they currently are. Time will tell.

 

[soonereng]

1 - combination of clinical and surgical care. No other surgical specialty except for ophtho has the same luxury as to provide the complete range of care for a pt's medical condition. Some derms come close. For urologists, there's nephrologists. For general surgeons, there's internists/GI/Oncologists. For neurosurgeons, there's neurologists. For Cardiothoracic surgeons, there's cardiologists.
2 - variety. In ENT you have ortho, plastics, trauma, derm, endoscopic, pediatric, airway, endocrine, and neuro surgical components. Tell me a field in any surgical realm which comes close to that range of options any of which you could specialize in or generalize in all. Plastics probably comes closest. Certainly general surgery does not.

It's like you read my mind...

 

[Leforte]

I got the impression he liked a number of us but couldn't justify a rank list that would give him 4 or 5 students from the same school.

I hear what you are saying about this. Honestly, I remember when I was on the trail I interviewed at Michigan. The current PGY-1 ENTs there (4 of them) all did medical school there. It was brought up by the chairman that it was not there intention to have a class that was all from there and that everyone was being considered equally. My year, if I remember correctly, 3 of 4 who matched there were from Michigan, too. So while there can be bias against getting too many students from one school, the bias can also go the other way. Indeed, again, when I was a MS-4, 3 of us were applying form my med school. We had a residency with 2 accepted per year. The chairman told two of us that one of the positions was definitely going to the third (he did a year of research with them), but we were both being considered (along with the other applicants) for the second position. I remember feeling that, "that sucks", but it is what it is, and being upset about it doesn't change it. In the end, we all matched, fortunately.

I guess my point is that you cannot control how many people apply from your school, nor who they eventually choose, or a multitude of other things in the whole process. What you can, control, however, is what you do prior to applying (get involved with the department, start with a research project, etc) and be nice and humble on the interview trail. You'd be amazed at how many people will fail at those few easily controllable things.

 

[neutropeniaboy]

How is what I posted immature? It's possible that I worded it carelessly. Most of the people I know who are going into ENT do it because they love the OR, but the thought of suffering through a general surgery residency and brutal, unrewarding career is too much for them.

GoLytely,

I think what you said there sort of sums up how little you know about what drives people to do the things that they do.

I could easily turn the tables here: Why would anyone spend five years training to be a general surgeon to scrape butt ulcers, burn of anal warts, pick poop out of people's rectums, deal with slimy intestines, and attempt to think they know what's going on in the neck while at the same time griping that specialists in other fields (and within) are taking away all the "good" general surgery cases?

The motivations behind anyone's life choices are in most cases carefully calculated. They may be based upon ignorance, but most people do spend a lot of time thinking about what they like and what they want to do.

Most people enter ENT because they like what ENTs do. Honestly, I pretty much don't like snot and sinuses, but I love ears and CPA tumors. Airway, schmairway. Why? I just do. I like the anatomy. I like restoring hearing. I like doing what few others are capable of doing. I enjoy the fact that YOU won't be taking my cases away sometime in the future. I like that my patients usually go home right after the surgery. I like that I work 60 hours per week. I like that I get to spend time with my kids at home, go to their school (while they are actually in school), go on trips with them, etc. I like that I am taking flying lessons on a week day. I enjoy the fact that all my colleagues are friendly and back me up (and vice versa). The short of it is that I like ENT as a field.

On the flip side, if someone told me that they wanted to go into ENT strictly because it's not general surgery, "they couldn't hack general surgery," or liked the money, or liked not having to work as hard -- hey, that's their choice. Who am I to judge their reasons?

But don't think for a moment that ENT residencies are cushy. I remember logging more hours as a resident and taking more call than some of my general surgery colleagues. I see my residents arrive before me (I usually round in the hospital between 6:30 and 6:45) and I'm usually out of the OR between 7-8pm on my days. When they're not with me, they're with my partners who have the same schedules. They all round on the weekends. At the VA, they see on average 70-90 patients per clinic day and operate sun up to sun down when it's time. They're workers; I'll bet they'll go toe to toe with the neurosurgery residents and GS residents. And for darn sure, I'll bet they're a whole lot nicer to deal with when consulted.

-nb

 

[the12thmd]

I know this thread took an unexpected turn, but to the OP and anyone else with many ENT applicants from one institution: it can be done.

UT-Houston matched 9/9 students into ENT. I don't really see the harm in posting where we all matched...

Mayo MN
Kentucky
MUSC
Vanderbilt
Baylor
Miami
Michigan
Georgetown
Northwestern

It can be done.

 

[DoctwoB]

I know this thread took an unexpected turn, but to the OP and anyone else with many ENT applicants from one institution: it can be done.

UT-Houston matched 9/9 students into ENT. I don't really see the harm in posting where we all matched...

Mayo MN
Kentucky
MUSC
Vanderbilt
Baylor
Miami
Michigan
Georgetown
Northwestern

It can be done.

Very impressive.

My thought is that it is a disadvantage to have tons of applicants from your home program (fewer available mentors, research projects, harder to stand out/get good LORs, much less likely to get accepted by home program) but as the above examples show it definitely can be overcome.

There are benefits as well, including having people to bounce ideas about interview impressions off of, working with familiar folk during Subi's etc, but I'd guess the disadvantages predominate.