What are the alternatives to the Match? What do you think would happen if it were abolished?

[YCAGA]

The US MD senior match rate into family medicine with a step 1 of 194-200 AND Step 2 of 210-220 (4-7th percentile and 3-7th percentile respectively) was 89% from 2016-2020. It was 88% for pediatrics for the same stats and time period. N = 208, 100 respectively.

For DO seniors it was 86% and 78% (FM and peds) for the lowest COMLEX range for which data is available (400-500 on BOTH Level 1 and level 2). Admittedly this doesn’t look great for DO’s, but if you are in the bottom of a DO class, do you really deserve a spot over an IMG who is significantly more qualified just because you are a US citizen? Debatable.

If you get back to back single digit percentile scores on Step 1 and 2, it’s reasonable to assume there is also a repeated clinical year, one or more failed USMLE exams, long period of absence, etc in a large portion of that cohort, and still almost 9/10 match in the MD cohort described above. How could the system get any more fair???

We don’t have a huge match problem just like we don’t have a huge physician shortage. We have a speciality and physician distribution problem.

If bottom of the class US MD’s can no longer match FM/IM/peds then I think it is time to consider major changes to the match. But we are nowhere near that.

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[YCAGA]

If your goal is that PDs actually give stronger consideration and more time to each application they receive the number has to be lower than 50 I think. It has to have consequences and weight.

For example, 40-50 was the average number of applicants to general surgery a decade ago when I was applying. My program was a middle of the road at best community surgery program and at that time they were still HEAVILY screening on board scores, IMG status, and if they thought you had legitimate interest in going there or you were a Harvard grad gaslighting as a safety school and dumped half the applications in the garbage without looking at them. That was just reality.

I'm great friends with the coordinator and we talk often, and the only thing that has changed is that in the new environment/arms race they've cranked that minimum step score up because they can. Nothing else has changed.

Edit: Your point of application caps is that they demonstrate actual willingness and interest to truly attend the residency if you apply to it. 50 did not achieve that goal in the past.

Thank you for explaining that and tying in your experience. I was just going by gut that a 40-50 cap would still be too high to prevent PD’s from using huge filters. Sounds like I wasn’t totally off base haha. I think PD behavior wouldn’t change until around 20-30 max applications which is a number that would start to hurt even middle-tier applicants, let alone high tier applicants. It’s not uncommon at all for people applying to top specialities to rank 16+ programs.

 

[Lem0nz]

We could always put pressure on schools to actually do their jobs and properly guide students into appropriate specialties and apply to appropriate programs, seeing as that’s the whole point of the academic and clinical affairs offices; “Oh, you scored 457/ 216, average grades throughout school and one Shelf/ COMAT failure, and a case report on a common derm condition you saw in clinic? Sorry but we’re going to have to heavily recommend that you apply family med/ IM and not orthopedics like you planned.” Have ACGME and COCA investigate EVERY instance of unmatched students, and have a paper trail to find out how many slipped through the cracks vs how many were wholly unqualified for what they applied to without backups.

Now this thought I like and I would argue you actually take it much further. I don't remember what post it was, I think that assanine one where someone said you shouldn't have to pay med school debt if you don't match (lol k bye felicia that's dumb), but someone DID say med schools should be on the hook financially to be a part of the process. I'm not sure financially is necessarily the answer, I would actually say they should maybe be on the hook either financially OR legislatively. I think the process actually should under even more integration and that the medical schools should be linked to the residencies tighter.

I'm literally just thinking out loud as I write this, and these are high level ideas, but in a world where medical schools are responsible for getting medical students into residencies and making sure enough residency spots exist (perhaps even the medical schools are the ones sponsoring residency spots and the ACGME funding is going to the medical school rather than the residency - IDK the actual technical and logistical solution but I think people can understand what I'm trying to say) would be a very very interesting pie in the sky change. Solving nAPD's issue that medical schools don't have to be held to task for the fact that there are a specific amount of residency spots that must be filled. If medical schools WERE responsible for that, I wonder what the world would like look? I wonder what this would do to our distribution problem?

What would the world look like if it wasn't that medical schools should make sure that people match, but if they had to make sure people matched?

 

[YCAGA]

We could always put pressure on schools to actually do their jobs and properly guide students into appropriate specialties and apply to appropriate programs, seeing as that’s the whole point of the academic and clinical affairs offices; “Oh, you scored 457/ 216, average grades throughout school and one Shelf/ COMAT failure, and a case report on a common derm condition you saw in clinic? Sorry but we’re going to have to heavily recommend that you apply family med/ IM and not orthopedics like you planned.” Have ACGME and COCA investigate EVERY instance of unmatched students, and have a paper trail to find out how many slipped through the cracks vs how many were wholly unqualified for what they applied to without backups.

Schools already do that, starting from M1. We just had a class wide meeting with the deans about class rank came up. People were complaining afterwards that our deans were being rude and unfair when they said we should be trying to be in the top of our class if we want to go into specialities like ortho or derm. Some of my classmates were saying that this isn’t what medicine should be about, administration doesn’t care about mental health, and the system shouldn’t discriminate against people’s dreams.

One of the biggest changes of thinking in modern economics was to acknowledge that humans are rarely, if ever, completely rational actors. Applying to residency is the perfect example. Tons of people don’t follow game theory…like at all. Even if their schools advices them well.

 

[Lawpy]

If your goal is that PDs actually give stronger consideration and more time to each application they receive the number has to be lower than 50 I think. It has to have consequences and weight.

For example, 40-50 was the average number of applicants to general surgery a decade ago when I was applying. My program was a middle of the road at best community surgery program and at that time they were still HEAVILY screening on board scores, IMG status, and if they thought you had legitimate interest in going there or you were a Harvard grad gaslighting as a safety school and dumped half the applications in the garbage without looking at them. That was just reality.

I'm great friends with the coordinator and we talk often, and the only thing that has changed is that in the new environment/arms race they've cranked that minimum step score up because they can. Nothing else has changed.

Edit: Your point of application caps is that they demonstrate actual willingness and interest to truly attend the residency if you apply to it. 50 did not achieve that goal in the past. The secondary goal (cost containment of the process) is, for better or worse, not a worth while goal we should be measuring if I'm being perfectly honest. I know (I KNOW) that the extra 2k or 5k or whatever its costing these days is batty and ****ty as a medical student because I was there, I applied to 120 programs out of fear from a low step 1 (216), but it is insignificant over the course of our careers when we get a real paycheck a year later and when our loans evaporate because of attending salary/PSLF combination. It feels fking awful in the moment but any attending can tell you that 10k or 100k is not relevant over the course of your career. This is also why increasing the cost of the applications won't matter. If you crank that cost up and it suddenly costs 50k instead of 10k to apply and interview, it'll hurt like hell in the moment but you'll pay it and ten years later you'll just shrug and move on.

Hmm that is a very rough tradeoff. I think the steady state solution of everyone applying to every program is a very bad approach for everyone with debt skyrocketing and the process effectively being a crapshoot. A cap of 30 is extremely rough but might have to be necessary to avoid the crapshoot scenario and risk going unmatched or bad matches. It's not fun and there will be losers but i think it will be better than 2 evils.

Like for instance, i don't even know what top programs in surgery even means because community programs give better training and experience than competing or shadowing fellows in ivory tower academic programs. A cap would illustrate serious interest and fit and really force applicants what they want to do.

 

[YCAGA]

Hmm that is a very rough tradeoff. I think the steady state solution of everyone applying to every program is a very bad approach for everyone with debt skyrocketing and the process effectively being a crapshoot. A cap of 30 is extremely rough but might have to be necessary to avoid the crapshoot scenario and risk going unmatched or bad matches. It's not fun and there will be losers but i think it will be better than 2 evils.

Like for instance, i don't even know what top programs in surgery even means because community programs give better training and experience than competing or shadowing fellows in ivory tower academic programs. A cap would illustrate serious interest and fit and really force applicants what they want to do.

Coming from a community general surgery program is an uphill battle when applying to fellowships like surg onc and peds from what I have heard. CT and plastics too, just not as bad. And a lot of people going into general surgery want to do one of those fellowships, at least at the beginning. Of course people go into competitive fellowships from community programs but I think it’s similar to how people from low tier MD’s go into derm. It’s not impossible, it’s just easier if you went to HMS.

Also, like I outlined above, there isn’t a problem with people going unmatched who have passed all the step exams and apply to family medicine. There is a problem with people not matching into their desired speciality. But every country and every industry within the US is like that…competition because there are more applicants than spots. Not every accountant can work at a big 4 firm. Not every lawyer gets to make $180k/yr out of school and live in NYC. Not every pharmacist gets to avoid working retail. Competition is how we all got into medical school and that’s life :/

 

[Lem0nz]

Hmm that is a very rough tradeoff. I think the steady state solution of everyone applying to every program is a very bad approach for everyone with debt skyrocketing and the process effectively being a crapshoot. A cap of 30 is extremely rough but might have to be necessary to avoid the crapshoot scenario and risk going unmatched or bad matches. It's not fun and there will be losers but i think it will be better than 2 evils.

Like for instance, i don't even know what top programs in surgery even means because community programs give better training and experience than competing or shadowing fellows in ivory tower academic programs. A cap would illustrate serious interest and fit and really force applicants what they want to do.

For sure. It would. But even most surgery applicants don't know what top programs in surgery means. You don't learn that until you're literally interviewing (not applying, interviewing) and/or in residency. No medical school in the world teaches the difference between community surgery and academic surgery. All medical students know is academic surgery. They have many very strong and very wrong assumptions because of it. Things like you can't teach if you aren't in academic medicine. You can't do research if you're in academic medicine (or it is somehow of lesser quality). That you can't get into a good fellowship without being in academic medicine. That your residency name actually matters for getting a job - it doesn't, except in academic medicine. As an applicant, unfortunately, you only know what you've seen in medical school with is at best 1/5th of the real world but in most cases closer to 1/20th because some 95% of jobs are pure clinical at the end of the day.

The system is not great, its only the least evil that we know of. The steady state arms race until it hits its natural conclusion/everyone is applying to every spot sucks. But I have serious concerns that caps are not better because to be useful they would have pretty serious consequences.

Edit: I think application caps will also destroy the couples match or at least do serious damage. Even at 50.

 

[Lem0nz]

What do people think about matching being a qualification for graduation from medical school? Set aside non-residency jobs for just a second which are the vast minority.

Would this make students more realistic? It would keep them in school another year if they didn't match (and potentially even more years after that) and keep dipping them back into the process and either improving their application through serial years or downgrading their expectations.

Humor me and say just AMGs - MD and DO schools. Let's throw the carrib and IMGs out of the mix. Can't legislate them anyway.

 

[ACSurgeon]

I thought applying with the goal of matching ANYWHERE was the standard logic too, but I have heard of people applying to a handful of CT and vascular programs when there are only like 30-80 spots in the entire country and way more applicants than spots. I think some people are so delusional about location and not living in a “crappy city” that they will risk going unmatched. Or they are so arrogant that they don’t think it’s a realistic risk for them.

Some people just don’t understand how the match works.... there are people who don’t rank programs or don’t rank by their preference because of false notions...

 

[ACSurgeon]

What do people think about matching being a qualification for graduation from medical school? Set aside non-residency jobs for just a second which are the vast minority.

Would this make students more realistic? It would keep them in school another year if they didn't match (and potentially even more years after that) and keep dipping them back into the process and either improving their application through serial years or downgrading their expectations.

Humor me and say just AMGs - MD and DO schools. Let's throw the carrib and IMGs out of the mix. Can't legislate them anyway.

If you do this non AMGs should not be allowed to participate in the match or get any residency spot until all AMGs are placed somewhere.

 

[7331poas]

Number of AMCAS applications per applicant:
2011: 14
2020: 17

Number of ERAS applications per applicant (2020):
Total: 95.0
UMGs: 69.6
IMGs: 138.5

...Alright. Medical students who are applying to 95 programs are presumably applying to a mixture of tiers.

 

[NotAProgDirector]

I don't see how a medical school can guarantee a residency spot, unless the schools themselves start running internships. Would also be very difficult for the DO schools.

I'm mixed on app caps. Theoretically they will lead to more in depth reviews, and a higher interview rate. But I agree that they need to be low enough to make a difference. In any case, app caps would need to be paired with more transparency from programs -- but even that is difficult. If you asked me what my minimum S1 score was, I'd tell you it's hard to say. Let's say I tell you it's 210. What about the person who gets a 205 on S1, and a 263 on S2? I'd probably interview that person. What about taking into consideration 1st gen applicants (whom might score lower for lots of reasons)? Are my cutoffs the same for MD, DO, US IMG, FMG? And that's just about scores -- what about the other parts of the application? The Residency Explorer is trying to address this, but it's simply hard to do.

Reading through all of this, I still think the best way forward is an "early round" -- my initial thought being an early application process to fill 25-33% of the spots. This would allow those whom are very competitive, want to stay at their home school, or just know where they want to go to settle out early and leave more room for everyone else. Limiting to 25-33% of spots filled this way would leave plenty of spots left in the main round. But what if we took the competitive fields and made most of those spots fill in the early round? That way, most of the ortho/vasc/plastics spots would be gone, and people who didn't match to them could then apply to GS full throttle. All of the prelim spots would be left for the main round.

But, defining what's competitive and what is not is complicated. If we use match fill rate, most fields would be highly competitive.

I do agree with the suggestion of moving "unmatch" day back to Friday. More time to sort out plans is a good thing,

 

[Lem0nz]

That’s quite a punishment. To start that’s an extra year of tuition, plus idk how a lot of schools do it but mine removes our school-sponsored malpractice insurance once we’ve met clinical graduation requirements.

Is it? If you don't match isn't the recommendation for a lot of medical students currently to take an extra year and not matriculate so that you are still a US senior instead of a graduate if you don't match?

 

[Ms Procrastinator]

NRMP Match: Good, bad or ugly? | Student Doctor Network

Similar thread from 2019. Interesting to compare the theoretical question of whether residencies could do virtual interviews to what happened this year.

Weren't residencies forced to do virtual interviews literal months after this was discussed?

 

[Med Ed]

I am not following the significance of these numbers. It is an order of magnitude easier to apply to 70 residencies versus 70 medical schools in terms of hours spent. Honestly 10 times more time consuming is probably an understatement. It is also like 1/4 to 1/6th cheaper to apply to additional residencies versus additional medical schools. Very roughly you are looking at $1500 in application fees to apply to 70 residencies and $7000 to apply to 70 medical schools.

This was just a little tangent in response to an above poster, who stated that AMCAS applications per applicant had "ballooned" recently (they haven't).

The big advantage premeds have over medical students is the MSAR.

 

[Med Ed]

We could always put pressure on schools to actually do their jobs and properly guide students into appropriate specialties and apply to appropriate programs, seeing as that’s the whole point of the academic and clinical affairs offices; “Oh, you scored 457/ 216, average grades throughout school and one Shelf/ COMAT failure, and a case report on a common derm condition you saw in clinic? Sorry but we’re going to have to heavily recommend that you apply family med/ IM and not orthopedics like you planned.”

I wish you had some idea of how much of my professional life is spent having these very conversations.

The uptake is ~50%.

 

[Lawpy]

This was just a little tangent in response to an above poster, who stated that AMCAS applications per applicant had "ballooned" recently (they haven't).

The big advantage premeds have over medical students is the MSAR.

Will a potential residency version of MSAR help reduce the application volume?

 

[Dr.Bruh]

the match algorithm and process is not the problem. The problem is the gamification of the residency selection process. Lots of people complain about program empty words, but the fix to that is incredibly simple: dont believe them. If your advisors arent telling you that, they are doing you a disservice.

I think a major problem that’s often overlooked is just how many applicants do not apply strategically or even apply flat out irresponsibly. Applying competitive specialties with low scores/no research and not applying a back up, applying top heavy only, DOs applying competitive specialties with no step etc. I’m DO and convinced that the slightly lower DO match rate compared to MDs could easily be significantly closed with proper advising (which DO schools essentially have none of). The amount of just my classmates I know applying competitive surgical stuff with just a comlex and not even targeting former DO programs or not applying backups is staggering. Look at the charting outcomes data. There are a significant number of applicant applying to competitive stuff with steps scores in the 194-209 range. Etc

 

[operaman]

I had no issue with the Match and I was a very weak medical student.

As I've said before, I do think that SOAP is miles better than the old scramble system (not sure if you're enough of a dinosaur to remember that). I'm sure there are ways that it could be improved and I'm sure it's being looked at fairly regularly.

Yeah I think SOAP debuted while I was a medical student and yes - lightyears better than the scramble that came before.

 

[Melchizedek]

What are the barriers to an MSAR for residencies?

 

[7331poas]

What are the barriers to an MSAR for residencies?

They dont want to appear "lesser" by having lower median step 1 scores.

 

[Lem0nz]

They dont want to appear "lesser" by having lower median step 1 scores.

Completely wrong. Scroll up and look at nAPD's post describing how and why it is very hard to qualify applicants out of medical school - not limited to but including mismatched step scores (205 step 1 / 260 step 2), location, 1st gen cut offs, having different criteria for MD vs. DO vs. Carib vs. IMG, the list goes on and on. It is just not that simple.

 

[ohmanwaddup]

random question but kinda on topic since we are discussing students applying smart.

Are the numbers for board scores and what not from residency explorer accurate?

 

[7331poas]

Completely wrong. Scroll up and look at nAPD's post describing how and why it is very hard to qualify applicants out of medical school - not limited to but including mismatched step scores (205 step 1 / 260 step 2), location, 1st gen cut offs, having different criteria for MD vs. DO vs. Carib vs. IMG, the list goes on and on. It is just not that simple.

That argument makes no sense. The MSAR is not valuable because it includes the "minimum" mcat score that harvard is willing to entertain. it is valuable because it lists their median GPA and MCAT. I don't care what UVA's internal medicine program cutoff is, I care what their median step 1 and step 2 scores are for interview/current residents.

 

[Lawpy]

Completely wrong. Scroll up and look at nAPD's post describing how and why it is very hard to qualify applicants out of medical school - not limited to but including mismatched step scores (205 step 1 / 260 step 2), location, 1st gen cut offs, having different criteria for MD vs. DO vs. Carib vs. IMG, the list goes on and on. It is just not that simple.

How is it hard when it's just listing the median, 10th, 25th, 75th and 90th percentiles on various metrics?

 

[Goro]

I think a major problem that’s often overlooked is just how many applicants do not apply strategically or even apply flat out irresponsibly. Applying competitive specialties with low scores/no research and not applying a back up, applying top heavy only, DOs applying competitive specialties with no step etc. I’m DO and convinced that the slightly lower DO match rate compared to MDs could easily be significantly closed with proper advising (which DO schools essentially have none of). The amount of just my classmates I know applying competitive surgical stuff with just a comlex and not even targeting former DO programs or not applying backups is staggering. Look at the charting outcomes data. There are a significant number of applicant applying to competitive stuff with steps scores in the 194-209 range. Etc

I agree that this is an issue, but I'll wager that there are a fair number of schools out there who apparently have very poor advising, due to either ignorance of the Match game, OR to a bias towards getting people into Primary Care.

 

[NotAProgDirector]

What are the barriers to an MSAR for residencies?

random question but kinda on topic since we are discussing students applying smart.

Are the numbers for board scores and what not from residency explorer accurate?

Yes, Residency explorer is basically an MSAR for residencies, but instead of published tables you get a comparison of your numbers to program numbers.

There's no MSAR for lots of reasons -- mainly that programs really don't want one. If there was an MSAR, everyone would focus on step scores, and that would probably drive programs to rank more based on scores (to push their "ranking" up), which would only make the problem worse.

 

[Med Ed]

Will a potential residency version of MSAR help reduce the application volume?

At this point I doubt it. Were such a thing to exist I think applicants would have a better idea of where they are (and are not) competitive, but that would not necessarily lead to fewer applications being sent.

 

[Med Ed]

How is it hard when it's just listing the median, 10th, 25th, 75th and 90th percentiles on various metrics?

Perhaps difficult for small programs (1-3 residents/year).

 

[calivianya]

I really hope all the pro app caps people mean per specialty. I could almost get behind it in that circumstance. If someone’s applying an advanced specialty that requires a prelim, but then applying to a categorical program as a backup, 30 apps overall would just about guarantee the person doesn’t match. But 30 advanced, 30 prelim, and 30 categorical might be more reasonable.

I still can’t get behind the app caps thing firmly, though, because it kills dreams people have a real chance of reaching - not just stupid, irrational dreams like the low boards ortho example above. Like I have good board scores, top 1/4 of my class, great preceptor evals... but I am eyeballing a specialty that takes less than 150 applicants a year, DO or MD, for my top choice. In an app cap world, I wouldn’t apply to this specialty at all because of the risk of not matching, and my stats *are* competitive for it. Realistically, I think only tip top Ivy people are safe applying for the really small competitive subspecialties in an app cap world, and the rest of us can just go eat dirt I guess.

People with good, high 240s+ step scores, great grades, great evals, and no failures should be allowed to dream and aim for those competitive programs, and app caps would kill that tbh.

 

[NotAProgDirector]

Although I agree in principle, if the app cap is per specialty seems like that might increase the proportion of people who apply to two specialties which would totally defeat the purpose of an app cap.

 

[ohmanwaddup]

Yes, Residency explorer is basically an MSAR for residencies, but instead of published tables you get a comparison of your numbers to program numbers.

There's no MSAR for lots of reasons -- mainly that programs really don't want one. If there was an MSAR, everyone would focus on step scores, and that would probably drive programs to rank more based on scores (to push their "ranking" up), which would only make the problem worse.

Interesting, I wonder how accurate the research numbers are, the specialty I am looking at does not seem to be research heavy and yet residnciesare claiming everyone who matched had a peer review published paper

 

[ace_inhibitor111]

Residencyexplorer is such BS made up data. Why even give hours/week worked and weekends off per week if it’s so horribly inaccurate?

 

[efle]

I'd like to point out that premeds do a huge amount of self-selection. Tufts gets 2x as many applications as HMS. That's happening with no app cap - just accurate, useful data from the MSAR.

There might be a lot of programs in primary fields that cannot give clear answers about scores because they consider everyone, but that's not really where overapplication and Step mania have been wreaking havoc. For the hyper-competitive fields with increasingly absurd numbers, knowing screen thresholds and historically matched students' board IQRs would be a game changer, especially for the borderline folks most at risk from a cap.

 

[Lawpy]

I'd like to point out that premeds do a huge amount of self-selection. Tufts gets 2x as many applications as HMS. That's happening with no app cap - just accurate, useful data from the MSAR.

There might be a lot of programs in primary fields that cannot give clear answers about scores because they consider everyone, but that's not really where overapplication and Step mania have been wreaking havoc. For the hyper-competitive fields with increasingly absurd numbers, knowing screen thresholds and historically matched students' board IQRs would be a game changer, especially for the borderline folks most at risk from a cap.

Board IQRs will end up useless because P/F transition...

 

[efle]

Board IQRs will end up useless because P/F transition...

CK is going to immediately take the role of Step 1. Though I do think they'll both eventually be P/F

 

[Lawpy]

CK is going to immediately take the role of Step 1. Though I do think they'll both eventually be P/F

That leaves no IQRs to compare...

The ship has long sailed for any residency version of MSAR when Step 1 went P/F

 

[Lawpy]

At this point I doubt it. Were such a thing to exist I think applicants would have a better idea of where they are (and are not) competitive, but that would not necessarily lead to fewer applications being sent.

Although I agree in principle, if the app cap is per specialty seems like that might increase the proportion of people who apply to two specialties which would totally defeat the purpose of an app cap.

Do you think the existence of the online ERAS system led to overapplication? Because iirc, in the pre-ERAS system, the apps were written and delivered manually which took a lot of effort and so the craziness really wasn't a thing back then. With everything now online, the conditions for overapplication were set

 

[Espressso]

What do people think about matching being a qualification for graduation from medical school? Set aside non-residency jobs for just a second which are the vast minority.

Would this make students more realistic? It would keep them in school another year if they didn't match (and potentially even more years after that) and keep dipping them back into the process and either improving their application through serial years or downgrading their expectations.

Humor me and say just AMGs - MD and DO schools. Let's throw the carrib and IMGs out of the mix. Can't legislate them anyway.

That’s quite a punishment. To start that’s an extra year of tuition, plus idk how a lot of schools do it but mine removes our school-sponsored malpractice insurance once we’ve met clinical graduation requirements.

late to respond but this was interesting to me. I think it's actually a good thought although I would say that the school should be mandated to waive tuition for that student who didn't match. If the schools #1 priority is to match their students and their students don't match the school should be held more liable. I've heard horror stories about friends not matching and getting little to zero help from the school about SOAP. If these people don't secure a spot the school should be on the hook.

 

[Med Ed]

Do you think the existence of the online ERAS system led to overapplication? Because iirc, in the pre-ERAS system, the apps were written and delivered manually which took a lot of effort and so the craziness really wasn't a thing back then. With everything now online, the conditions for overapplication were set

I certainly don't think overapplication would be possible without ERAS. Click boxes, pay money, wait.

That said, having to do things in a manual, labor-intensive manner is really just a crude system of preference signaling. It forced applicants to prioritize, and everyone knew it.

The outfit tasked with fixing this whole mess is the Coalition for Physician Accountability. I doubt they will leap straight to application caps (although anything is possible). My best guess is some broader compromise that gives applicants more information on programs an programs some form of preference signaling.

 

[Med Ed]

late to respond but this was interesting to me. I think it's actually a good thought although I would say that the school should be mandated to waive tuition for that student who didn't match. If the schools #1 priority is to match their students and their students don't match the school should be held more liable. I've heard horror stories about friends not matching and getting little to zero help from the school about SOAP. If these people don't secure a spot the school should be on the hook.

So if some doofus who repeats a year, has lousy grades, evals, and Step scores, no research, no ECs, and maybe a professionalism sanction, decides to apply to ortho, the school should be on the hook when said doofus doesn't match?

 

[Espressso]

So if some doofus who repeats a year, has lousy grades, evals, and Step scores, no research, no ECs, and maybe a professionalism sanction, decides to apply to ortho, the school should be on the hook when said doofus doesn't match?

I feel like in that case, the school should almost require them to apply to backups and a lot of them. I sure am biased tbh because I'm at a DO school with very little ERAS/application support. I'm not sure how the admins of major MD programs are with their advising.

 

[Med Ed]

I feel like in that case, the school should almost require them to apply to backups and a lot of them. I sure am biased tbh because I'm at a DO school with very little ERAS/application support. I'm not sure how the admins of major MD programs are with their advising.

You've touched on the central issue with this approach: schools can't truly require anything of students when it comes to post-graduate plans (i.e. the match). The school's obligation is to provide an MD degree to every matriculated student who fulfills the graduation requirements and abides by the behavioral standards. That's it. By the time someone is going through the residency application process that person is ostensibly and adult and capable of making (and living with) their own choices.

 

[Lawpy]

late to respond but this was interesting to me. I think it's actually a good thought although I would say that the school should be mandated to waive tuition for that student who didn't match. If the schools #1 priority is to match their students and their students don't match the school should be held more liable. I've heard horror stories about friends not matching and getting little to zero help from the school about SOAP. If these people don't secure a spot the school should be on the hook.

The school shouldn't be held responsible for those who didn't match unless it fell into rare cases of bad advising and the unmatched MS4s who were truly competitive fell through the cracks. Which apparently is rare

 

[Lem0nz]

Tha was my point though. Schools do not have an obligation to get students into residency. Maybe they should. It would be a massive, massive change. But to the question of should schools be on the hook for the idiot who applied to ortho with a 196 step 1 and bad letters?

Yea. I think that might help. There would certainly be a lot more incentive to very loudly and frequently advise them and try to persuade them to apply to things within their ability and stats.

It’ll never happen in real life. More a thought project. But I think it could change things for the better. Would also probably restrict students in options, but maybe that’s what we honestly need. To crush some dreams that are not based in reality. That’s one of the things app caps would do, too, after all.

 

[efle]

While we're at it lets make law schools pay for the large percent of unemployed graduates. Pharma schools too. PhD programs in saturated fields like bio definitely need to be responsible for good postdoc placements. Lets make colleges refund tuition to premeds that don't get into med school. Heck, lets tie high school funding to their ability to get kids into ivy league colleges.

/s this whole concept seems insane to me

 

[Lawpy]

Tha was my point though. Schools do not have an obligation to get students into residency. Maybe they should. It would be a massive, massive change. But to the question of should schools be on the hook for the idiot who applied to ortho with a 196 step 1 and bad letters?

Yea. I think that might help. There would certainly be a lot more incentive to very loudly and frequently advise them and try to persuade them to apply to things within their ability and stats.

It’ll never happen in real life. More a thought project. But I think it could change things for the better. Would also probably restrict students in options, but maybe that’s what we honestly need. To crush some dreams that are not based in reality. That’s one of the things app caps would do, too, after all.

We need to stop treating med students like kids and force them to be like adults for once and accept responsibility for their actions and choices.

 

[ace_inhibitor111]

While we're at it lets make law schools pay for the large percent of unemployed graduates. Pharma schools too. PhD programs in saturated fields like bio definitely need to be responsible for good postdoc placements. Lets make colleges refund tuition to premeds that don't get into med school. Heck, lets tie high school funding to their ability to get kids into ivy league colleges.

/s this whole concept seems insane to me

Prelim surgery programs have started being held accountable for placements of their interns and I think that overall it has been a net benefit. I don’t know why you think that concept is insane.

 

[Lawpy]

I originally brought up accountability on the part of the schools because there are honestly schools out there who don’t advise their students at all. I never met with my assigned advisor once. This lack of advising can result in students applying for residency and having zero idea where they stand and what their chances are. It’s proven every day when I see people ask basic, basic questions on here or Reddit that could’ve easily been googled in 10 seconds.

I’ve seen the arguments about taking personal responsibility and finding your own resources, since they’re already available, but I’d make the argument that your school, which you’re paying 6 figures to graduate from, has some level of responsibility for helping guide us through this process and make sure that we have a good outcome. And it’s certainly more of a responsibility than we have to scour SDN or Reddit, and the internet more broadly, for hours to find the exact answer to a question.

Bad advising is an admin issue. Still doesn't justify forcing schools to accept responsibility for residency placements. We're talking med students in their 20s who are adults. They should know how to do their own research and get advice.

 

[Lawpy]

Like i'm a millennial (who regularly gets viewed as a zoomer even by Gen Zers) and even i think this is ridiculous. We need to stop sheltering med students and make them accountable for their own decisions.