<p>I have my heart set on medicine but there is one concern that I have. I was wondering how often is a MD student NOT matched with their first choice residency. What if I am very passionate about becoming a cardiologist but after the internist residency, I am not accepted into it and then would I be forced to work as an internist if that's not what I want to do. </p>
<p>What about surgeries? What do those doctors do in those situations? I understand that the ROAD specialties may be harder but what do they do if they apply for those residencies and don't get them. </p>
<p>And what about fellowships? Let's say I wanted to become a reproductive endocrinologist. It requires that you do an OB/GYN residency first. What would I do if I couldnt get into a reproductive endocrinology fellowship or maybe an interventional radiologic fellowship?</p>
<p>Outside of uber competitive specialties like plastics and derm, the match rate is very high. Even for competitive specialties like radiology, you'll see 90%+ match rates. This is mostly due to self-selection. Every school mandates that you meet with the dean before applying for residency. If your application is not good enough for a particular specialty, you will be forced to apply for a less competitive specialty. They will not support you if you over-reach. </p>
<p>Most fellowships are not uber-competitive but cardiology is, not surprisingly, one of the more competitive fellowships out there. You can boost your chances for competitive fellowships by matching into prestigous, academic residencies (this is where getting into top residencies can be a huge help).</p>
<p>Also when someone says the school matches 60% into top choice and over 85% into top three, is that meaning the top three residency positions that they applied for (ex. three programs all for urology) or one of their top three areas (ex. urology, radiology, pediatrics)?</p>
<p>They mean top 3 residency positions they applied for. Most students will only apply for residency in 1 or 2 specialties so it's definitely not top 3 specialties. Again, keep in mind, students at this point are very realistic about where they can and cannot get into. So, 85% match rate into one of the top 3 choices is actually not that impressive (it might even be below average; I forget the average numbers). This has to do with students only ranking programs they can legitimately get into.</p>
<p>Fellowship match and residency match should be considered different animals. In part because there are a lot of other factors that are going into these decisions on both the applicants and the fellowship programs sides. There's less data out there on fellowships to analyze, and the range of competitiveness between each specialty (ie between medicine and peds) and also within each specialty (ie between IM cards and IM Nephrology) makes it hard to evaluate. </p>
<p>For residency information spend time looking over the Charting Outcomes in the Match report from the NRMP.</p>
<p><a href="http://www.nrmp.org/data/chartingoutcomes2007.pdf%5B/url%5D">http://www.nrmp.org/data/chartingoutcomes2007.pdf</a></p>
<p>While I agree with NCG that there is self-selection in part due to perceived competitiveness factors, I really think that the larger force at play is simply personal preference. You'll see it as you go through third year clerkships and into fourth year, but people fall into the specialties that they genuinely enjoy. Yes, there are individuals out there who look at loans and lifestyle and salary as their primary motivations for their choice, but they do represent a minority.</p>
<p>But the real bottom line should be this: if you're a pre-med, there's really no use in worrying about these sort of statistics right now. There are so many steps that must be finished before worrying about this that it kind of boggles my mind that I managed to make it through them all.</p>
<p>BRM</p>
<p>Your message is very helpful. There are lots of Premeds (including my DS) who have no idea which sub-specialty of Medicine they will most enjoy. I have been advising my DS that by the time he completes first 2 years in med school, he will have a better idea. Next time he brings up the topic, I will point him to your post.</p>
<p>I think the usefulness in having some idea of the areas you're interested in lies in the fact that the only time you have for research during medical school is after your first year. Obviously, no one can definitely nail down a specialty by that time, but if you have at least a little idea of your interest, then you can skew your research towards those areas.</p>
<p>A lot of my classmates interested in competitive specialties started their research in the area even before starting med school. To get into derm or plastics, you really need to start as soon as possible and just hope you won't change your mind (if you start high, even if you switch away from derm, your app should still be very competitive for other specialties).</p>
<p>Here's a quote from JHU Radiology: </p>
<p>
[quote]
Only the academically extremely strong should even think about this [Radiology]. USMLE scores must soar well above 230s/mid 90s, transcripts groan under the weight of A’s, Honors and applause; accepted publications bend your mailbox from sheer volume; whole communities praise you as their savior; and your letters must make you appear likely to qualify for instant sainthood. On top of that, you must present a sparkling and error-free ERAS, a compelling Pulitzer-level Personal Statement, and project the vivid and charismatic presence of a talk-show host. A successful, articulate one.
[/quote]
</p>
<p>Unless you know you are satisfied with family med or psychiatry, the hard work doesn't end once you get into med school.</p>
<p>I'll believe that ANY radiologist has the semblance of a personality when I see it...</p>
<p>Of course, I'm being facetious, but really, there are people in my class going into rads that when we found out, we all said "but you've got too much personality to be a radiologist". </p>
<p>My friend who applied to some Rad Onc programs recently complained on his Facebook status that there have been World of Warcraft discussions at every interview he's been on...</p>