<p>There will always be a few unmatched spots, even in competitive specialties (these specialties will fill via the SOAP/scramble). Never overestimate the arrogance of some residency programs. Many programs are too stringent in offering interviews or in ranking candidates (meaning they don’t rank enough of the people they interview). Thus, they are left with open spots on match day and are forced to fill via the scramble. Typically, these are community programs or less desirable programs but ever once in awhile, a solid program trips up. For example, Case Western’s radiology program last year didn’t fill not one but two spots. I guarantee that this year they are much more careful about ranking.</p>
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<p>Not true from what D1 has been telling me. At her school, in-state residency slots in primary care fields and general surgery are reserved for individuals who own homes locally and/or have children enrolled in school. IOW, those for whom relocating would be a hardship. Basically they’ve told all the singletons/marrieds without kids they’re going to end up somewhere else.</p>
<p>"there are 38,000 applicants, 27,000 positions to be filled in 4,000 residency programs. "</p>
<p>-So, that means that about 25% do NOT match at all despite of SOAP? 11,000 will not match according to numbers above. I am missing something as 25% is a very high number.
And I am still NOT grasping the meanning of “less desirable” programs if everybody at the end will be MD practicing medicine, what is the importance of being in very desirable program vs undesirable, what is a difference for a person’s future as a practicing physician?</p>
<p>BTW, all is very interesting and I forwarded some to my MS1, I do not know how much she knows, but she started thinking about timing of her Step 1.
So, thank you very much for sharing, the more, the better for the ones who follow in your footsteps.</p>
<p>Sorry for 3rd post in a row.<br>
Do you think that Medical Student at particular Med. School have a better chance to be matched to the program at their Med. School or related Hospital?</p>
<p>Miami:</p>
<p>My son says that his medical school, within limits, does look our for its own students in residency programs. However, his medical school is middle of the pack, not a top 20 type program. This might be less true at medical schools that have a higher profile, with highly competitve residency applicants from around the country.</p>
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<p>As eadad said, in surgery and a good number of other fields, taking 5 interns per year is a “large” program. On the flip side in Internal Medicine and Peds, taking fewer than 20 interns per year is good enough only to be “midsized”. In Peds, the most highly ranked residency programs (CHOP, Texas Children’s, Boston Children’s, Cincinnati Children’s) all take >40 interns per year. While this sounds like differing levels of competition, the average stats for the interns in these places will be similar to those in radiology or ophtho and certainly better than less desirable programs in those fields.</p>
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<p>The overwhelming majority of applicants that don’t match are international medical grads (IMG’s). The stats for the US Grads have been very consistent over the past 5-8 years of match rates of 92-94% depending on the year, with >99% of all US Grads having a residency position at the end of the Scramble (now brought to you by NEW Management - say “hello” to SOAP). This is one of the reasons why whenever some pre-med brings up International Schools, many of us our very adamantly opposed. The odds are so remarkably in favor of US Grads, that International schools are an awful risk.</p>
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<p>So, there can be a lot of things that make a program less than desirable. It may be as dumb as something like “a person there looked at me funny” - true story, as I was going through my fellowship interviews this fall, the place that ended up last on my rank list was there because the fellowship director during my 1-on-1 interview just sat down and said “why critical care?” instead of trying to sell me on her program…I just really felt strongly that if I was interviewing with 6 or 7 other people during the day, one of them could ask me that, but the person most in charge of the program should be telling me about all the wonderful things they have to offer. She didn’t so they ended up last.</p>
<p>Location is obviously a MAJOR component. I know of several really great programs that aren’t as highly regarded as they should be due to where they’re located. Other considerations include things like call schedules, facilities, congeniality of housestaff towards each other, number of electives, patient populations and size of the program. More specifically to each applicant, some programs represent great launch pads to fellowships while others don’t. In particular for an applicant who knows they want to do a particular field, the relative strength of a program in that field may be a significant draw. Again, personally, I was fairly well set on peds critical care, so things like the actual PICU, the notoriety of the intensivist faculty and whether the hospital had a critical care fellowship were important considerations for me. Places that didn’t put a lot of residents into fellowship were not attractive for me. Other considerations may include research opportunities in particular areas. As I prepared for fellowship interviews, I knew I wasn’t that interested in doing bench research, and so that was something I made sure at every place I went, that I wouldn’t be forced to sit in a lab during all my research time - I knew I wanted a place that would be supportive of a clinical research question. One program I applied to even declined to interview me (my only rejection) because they didn’t feel like I had a research interest that would make their program a priority. It was a great program, one I would have considered myself lucky to match into, and yet, they were right. I probably wouldn’t have felt like I fit in there very well because they are HEAVY into bench research.</p>
<p>I would hesitate to say that every program that doesn’t fill is completely undesirable. Some programs may have just been 2nd on everyone’s list and when people get their first choice the program may end up out of luck. More concerning would a trend of multiple years in the recent past without filling. The University of Michigan Peds Critical Care program didn’t fill this year, easily a first quartile program, moving into a brand new children’s hospital in the fall, with exceptionally nice faculty members. I really enjoyed my interview there, but in the end, the size just wasn’t what I was looking for, I didn’t have many friends in the area, and some of their administrative setup didn’t fit well with me. So it ended up further down my list. Sometimes that’s just the way it goes.</p>
<p>congrats, Bigred, you are doing great!
Mich. would be a great choice fo my D. But if she is able to stay at her school, then it would be less tressful, moving…etc. Will see in 3 years…so much can change…she has no idea about specialty as her original one(s) is gone…too much research required, she is just like you, she does not mind it but her preference is clinical, working with people, she is very excited to be help[ing at the doc. office</p>
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<p>It’s more like 27,000 residency positions, 17,000 US graduates, and 10,000 DO and FMG/IMG applicants. There are more than enough residency positions for US graduates and almost all of them will match.</p>
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<p>Location and quality of program is important. Unlike with medical schools, there is a lot of heterogeneity among residency programs in terms of amount of research (important for fellowships), clinical volume, breadth of clinical cases, patient population, reputation, etc. It’s not just about getting a MD and practicing. Everyone wants to get the best training possible so they can be the best physician possible.</p>
<p>The other important factor is location. Boston, California, NYC, Chicago, Philly, etc. are going to be more competitive than Detroit, Iowa, South Dakota, etc. This is less of an issue for your daughter as she is determined to stay in the Midwest but for others, especially people who are single, it is far more desirable to live in Manhattan than in St. Louis. </p>
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<p>Within reason, yes. This is probably more true for residency programs that take a large number of interns (internal med, peds, etc.). If you take 40 interns a year, then you can afford to take a few extra from the affiliated med school. But, if you are a small ENT or derm program that only takes 2 interns a year, then it’s unlikely you are willing to given an advantage to someone from the affiliated med school.</p>
<p>Yes, NYC, Chicago and Philly are certainly not for us…I cannot see that D.even consider these, especially visiting NYC almost every year, but my S. loves it there. Very different life.
Thanks, very helpful!</p>
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<p>Just curious, who does not match, even after scramble/SOAP and what happens to him/her?</p>
<p>When it comes to the SOAP, you can elect to apply to a different specialty (for example, if you didn’t match in radiology, you can totally revamp your application and apply to internal medicine) or you can stick with your original specialty. If you are totally not competitive for that specialty (for example, if you have a 200 USMLE score and you continue to apply to derm), you can conceivably not get a position through the SOAP either.</p>
<p>If you fail to get a position you have two options:
- Take a year off (do some research or something) and reapply next year.</p>
<ol>
<li>If you managed to match into a prelim year but not an advanced position (for example, if you were applying to derm or radiology and matched into a prelim med/surg spot but not the derm/radiology program), you can still start your prelim year and work as a resident and apply to an advanced position in your intern year.</li>
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<p>NCG,</p>
<p>A friend’s son got into anaesthesiology but had to complete 1 year in internal medicine before starting anesthesiology residency. Is this what they call the ‘Prelim’ year?
I have also heard the term ‘Transitional year’ being used on SDN. What is the difference between Prelim year and Transitional year? And are there certain specialties that absolutely require prelim year?</p>
<p>Pharmgal: I can partially answer your question. Anesthesiology is a four year deal; one year of internal medicine followed by three years of anesthesiology. Some programs do all four years, some do only the three year part, so you have to start somewhere else for a year of internal medicine. (Actually, most programs actually have some four year and some three year slots). For the first year of internal medicine, you can do prelim or transitional years. My son has told me the difference but it didn’t stick. I’ll leave that to others.</p>
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<p>Yes. Certain specialties require such a year including anesthesiology, radiology, physical medicine and rehab, opthalmology, neurology, dermatology. </p>
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<p>In general, transition years are cushier. There were fewer ward months, fewer ICU months, more elective months, and less call. At the cusiest transition year programs, it’s not unheard of to have interns finish the work day at 2 or 3 PM.</p>
<p>I think neurology absolutely requires a prelim year (and often the prelim year is built-into the neurology residency). Maybe PM&R too. My transition year interviews were dominated by anesthesiology, radiology, opthmo, and derm hopefuls. As you can imagine, due to the benign work hours, transition year programs are very competitive.</p>
<p>The other major difference is that prelim years are offered by academic and community programs alike while transition years are only offered by dinky community hospitals. No self-respecting academic hospital offers a transition year. It’s kinda like majoring in premed in undergrad. It doesn’t teach you to do anything and the only purpose is to get you through the required intern year before you start in your real residency.</p>
<p>So, what do the community hospitals get out of it? They get to recruit the quality of interns that otherwise would never give them the time of day. The internal medicine programs at these community hospitals are usually filled with FMG’s/IMG’s while the transition year programs are filled with people doing derm, radiology, etc. (ie some of the best med students in the country). It’s interesting to see the dichotomy of residents on the same team at these hospitals.</p>
<p>will you be less prepared for residency by doing a transition instead of prelim? will it have an effect on your CV later on after residency?</p>
<p>You’ll hear varying opinions. If you talk to the residents on the interview trail, they’ll encourage you to do transition years. Managing your 100th heart failure patient during intern year is not likely to help you in your career as a radiologist or dermatologist. If you talk to the program directors, they’ll encourage you to do a prelim year because prelim years are more rigorous. </p>
<p>There is some thought a surgery prelim year helps with interventional radiology later on but, as you can imagine, a surgery prelim year is not very popular with radiology applicants (probably fewer than 5% do a prelim year in surgery).</p>
<p>OK - not having gone through all the posts, can somebody explain what SOAP is besides what you use for washing yourself or dishes?</p>
<p>Thanks for the info, NCG. DS is looking at one of the ROAD specialties. So, it looks like he needs to be ready for a Prelim year.</p>
<p>Do you have separate interviews then for the prelim year and the actual specialty residency? Can they be at different institutions or should they be at the same place?</p>
<p>Thanks much,</p>