Thanks, IWBB.
Also keep in mind, the 80 hour work week is 80 hours/wk averaged over 4 weeks. So, itâs possible to exceed 80 hours any one week and still be under the work hours limit.
Congratulations to all the new residents! Wishing you / your sons and daughters a wonderful 3+ years. Also sending good wishes to the continuing residents and those beginning fellowships. My advice (taken from D): Work hard, donât be afraid to lean on your family, friends, and all the people you will work with, take time to relax, get sleep when you can, and when you make a mistake, and you will, own it, fix it, and keep moving forward.
D and I have not talked about loan repayment. I know that during residency she was making income based payments. She and her H are hoping to pay her loans off quickly, hopefully in two years or less.
D has officially completed residency. She is completely exhausted and has been enjoying some time off before she begins her new career in a few weeks. She is reconnecting with family and friends and taking time to travel with her H. She worked harder than she ever imagined possible, but the opportunity to do this placed her in a wonderful position for the future. There were many fun celebrations during the last few weeks. We were happy to hear so many positive comments about her âclassâ and about her personally. One of the family parties was kind of like parent/teacher conferences (I guess it would be parent/attending physician conferences in this case) and we left feeling so very proud of our D. She will never work another 80+ hour week - and for that she is very grateful.
Congrats, hrh19!
For us it is all ahead. D. is still in elective for another week. Then she will start shift on the floor, but only for one month. She sent us her shift schedule and it is crazy. As I said, all rules have exceptions. But after 4 weeks, she is back to electives for 6 weeks. She could have avoided all of it if she chooses the transitional program. But then, she would have to move for one year, so it was not attractive for her. After her prelim year, she will not have 80+ hour week.
Long time no see, everyone!
I do still exist and have managed to escape, mostly unscathed, from fellowship. While I had a much rougher than expected job search, Iâll start my first job as an attending after the first of the year at a private practice PICU in the Southeast.
So what are the new controversies around these parts? Still arguing over Ivy League schools vs state schools? Or how high school students are convinced theyâre going to be Harvard neurosurgeons?
Congrats, Bigredmed!
We are here basically sharing the Residency experiences of our kids.
Maybe few went to Ivyâs at some point of time, but it is not important now and was irrelevant few months ago during matching cycle. Match was by far the most stressful experience for those who kind of glided into college, then glided into Med. School with the smile on their face. But match day came and went and it was one of the most memorable days in our family.
Surprised to hear that you âhad a much rougher than expected job searchâ. Why do you think it happened if you do not mind to share. Just curious, although for us is it very long time from now.
Probably more related to my field (Peds ICU) rather than anything more general and widely applicable.
Itâs multifactorial.
On a systemic level, most (not all, though) PICUâs tend to be limited to academic medical centers, so the expansion of Critical Care Divisions end up being limited by multiple aspects that go beyond simply patient volumes (as peds is rarely a moneymaker). Additionally, while we are on the cusp of a generation of pediatric intensivists reaching retirement, with Peds Critical Care being a relatively new specialty that group is not as big as the numbers of new physicians graduating fellowship, and the recession likely caused many of those ready to retire to hold off a while longer.
From a career interest standpoint, management of congenital cardiac defects is not a passion of mine. Meanwhile, this area of peds critical care and pediatric cardiology is the one segment that is growing fairly fast as this becoming its own new sub-subspecialty. Lots of places are looking to hire those with extra Cardiac ICU training and use whatever sort of resources for expansion to attract those individualsâŠIâm simply not the type who really gets into these patients though and so it doesnât help me at all.
Personally, for the first time in my career, Iâm moving to the next step with a significant other in tow. While I obviously love my fiancee a great deal, itâs simply the truth that her presence and her needs made a difficult situation that much more complex. Locations that donât limit her career opportunities (sheâs not in medicine) were much more limited than the number of jobs that were available.
In the end, it all worked out. While I didnât expect to be joining a private practice job, I managed to find one that covers a 35+ bed unit, is looking to expand, has a reasonable schedule, and will allow me to pursue some of my administrative interests. If things donât work out in our new location, I should be able to grow as clinician and be able to transition back to an academic position - which is not always the case with many private practice gigs in peds critical care.
Thanks for sharing! Interesting details that we would not find anywhere else.
I wonder if peds subspecialty in other specialties also experience similar difficulties. Also, most at this age have significant others, the people who made significant personal sacrifices and contributions to the success of the future MDâs. Some go even as far as considering the change in career. So, I perfectly understand this part.
Again, huge congrats despite all obstacles!!!
sigh nothingâs changed
I have a good friend who is applying to NICU (neonatal ICU aka where all the preemies go) fellowships right now. He was saying exactly the same thing. His wife is in internal medicine and applying for allergy and immunology. Luckily she finds out where she matches 6 hours before his rank list is due so his rank list for fellowships will be adjusted based on wherever she ends up (and luckily there are many more NICU spots than A&I spots around the country so itâs going to be easier for him to match towards the top of his list than it will be for her)
Residency Question: Probably uber basic for this crowdâŠBFFâs son is about to embark on this path (he is MS4âwants to do orthopedics) and Iâm not clear on how it works. Sheâs told me about the algorithm and the national matching program so Iâm not totally ignorant on the topic. Do I have it right?.. Applicant applies to lots of programs, applicant gets some interviews from the applications, applicant goes to interviews and gets a feeling of the program, etc, applicant decides where he/she would like to spend the next 4/5 years, applicant ranks the programs he/she is interested in, residency programs rank the applicants theyâd like to train, all this is put into an algorithm and applicant goes where the computer tells them or, for some, they donât match and they scramble for âPlan Bâ or some may have to go through the process again the next year.
Does the applicant have a verbal idea of which programs really like them? Iâm thinking of a behind the scenes: ââŠwe really like you rank us highlyâŠâ Or is it really a gamble/surprise?
What if several programs rank me highly and I donât rank them highly? What if the programs I really like donât rank me highly? Is there another step after the interviews? Is there a âsecond lookâ opportunity?
Just trying to be able to converse with my friend on a more intelligent levelâŠ
Yes, you have the basics correct. You can read more about the process here:
http://www.nrmp.org/match-process/match-algorithm/
Programs arenât allowed to make any kind of promises or commitments to a candidate outside of the Match. Any communication between the a program and a candidate dealing with the Match is illegal and can result in a sanction on either or both sides. (A sanction is very bad thing. For candidates being sanctioned means potentially being banned from the Match for life.) This is not to say thereâs no communication between a candidate and a program director, but âlove notesâ arenât in the least bit binding and cannot go beyond superficialities like âWe hope you had a good visit to Erehwon General Hospitalâ or âI enjoyed talking with you last week on Interview Dayâ.
Hereâs video that explains the process:
https://www.youtube.com/watch?v=ywzYRo1YIv4
More weight is given to the applicantâs preference than to the programâs preferences. But if a program you really like ranks you low, you have very little chance of matching there since everyone else higher on the list who will get taken before you are.
Generally speaking applicants should NOT rank any program he/she isnât interested in attending.
(But for highly competitive specialties like ortho in which only 75-80% of candidates match at all, an applicant would be an idiot not to rank every program where he/she interviewed because the likelihood of not matching at all is significant. Applicants in competitive specialties are also more likely to interview in 2 different specialties: a first choice specialty and back-up specialty. For ortho, for example, the back-up is typically general surgery.)
No.
No.
After interviews are over in February, the applicant submits a ranked list of schools and the program submits a ranked list of intervieweesâthe rest is done by computer. Students wonât know until they open their envelope on Match Day (around March 15) where they will be going or, in the case of candidates who applied/interviewed for more than one specialty, what specialty they matched into. Ditto for programsâthey wonât get a list of who matched to their program until Match Day.
The process, as you can imagine, is quite stressful.
Thanks so much, WOWM, for the information and the links. Iâve developed a whole new respect for those who choose this path.
âdonât match and they scramble for âPlan Bâ or some may have to go through the process again the next year.
Does the applicant have a verbal idea of which programs really like them?â
-These two aspects are different for very selective specialties. âScrambleâ process may not be available for them, there are may be 3 or so spots available after match in whole country in certain specialty. So, if one does not match, they still most likely will match for prelim year and will have a chance to re-apply later while doing something like Research fellowship for year or so. Not matching in highly selective specialty is pretty tragic and sad even for outsiders knowing what entails to even get into match day and simply to have interview invitations.
Also, in the selective specialties, they tend not to show any âloveâ to applicants and interviews are more intense (this is just from talking to classmates applying to different specialties).
And if specialty requires a prelim/transitional first year, they have to apply to them separately and go to interviews to each of these âprelim yearâ programs and rank them also. There are few categorical specialty programs that include prelim year, they may not be at the top of the applicant list though.
The residency application process was by far the most stressful application process in my Dâs life. She ended up going to 12 specialty interviews and about 14 or so prelim/transitional interviews and by some incredible luck escaped all those NE snowstorms by few weeks. Another mysterious fact was that the interview places were completely random and did not coincide at all with predictions that were made for her by her mentors with huge amount of experience in specialty and nationally recognized names. She kept repeating one thing, âGood that I did not listen to anybody and applied much widerâ. For all future applicants, trust your own intuition, somehow it works!!
If they match in general surgery instead of orthopedics, and they become general surgeonsâŠIs there then a shorter route to doing orthopedics?
Had no idea this poor kid has a 20% to 25% chance of NOT getting his heartâs desire. Thatâs just crazy after four years of knocking himself out to get high scoresâŠIs it safe to assume the ones who donât match are those with lower scores on the two âstepâ test?.
No. After completing a general surgery residency (5 years), heâd have to apply and start all over again in ortho. If he applies and matches into a preliminary general surgery position (which are 1 year terminal contractsâi.e. dead end positions), he could re-enter the Match for ortho the next year, but if he matched into ortho, heâd be starting his ortho residency from the beginning.
No. There are all sorts of reason why people donât matchâmost of which have nothing to do with test scoresâ
poor interview skills, poorly written personal statement, weak or lukewarm SLOE (Specialty Letter of Evaluation), âpoor fitâ with specialty or programs, didnât do [enough] audition rotations in specialty, didnât honor rotations in med schoolâparticularly in surgery/ortho, applying to too few programs, ranking too few programs, applying in too restricted of a geographical area, lack of relevant research/publications in future specialty, plus bunches of others.
The residency interview process (like the med school admission process) has a ton of subjective factors involved as well as the objective data (test scores)
http://www.nrmp.org/match-data/main-residency-match-data/
Above is link to most recent match data and Program Director (PD) Survey. Survey lists factors that PDs consider important in making their decision to offer interview and in making their rank lists. Although Step 1 is very important, other factors play an very important roles. When S interviewed he said one PD stated that applicants offered interviews were initially ranked A, B and C (top to bottom). After interviews some applicant could go up or down, and some could be given D ranking (aka DO NOT RANK). I think most residencies use similar system.
.
"Had no idea this poor kid has a 20% to 25% chance of NOT getting his heartâs desire. Thatâs just crazy after four years of knocking himself out to get high scoresâŠIs "
- Well, in Dâs class, 9 applied to one of very selective specialties, 1 out of 9 did not match. So, I am not sure about 20/25% not matching. I guess, sometime, it is closer to 11% not matching. While 11% is much lower than 25%, yes, it is very sad after knowing what they are going thru just to get those interviews. But the one person who did not match, had only 6 interviews for specialty. That was a âredâ flag. We do not know if the low number (6 vs desired 10) was caused by lower stats or by not applying smartly. If my kid listened to advises that she was given, she would have a very low number of interview invites. Low number still can produced desired results though. It is a game of poker with too many unknowns. My advise is just to make yourself feel better, in case of very selective specialties, apply very widely, apply to places that seems to be un-reasonable to apply, nobody knows which will send an invite. Some applicants apply to all programs in a country, believe it or not. At this point you do not want to count $1k plus or minus, basically irrelevant after spending few hundreds of thousands. Not matching will cause much higher cost because of delayed specialty residency and re-applying.
D. believes that the LORs from nationally recognized people especially those who tend to give very hard LORs played a huge difference in her application, she believes that her LORs could be the most likely reasons why she got 12 interviews in her specialty. At this point, everybody had kind of similar stats. Other factors like AOA and publications seemed to be less important in D. and her classmates specific cases. They maybe important under other conditions that I do not have any knowledge about.
@MiamiDAP, according to the 2015 match data in the link from @Jugulator20 , the match rate for US MD grads into ortho was 663/885 or 74.9%. In other words, in 2015, 25% of US MD grads applying to ortho did not match into ortho. Later in the document it notes that ortho had 100% positions filled in the match and that 94.3% of those positions were filled by US MD grads.
In this document: http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf you can get a better sense as to the stats of matching vs. not matching students. For US MD grads for example the mean step 1/2 scores of matched ortho residents were 245/251 whereas the unmatched group average was 231/238.
" according to the 2015 match data in the link from @Jugulator20 , the match rate for US MD grads into ortho was 663/885 or 74.9%"
- you cannot claim that it is all across at all schools, that each school has 75% success rate and the chance for a specific student is only 75%⊠Anyway, that is why I never use internet statistics, it is NOT specific to certain school / specific student with his specific stats, LORâs and other stuff that are reflected in application. It is more SDN thing, but I hope we here are a bit more grounded than that. There is no reason to throw 75% success rate at somebody who do not know at all. It may not be applicable to this person. The example that I gave before was not for ortho but for more selective specialty. Again, general statistics has nothing to do with the statistics at specific Med. School and it is completely NOT applicable to specific student.
I never said the 25% number was uniform across all schools. You however implied that the number was wrong because some other specialty that you didnât name was only 11% at your Dâs school. Maybe if you had written what you just wrote now the first time I wouldnât have thought that you were ignoring real data in favor of anecdotal data and thus posted the real data to correct you.