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Wednesday, January 3rd 2007

Residency Competitiveness: Loud Noises!


“Years Later A Doctor Will Tell Me I Have An IQ of 48.”

These residencies might be considered less competitive.

14. Internal Medicine
15. Pediatrics
16. Obstetrics/Gynecology
T-17. Psychiatry
T-17. Neurology
19. Physical Medicine & Rehabilitation
20. Family Practice

Internal Medicine is a tough specialty to rank, which may seem surprising at first, seeing as it is so ‘popular’. By far, there are more internal medicine residency positions than any other specialty (more than 5000 categorical positions).

It enjoys a higher mean and median Step 1 score for matched students and a higher AOA % than some of the specialties placed in the category above it (Made With Real Bits of Panther). So this position needs some justification.

The breadth of applicants makes internal medicine an odd specialty. There is much less self selection (both negative and positive) going on. What I mean is, there are pressures (work hours, reimbursement, depth of practice, etc.) that make the most qualified applicants tend to disfavor specialties like family medicine or ob/gyn right now. However, these forces are weaker in internal medicine. With so many positions, with so many opportunities for specialization, there are a lot of incredibly talented students who desire to do IM.

Although the distribution of Step 1 scores is still a bell curve, it appears that there is a broader range of strong-to-weaker applicants, seeking internal medicine positions than positions in other specialties. This could certainly “boost” up the mean Step 1 score of 220 for U.S. Seniors who applied to internal medicine and still allow for an explanation of how greater than 95% of U.S. Seniors applying to medicine match somewhere and a 100+ unfilled residency positions is the norm (note: technical problems – the residency position is still on the book but the program has downsized or closed – can contribute to the number of open unfilled positions).

Pediatrics follows a similiar explanation, just with a lower mean Step 1 score for Senior applicants (215).

Ob/Gyn has a lower median Step 1 for matched U.S. Seniors (~213). It is enjoying a bit of a resurgence. 73 Seniors failed to match into it last year (2006), the highest in a number of years. Yet your chances of matching as a Senior are still likely to be 90+% for years to come. Similiar U.S. Senior match rates with the lower Step 1 median, led me to believe it belonged at #16.

Psychiatry “enjoys” worse U.S. Senior match rates than ob/gyn (91% last year). That may be because weaker students take the specialty for granted and see it as “safe” (as if matching into any specialty is). The median Step 1 score for matched seniors falls below 210 for the first time.

There are of course perhaps other contributing factors to this, we might expect psychiatrists to put less weight on standardized scores or academic performance (the AOA % is the second lowest of any specialty).

Neurology has been having a bumpy ride over the past several years. Its average Step 1 score last year (the last year it will be an early match) was actually above even Peds at 219. Traditionally however better than 95% of U.S. Seniors match. As well, although this is certainly not in and of itself direct evidence, neurology has one of the largest populations of international medical graduates of any specialty.

Physical Medicine comes in at #19 in terms of competitiveness. It has the lowest % of AOA students who sought it out of any specialty and the lowest median Step 1 score of U.S. Seniors who matched. So why is it above Family Practice (which was second from the bottom in Step 1 average). Because, although the sample sizes are small, it has left some U.S. Seniors out in the cold the past two years (88 and 80% U.S. Senior match rates). Meanwhile Family Medicine enjoys the single highest likelihood of you matching as a U.S. Senior.

Come back tomorrow for “Made With Bits Of Real Panther” (Competitive Residencies) and Friday for “Whammy!” (Very Competitive Residencies).

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