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Friday, January 5th 2007

Residency Competitiveness: Whammy!


“I’m All About Having Fun…”

Ah, the section stuffed with surgical sub specialties and docs who play with radiation.

3. Otolaryngology
T-4. Orthopedic Surgery
T-4. Urology
6. Neurosurgery
7. Radiation Oncology
8. Radiology

ENT, in my opinion, right now, is the second most competitive surgical subspecialty. ENT has recently gone to the regular match but in 2004 it enjoyed the second or third highest Step 1 average of any specialty at 237. It is true that U.S. Seniors that year matched at a 76% rate, compared to say even General Surgery from last year which was 74%.

That should just go to show you how much self selection goes on in this process.

Orthopedic (or if we go a little high brow with a British accent then orthopaedics), comes in tied at #4 with Urology.

Ortho Surgery has a reputation for being a ‘jock’ specialty. That is probably true; I wouldn’t want to go to into the interview without being able to talk about your sports playing experience (and not your equestrian riding). But these “guys” (and gals) are wicked smart.

You get to play with cool toys, and it turns out the spine work is probably the best paying work in all of health care. I worked in a big spine practice for a while. On top of that, the hand is one of the coolest things I’ve ever seen.

I’ve trailed off a bit, mostly cause I have some experience here having worked through my summers in a large orthopedic practice. Back to the true topic we find the median Step 1 for those who matched at around the same level as ENT, perhaps just slightly lower 235 – 237.

Urology is weird. They’ve decided they want to run their own match. That is right, there is a match ONLY for urology. It is the one specialty we do not have AOA % and Step 1 medians and means for.

So how can I justify putting it way up here?

Well I cannot imagine (looking at the other surgical sub specialties, the earning potential, etc.) that its Step 1 mean is lower than 230 and probably closer to 235. As well, the past two years it has filled completely. That is right, not a single unfilled residency spot.

Along the same lines with many surgical sub specialties it finds a U.S. Senior matching rate of ~75%.

Neurosurgery is a little odder. Its Step 1 slides down a little from say ENT to an average Step 1 of 234 for those who matched in 2005.

Yet it has a U.S. Senior matching rate approaching 90% in many years. That needs at least a little exploration. Personally, I think just from conjecture and hearsay there is a reasonable argument this might be the “toughest”/most work of any residency. It is certainly long. And while the earning potential is great, it has also faced major liability issues in recent years.

There may be self selection (to say ENT or other surgical sub specialties) amongst the “strongest” medical school graduates away from neurosurgery. Certainly we’ve seen an upticking in the % of U.S. Seniors matching (as recently as 1998 it was down at 71%), which would seem to support this theory.

In any case, the % U.S. Seniors matching should not be seen as neurosurgery being easier.

Radiation Oncology is a well paying specialty (not to make medical students seem shallow with all this discussion of earning potential). The matching rate for Seniors is up above 80% (although 2005 was a popular year for the specialty) and the Step 1 median for matched U.S. Seniors is right around 234.

The AOA % is right around 20, which is closer to neurosurgery than ENT or the 25+% of orthopedic surgery.

Finally, I was surprised at #8. You hear radiology is tough, but this isn’t a specialty that is on the brink of falling down into the category below (Made With Bits Of Real Panther). You could easily justify actually switching radiology with radiation oncology.

In part this is fairly amazing considering the number of radiology spots (more than a 1000, pretty comparable with general surgery). True there were actually less U.S. Senior applicants than positions. But that didn’t stop only 82% of those Seniors from matching.

The median Step 1 score for radiology is identical to that of radiation oncology at 234.

It is good to note that from the two specialties in the category to be revealed tomorrow you stay above 230 for the median Step 1 for Seniors who matched through Radiology and then drop SHARPLY, about 10 points, to the median Step 1 for pathology.

When you see it on a chart, it is a pretty impressive graphic demonstrating the strength of those who match into the specialties in this category (and the two to be revealed tomorrow). These are competitive specialties – open up that book, get to work on that QBank, work your ass off on the wards.

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