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Session 59 Looking at the Psychiatry Match data, it's easy to see that it is becoming a more popular field. I discuss all the data in today's Specialty Stories podcast. Finding physicians for this show has been a challenge so we'd like to ask for your help. If you know a physician who would be a great addition to this podcast, shoot me an email at ryan@medicalschoolhq.net . Go to medicalschoolhq.net/specialtiescovered and you'd find a list of physicians that we've already covered here on the show. Today, we cover Psychiatry match data based on the 2017 NRMP Main Residency Match Data. [03:20] General Summary There are 236 programs in psychiatry. Comparing it with other specialties, pediatrics has 204 programs. So there are 32 more psychiatry programs than there are pediatric programs. The total number of positions offered for Psychiatry is 1,495 spots. This means a little over 6 spots per program. Whereas pediatrics is much bigger with twice as many spots of 2,738 in 204 program. So it's almost 13 1/2 spots per program - almost double the size of psychiatry programs. There were 3 unfilled programs in 2017 and the total number of U.S. Senior applicants for those 1,495 spots was only 1,067. These are the students at MD medical schools who are still in school, and not those that have graduated. So there were less students applying to those spots than there were spots available. There were 2,614 applicants. It's almost 1,200 more applicants than there were spots available. This is still pretty competitive to apply. Looking at the number of those that matched, only 923 of those 1,067 U.S. Seniors did match while over a hundred of those did not match into Psychiatry. It was only about 61.7% of those that matched are U.S. Seniors. Looking at other fields that matched, Anesthesiology was 66.8%, Dermatology at 92.3%, and PGY-2 positions for dermatology is 81.8%. [07:05] Types of Applicants and Growth Trends Table 2 of the NRMP Match Data for 2017 shows the matches by specialty and applicant types. For Psychiatry, there were four spots that went unfilled, 923 were U.S. Seniors and that's about almost 62%. 49 were U.S. Graduates. These were students who went to anMD school but had graduated already. Maybe they didn't get in the first time or they were just taking a gap year doing some research or travel, whatever. "A good percentage of osteopathic students are getting into Psychiatry." There were 216 osteopathic students, 166 U.S.-Citizen International Medical Graduates, and 137 non-U.S.citizen International Medical Graduates. There were four unfilled positions. Table 3 shows the growth trends covering 2013 to 2017. Psychiatry is growing a bunch, about 5% every year. In 2017, it grew 5.2%. Table 7 shows positions offered and number filled by U.S. Seniors and all applicants from 2013 to 2017. There's an interesting trend in Psychiatric that it's becoming more popular among U.S. graduates. When you go back to 2013, it was only about 52% of the class who were U.S. graduates. "If you're interested in Psychiatry, it seems to be growing. Hopefully there'll be spots for you as you continue down your training path." In 2017, U.S. Seniors comprised 61.7% while in 2013, it was only around 52% and been going up year over year. Table 9 shows you how big a specialty is int he grand scheme of specialties. Ophthalmology is a separate match so that's not included. For Psychiatry, 5.4% of all students who matched, matched into Psychiatry. Just to give you a scale, Anesthesiology was only 4.1%, Emergency Medicine is 7.4%, Internal Medicine is 25.6%, Family Medicine is 11.6%. OB/GYN is 4.7%. [11:40] Osteopathic Students And if you're an osteopathic student interested to know your chances, Table 11 will show it to you. 7.4% of all DO students who matched into an MD program, matched into Psychiatry. Compared to the rest, Family Medicine and Internal Medicine are huge, Anesthesiology is 5.6%, Emergency Medicine is 9.6%. So the ratios are very similar. Figure 6 shows the percentages of unmatched U.S. Seniors and Independent Applicants who ranked each specialty as their only choice. If you are only ranking Psychiatry, there's a total unmatched percentage of 30.8%. But don't let that scare you if you're a U.S. Senior. Because their unmatched percentage is only at 7.4%. 52.9% of those who are independent applicants (ex. DO students, U.S. citizen and non-U.S. citizen international medical graduates, Canadian students) did not match [13:13] SOAP Let's go to the SOAP (Supplemental Offer and Acceptance Program). There were four unfilled programs, when you look at the data. But interestingly, when you look at the SOAP for 2017, there were only three available positions. One of those positions was either filled or taken off of the board. So there were two programs with three positions available. And all three of those spots were filled through the SOAP. [13:45] NRMP Charting the Outcomes 2017 - Contiguous Ranks Based on the 2016 NRMP Charting the Outcomes, Table 1 shows the number of applicants and positions in the 2016 match by preferred specialty. Psychiatry has 1,586 spots, 2,134 applicants, number of all applicants per position was 1.54, as one of the highest on this list. There are a lot of International Medical Grads and DO students are applying for these spots. Specialties like vascular surgery only has 56 positions and the total number of applicants per position is 1.91. The only one here above Psychiatry other than that is Neurosurgery which is 1.58. So there are a lot of applicants for those spots. Chart 4 tells the median number of contiguous ranks of U.S. Allopathic Seniors. Those who matched in Psychiatry ranked 9 programs in a row; while those that did not match only ranked 5. "You need to apply to a lot of programs and rank a lot of programs. That is the same across the board for every specialty." Further down the report is Table P-1 is the summary stats for Psychiatry. The mean number of contiguous ranks for those who matched is 9.6 while those who didn't is 5.6. Mean number of distinct specialties ranked is 1.1 for those who matched and 1.3 for those who went unmatched. For those who did not match were a little bit wishy washy with their specialty choice. [16:30] Step 1 and Step 2 Scores, AOA Members, and PhD Degree Step 1 scores for Psychiatry is not as high as some of the other programs. Psychiatry has 224 for mean Step 1 score and 214 for those that did not match. For Mean Step 2 Scores, 238 for those that matched, and 226 for those that did not. For AOA (the honor society for medical students) members, only 6.2% of the students who matched were AOA members while none of those that did not match were AOA members. 4.4% had a PhD degree and 0 unmatched had a PhD degree. You could look at that saying that you have to have a PhD degree to match into Psychiatry or you have to be an AOA member to match. But you have to look at the data yourself. [18:00] 2018 Medscape Lifestyle and Compensation Reports The 2018 Medscape Lifestyle Report shows the highest outside of work is 61% for Allergy Immunology and the lowest is Cardiology at 40%. Psychiatry is right in the middle at 51%. But let's also look at the 2017 NRMP Main Residency Match Data. Psychiatry and mental health are at the bottom for burnout at 42% versus Emergency Medicine at 59%. How severe is the burnout, they're much lower at 4 on the scale. "Not surprisingly, the question which physicians are most burnt out, Psychiatry and Mental Health are at the very bottom. They probably have some coping skills." Which physicians are happiest outside of work and at work? Psychiatry is lower on the list with 66% happy outside, and 37% are happy at work. And they're found on the lower end of the scale. Looking at the 2017 Medscape Compensation Report, Psychiatry is on the lower end. That's understandable because usually, the more procedure-heavy specialties are compensated more. Their average annual compensation is at $235K while Orthopedics is up at $489K. So that's a big difference. Pediatrics is the lowest at $202K. However, they're getting 4% salary increase year over year. Slide 18 shows which physicians feel fairly compensated and Psychiatry is top 3 at 64%, next to Dermatology and Emergency Medicine (first). Slide 38 is a question about whether they'd choose medicine again and Psychiatry is top 2 at 82%, Rheumatology is at 83%. 87% of Psychiatry also say that they would choose the same specialty again. The highest is Dermatologist and Orthopedics is next. [21:38] Final Thoughts As mentioned earlier, we are in need of more physicians to interview. Please help us find out which physicians are interested in coming on the show. Go to medicalschoolhq.net/specialtiescovered and see which ones have been done. Links: medicalschoolhq.net/specialtiescovered 2017 NRMP Main Residency Match Data 2016 NRMP Charting the Outcomes 2018 Medscape Lifestyle Report 2017 Medscape Lifestyle Report 2017 Medscape Compensation Report

Session 56 Neurosurgery follows the rules of economics. There are very few spots, so it is really competitive to get into. We covered the NRMP Match data for Neurosurgery. Neurosurgery is one of those residencies that are super hard to get into. Ryan has had an academic neurosurgeon previously on Episode 20 of this podcast. Please subscribe to this podcast. We're on Spotify now! Check us out there as well as on any Android phone, or on Stitcher and Google. Nevertheless, the podcast app on the iOS is the best way to subscribe on an iPhone or iPad. You will also find all our episodes on the MedEd Media Network. Let's dive into today's data... All information here are based on the NRMP Main Residency Match 2017, Charting the Outcomes 2016, Medscape Lifestyle Report 2017, and Medscape Compensation Report 2017. Ryan walks you through the data along with some commentaries. So you will know what it means and what it looks like and what you should be thinking about if you're interested in Neurosurgery. [02:30] Match Summary for 2017 Looking at Table 1 of NRMP Main Residency Match 2017 Summary, Neurological Surgery is how they list it. For this field, they have 0 unfilled programs. This means lots of people are applying for neurosurgery and they're getting filled. There are 107 programs. Comparing this to other fields, Emergency Medicine has 191 programs and Anesthesiology with 124 programs. So for neurosurgery there are 107 programs and 218 positions. It's just over two spots per program. Comparing this to Anesthesiology, it has 124 programs and 1202 positions. This is almost 10 spots per program. This said, there are not a ton of spots and programs for neurosurgery, but every program is super small on average. As you think about your journey, and you're dead set on being a neurosurgeon, all this data shows that you need to well. "If you're dead set on being a neurosurgeon, you better buckle down for medical school...to make sure you have great board scores, great grades." So for U.S. Seniors there are 212. Again, U.S. Seniors here means that it's somebody who's an allopathic/MD still a senior in school. So this doesn't include U.S. Grads who are now taking a gap year, doing research, or doing something else who have graduated. There are 311 total applicants for those 218 spots. Through this episode, Ryan will discuss where these other 99 students are coming from. And out of those U.S. Seniors, 183 matched. So it's 83.9% U.S. Seniors matching in an allopathic medical school. This tells you that they're favoring students at allopathic medical schools. [06:45] Summary of Students: U.S. Seniors, U.S. Grads, IMGs, Osteopaths Table 2 shows where these students are coming from. Again, 83.9% of those that matched are U.S. Seniors. And 15% of those students are U.S. Grads. This means they probably took a year off or they didn't match their first time around so they did research or whatever. There are 2 osteopathic students and 4 U.S. citizen international medical graduates matched into neurosurgery. Looking at this data, is going to a Caribbean school better than going to an osteopathic school? Thinking this alone is wrong. You can't draw these conclusions as to why the numbers say so. If all four of those students when to a DO school, they might have still matched because of who they are, not the letters after their name. "You can't draw conclusions that says going to Caribbean school, Australia, or Ireland better than going to a DO school if you want to match into neurosurgery." Non-U.S. citizens international medical graduates are 14 of those that matched. They are obviously strong students who crushed their boards that they were able to match almost as many students as U.S. graduates. [09:22] Yearly Trends Table 3 shows the yearly trend showing a slow, steady incline every year for the number of positions from 204 to 218 over the last five years. It's a 0.8% increase every year from 2013 to 2017. Looking at Table 8 shows the number of positions offered and the percent filled by U.S. Seniors versus all applicants. For 2017, 83.9% were U.S. Seniors and the numbers are pretty high every year. In fact, this is the lowest year since 2013. It's 92.6% in 2016, 89.5% in 2015, 91.7% in 2014, and 93.1% in 2013. This tells you a couple of things. That for 2017, less U.S. Seniors matched percentage-wise for the total number of positions offered. This tells you that either there were less qualified students applying this year or there are more qualified non-U.S. Seniors applying this year. Table 9 gives you scope of how big a specialty is. For neurosurgery only 0.8% of all applicants matched into neurosurgery. There are a total of 27,688 students and 100% of those students are matching. Another surgical subspecialty that is low is ENT with 1.1%. Not a ton higher but still higher. "Out of the 27,688, only 0.8% of those are matching into neurosurgery. So it's a very, very small specialty." [12:35] Unmatched U.S. Seniors and Independent Applicants, SOAP Looking at Figure 6, Neurosurgery has an unmatched percentage of 20.6% so one out of every five students is not matching into neurosurgery. 55.4% of the independent applicants go unmatched. So it's a large percentage of that are non U.S. Seniors. Only 10.4% of U.S. Seniors are unmatched. Comparing this with other specialties, plastic surgery is 16.3% for U.S. Seniors, Dermatology is at 13.8%. This is a high percentage but not the highest. Table 18 shows the SOAP (Supplemental Offer and Acceptance Program). Neurosurgery had 0 unfilled programs so no neurosurgery programs needed to participate in SOAP. [14:00] Charting the Outcomes 2016 Digging into the Charting the Outcomes 2016, looking at percent match by preferred specialty, Chart 3 shows that 76% of U.S. allopathic seniors matched into it. This the third lowest. Vascular surgery is 71%, Orthopedic surgery is 75%. This tells you that it's one of the most competitive specialties out there, at least for U.S. Seniors. Table 2 talks about the mean USMLE score for Step 1 and Step 2 CK (Clinical Knowledge) versus CS (Clinical Skills). The mean USMLE Step 1 score for all specialties combined for those that matched was 233 and 230 for those that did not match. Keep these numbers in mind. "To match, you have to rank a lot of programs. The more programs you rank, the higher the chance that you will match." Chart 4 shows that in Neurosurgery, the median number of contiguous ranks is at 16 while those that did not match only had a median number of 11. So you need to rank enough programs to match. If you want to match, you cannot be very picky. Are these people not ranking programs because of location? Or prestige? Or are they not ranking programs because they just didn't interview there and decided not to rank them. So there are many questions there. Again, the data is just data. You can't draw conclusions based on this data. We can only make some inferences and discuss what is behind these numbers. But there is no way of knowing specifically why the numbers are what they are. [17:23] Ranking by Specialty and Step 1, Step 2 Scores Ryan always tells students that if you want to be a physician, don't have a plan B of being a PA. Don't have a Plan B of being an NP. Don't have a plan B of using your Biology degree or something else. If you want to be a physician, figure out how to get there. "Don't have a plan B of being a PA... If you want to be a physician, figure out how to get there." Chart 5 talks about the mean number of different specialties ranked by U.S. Allopathic Seniors. This tells you that those who have a plan B did not match at a much higher percentage in most instances than those that didn't have a plan B. Looking at Neurosurgery, the mean number of different specialties ranked was 1.1. This means a  large majority of students only ranked neurosurgery on their rank list. The mean number of those that did not match was 1.4. It means there are more of those students putting in different, most likely, surgical specialties. If you're applying for neurosurgery, that means you like the operating room. This probably means you're applying for maybe general surgery as a backup. And that back up might hurt you. Psychologically, it might hurt you. And the data shows it leans that way. Chart 6 looks at Step 1 scores. The mean Step 1 score for all specialties was 233. For neurosurgery, the mean Step 1 for those that matched was 249. Those that did not match was closer to 238. So you need to have great board scores to match into neurosurgery on average. The same thing for Step 2 scores. The mean Step 2 scores for all specialties was 244.8. For those that matched into neurosurgery, the number was upward to 251-252. For those did not match, it's closer to 242. "You need to have great board scores, if you're planning on being competitive for neurosurgery." [20:21] Scores, Research, Publications, AOA Table NS-1 shows that Mean USMLE Step 1 Score is 249 for those that matched and 238 for those that did not. Step 2 Score is 251 for those that matched and 241 for those that did not match. Research experience is 4.8 versus 4.2. Number of abstracts, presentations, and publications for neurosurgery is 13.4 for those that matched versus 8.4 for those that did not. This tells us that research is very important for neurosurgery. "Research is very important for neurosurgery." The number of students that are AOA (the medical student honor society) based on grades, almost 33% of those that matched were AOA versus only 11.5%. It's not just about having the AOA label, but having the grades that made you competitive and that led you to AOA. It means having the grades to give you the knowledge to do well in the boards. So you can look at this thinking you have to be AOA but you have to have a solid foundation of scientific knowledge of all those courses you've taken in medical school. And this leads to AOA. But it also leads to great board scores. So it's not just AOA. So 9.5% of those that matched have a PhD degree versus 7% who did not. Mean number of contiguous ranks is 15.7% of those that matched versus 10.2% for those that did not match. Again, you need to rank a lot of programs to increase your chances of matching. [22:27] Burnout Rates and Compensation Moving on to the data of Medscape Lifestyle Report 2017, Neurosurgery is not on the list since there are only a few number of them. And looking at Medscape Compensation Report 2017, it's the same thing, Neurosurgery did not have enough representation to be in this list. Anecdotally, Neurosurgery is one of the highest paid specialties out there. If this is something that's motivating you, which shouldn't be, neurosurgery is up there. Based on the NRMP Match Data, it's very hard to get into neurosurgery. But if this is what you want to do, start now. Make sure you have a solid foundation of your classwork. Get AOA as much as possible and get great board scores. Get those connections to neurosurgery programs. Make a great impression as you go through this process. Links: MedEd Media Network Specialty Stories Podcast Episode 20 NRMP Main Residency Match 2017 Medscape Lifestyle Report 2017 Medscape Compensation Report 2017 Charting the Outcomes 2016 The Premed Years Podcast

Session 52 This week, we're diving into the match data and cover Pathology. Interestingly, Pathology is a small field that seems to be losing interest among graduating U.S. seniors according to the data. I'm digging into the results of the NRMP Residency Match Data 2017. As you're going through the process, you can understand what this data is telling you and what you should know to help you better plot a path. [02:40] General Overview Table 1 shows the match summary. Let me clarify first that the U.S. Seniors for the NRMP match data means U.S. students in an allopathic/MD program who are still in school. So a student could have graduated from an allopathic program and now applying to residency. Maybe they didn't get in the first time or took a gap year for some reason. Caribbean students and international medical grads, foreign and U.S. citizen international medical grads are not counted as U.S. Seniors. DO students are not counted as U.S. Seniors. Back to the data, there are 159 programs in Pathology with 601 spots. It's a very small specialty. Just to give you a comparison, Anesthesiology has 1,202 positions with 124 programs. So it has less programs but double the spots. This said, Anesthesiology has much bigger residency programs than Pathology. Unfilled programs for Pathology is 33. It ranks up there with a lot of other programs that go unfilled. It's interesting to know why this is. U.S. Seniors who applied are 232 out of 601 spots. Let's say out of 150+ medical schools in total, only one and a half students per medical school are applying to Pathology. So it's not a lot of senior medical students are applying to Pathology. There are 876 total applicants for those 601 spots. Even though there were more applicants than positions, they still went unfilled. Out of the students who filled Pathology, only 36% were U.S. Seniors and 91% of all the spots were filled. Pathology does not have PGY-2 positions and it doesn't have any physician positions here. "It's a good number of programs, but very small programs." [06:25] Matches by Specialty and Applicant Type and Trends Table 2 of the NRMP Match Data 2017 shows the matches by specialty and the applicant types. Out of 601 spots in Pathology, only 545 were filled. This data is only pre-SOAP.  Let's see if they filled the programs after the SOAP. Out of the 545 filled, there were 216 U.S. Seniors who were accepted. There were 25 U.S. graduates, 32 osteopathic students, no Canadians, 57 U.S. international medical graduates, 215 non-U.S. citizen international medical graduates, and 56 unfilled spots. Table 3 shows how many spots are available each year from 2012 through 2017. Every year, it goes up by 2.1% or 2.2%. So it's a slow steady rise in the number of spots available. Table 8 shows us the number of positions offered and the percent filled by U.S. Seniors and all applicants from 2013 to 2017. There was a dip from 2015 to 2016. The number of U.S. Seniors that filled those spots went from 45.1% in 2013 to 42.9% in 2014, then 46.6% in 2015 and down to 42.8% in 2016, and further down to 35.9% in 2017. There's been a pretty sharp decline of U.S. Seniors filling up those spots. "There are less U.S. Seniors who seem to be interested in going into Pathology." Table 9 shows the number of all applicants that matched by specialty from 2013 to 2017. 2% of all students that matched, matched into Pathology. Anesthesiology is 4.1%, Emergency Medicine is 7.4%, Family Medicine is 11.6%, and Internal Medicine is 25.6%. Orthopedic Surgery is 2.6%. It's the only one that's close to compare Pathology with. Neurology is 1.7% and Medicine-Pediatrics is 1.3%. [10:42] U.S. Seniors, Osteopathic Students, Foreign-Trained Physicians Table 10 shows U.S. Seniors that matched by specialty. 1.2% of U.S. Seniors matched into Pathology. This is less than last year of 1.5% and less than a year before at 1.7%. Table 11 shows osteopathic students that matched. 2.1% of all osteopathic students matched into Pathology in 2016. While it was only 1.1% in 2017. There were 51 in 2016 and 42 this year, 2017. It was 44 in 2015 (1.9%) and 51 (2.4%) in 2014, and 2.4% in 2013. So it's going down dramatically over the years. "If you're an osteopath and you're interested in Pathology, there's another sharp decline in Pathology for osteopathic students." Table 12 shows the foreign-trained physicians that matched by Specialty. There were 272 foreign-trained physicians who matched into a PGY-1 spot for Pathology. It went up to 4.1% in 2017 from 3.3% in 2016. But the number of U.S. trained physicians is going down. [12:20] Unmatched U.S. Seniors and Independent Applicants Who Ranked Pathology as Their Only Choice Figure 6 shows the percentage of unmatched U.S. Seniors and Independent applicants who ranked their specialty as their only choice. Pathology is high up on the list for total unmatched applicants at 23.3%. That's because there's a large contingent of non U.S.citizen foreign medical graduates applying to pathology. Hence, the large percentage of unmatched total applicants. 33.5% of those are unmatched independent applicants, which are anybody other than U.S. Seniors. Only 5% unmatched U.S. Seniors. Looking back at Table 1, there are a lot of spots for a little number of U.S. Seniors applying and yet 5% of them still were unmatched. There could be a number of reasons why they didn't match. It could be that they didn't apply to enough programs. Or it could be their board scores were terrible. It could be that they didn't have enough research experience. It could be that they didn't have enough exposure to Pathology when asked why they wanted to be a pathologist. That's what residency is all about. So you can ask yourself whether you can work with this person for 80 hours a week for the next four or five years. "It's all about getting to know that person who's sitting from you on the table during the interview." [14:40] SOAP There were 31 Pathology programs that participated in the SOAP for 54 positions. If you look at Table 1, there were 56 positions that went unfilled. So two positions magically disappeared. After the SOAP, there were only 22 programs that went filled and 45 spots were filled as shown in Table 18 of the NRMP Match Data. So even after the SOAP, there were 9 positions still available. In 2016, there were 14 programs for 24 spots and all of those spots were filled. "It's telling me there are not a lot of qualified candidates for Pathology out there if these programs are going unfilled." [15:55] Charting the Outcomes 2016 Let's go to the Charting the Outcomes for U.S. Allopathic Seniors 2016. Looking at Table PTH-1, the mean number of contiguous ranks means how many students ranked before leaving a blank spot in their rank list. Those who matched had 9.9 contiguous ranks. Those who did not match only had 5.1. This shows that you have to rank enough programs if you want to match. If you're restricted by geography or some other reason, you need to be aware there's a good chance you won't match because of that. "You need to rank enough programs if you want to match." The mean USMLE Step 1 score is 233 for those who matched and 210 for those who didn't. There's a very low Step score for those who didn't match versus those who did. Mean Step 2 score is 243 for those who matched and 225 for those who didn't. The mean number of research experiences is 2.8 for those who matched and 2.4 for those who didn't. Mean number of abstracts, presentations, and publications is 5.9 for those that matched and 7.6 for those that didn't. Maybe they spent too much time writing abstracts and not enough time studying for the boards. Percentage of AOA members is 13.3% for those that matched and 0% for those who went unmatched. The percentage who graduated from one of the 40 U.S. medical schools with the highest NIH funding is 37.6% for those that matched and 12.5% for those who went unmatched. Those who have PhD degrees have 22.4% for those that matched and only 20% for those that did not match. [19:20] Medscape Lifestyle and Compensation Reports 2017 In the Medscape Lifestyle Report for 2017, Slide 2 shows the physicians who are the most burned out. Pathology is near the bottom at 43%. Psychiatry and mental health are the lowest at 42%. Slide 3 shows how severe is the burnout and Pathology is near the top at 4.4. It's a random 1-7 scale and all of them are between 3.9 and 4.6. Slide 18 shows which physicians are the happiest at work and outside of work. Pathology is pretty low for at work at 36% and 66% outside of work. In the Medscape Physician Compensation Report 2017, Slide 4 shows the average annual physician compensation. Pathology is in the middle of the pack at $293K a year. Pediatrics is the lowest at 202K and Orthopedics is the highest at 489K. Slide 5 shows who's up and who's down year over year. Pathology is higher up at 10% increase along with Orthopedics. Pediatrics is the only one that went down year over year. Pathologists feel fairly compensated at 62% as shown in Slide 18. Emergency Medicine is the highest at 68%. Slide 38 shows only 76% of pathologists said they would choose medicine again. 83% is the highest with Rheumatology and the lowest is Neurology at 71%. And for those who would choose the same specialty (Slide 39), Pathology is at 85%. Links: NRMP Match Data 2017 Charting the Outcomes for U.S. Allopathic Seniors 2016 Medscape Lifestyle Report 2017 Medscape Physician Compensation Report 2017

Session 48 Pediatrics is a primary care specialty. Usually, primary care spots are easy to match into. Does pediatrics keep up the trend? We’ll dig into their data. The reason for this episode is to give you an idea as to how hard or easy it is to match into a specific specialty. I'm getting all of this data from the NRMP Match Results and Data for 2017. An overview: When you're in medical school, you apply to match into residency in the U.S., through an algorithm-based system. The three people who created this algorithm won a Nobel Prize for it. It's not a usual job application where you apply to 40 places, get interviewed in all of them. Then whoever wants you offer you something you say yes or no. With residency matching, you rank based on what programs you like. And the programs will also rank based on who they like. And the magic happens. [02:47] General Summary of the NRMP Match Results and Data for 2017 Table 1 of the NRMP Match Results and Data for 2017 shows the general summary. Pediatrics for categorical slots have 204 programs and there are 2,738 different positions available. "Categorical means you are going for all three years to that program." They have a pediatrics preliminary (PGY-1) slots. So maybe for those who didn't match into a categorical, you can apply for a preliminary slot to make sure you're going somewhere. In this episode, we're covering mostly categorical.That means you're applying to one program for all three years for your pediatric residency. Comparing it with other specialties, Family Medicine has 520, Internal Medicine has 467, Psychiatry is 236. So there are more psychiatry programs than there are pediatric programs. Surgery is 267. Number of unfilled programs based on Pre-SOAP.  SOAP is the Supplemental Offer and Acceptance Program. The students who match in SOAP are not counted in this chart here. There were 13 programs that went unfilled in the 2017 match. That means they have at least one spot left. Out of 2,738 positions offered, there were only 2,056 U.S. Seniors applying for those programs. So almost 700 spots available for U.S. Seniors assuming your qualified for the spot. This does not count the number of DO students applying for these programs or the number of international medical graduates. The total number of applicants is 3,763 so there are a thousand more applicants than there are spots available and about 700 less Seniors. This implies that there are a lot of international graduates likely applying for the spots. "This is an MD data. The U.S. Seniors in this chart means students at an allopathic medical school." Of those that matched, there were 1,849 U.S. Seniors. There are still 200 U.S. Seniors that applied and did not match. Why? There could be several different reasons for that. Their board scores were terrible. Pediatrics is not a board-heavy specialty but it doesn't mean you can bomb your boards and match. Or maybe they're a bad interviewer or didn't apply to enough programs. Again, 700 fewer U.S. Seniors were applying for the spots but a thousand more total applicants than there were spots available. [08:50] Table 2: Matches by Specialty and Applicant Type Table 2 of the NRMP Match Results and Data for 2017, out of 2,738 positions, number filled 2,693. That's 45 spots that went unfilled. U.S, Seniors that matched were 1,849. So there were 889 left for other applicants. 24 went to U.S. Grads. Again for this data, U.S. Seniors are students who are currently at an allopathic medical school. A U.S. grad is somebody that's already graduated from an MD-granting medical school. These could be students who didn't know what they wanted to do so they did more shadowing or research. Or these could be former students who didn't get in previously. Moving on, there were 361 allopathic students that got into a Pediatrics (Categorical) residency and two students were Canadian.  It doesn't mean a Canadian at a U.S. school means a Canadian graduate. When you look at the overall numbers, only 7 total Canadian graduates got into a PGY-1 position and two of them went into Pediatrics. There were 204 U.S. IMGs (International Medical Graduates). This is somebody who's a U.S. citizen who went to an overseas school - the Caribbean, Israel, Australia, Scotland, or wherever that may be. And 253 were non-U.S. citizen international medical graduates. Lastly, there were 45 spots that went unfilled for the Pediatrics (Categorical) rotation. "Good for allopathic and U.S. IMGs since there's still a big opportunity for you to go into Pediatrics." [12:13] Trends in the Match Program (2013-2017): Growth, PGY-1, Osteopathic Students Pediatrics is growing pretty substantially to about 10% every year from 2013 to 2017. 2013 started off at 2,616 and there were 2,738 in 2017. It's between 9.5% and 10% growth year after year. Figure 5 of the NRMP Match Results and Data for 2017 shows just how big Pediatrics is. Internal Medicine has the most positions offered followed by Family Medicine and Pediatrics is third at 2,821 and 2,775 of those were filled, and 1,880 were filled by U.S. Allopathic Seniors. Table 8 shows the Percent Filled by U.S. Students and All Applicants. In 2017, 67.5% were filled bu U.S. Seniors. And in 2013, 70.2% were filled. It has gone down a little bit for the last couple of years. It's not a huge shift but it's showing you that it's roughly the same every year. "When you look at the average total PGY-1 slots being filled by U.S. Seniors, 60.6% is the average based on all of them." Table 9 shows that 9.7% of all applicants matching into a PGY-1 specialty are categorical Pediatrics. Just for comparison, Family Medicine is 11.6%, Internal Medicine is 25.6%, OB/GYN is 4.7%. Table 11 shows that 12.3% of all osteopathic students an allopathic PGY-1 position program match into Pediatrics. Family Medicine is 19.6%. 23.5% of osteopathic students match into Internal Medicine. [16:37] % of Unmatched U.S. Seniors and Independent Applicants and SOAP For this data, independent applicants refer to IMGs and osteopathic students. For Pediatrics, the total unmatched is 12.4%. The unmatched independent applicants is 30.5%. It's very heavy with independent applicants. Unmatched U.S. Seniors is only 2.3%. In comparison with other specialties, Internal Medicine/Pediatrics shows 0.5% of U.S. Seniors are unmatched. Surgery (Prelim) is 1.3%. Surgery-General is 9.6%. Neurosurgery at 10.4%; Orthopedics at 15.1% for unmatched U.S. Seniors. So pediatrics is relatively low as you would expect. Table 18 shows the programs and positions filled in the SOAP program. SOAP (Supplemental Offer and Acceptance Program) is for students who didn't match in the first go round. This used to be called Scramble. There were 12 programs in Pediatrics that did not fill and participated in the SOAP program. 44 positions were available and all spots were filled through the SOAP program. "In Table 2, it looks like there's unfilled spots. But that doesn't count the SOAP and filling those spots through the SOAP." [18:44] Charting the Outcomes in the Match 2017: Apply Broadly Now, we dig into the Charting the Outcomes in the Match for U.S. Allopathic Seniors in 2016. It displays the information a little bit different so it's very interesting to look at. Chart 4 shows the Median Number of Contiguous Ranks for U.S. Allopathic Numbers. For Pediatrics, students who did not match only have 3 programs contiguously ranked. While those that matched ranked 12 programs. "This is going to be the theme of matching or not matching for every specialty. You need to rank enough programs to match." This being said, you cannot be super selective with programs where you're applying to match. You have to apply broadly. Just like medical school where the average number for the AMCAS applications is 14-15 as well as for DO schools. The same goes for your rank list when applying for residencies. The biggest mistake you can make is not ranking enough programs. Chart 8 looks at the Mean Number of Research Experiences for U.S. Allopathic Seniors that matched and did not match. The numbers are almost identical - 2.4 for those who did not match and 2.5 for those that matched. Chart 12 shows the percentage of U.S. Allopathic Seniors who are members of the AOA. In pediatrics, 16% of the Seniors that matched are members of AOA (Alpha Omega Alpha), the U.S. MD Premed Honor Society for Medical Students. In comparison with other specialties, Dermatology is 53%, Plastic Surgery at 52%, and ENT at 45%. "AOA is very much tied to the more competitive specialties." [22:44] Mean Number of Contiguous Ranks, USMLE Step 1 and Step 2 Scores Still looking into the Charting the Outcomes in the Match for U.S. Allopathic Seniors in 2016, PD-1 (Page 159 of 211) shows the summary statistics on U.S. Allopathic Seniors  for Pediatrics. The mean number of contiguous ranks for those that matched is 11.9 and for those that did not match is 4.0. Again, you have to rank enough programs. Mean USMLE Step 1 Score is 230 for those that matched and 207 for those that did not. Mean Step 2 Score is 244 for those that matched and 224 for those that did not match. Graph PD-1 (page 161 of 211) shows the curve of the probability of matching which is around 64% if you only ranked one program. 70% for two programs. Roughly 75% for three programs. 83-84% for four programs. The more programs you rank, the better your chance will be, even up to a 100% of matching at around 13 programs ranked. [24:14] Medscape Lifestyle and Physician Compensation Reports 2017 The Medscape Lifestyle Report 2017 looks at which physicians are most burnt out. Slide 2 shows that Pediatrics is right above the halfway point at 51% with Emergency Medicine as the highest at 59%. As to how sever the burnout is, Slide 3 shows that Pediatrics is on the lower end at 4 on a scale between 1 as the lowest and 7 as the highest. Which physicians are the happiest? Slide 18 shows Pediatrics is higher up at 36% happiest at work and 70% happiest outside of work. Based on the Medscape Physician Compensation Report 2017, Slide 2 shows that overall, Specialties earn $316k while Primary Care (where Pediatrics is a part of) is $217k. Who has the highest average annual physician compensation? Slide 4 shows that Orthopedics is at $489k and Pediatrics is the lowest at $202k. If you've listened to our previous episodes where we talked to pediatric specialists, on average, they say they're always paid less than their adult counterparts. It's still a great salary though. "On average, they all say that pediatric specialties are always, always, always paid less than their adult counterparts." Slide 5 shows Who's Up, Who's Down and Pediatrics is the only one that went down by 1%. Interestingly, even though Pediatrics is the lowest paid specialty, more than half of the physicians feel compensated at 52% as presented in Slide 18. In Emergency Medicine, 68% of them feel fairly compensated while Nephrology is the lowest at 41%. Would you choose medicine again? Slide 38 of the Medscape Physician Compensation Report 2017 shows that the highest is Rheumatology at 83% and the lowest is Neurology at 71%. Pediatrics is at 78%, right in the middle of the pack with everybody else. Slide 39 shows who would choose the same specialty again. Dermatology is the highest at 96% where they say they would choose the same again and Internal Medicine is at the lowest at 64%. For Pediatrics, 81% of them say they would choose the same specialty again. [27:44] Final Thoughts If you're interested in going into Pediatrics, these are great information to figure out what you want to do with your career moving forward. Additionally, if you know a physician that you want me to talk to, shoot me an email at ryan@medicalschoolhq.net. I'm always looking for a guest for this podcast. If know someone on Facebook or Instagram, reach out to them and let them know about me. Put us in contact. Links: NRMP Match Results and Data for 2017 Charting the Outcomes in the Match for U.S. Allopathic Seniors in 2016 Medscape Lifestyle Report 2017 Medscape Physician Compensation Report 2017 ryan@medicalschoolhq.net

Physician burnout is a big issue in the medical community. According the the Medscape Lifestyle Report 2017, over half of physicians report burnout. But physician burnout isn’t just a problem for physicians. It is a problem for patients, for other medical staff, and for the health care economy. Today we dig into the causes of physician burnout and how it can be addressed. Here’s a hint: It doesn’t involve meditation or counseling. Resources: Medscape Lifestyle Report 2017 2 Docs Talk About Pricing Transparency 2 Docs Talk About Medicare for All 2 Docs Talk About Drug Pricing Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

Session 37 This week, we take a deep dive into the match data for dermatology. We cover the Match data from 2016 and 2017 to give you an idea of what you're up against. Dermatology is one of the hardest specialties to match into. Historically, it has been known as the ROAD specialties (Radiology, Orthopedics, Anesthesiology, and Dermatology). "Dermatology is still one of the more competitive residencies to apply to as a medical student." As we dive into this data, it gives you an idea of what you should be thinking about or doing when it comes to starting your journey. Hopefully, this will help you determine how much effort you put into getting the best possible board scores and everything else you need to get into dermatology. Also, check out everything we have at MedEd Media Network including The Premed Years Podcast, OldPreMeds Podcast, and The MCAT Podcast. [01:51] Match Summary As always, all of this data come from the NRMP Main Residency Match Results and Data First off is Table 1 which shows the summary of the match. It starts with PGY-1 positions and Dermatology has 11 programs, 26 positions. Don't freak out since there are actually a lot more dermatology spots offered. Dermatology has a prelim typically a medicine or transitional or surgery year that you do before you start your dermatology residency. As a medical student when you are applying to dermatology, you need to apply typically to a dermatology residency. This starts at PGY-2. Then you apply for a prelim year or an internship year which is your PGY-1 year at either a medicine, surgery or transitional program. So you can't go look at those numbers on Table 1 alone. Instead, go down to the continuation of Table 1 which shows the PGY-2 positions. There you will will see they have 121 programs and 423 positions offered. Looking at this chart across the column, the total number of U.S. Seniors applying out of those 423 spots is 479. So there are more U.S. Seniors than there are spots available. For this purpose, U.S. Seniors for the NRMP refer to students who are in an allopathic/MD medicine program and they're still in school. Now, out of those 479, 81.8% matched into Dermatology. That's a pretty good number and it's one of the higher numbers around. "If you are a DO student or an international medical grad, your chances are already starting off not that great." [05:00] U.S. Seniors, U.S. Grads, Osteopaths, and U.S. IMGs Table 2 shows that out of 423 positions, 415 were filled on the main match. 346 of those 415 were U.S. Seniors, 48 were prior U.S. grads, which means prior MD graduates. These are those that possibly didn't match their first time around and then reapplied. Or maybe they didn't apply to a residency program the first time around because they weren't very competitive. They wanted to do some research. Maybe they really wanted to go to one specific program so they went to do some research in that program, reapplied, and got in. There were 7 osteopathic students which makes up less than 2% of the 415 spots that were filled. It a very low number. Just to give you an idea, let's look at other specialties. Anesthesiology has 1,146 spots, 164 of which were osteopathic students. That's over 14% of Anesthesiology but less than 2% for Dermatology. It's possible there's still some bias tin the Dermatology world for DO's. There were 3 International Medical Graduates or IMGs who are U.S. citizens that went to a foreign or international medical school and 11 were non U.S. Seniors or non U.S. citizens that went to an international medical school. So it's high numbers for U.S. Seniors and good numbers for U.S. grads. Not good numbers for osteopathic students, and terrible numbers for U.S. International Medical Graduates. Lastly, it's pretty bad numbers for non-U.S. citizen international medical graduates. "High numbers for U.S. Seniors and good numbers for U.S. grads. Not good numbers for osteopathic students." [07:20] Growth Trends, Unmatched Applicants, and SOAP Table 3 shows the growth trend of each specialty from 2013 to 2017. Dermatology has been growing and growing with 13.3% in 2013. In 2017, there was a 15.8% year over year growth. There were 399 spots in 2016 and 423 in 2017. There are more and more programs opening up for Dermatology which is good for you if you're interested in Dermatology. "There are more and more programs opening up for Dermatology." Figure 6 looks at unmatched U.S. Seniors and independent applicants ranking all the different specialties. Dermatology ranks up as the second highest for all of the programs with 33.8% total unmatched. The majority of that are the independent applicants. They're outside of the U.S. Seniors and those were 47.3%. Almost half of the applicants were applying independently. Again, these are the IMG's and osteopathic students. I assume the U.S. grads are included here as well. The U.S. Seniors that went unmatched made up 13.8%. At a quick glance, it's the third highest behind Plastic Surgery and Orthopedic Surgery. So Dermatology is very, very competitive. Looking at Table 18 is the SOAP (Supplemental Offer and Acceptance Program) process, for PGY-2 positions, Dermatology had four positions available and all four were filled. [09:48] Ranking, Steps 1 &2, Research, AOA Chart 4 is one of the most telling charts when it comes to residency matching. When you match or apply to match, it depends on what programs you're applying to. A lot depends on how many program you are ranking. It's a big algorithm that matches you to programs. "You submit a rank list. Schools submit a rank list. And the magic happens." The median number of contiguous ranks is eight. This means that student that matched put Dermatology program eight times in a row. Those who did not match was only three. So you have a much lower chance of matching if you are much more selective when it comes to matching. The same goes if you're also being selective with the programs your'e applying to or you're interviewing at. Or you're not a competitive applicant and you didn't interview at a lot of program so could not select a lot of programs to actually match to. A lot of it comes down to how many programs you ranked. It's a numbers game. You apply to more medical schools, your chance goes up. You apply to more residency programs, your chances goes up. The same with fellowship programs. Chart 5 dives into the mean number of different specialties ranked. Typically, if you want Dermatology, apply to Dermatology programs. "If you have a Plan B, you're less likely to succeed in your plan A." There's a lot of psychology research that shows having a plan B decreases the likelihood for your Plan A to succeed. But the data here shows that those who matched in Dermatology applied to a mean number of 2.2 different specialties and those that didn't match is 2.3. So the numbers are not very off. This could be skewed since in dermatology, you have to apply to a categorical or prelim year. I wonder if that data is being included in this. It doesn't mention anything in the graph data, but I wonder if that's the reason the numbers are so high at 2.2. It's much higher than everything else except for radiation oncology. Looking at Table DM1, it gives us all the hard data behind Dermatology. The mean number of contiguous ranks is 8.9 versus 4.2. Mean number of Distinct Specialties was 2.2 versus 2.3. The mean USML Step 1 score was 249 for those that matched and 239 for those that didn't match. The mean Step 2 score is 257 to those that matched and 246 to those that didn't match. Sometimes, Step 2 score isn't really that useful. But the Step 1 score is huge here. The mean number of research experience is 4.7 for those that matched and 3.8 for those that did not match. Mean number of abstracts, presentations, and publications is 11.7. You need to get out there. You need to do your research. "You need a very, very strong Step 1 score and a strong Step 2 score... you need to do your research." AOA  (Alpha Omega Alpha) comprised 2.8% of those that matched. This means they were very successful in their medical school classes early on. Their pre-clinical is 52.8% of those that matched and only 25.8% for those who did not match. Chart DM2 shows those that matched versus those that didn't with the number of contiguous ranks. You can clearly see that those that did not rank a lot of programs did not match. Then as soon as you get past that eight mark, it goes down. And after eight, only six people didn't match. So you have to rank a lot of programs. "You have to be competitive enough to get interviews and to rank a lot of programs." [15:40] Medscape Lifestyle and Medscape Physician Compensation Report The Medscape Lifestyle Report 2017 talks about the lifestyle of a Dermatologist. As to which physicians are the most burnt out, Dermatology is near the bottom at 46%. (See Slide 2)The lowest is Psychiatry at 42%. As to how severe is the burnout, Dermatology is hanging at the top at around 4.3. Highest is 4.6 with Urology. (See Slide 3). Slide 18 shows which physicians are the happiest and Dermatology is number three on the list at 43% happy at work and 74% are happy at home. The Medscape Compensation Report 2017 is the fun part. Highest salary is Orthopedics at $489K a year. Dermatology is number eight on the list at $386K. Below Orthopedics are Plastic Surgery, Cardiology, Urology, Otolaryngology, Radiology, Gastroenterology, and Dermatology. These are the top eight and all of these are procedure-based specialties. (See Slide 4) "The way our healthcare system is set up, those who perform procedures and do surgeries are compensated with more money." Even if what you're interested in is not within these eight, that's okay. You'd still make a good living as a physician. The lowest on this list is pediatrics at $202K. Dermatology pay according to this survey on Slide 5, only went up 1% (See Slide 5). Which physicians feel fairly compensated, Dermatology is the second highest at 65% (See Slide 18). Looking at slide 38, those who would choose medicine is up there at 80% and the highest is 83%. So Dermatologists are happy. They like being a doctor. They would choose it again. Who would choose the same specialty? Slide 39 shows it's Dermatology. They love their jobs. If you want to be a dermatologist, it might be good for you to check out Dermatology. [19:25] Be an Intern I'm looking for an intern. If this is something you're interested, email me at ryan@medicalschoolhq.net. I'm looking for one savvy for social media who can oversee my social media accounts and help me go out and find physicians to interview here on the podcast. It would be a great help to me and we can turn this into an extracurricular for you. We'll figure out a way to make it worth your time in helping this show succeed for every premed student, medical student, and even for residents out there looking for fellowships. In the subject line, kindly place Specialty Stories Intern. And I will get back to you as soon as you can. Links: MedEd Media Network The Premed Years Podcast OldPreMeds Podcast The MCAT Podcast NRMP Main Residency Match Results and Data Charting the Outcomes 2016 Medscape Lifestyle Report 2017 Medscape Compensation Report 2017

Session 30 This week, we're doing a deep dive into the 2017 Ophthalmology Match Summary Report which is actually outside the NRMP match. The match is the program you apply to while in your medical school to determine where you're going to do your residency. The people that made the algorithm actually won a Nobel Prize for it and it's used in a lot of different things now other than the match. However, not every specialty participates in the main ERAS match which stands for Electronic Residency Application Service put on by the NRMP (National Resident Matching Program). Most specialties are part of the main match so when you hear "The Match," this is what most people are talking about. Today, we're covering Ophthalmology, the rare exception that does not participate in the normal match but it's done by the SFMatch system. While normal medical student match for their specialties in march, students applying for Ophthalmology match in January. [03:30] Spots Offered, Filled, and Left Looking at Page 2 of the Ophthalmology Match Summary Report 2017, they have data going all the way back to 2008 so it's nice to see a ten-year data for matching. In 2008, there were 454 spots offered and 468 in 2017. It hasn't been growing a ton and what's interesting is the number of spots left open after the match which is 1 in 2008 and 6 in 2017. Ophthalmology is typically one of those residency matches that are very competitive and the fact here are 6 left. "Keep that in mind when you are applying for other residency programs that the match data the NRMP gives out shows that those that don't match are typically not ranking enough programs." As for Ophthalmology, there are 6 spots left probably because students weren't applying broadly enough. Everybody wants to be in New York or California and nobody things about the "flyover" states in the middle of the country. If you are flexible, this is a big opportunity for you to look at those other options as well. [05:35] Means for Matched and Unmatched The matched mean for 2017 was 243, which is a very high number, and the unmatched mean is 227. Once you're in medical school, you know that the MCAT and GPA are important but usually, a strong application can help overcome some deficiencies in some areas. But this is one of the unfortunate things with the match is that when it comes to matching. "Your Step 1 score or COMLEX Level 1 score for DO's is basically it. It's a huge part of your application and it's what opens the doors for you for these competitive residencies." [06:50] Allopathic and Osteopathic Students Still found on Page 2 of the data, the U.S. Allopathic Seniors made up 80% of those that matched in Ophthalmology. U.S. Allopathic Graduates were 7%. So 87% of all the physicians that matched were from U.S. MD schools. 4% were from osteopathic schools. "For you DO's out there, it's a slimmer chance but there is the opportunity." You can't just base on this data to say that you're not going to a DO school because that's not always the case. This doesn't mean you shouldn't go to an osteopathic school. It just means it's going to be harder for you to go into ophthalmology if you go to a DO school. There could be a number of reasons why it's harder. Probably it's because you don't have exposure to academic medical center where most of these ophthalmology residencies may be. So you're not getting the exposure MD students are going to get. Or it could be because you need to travel around a bit for your clinical rotations so it's harder to build relationships with program directors and get that experience and research. So if you're in a DO school, don't give up on being an ophthalmologist. Just think through what else you may need to do. [09:10] U.S. Allopathic and Osteopathic Seniors and Graduates Looking at Page 3 of the data, 26% of U.S. Osteopathic Seniors matched. It's interesting to note that while 34 registered for the match, only 19 participated in the match and 5 of those matched. Comparing that to 89% of U.S Allopathic Seniors that matched, it's a big difference. For U.S Osteopathic Graduates who are DO students that took some time off probably to do some research or maybe they didn't match in the prior year, nobody matched while for US Allopathic Graduates, 19 matched which makes up 44%. These are those who graduated from an MD school and went off to do the research to strengthen their application. 36% of International Graduates matched which is a higher number than osteopathic students. Again, this does not mean that you should go to a Caribbean school because your chances are higher just because you based it on these numbers. Interestingly in 2016, U.S. Osteopathic Seniors made up 41% match rate versus 23% for International Applicants. [11:25] Choosing Your School This is the key reason why I don't recommend, if you're premed, looking at match data to choose where you go to medical school because it varies from year to year, student to student, class to class. It has nothing to do with the school. It could be affiliated with the top ophthalmology residency and you get great exposure and it's going to increase your chances of getting into an ophthalmology residency but it's you that goes out to form that relationship with the residency program and form that network with the other residents, program directors, and the attending physicians.It's you that goes out to get those letters of recommendation. It has nothing to do with the school. It's you that does well on your boards and goes out and networks and builds those relationships to match in a competitive program. "Don't look at the school match list to determine where you should go to school." [12:40] Average Number of Applications Page 4 shows the Average Number of Applications per Matched Individual which is 70 in 2016 and 72 in 2017. Applying to medical schools, most people are freaking out over 20. This is 70. It's not as bad as medical school where you're writing secondaries for every school. "If all these 70 schools want interviews with you, that's a lot of travel, a lot of money." Compared to USMLE NRMP data where the matched versus unmatched usually has a big divide, for Ophthalmology match in 2016, those that went unmatched applied to 73 programs, which is just 3 programs more than those that matched. In 2017, there were 72 average number of applications per matched individual versus 67 for those that did not match. [14:20] USMLE Step 1 Scores The USMLE Step 1 Scores Information is shown on page 7 of the data. From an average USMLE Step 1 score of 232 for those that matched in 2008, it went up by 11 points to 243 in January 2017. For those unmatched, the average USMLE Step 1 score was 212 in 2008 and 227 in 2017, which went up by 15 points. When you see numbers like this, it means it's getting more and more competitive. It was even higher in 2016 with 244 that matched and 229 for unmatched. “If you're thinking about Ophthalmology, research is important as well as getting those connections, getting those relationships, and Step 1 scores are obviously huge.” [16:00] Medscape Lifestyle and Physician Compensation Reports Based on the 2017 Medscape Physician Compensation Report, Ophthalmology is a little bit higher at $345K for average annual physician compensation. Orthopedics is at the top at $489K. Around Ophthalmology is General Surgery at 352K and Emergency Medicine at $339K. Ophthalmology had a 12% increase in their compensation from last year. For the percentage of physicians that feel fairly compensated, Ophthalmology is at 53%. Whether they would choose medicine again, Ophthalmology is on the higher end at 79% and whether they would choose the same specialty again, Ophthalmology is there near the top at 93% so they seem to like their job. Moving on to the Medscape Lifestyle Report 2017, Ophthalmology is near the bottom of burnout at 43% while Psychiatry is the lowest at 42%. As how severe is burnout, it's still near the bottom at 4 on a scale of 1-7. As to which physicians are the happiest, ophthalmologists are the second happiest at 74% outside of work and 42% at work. [18:20] Final Thoughts Ophthalmology residency is outside of the normal match (ERES/NRMP) which is through SFMatch. They match earlier in January instead of March for the NRMP. Check out the SFMatch.org for more information including some links and FAQs. They have lots of good information to help you get ahead so come match time, you're not surprised with information at the last minute. Links: SFMatch.org 2017 Ophthalmology Match Summary Report 2017 Medscape Lifestyle Report 2017 Medscape Physician Compensation Report NRMP

Session 27 This week I'm breaking down and reviewing the match data for OB/GYN. There are a handful of surgical specialties thought to be a good mix of medicine and surgery specialties. OB/GYNE is one of them along with ophthalmology, urology, and ENT. If OB/GYN interests you, take a listen to this episode to see what you need to do! [02:30] Match Summary Table 1 of the NRMP Main Match Data 2017 shows the summary of the match and OB/GYN is listed separately from everything else having its own category. There are 241 OB/GYN programs. Compared to other specialties, Surgery has 267 programs, Internal Medicine has 467 programs, Emergency Medicine has 191 programs. While OB/GYN has 241 programs, there only 1, 288 spots available compared to Emergency Medicine with 191 programs but there are 2,047 spots. That's almost 800 more spots even if there are 50 less programs. Hence, there are less spots per program in OB/GYN. Out of those 1,288 spots, there were 1,202 U.S. Senior applicants. This means there are less of them applying than there are spots available which is a good thing. (For our conversation, U.S. Seniors based on this data specifically talks about allopathic medical students. The NRMP is the match for allopathic medical schools.) There are a total of 1,753 students applying. Aside from U.S. Seniors, there could be physicians in another country applying for OB/GYN residency here in the U.S. They could be Caribbean grads, DO students, etc. Only 81.4% of the U.S. Seniors matched so out of 1,202 U.S. Senior applicants, only 1,049 matched and 153 did not match. There could be a number of reasons students are not matching for residency. Maybe they weren't competitive enough or they interviewed poorly. Or maybe they didn't apply to enough residencies or performed poorly on their audition rotations. [05:45] SOAP and PGY-1 For OB/GYN total, 100% of spots were filled. If for some reason you're trying to Scramble, which is now called SOAP, for OB/GYN in 2017, there were no spots available. There are only 19 PGY-1 OB/GYN spots, Typically, for OB/GYN spots, you have medicine, surgery, or a transitional year which is a mix of medicine and surgery. It's pretty interesting that OB/GYN has a prelim year. This is for the students that need to SOAP and the students that didn't match maybe they were able to get a PGY-1 spot. However, there is no discussion about OB/GYN having any PGY-2 positions. I'm wondering what happens to these students once they finish their PGY-1 spot. So there were 19 programs and 23 positions offered, which seems to be just an extra spot for interns, and then 8 programs went unfilled. 142 U.S. Seniors applied and 202 total applicants and only 6 U.S. Seniors matched. As to why this is the case, they probably applied to both categorical OB/GYN spot and the prelim spot so you get a lot more applicants to the PGY-1 spot that hopefully matched in the categorical and didn't need to go onto the prelim year. If that's the case, they wouldn't have matched in terms of how the algorithm works because they are two different programs. [09:00] Specific Applicants and Trends Table 2 shows who matched in the specialty. For OB/GYN, there are 1,288 spots for the categorical programs and all spots were filled. 1,049 were filled by U.S. Seniors so 81.4% of all spots went to U.S. Seniors who are those still in school. 11 of those spots went to U.S. graduates who are students that went to an allopathic or MD school who aren't in school anymore that possibly reapplied or took a year off to do some research. There are 123 osteopathic/DO students matched into an allopathic OB/GYN categorical spot. Outside of the U.S. allopathic and osteopathic students, 64 U.S. IMGs matched into an allopathic OB/GYN categorical spot and 41 non-U.S. citizen IMGs matched. So 105 graduates from a non-U.S. medical school matched. Table 3 shows the growth of programs year over year (2013-2017). For OB/GYN, it's been growing around 4.5-4.7% every year and this is a good pace. Table 8 shows the percentage of applicants filled by U.S. Seniors from 2013-2017. 81.4% of those that matched were U.S. Seniors in 2017, 77.5% in 2016, 79.8% in 2015, 76.5% in 2014, and 76.2% in 2013. Table 9 shows how popular OB/GYN is compared to all of the other specialties. 4.7% of all applicants who matched, matched into OB/GYN. To give you an idea of what that looks like, 7.4% matched into Emergency Medicine, 4.1% into Anesthesiology, 5.4% into Psychiatry categorical. Table 10 looks specifically at U.S. Seniors who matched by specialty. 6% of all U.S. Seniors matched into OB/GYN. This is a good number. Table 11 shows osteopathic students who matched into OB/GYN.  4.2% of all osteopathic medical students matched into OB/GYN. Table 12 shows foreign-trained physicians (international medical graduates) and only 1.6% of IMGs matched into OB/GYN. This makes sense since more of the subspecialties are harder to match into as an international medical graduate. Now compare this to 46% of all IMG's matching into Internal Medicine. Just to give you a comparison here for students who matched into Internal Medicine, Osteopathic students make up 23.5% (Table 11) and 25.6% for all applicants (Table 9) and 18.6% were U.S. Seniors. 25.6% of all applicants is kind of held up by the International Medical Graduates leaning into Internal Medicine. [14:36] Applicant Choices by Specialty, Matched and Unmatched Table 13 shows the applicant choices by specialty. For OB/GYN with 1,288 total positions available and all of them matched. 968 of U.S. Seniors that matched only ranked OB/GYN programs. 198 U.S. Seniors ranked OB/GYN as their first specialty and they had a different specialty after that. 36 students U.S. Seniors had a different specialty before OB/GYN. This is common but I personally can't understand ranking more than one career. This is your residency training. This is your specialty. While yes, it is possible to change careers at some point, don't you only want to do it once? I wonder how it feels like to open up your envelop seeing you matched into the specialty you didn't rank first. My advice is try to narrow it down to one program because the data shows that when you rank more than one program, it starts to work against you. There's probably some psychology working in there but it's interesting information. Table 14 shows the ones that actually matched who ranked their specialty as their only choice. For OB/GYN, there are 890 that matched out of the 968 that applied as their only choice. Figure 6 shows the percentages of unmatched U.S. Seniors and independent applicants who ranked their specialty as their only choice. OB/GYN is near the bottom for total unmatched percentage at 15.4%. This is pretty good since we covered Physical Medicine and Rehabilitation before and their unmatched rate is 27.5%. Family Medicine is 25.3%. The majority of those unmatched applicants are the independent applicants. Unmatched U.S. Seniors is very small at 8.1% for OB/GYN (Pls. refer to Table 14). Compared to other specialties, this percentage is on the higher end of U.S. Seniors unmatched. Anesthesiology is only 0.9% of U.S. Seniors, Internal Medicine is 0.5%, PM&R is 7.1%. So even though the total unmatched rate is 27.5% for PM&R and OB/GYN is 15.4%, the U.S. Seniors unmatched is still pretty high at 8.1%. Table 18 covers SOAP information for 2016-2017 and as mentioned earlier, the 1,288 spots available for OB/GYN went completely filled. When you look at this, Table 1 shows you all of those that matched pre-SOAP and if there are no programs available based on table 1 then obviously, no programs are available for the SOAP. With the OB/GYN prelim year (PGY-1), there were 8 programs, 9 spots available and 8 of those spots went filled. [20:27] Charting the Outcomes 2016 Looking at Chart 5 of Charting the Outcomes 2016, the students that did not match were equal to or more than the number of different specialties ranked. Those that did not match rank more specialties in their match list than those that did match. So you're focusing your efforts on too many different places instead of honing in on one and putting all your cards on the table for one specialty. Based on the data, it shows that those who spread out too thinly and applied to more programs didn't match whereas those who applied to fewer programs actually matched. Hence, focus your energy on one specialty. First, note that there is an overlap with a lot of different specialties. For example, diagnostic radiology can be very similar to interventional radiology. Chart 8 shows the mean number of research experiences from U.S. Allopathic Seniors and OB/GYN is higher for those that matched at 3.2, a decent number right in the middle of the pack. Orthopedic surgery is at 4 and Otolaryngology (ENT) is at 5.1. Those that did not match for OB/GYN had 2.8 so not a lot fewer. Chart 12 shows the percentage of U.S. Seniors who are members of the AOA (Alpha Omega Alpha), the honor society for medical students. For OB/GYN, 15% matched while 2% of those that did not match were AOA. [23:25] Contiguous Ranks, Step 1 & 2 Scores, Top 40 Schools Moving down to the OB/GYN specific information Table OB-1 (Page 123), the mean number for contiguous ranks that matched was 12.5. If you've listened to any of these deep dives before, you will know that this is one of the key indicators of who's going to match and who's not. You are more likely to match when you rank more programs. Those did not match had 6.7 mean number of contiguous ranks. So those who matched almost doubled than those who did not match. For those that matched, the mean Step 1 score of those that matched was 229 versus 214 for those that did not match. Mean Step 2 score was 244 for those that matched while 230 for those that did not. The tenth on the list indicates the percentage who graduated from one of the 40 U.S. medical schools with the highest NIH funding. I get a lot of students asking if it matters where to go to medical school and the I always tell them it doesn't matter unless you have aspirations of being a top academic person at Harvard or Stanford and then think about going to some of those more elite schools. But for OB/GYN, specifically, 31.2% of those that matched came from one of those 40 schools. This goes to say that most of the students are coming from somewhere else. You don't have to go to an elite school to match into OB/GYN. On the other hand, 29.8% of those that did not match went to one of the top 40 U.S. medical schools based on NIH funding. To me, this doesn't tell anything about the quality of schools, it just means the school does a lot of research and it's good at writing grants for money. [26:25] Medscape Lifestyle and Compensation Reports 2017 Looking at the Medscape Lifestyle Report, it tells us that OB/GYNs are pretty burned out, being the second highest on the list at 56% next to Emergency Medicine at 59%. Slide 3 shows the severity of burnout and OB/GYN is near the top at 4.3 in a scale of 1 to 7 (where 1 equals "It does not interfere with my life" and 7 equals "It is so severe that I am thinking of leaving medicine altogether.") When you look at all of the specialties listed here, none of them dropped below 3.9 so it seems everybody is on the way out. This is one of the questions for premeds out there, why do you want to enter this? You have to be ready to answer that question on your interviews. Slide 18 shows which physicians are the happiest, OB/GYN is right in the middle at 69% happy outside of work and 32% happy at work. Moving on to the Medscape Compensation Report 2017, OB/GYN is near the middle but lower than half at $286K as the average annual physician compensation. Orthopedics is first at $489K and Pediatrics at the very bottom at $202K. Slide 18 shows which physicians feel fairly compensated and OB/GYn is near the bottom at 48%. Whether they would choose medicine again, OB/GYN is second from the bottom at 72%, just above Neurology at 71% while Rheumatology is on top at 83% followed by Psychiatry at 82%. Whether they would choose the same specialty again, OB/GYN is pretty near the bottom at 76%. It looks like not a lot of OB/GYNs are happy with their chosen specialty. [29:30] Final Thoughts With a lot of OB/GYN not very happy with their career, more so, not choosing the same specialty again. But information is power. Knowledge is power. So take this information and use it to your advantage. A lot of people go into specialties not knowing enough about the specialty or what their life is going to be like and this why we have this podcast. Take this information and use it so you can best make an informed decision. Links: NRMP Main Residency Match Results and Data Charting the Outcomes 2016 Medscape Lifestyle Report Medscape Compensation Report MedEd Media Network

Session 19 Today, I'm going to do a deep dive into some match data for Orthopedic Surgery, which is one of the more competitive specialties out there. Let's look at the data to see if this holds true and find out who you can set yourself up for success early on if this is something you’re interested in. In general, Orthopedic Surgery is a surgical specialty. It's a five-year residency with a lot of subspecialties after that. I had Dr. Muppavurapu to talk about being a hand surgeon back in Episode 05 and he talked about the many other things you can do like joints, spine, hand, and so much more. Today we're going to talk generically about ortho residency matching as a medical student. [02:55] Number of Programs, Spots, U.S. Seniors NRMP is the MD application. (If you're reading this way in the future, words like ACGME and AOA won't really mean much because the MD and DO residency programs will have merged assuming all goes well as planned out for 2020.) Looking at Table 1 for the NRMP Results and Data 2016 Main Residency Match, there are 163 programs in the country for orthopedic surgery. Just to give you an idea of the number of programs for other specialties, Anesthesiology had 119 PGY-1 spots and 77 PGY-2 spots, a total of 196 compared to 163 for Orthopedic Surgery. Neurosurgery had 105 programs, Emergency Medicine had 174 programs. This somehow gives you an idea of how many programs are out there for Orthopedic Surgery. Another important number to look at here is the number of spots available. Orthopedic Surgery had 163 programs with 717 different spots available so that's average of 4.398 spot per program. Comparing to other programs, Emergency Medicine had only 11 more programs but more than double the number of spots offered. Out of the 63 programs for Orthopedic Surgery, none of the programs went unfilled. Many residency programs here had 100% fill rate so it's not unusual but again, an important thing to keep in mind. As you think about your specialty, how competitive is it for you to match into? How spots are going to be available? If you don't match for some reason, can you do the Supplemental Offer and Acceptance Program (SOAP)? Can you find an open program? For something competitive like Orthopedics, you probably won't be able to find one and it's going to be much, much harder for programs that typically go completely filled. There were 717 available spots while there were 1,058 total applicants. 874 of those were U.S. Seniors. Note that the number of U.S. Seniors applying are even more than the spots offered. Out of the number of students that matched, 650 were U.S. Seniors. That means U.S. Seniors make up 90.6% of students that matched into orthopedic residency. U.S. Seniors here are allopathic U.S. Seniors (students at MD Programs). Ortho do not have any programs that match directly into PGY-2 positions. They are all categorical spots where you apply for ortho, you do your internship right there in that one program for five years. [07:25] Allopathic and Osteopathic Students There is always this DO versus MD "competitiveness" going on in the premed world. Here is where there is some bias among residencies. Orthopedic Surgery has been known historically as one of the biggest residency programs out there that has some negative bias towards DOs. NRMP Match Data Table 2 shows matches by specialty in applicant type and looking at Orthopedic Surgery with 717 positions, 717 filled, 650 were U.S. Allopathic Seniors, 49 were U.S. Grads (this refers to those who either took some time off and didn't apply during the normal time you're supposed to apply to residencies or maybe didn't match the first time, went and got some research opportunities and ended up matching after graduating), and only 4 of the 717 were osteopathic students. That is just about half of 1%. Compared to other specialties, Anesthesiology seemed very favorable to DO's with osteopathic students comprising 14.4% of all that matched. While in Emergency Medicine, 11.8% of those that matched in the filled spots were osteopathic students. Apparently, Orthopedic Surgery stuck with the the tried and true position of not being very "DO friendly." Remember that osteopathic schools and students can apply to osteopathic residencies and you can also apply to the MD residencies which accounts for the number of osteopathic numbers on the NRMP (allopathic) data. But in the osteopathic world, there are orthopedic surgery residencies. Therefore, don't think that just because you only got into an osteopathic school that your chances of getting into an orthopedic surgery residency are going to be slim to none. Based on the AOA Match Data for 2016, there are 40 Orthopedic Surgery programs in the osteopathic world, with 121 positions, 118 were filled, 3 went unfilled. In the MD world, it's highly unusual to have unfilled orthopedic spots. [11:06] Growth, Positions Filled, U.S. Seniors and All Applicants NRMP Match Data Table 3 shows the growth of each of the specialties over the period of five years (2012-2016). Orthopedic Surgery is among those growing at a good pace around 2.5% each year. With 682 spots in 2012, it has grown to 717 in 2016 which suggests a pretty steady growth. This is good for you especially if you're thinking about Orthopedics since it means there are more and more spots offered. The data in Table 7 confirms how Orthopedic Surgery is usually a specialty that doesn't go unfilled. There were no available spots in 2016, 2015 and 2012, only 2 spots in 2014, only 1 spot in 2013. Looking at Table 8, it shows the Positions Offered and Percent Filled by U.S. Seniors and All Applicants (again, U.S. Seniors being MD Seniors that have graduated from an MD school). In 2012, 94% of those offered a position consist of U.S. Seniors. This percentage dipped to 91.9% in 2013 and went back up to 93.4% in 2014, and 94.3% in 2015, and then dropped down further to 90.7% in 2016. This tells us that there are a lot of students who are non-U.S. Seniors filling these spots. They could be international medical graduates or U.S. grads that were not Seniors who are people that have taken some time off. [14:15] PGY-1 for All Applicants and Osteopathic Students and Unmatched Students Table 9 shows the percentage of applicants that have matched to a PGY-1 spot in each specialty compared to the whole. Anesthesiology is at 4%, Emergency Medicine with 7.1%, Family Medicine 11.5%. Orthopedics is 2.7% which is pretty small compared to some of the bigger ones like Family Medicine, Internal Medicine, and Pediatrics. Even Psychiatry is pretty big at 5.1%. For the Osteopathic students looking at the NRMP Match Data Table 11 shows the percentage of students that are osteopathic graduates that matched into Orthopedics with only 0.2% of all osteopathics students that matched did match into Ortho that means only 0.05% osteopaths matched into a spot. And comparing this to the bigger programs, Anesthesiology at 6.4%, Emergency Medicine at 9.3%, and Family Medicine at 15.9%. Again, it is very hard for an osteopathic student into a MD orthopedic surgery residency. NRMP Match Data Figure 6 shows the percentages of unmatched U.S. Seniors and independent applicants who ranked Ortho and other specialties. 25.1% of all those that applied to Orthopedic Surgery went unmatched, 20.8% were U.S. Seniors, 56.6% were unmatched independent applicants (the DOs and international medical grads). As a non-US allopathic medical school grad, it's very hard to match into an allopathic orthopedic surgery residency. [17:05] Charting the Outcomes for U.S. Allopathic Seniors Looking at the data found in NRMP Charting the Outcomes 2016, Table 1 breaks down the number of applicants per position for Orthopedic Surgery. With 717 positions offered and 1,034 applicants, there were 1.4 applicants per position. Outside of four other specialties, Orthopedic Surgery is the most competitive. Dermatology is last at 1.4, General Surgery at 1.49, Psychiatry at 1.54, and Vascular Surgery at 1.91. This goes to show how Orthopedic Surgery is a highly competitive residency. Chart 4 shows the Median Number of Contiguous Ranks of U.S. Allopathic Seniors. This is the ranking of how many programs they've ranked, they've matched and didn't match. And this is always one of the biggest question marks if you don't match into a residency, which is: Did you apply to enough spots? The answer is usually no. This is very similar to medical school application where if you didn't get it, you'd have to ask yourself if you applied to enough schools to increase your odds. For Orthopedic Surgery, the median number of contiguous ranks was 12. Those that did not match was only 6. So if you only ranked half of those that matched, then you'd have a much better shot at not getting in. [19:15] USMLE Step 1 Scores, Research Experiences, and AOA If you're a medical student getting ready to study for the Boards or if you're in your first year and just preparing, we are launching a Step 1 Level 1 Board Review Podcast called Board Rounds in the next couple of weeks so stay tuned for that! Subscribe to it now. Charting the Outcomes 2016 also shows the USMLE Step 1 scores for U.S. Allopathic Seniors. For Orthopedic Surgery, it's at the top spot with some of the other more competitive specialties with those that matched averaging at 248-250 and those that did not match were right there on 240. Therefore, you need to do well on Step 1 to match into Ortho. One of the misconceptions about Orthopods is them being dumb jocks but that's not true of course. You need to get really great board scores to get into Ortho and research experience doesn't lack either. Based on Chart 8, the mean number of research experiences is 4 for those that matched and 8 for those that did not match. So if you're interested in Orthopedics, do some research as it seems important based on this data. Chart 12 shows the percentage of U.S. Allopathic Seniors who are part of AOA (Alpha Omega Alpha), the honor medical society that highlights the students who do well the first couple years of medical school. For Orthopedic Surgery, 34% of those that matched are AOA students while 12% for those that did not match. The takeaway here is to start off medical school doing really very well so you can try to get AOA. [21:47] Medscape Lifestyle Report 2017 The Medscape Lifestyle Report 2017 presents data on burnout, bias, race, etc. Orthopedic Surgery is in the bottom half of the burnout chart at 49%. Yes, this is still a lot but this is the bottom half of the chart. The biggest takeaway is that a lot of physicians are burned out and Orthopedics is one of the least, which is good. How severe is the burnout? Orthopedic Surgery is in the lower half of the chart. Which physicians are the happiest? Orthopods make up the top half with 37% saying they're happy at work and 71% saying they're happy outside of work. This is another pretty good data compared to the rest. [23:00] Medscape Physician Compensation Report 2017 Looking at the recently updated Medscape Physician Compensation Report 2017, Orthopedics is at the top of the list for most compensated physicians with an average annual compensation of $489,000. If you're interested in Orthopedics then you will probably make a very good income which is well-deserved. And this is up 10% from last year. Only 48% of Orthopods feel fairly compensated and this is strange considering they're the highest paid of all the specialties. 79% of Orthopods say they'd choose Medicine again, and unsurprisingly, 95% of Orthopods say that they'd choose Orthopedics again. In general, Orthopods are pretty happy with their career choice. [24:29] My Final Thoughts I hope this helped you get some clarity with Orthopedics Surgery if this is something you're interested in. I hope you're also pretty early on in your journey because as I've mentioned, research is necessary and you need to do well on Step 1 as well as try to get AOA. Therefore, you need to start setting yourself up for success as soon as you can. Links: NRMP Results and Data 2016 - Main Residency Match AOA Match Data for 2016 NRMP Charting the Outcomes 2016 Medscape Lifestyle Report 2017 Medscape Physician Compensation Report 2017 Board Rounds Podcast SS 05: What Does the Life of an Orthopedic Hand Surgeon Look Like? NRMP ACGME AOA Supplemental Offer and Acceptance Program (SOAP) AOA (Alpha Omega Alpha)

Session 14 Today, we break down the match data, compensation surveys, and lifestyle reports for Emergency Medicine. If you’re interested in EM, this is a must listen. I also talked about dove into match data back in session 11 specifically on Anesthesiology and now I'm going to dive into Emergency Medicine. If you follow the NRMP results, Anesthesiology is first in the alphabetical order, followed by Child Neurology and then third, Dermatology. However, these two are relatively smaller so I'll reserve a separate discussion on the smaller programs at a later date. For now, let's focus on Emergency Medicine, which is a very popular specialty these days. [02:05] Emergency Medicine at a Glance Back in Session 2, I was able to talk to an Emergency Medicine physician and learned that because of the shift work and the amount of work, it has become popular. What is considered full-time for an Emergency Medicine physician is about 15-16 shifts a month. That is equivalent to three business weeks (Monday through Friday, five days times three) which means an extra whole week off per month. Of course shift work comes with some negatives which were also mentioned in that episode. [03:10] NRMP Match Data for 2016 First, check out this 120-page PDF document called, Main Match Results and Data for 2016. Looking at Table 1 (page 12 of 120) for this NRMP match data, Emergency Medicine has 174 programs, which means it has 55 more programs compared to Anesthesia with 119 programs. Of those 174 programs, there are 1,895 spots and this works out to almost eleven spots per program. It is a very competitive and a very, very wanted specialty that out of those 174 programs, only one program went unfilled. Number of applicants: 2,476 Number of available spots: 1,895 Number of applicants that matched: 1,894 Number unfilled: 1 Number of U.S. Seniors that matched: 1,486 (78.5%) As compared with Anesthesiology, 72% of those that matched were U.S. Seniors. Hence, Emergency Medicine is matching more U.S.-based Seniors going into Emergency Medicine. This possible means that there are less international students applying for Emergency Medicine and less students who didn't match right away. Looking at the total number of matches which is 1,894 (out of 1,895 positions offered), there was one spot in one program that went unfilled. This suggests how very competitive the specialty is with 99% were filled for Emergency Medicine. [06:18] Emergency Medicine and PGY1 Positions Last time, when I talked about Anesthesiology, Table 1 has PGY1 positions, PGY2 positions, and physician positions. Emergency Medicine, however, only has PGY1 positions listed in Table 1.0, which means that you don't go to do an internship separate from your Emergency Medicine residency because it's all built into the one main residency. It can be very confusing considering that different specialties have different terminologies. As with Emergency Medicine, it does not have other internship outside the program so there are are no PGY2 positions or physician positions available to apply to. [07:35] Applicant Types in Emergency Medicine Table 2 (page 16 of 120) of the 2016 NRMP match data breaks down the specialty and applicant type. For Emergency Medicine: Number of filled positions: 1,894 % of U.S. Seniors that filled: 78.5% Number of (non-Senior) U.S. Grad: 73 (almost 4%) - U.S. Grad means that you either took time off between trying to match and graduating from medical school. It's either you didn't try to match during your senior year of medical school or you didn't match and you took some time off and strengthened your application and reapplied and now are getting in. Number of Osteopathic students matching into EM: 224 (almost 12%) - These are osteopathic students that went outside of their AOA match, or national match, and applied through these MD programs instead of to DO Emergency Medicine programs. Number of Canadians: 1 Number of U.S. International medical graduates: 87 Number of non-U.S. international medical graduates: 23 (These are non-U.S. citizens that graduated from an international medical school) Number of unfilled spot: 1 Comparing it with Family Medicine, which you may assume as a primary care specialty to have a large percentage of availability for international medical grads, they had 382 international medical grads out of 3,083 spots, equivalent to 12% more or less. [11:20] Emergency Medicine as a Relatively New Specialty We learned from the Specialty Stories Podcast session 2 where we interviewed a community-based EM physician, that Emergency Medicine is still a relatively new specialty. Table 3 (Page 20) of the NRMP match data for 2016 shows the positions offered from 2012 to 2016. And Emergency Medicine (outside of the primary care specialties) is the fastest growing specialty out of all of the more sub-specialties. If you're interested in Emergency Medicine, that means there are more and more spots available every year which is a good thing. 2012 - 1,668 spots 2013 - 1,743 spots 2014 - 1,786 spots 2015 - 1,821 spots 2016 - 1,895 spots It's growing relatively consistently between 6.5% to 7% year over year. Now if you look at some of these other ones, the primary care specialties, family medicine growing 11.5% every year which is huge but expected for primary care specialty. Pediatrics almost 10% every year. But Emergency Medicine as a specialty outside of primary care is the fastest growing which is pretty awesome. [13:20] Osteopathic Students in Emergency Medicine The national matching service which is the DO matching service, their program has a 2016 program stat. If you Google ‘national match DO 2016,' I'm looking at a very different amount of data compared to the NRMP. While, the NRMP is 120-paged report, this specific list is just a one-paged website showing that Emergency Medicine for osteopathic students had 58 programs and 307 positions. NRMP has 174 programs and 1,895 positions. So a lot more MD programs which makes sense I think historically. Obviously there are more MD programs throughout the country since DOs are still relatively new in the grand scheme of things (Emergency Medicine is a newer specialty but still DOs being a newer breed of doctors). So they just have less of a footprint which is neither good nor bad but it's just what it is. So 58 programs, 307 positions available, and five of those positions went unmatched in the Emergency Medicine for osteopathic students in their matching in 2016. [15:20] U.S. Applicants & PGY-1 Positions Going back to the NRMP match data for 2016, Table 7 (Page 30 of 120), shows the number of positions offered and filled by US seniors and all applicants between 2012 and 2016. And so doing some quick math, the number of US students that are filling these spots for Emergency Medicine has basically stayed the same, around 78% to 80% every year, which is pretty good. It means U.S. applicants are staying very competitive for these programs. Table 9 (Page 37 of 120) of the NRMP match data for 2016 shows all applicants matched to PGY-1 positions by specialty from 2012 to 2016. Emergency Medicine being one of the fastest growing specialties out there or has been the fastest growing outside of the primary care specialties, applicants and students that matched made up the most out of any of the specialties, again outside of the primary care specialties. They made up about 7% every year since 2012, with the 2016 match data showing 7.1% of all students matching into a PGY-1 position, or matching into Internal Medicine. Now just for numbers here, 11.5% matched into family medicine, almost 26% matched into Internal Medicine, 6.8% matched into a PGY-1 only spot for Internal Medicine, and Pediatrics was 10%. So all of these big primary care specialties are 11.5%, 10%. Internal Medicine is huge at 26%. But Emergency Medicine has the largest number of students matching into it outside of the primary care specialties. Looking at Table 11 (Page 39 of 120) shows the osteopathic students matching into PGY-1 spots for these DO programs and Emergency Medicine is the highest outside of the primary care specialties at 9.3%. So 9.3% of all osteopathic students matching into an MD position matched into Emergency Medicine. [18:15] Emergency Medicine as Only Specialty Choice Figure 6 (Page 45 of 120) in the NRMP match data talks about the percentages of unmatched US seniors and independent applicants who ranked each specialty as their only choice. Emergency Medicine had 11.3% unmatched number and almost 6% of U.S. seniors that were applying for Emergency Medicine as their only specialty choice did not match. However, that data alone doesn't tell you enough actually. Here are comparisons of U.S. Seniors unmatched for other specialties: 8.7% of U.S. seniors unmatched for Psychiatry 20% for Neurosurgery 5% for Family Medicine 20.8% for Orthopedic Surgery So 6% of unmatched U.S. Seniors isn't very high and when you look at these you just have to question how competitive were these students for Emergency Medicine if they weren't matching? [19:58] SOAP Data Table 18 (Page 55 of 120) of the NRMP match data shows the SOAP data for 2015 and 2016. SOAP stands for the Supplemental Offer and Acceptance Program through the NRMP. These are for students that did not match, they find out before the actual match date, and they are given time to talk to programs that have some spots and hopefully match after they find out they didn't match to begin with. For 2016, Emergency Medicine did not participate in the SOAP. And that kind of makes sense because there was only one spot unfilled. [21:00] Charting the Outcomes - Emergency Medicine Switching over to the NRMP Charting Outcomes Report, which is another great 211-paged report. Chart 3 (page 10 of 211) shows the rates of U.S. allopathic Seniors. 91% of US allopathic seniors matched into their preferred specialty. Chart 4 (Page 12 of 211) shows the median number of contiguous ranks of US allopathic seniors. So when you make your rank list, you're ranking the programs that you interviewed at or applied to, and you rank all of the programs that you want to go to in order of how you want to go to them. The median number of contiguous ranks of those that matched for Emergency Medicine was 12. Those that did not match was 4. So these students that did not match were very, very selective with who they ranked. They were probably hoping to only match in a very specific part of the country or to a couple very specific programs. When you do that, the less schools that you apply to, the more strict you are with your availability to apply to a larger number of schools. This is going to limit your chances getting into medical school. That's exactly what happened here with students applying to Emergency Medicine is they didn't apply and they didn't match to enough programs. Again, 12 compared to 4 contiguous rank numbers. [24:23] Charting the Outcomes - Step 1  and Step 2 CK Scores Chart 6 (Page 14 of 211) in Charting the Outcomes shows the Step 1 Scores of U.S. Allopathic Seniors. For osteopathic medical students, they take the COMLEX Level 1. Osteopathic students can take the USMLE but we're focusing here on U.S. allopathic seniors. Those that matched into Emergency Medicine scored between 225 roughly and 245 which are great scores, and those that did not match scored in roughly 205 to 235. Their scores were much lower on the bottom end, and only went up to about the middle of the road for those that did match. So Step 1 scores mean a great deal for your ability to match. Just like a great MCAT score, it opens up a lot of doors. Looking at Chart 7 (Page 15 of 211) shows the Step 2 CK scores, Emergency Medicine, they were between 238 roughly and 255, and those that did not match were 224-ish to 242-ish. So again, lower obviously Step 2 scores. [25:54]  Importance of Research, Abstracts, and Publications Looking at Chart 8 (Page 16 of 211) for the charting the outcomes NRMP match data, research didn't seem to play a huge part in those that matched and did not match. The Mean Number of Research Experience for U.S. Allopathic Seniors was 2.4 for those that matched and only 2.2 for those that did not match. Though research that actually led to something seems to be more important. The Mean Number of Abstracts, Presentations, and Publications (Chart 9 - Page 17 of 211) for those that matched in Emergency Medicine, they had 3.3 and those that did not match had 2.2. [26:39] AOA Data Chart 12 (Page 20 of 211) shows the AOA Data, referring to the Alpha Omega Alpha which is the medical Honor Society. 13% of U.S.seniors that matched were AOA for Emergency Medicine and 1% of those that did not match were AOA. AOA seems to play a little bit of a role in matching to Emergency Medicine. It's usually the case with the more competitive specialties. The AOA seems to play a role, though is it really the AOA that plays a role, or just the fact that you have great grades? Obviously, having great grades leading to the ability to do well on your board scores. [27:31] Step 1 and 2 Scores and Distinct Specialties Table EM-1 (Page 60 of 211) in Charting the Outcomes Report shows all of the raw numbers. Mean USMLE Step 1 score: 233 for those that matched and 220 for those that did not match Mean USMLE Step 2 score: 245 for those that matched and 232 for those that did not match Chart EM-1 (Page 61 of 211) has the number of distinct specialties ranked by U.S. allopathic seniors. For US allopathic seniors that only ranked Emergency Medicine, 1,269 matched, 72 did not. That's 5.4% roughly of those that only listed Emergency Medicine did not match. The second column here in chart EM-1 shows that 88 students (column number two is if you had two programs or two specialties that you're ranking for). And so for students that aren't 100% in on Emergency Medicine, 88 of those matched and 40 did not. So if you look at that number, it's 31% of those that ranked two programs here did not match compared to 5% for those that are only ranking one. You need to make up your mind because you're obviously not selling the programs that you're interviewing at that you're dedicated to going to whatever specialty that you're interviewing at for that day. [30:43] Medscape Lifestyle Report 2017 Diving into the Medscape Survey Data for Emergency Medicine, and looking at the newest Medscape Lifestyle Report for 2017, Emergency Medicine. Slide 2 shows that 59% (at the highest) of Emergency Medicine physicians are stating they are burned out. What's interesting though is on the next slide, when it asks about the severity of burnout, Emergency Medicine is way down the list at 4.2.  So it's a scale from one to seven, Urology is at 4.6 at the highest, Infectious Disease is the lowest on this list at 3.9, Emergency Medicine is 4.2. So they're burned out but not the highest which is interesting. Not surprising for Emergency Medicine given that it's shift work, is that they are almost very close to the top, specifically, fifth on the list for which physicians are happiest. It looks like it's mostly based on outside of work. Urology is 76% are happiest outside of work, Emergency Medicine is 71% are happiest outside of work, and Emergency Medicine is 28% happiest at work. So there's a big discrepancy there, and obviously with shift work you have a lot of time outside of work which is great, and so Emergency Medicine physicians are loving that time, but they're getting burnt out at work. [32:26] Medscape Physician Compensation Report 2016 Switching one more time to the Medscape Physician Compensation Report for 2016. How much do physicians earn overall? Orthopedics at the very top just to give you some understanding of where we're at. Pediatrics at the bottom. Ortho at $443,000, Pediatrics at $204,000, and Emergency Medicine is almost in the middle at $322,000 a year. What's interesting in this compensation report is that they have a list here for which specialties have the most female physicians and Emergency Medicine is on the lower end of the list at 19%. OB-GYN unsurprisingly is 55%, Pediatrics, again unsurprisingly 53%. Emergency Medicine is 19%. We need some more female physicians in Emergency Medicine. So if you are a female, go for it. For physicians that feel fairly compensated, Emergency Medicine is top three at 60%. Dermatology 66%, Pathology 63%, Emergency Medicine right there at the top at 60%. What's interesting looking at Slide 17 here, Emergency Medicine has the fifth highest satisfaction overall for physicians at 57%. 60% being satisfied with their income, 66% would choose medicine again which is at the higher end, but only 44% would choose Emergency Medicine again. Now I have a hypothesis about this. I don't think it's Emergency Medicine necessarily that is causing this 44% that would choose this specialty again. Looking back, speaking to an Emergency Medicine physician back in Session 2, he talked about how Emergency Medicine doctors need to know a lot about a lot and I have a feeling that a lot of people go into Emergency Medicine because they haven't found that one thing that lights them up every day all day. And when they're practicing Emergency Medicine, at some point they realize what that thing is, and then they wish their whole time was spent doing that one thing, but they're ‘stuck' in Emergency Medicine. So although Emergency Medicine is nowhere near the bottom, it's still one of the lowest ones. You have Pulmonary Medicine which is kind of surprising at 37%. OB-GYN 41%. Unsurprisingly Internal Medicine is at 25% which is too bad. Links: NRMP Main Match Data for 2016 Charting Outcomes in the Match for U.S. Allopathic Seniors National Match DO 2016 Medscape Lifestyle Report 2017 Medscape Compensation Report 2016 Send me an email at ryan@medicalschoolhq.net MedEd Media Network Specialty Stories Podcast session 11 Specialty Stories Podcast session 2 Facebook Medical School Headquarters Hangout Page

Physician burnout is a big issue in the medical community. According the the Medscape Lifestyle Report 2017, over half of physicians report burnout. But physician burnout isn't just a problem for physicians. It is a problem for patients, for other medical staff, and for the health care economy.  Today we dig into the causes of physician burnout and how it can be addressed. Here's a hint: It doesn't involve meditation or counseling. Resources: Medscape Lifestyle Report 2017 2 Docs Talk About Pricing Transparency 2 Docs Talk About Medicare for All 2 Docs Talk About Drug Pricing Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!