2023 Match Data

The NRMP recently published data regarding the most recent Match. Of note, emergency medicine – my specialty – had a whopping 554 positions that remained unfilled. Ouch! Additionally, although the numbers were better than last year, IMGs still struggled: US citizen IMGs saw only a 67.6% Match rate and non-US citizen IMGs had only a 59.4% Match rate.

There is a lot of data to review, so take a look here if you want more information on DO Match rates, specialty competitiveness, and SOAP. 

USMLE Performance Data 2022

The National Board of Medical Examiners (NBME) publishes USMLE performance data year after year, and the most recent information regarding the 2022 testing cycle is particularly interesting. Frankly, I'm not sure what to make of it, but performance on Step 1 is notably worse than years prior (e.g. 2021 compared to 2020; 2020 compared to 2019). I'm not sure if this is related to the pandemic, changes in the test itself, or some other factor. Here is the data.

What Coursework is Really Required for Medical School?

While there is a core curriculum that is a prerequisite for medical school, certain schools require additional coursework or competencies (like the CASPer exam). The AAMC does a good job of keeping up a database of that information, listed by school. An applicant can sort through to see what each institution requires. You might have to do a little bit of digging once you open a school's link, but the information is usually accessible.

Of note, if a course is required for admission, it's probably best not to take the class on a pass/fail basis.

Start Your Engines...

The medical school application cycle is revving up soon, so it's time to get started on your candidacy. Here's an article I wrote for Student Doctor Network a few years back called "Ten Ways to Improve your Medical School Application." The piece includes statistical truths, strategies for optimizing your approach, and philosophical guidance. It covers grades, clinical experience, letters of recommendation, where to apply, the MCAT, the personal statement, and your happiness, among other critical factors. Enjoy!

Your Residency Application: Five Factors to Prioritize When Creating your Rank List

Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want - first goes first, second goes second, etc.
2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.
3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.
4. Consider whether you could spend your whole life at the institution or in that program's location. It's a lot to grapple with, but many residents graduate and stay for the rest of their careers.
5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

How Race and Gender Affect Medical Specialty

The AAMC published an interesting piece recently showcasing the results of their Physician Specialty Data Report on the interplay of race, gender, and specialty. 

It's worth combing through the data yourself, but here are a few takeaways:

Doctors from underrepresented groups are more concentrated in primary care fields. These specialties are extremely needed and noble, but since primary care is less well remunerated than surgical specialties, it's worth thinking about the disproportionate density of minority physicians.

Women make up the majority of medical school students for the fourth year in a row.  

Women represent a significant minority in surgical specialties like orthopedic surgery (5.9%), thoracic surgery (8.3%) and neurosurgery (9.6%). Ouch.

Focusing on another demographic, the doctor workforce has grown older. Over 46% of active U.S. doctors are 55+. That number was ~38% in 2007. 

For more details, read the report here.

What to Know about the AAMC Fee Assistance Program

Now that the 2022-23 medical school application process is on the horizon, I want to remind candidates about the Association of American Medical Colleges' (AAMC) Fee Assistance Program (FAP) and Insider Medical Admissions' available discount for those with a current FAP. The FAP is designed to offer help to individuals with financial limitations who cannot pay the MCAT registration and/or AMCAS application fees without financial support. (Of note, there also exists an FAP for  dental school candidates through the American Dental Education Association.)

If you think you are eligible, it's worth applying for an FAP grant early: When applicants submit their AMCASes prior to receiving decisions on their FAP applications, those candidates are ineligible to receive the FAP benefits for the AMCAS even if their FAP grants are approved. In other words, the FAP is not retroactive. You snooze, you lose.

For more information on the FAP, please click here. I offer a significant discount on one non-package service for any applicant who can demonstrate financial hardship through a current AAMC FAP grant. After researching the issue, I believe Insider Medical Admissions is the only medical consulting company that currently supports a discount for FAP grant recipients. (I apologize if I'm missing a company.) Once you have been granted the FAP and thus, can prove receipt, please feel free to contact me for more information.

Medscape's Annual Physician Burnout Report is Out and - As Usual - It's Disturbing

Every year Medscape surveys physicians about career satisfaction. The last few annual reports have been pretty upsetting. Unfortunately, 2022's results are not happy either.

This year emergency physicians (my colleagues) reported the highest burnout rates of all specialties at 60%. Last year this number was 43%, so there was a large jump in already-high dissatisfaction levels. Next in line were critical care physicians at 56%. But even the specialty with the smallest percentage of burned out physicians – public health and preventive medicine – had rates at 26%. So even in the happiest cohort, one in four surveyed doctors reported burnout.

Looking at gender, fifty-six percent of female physicians surveyed reported burnout; men seemed less dissatisfied, but they were at 36% so that's not so great either.

Bureaucratic tasks were perceived to be the biggest contributor to physician burnout by their own assessment.

It's important for those who are considering a career in medicine to approach it with eyes wide open: Take a look at the Medscape National Physician Burnout & Suicide Report 2022 slide deck yourself for more details, and check out my Kevin MD piece on EM burnout here.

Residency Applicants, Thinking about How to Create your Rank Order List? Check out this Easy Advice.

For those of you who are starting to craft your Match rank order list, please make sure you follow this simple strategy: Rank your first choice first, your second second, your third third, etc.

In other words, your most successful approach is to create your list in order of your real preferences. Although the Match algorithm is mathematically quite complicated, because the process always begins with an attempt to match an applicant to the program most preferred on the applicant’s list, you do not want to try to “game” the system. For example, I’ve had applicants tell me that they plan to rank a less preferred institution higher because that program has more residency slots. That’s a no-no. The applicant will actually be harming him/herself with that strategy.

Two weeks ago I posted a short NRMP video that explains the Match algorithm. Here it is again. Here’s also a less-than-one-minute Guru on the Go© video “NRMP Ranking to Avoid a Spanking” to emphasize your optimal strategy.

The Main Demographic Factor Associated with Decreased Satisfaction for Physician Work-life Balance is Female Gender

Wow. When I read that fact in a recent piece on time management by Dr. Sandra Scott Simons in Emergency Medicine News, I was a bit taken aback. It's not surprising once you really think about it, but at first, it's a slap in the face. 

In her article, Dr. Simons' discussion of the pitfalls of distractions is particularly resonant for me. If you haven't already, make sure to familiarize yourself with the concept of Deep Work by Cal Newport. (He has a book, a podcast, you can also find many interviews of him online.)

Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

As you look toward the NRMP Match rank order list deadline on March 1, you'll want to avoid simple missteps. Improving written materials and interview skills is critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back in November 2015, the NRMP published an article called, "Understanding the interview and ranking behaviors of unmatched international medical students and graduates in the 2013 Main Residency Match" in the Journal of Graduate Medical Education. The data is still relevant today.

Sadly, the authors found that some applicants made strategic errors including the below:

• Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
• Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
• Misunderstanding the Match and, thus, ranking programs at which applicants did not interview.
• Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

Match Schedule 2022-3

Here are some important upcoming dates for those applying for the Match:

January

Jan. 31, 2023: The registration deadline for the NRMP Match is at 11:59 pm EST on this date. After this time, applicants will incur a $50 late fee. (The process is expensive enough; no need to pay more.)

February

Feb. 1, 2023: Rank order list entry opens at 12 pm EST. 

March

March 1, 2023: Rank order list deadline. Candidates must have their rank order lists certified by 9 pm EST.

March 13, 2023: NRMP Match Week starts. SOAP applicants can begin preparing applications in the ERAS® system.

March 16, 2023: SOAP rounds 1-4.

March 17, 2023: NRMP Match Day.  Match results are available at 12 pm EST.

Over the course of this month and next, I'll be blogging with tips on how to create your best Match list. 

“Unhappy is He Who Depends on Success to be Happy" - Alex Dias Ribeiro, Former Formula 1 Race Car Driver

Age-related professional decline is the last thing many doctors want to think about. Those who have just finished years of arduous training can't imagine that they have only 15 years until they will deteriorate (statistically true), and those of us in middle age don't want to think about our impending, cognitive retreat from medicine. And yet, this fantastic piece in the Atlantic "Your Professional Decline is Coming (Much) Sooner than You Think" by Arthur C. Brooks is a fascinating, well written article about happiness, gifted and accomplished people, and personal relevance with multiple interesting celebrity examples. Brooks also proposes some quasi-solutions (or at least some work-arounds). I strongly recommend this compelling piece for physicians of all ages and stages.

Medical School Interviews: Preparing for your MMI

Although the majority of medical school interviews are still traditional, many institutions (including dental schools) are using the MMI platform - even though interviews are now held in a virtual setting. The MMI (multiple mini interview) is a format that uses several timed stations to assess applicants' interpersonal skills and judgment.

A few things to note about MMI interview questions:

1) They are not always medically-related. You may be asked to manage an everyday problem (e.g. a disagreement at the supermarket).

2) They are not always situational. You need to be prepared for conventional questions too (e.g. what are your three greatest strengths?).

3) Schools are trying to assess whether you can skillfully employ important techniques and demonstrate professionalism. Underlying topics might include your ability to offer effective counseling, your understanding of patient-doctor confidentiality, your ability to diffuse a heated situation, your capacity to admit wrongdoing, etc.

It is important that you practice MMI questions before you go to your medical school interview. Even if you have excellent social skills, there are techniques you should hone to expertly manage the challenging MMI format. 

The Medical School Waitlist: Can Anything Be Done?

Just when you’ve completed your interviews and feel that you can finally sit back and relax a little because – after all – the rest is out of your hands, you may be surprised by a medical school waitlist notification. What can you do?

1. Realize that getting into medical school has become increasingly competitive year by year. Being waitlisted is infinitely better than being rejected, and thus a positive, despite the anxiety it causes.
2. Send a letter of interest. Let the school know of your continued enthusiasm and your new accomplishments. Ensure the letter is well written, streamlined, and brief. If the school is absolutely, positively your first choice, let the admissions committee know that. Feel free to send more than one letter if you are on a medical school wait list for months.
3. Ask the school if you can set up a second look. A supplementary visit indicates to the institution that you are serious, and it offers you more data in making your decision if you're later offered a spot.
4. Do not neglect your other options. Don’t focus all of your attention on this institution to the exclusion of others: Ensure you are well-prepared for any late interview invites at other medical schools.
5. Ask a well-positioned faculty member who knows your work to make a call or send an email on your behalf. This tactic is especially helpful if the supervisor has a connection to the institution. (I do not recommend that a family friend who hasn't worked with you contacts the school.)
6. Plan for last minute notice. At some institutions, applicants are offered slots off the medical school wait list throughout the summer. I’ve even heard of acceptances being offered the day before school was to begin. Would you be able to change your living situation, move your personal belongings, and uproot if this were to happen? Be prepared. 

Being Valued is Undervalued

I read an interesting JAMA study on burnout recently. We've all heard about the problem and its growth over the past few years. But I found the results of this study particularly interesting: The authors found that chaotic workplaces and lack of control of workload were associated with higher burnout (think emergency departments or a poorly run, overscheduled clinic), while efficient teamwork and feeling valued were associated with lower burnout. People sometimes pay lip service to the importance of being appreciated, but this study really proves its significance. 

It's worth considering this study's results when making decisions about what field to choose, where to train, and what position to take after residency. Here's the article.

Pared to the Bone

I heard a great Fresh Air interview of Siddhartha Mukherjee, who was a lovely acquaintance of mine at Harvard and who has since won the Pulitzer Prize for his book The Emperor of All Maladies. Sid is a hematologist/oncologist clinician/scientist who has a new book out called The Song of the Cell. 

Terry Gross asked Sid how he successfully writes for both the scientific community through his journal articles and for lay people through his books - two different skill sets. Sid responded by explaining the importance - for any genre - of crafting manuscripts that are "pared to the bone," meaning they avoid verbiage. His recommendation was excellent advice for any writer, even one who is crafting a personal statement. Take a listen to the full interview with Dr. Mukherjee here. 

Leaving the Medical Workforce

Beware: The article I'm about to recommend has a bitter tone, but it's important for those who are considering the medical field to hear all perspectives. Plus, many of the issues this anonymous writer brings up - understaffing, corporate medicine, twisted financial incentives,  lack of fulfillment - are on point. 

Here's the piece.

Surgery Without Anesthesia

As we look forward to Thanksgiving, I recommend this short NYT piece by AJ Jacobs on gratitude. It’s a few years old, but it's still relevant, fun, and reflective.

How to Evaluate an Institution: Consider Your Happiness and Trust Your Intuition

A few medical school and residency applicants have asked me how to evaluate institutions, especially since interviews are virtual. This is a huge topic, but here are some thoughts:

• To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
• Cost is sometimes a deal breaker when it comes to medical school. There's not much more to say here except that most institutions are extremely expensive.
• Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many medical schools of similar caliber have equivalent curricula and programs. You likely could be happy at many different medical schools. With regard to residency, it's important to ensure you are getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
• Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is very important (understanding that he or she could leave).
• With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.
• One of your best bets is to talk to current students at medical school or current residents in a training program. Oftentimes they will be very honest about the pros and cons of their institution.

Once you've assessed all of the above - narrowing down your list by geography and quality - I would analyze the vibe you have. If this sounds too touchy-feely, remember that intuition is not a magical assessment; it's based on major and minor facts that you consciously and subconsciously analyze.

Remember: If you're a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is getting harder every year. It's a great problem if you need to struggle to decide among multiple schools!