Hi there,
Many programs do not accept offshore graduate (regardless of USMLE scores or citizenship). Many of these programs are in the more competitive residencies which peds is not. Surgery especially categorical surgery is fairly competitive and has seen an surge in applications. The number of unfilled categorical slots last year was less than 5 across the country and three of those were not funded and thus were not up for filling.
Residency programs are not under any obligation to take any applicant regardless of USMLE scores. There is more to being a good resident than board scores. Many program directors feel that taking offshore graduates lessens the prestige of their program. This can be a huge problem regardless of US citizenship.
Natalie
What you will hear program directors say is that while off-shore graduates may have the USMLE scores, they vary widely in terms of clinical preparation to begin residency in U.S. programs. While many IMGs are doing their clinical training at U.S. hospitals, the oversight for the programs they participate with is often sketchy. I have to be honest, I saw this last year as an intern - the students from the local medical school were carefully watched over by the department chair and people in charge of the clerkship, but the (American) student of a foreign school had much more latitude about what he did or didn’t do on any given day. In the particular case I’m recalling, he was an enthusiastic student who sought out learning opportunities, but as a student I saw international students who were not so persistent and, I suspect, learned little from the rotation.
Mary
Hi there,
OUr final rank list of applicants went in last week. We are happy to have this chore out of the way. Now the applicants have a few days to get their rank lists into the computer and the churing starts. It will be the third week in March when the regular Match results will be available.
Natalie 
Hi there,
Just as I thought, General Surgery was super-competitive this year. There was only one unfilled categorical slot after in the Scramble. It was brutal.
Natalie
Sounds like surgery did great.
I was playing with the numbers for fun-- and if you use percentage of unfilled positions (#unfilled/#offered) to gauge competitiveness IM is more competitive than Anaesthesiology, Derm, EM, Prelim Surg year, Ortho, Peds, PMR, Rad and FP. 
Of course, number of unfilled positions means nothing without knowing the number of applicants. To gauge competitiveness of a specialty you need to look at how many people who applied to that specialty as their top choice didn’t match in it. Hypothetically, there could be 4734 IM applicants for the 4735 positions, there would be only one unfilled position-- but 100% of applicants would have matched in it, hence it wouldn’t be competitive. Until those numbers are released, the competitiveness of specialties can’t be determined. Even though I’m going into IM, I don’t buy that it’s more competitive than Ortho! (And of course there is the whole issue of pre-selection, as people don’t rank a specialty they didn’t get offered interviews in).
I’m looking forward to seeing those numbers. Should be interesting as even with the disclaimers above there seem to be some changes in trends.
In the words of Mark Twain, “If you torture numbers long enough they’ll confess to anything.” 
Anesth had its tightest year yet. Pre-scramble, filled 98.1% of 1312 slots - ZERO left after the scramble. We were tied with Ophtho & Derm for most complete pre-scramble match…according to what our dept told us. We filled with some strong folks!
What were your matched candidated profiles?
I’m VERY interested in gas (my dad is a CRNA and I shadow him a LOT - SUCH a cool job) - and just overall curious as to what the programs look for in a new resident .
Not that I have to worry yet - I’m not even in the med school application cycle, but I like to read about it and keep up with it
NRMP put out a press release discussing the match results, and discussing the competitiveness of different specialties. The link is www.nrmp.org You don’t have to be able to log in to read the press release on that page. The tables are also available on that page.
Per this release:
Derm filled 100%/93% US grads
Gen Surg filled 99.99999 (to some number of 9’s)/83+% US grads
ENT, OB/GYN and IM filled 98%/92%, 72% and 56% US grads respectively
Anaesthesiology filled 97%/80%+ US grads
Peds 96.5% filled/73% US grads
FP filled 80%/41% US grads
EM was not mentioned in the release, but the tables show it filled 97.3%/77+% US grads
Happy reading.
Hi there,
We filled (all American grads) this year. Overall, with the exception of some of the primary care specialties (OB-Gyn, Family Medicine etc.), all specialties were pretty tight. The good programs (like Dartmouth) were super-competitive. What this all means is that you have to do well in medical school for most specialties in order to sure that you match well. If you wanted to go into something like Anesthesia, Ortho, Gen Surgery, you have be at the top of your class.
Natalie
For reasons of confidentiality, we do not get their profiles - big part of the “collegeal” atmosphere they rigorously maintain at Dartmouth. No quicker way to get canned as a staff physician than to act like like an a-hole to people…that includes ALL Dartmouth employess & not just other physicians!
But, as Nat pointed out, Gas has returned to its former status as one of the highly competitive specialties - was forever, had a severe downturn late-80s thrulate-90s & then an explosion in competitiveness beginning w/ the class 2001 match. My match year was the 3rd after it took off & it has done nothing but get stiffer each year.
To be competitive - be on top of your game & do the best you can to have the best clerkship grades (1st 2 years grades are not heavily emphasized by anesth programs), letter of recommendation & board scores. All three must be strong & you need to demonstrate balance - they like to see applicants who can do well with all of the above & still maintain some degree of extra-curricular involvement.
It is & will be tough.
Hey Dave,
You are totally correct in that Anesthesiology was very, very competitive. It’s right up there with Orthopedic Surgery because of its great lifestyle and interesting breadth of practice (Critical Care to Chronic Pain Management).
I believe that many medical school graduates were looking for a great lifestyle as well and interesting work. I am still at a loss as to why Family Medicine seems to be so unpopular. There is great variety and good hours with the ability to treat everyone from newborns to geriatrics. Family Medicine practictioners perform minor office surgery and do loads of preventive medicine. There are also fellowships in Geriatrics and Sports Medicine.
Natalie
Nat,
I can tell you that some FPs are turned off by dealing with payor sources that don’t pay, high malpractice costs for a lower-paying specialty (esp. if OB is involved) and lots of call involved for lower-paying specialty, esp. for rural docs. When I say lower-paying, I mean compared to non-primary-care specialties.
I can see this with my mom, who is an FP (with 4 other partners and 2 PAs in her practice). She has told me not to go into FP because the lifestyle isn’t that great (I will decide for myself once I get to med school - every situation is different!!). I’m sure some places are better than others, but I’ve seen her go through all of what I described over the past 10 years. She was the only FP in her practice who practiced OB, and eventually she had to stop her practice and the hospital had to close its OB unit due to high malpractice premiums. In fact, the last year she practiced OB, she paid $20K more in premiums than she made from OB cases (not overall income, just OB). Now women in the area have to travel at least an hour to a hospital with an OB unit - even though there are plenty of community hospitals in the surrounding towns.
Her practice has gotten better with call, especially since she’s the “middle-man” in a group of 5, but when she started, it was a group of 3 and she took call every 3rd night and 3rd weekend. That on top of being in a rural community with a published phone number for anyone to call with all sorts of complaints, as well as the hospital calling when one of her patients is admitted (about every day/night).
I contrast that with my dad, who although is a CRNA, does a solo practice for the same hospital my mom is affiliated with. There are no anesthesiologists within a 40-mile radius, so my dad handles all the ER and OR cases (used to do OB when the unit was open). He also has a large malpractice premium, but his work is a lot less stressful. When he’s off - he’s off. No hospital calls, no patient calls. When he’s on call, of course he expects the phone to ring. His schedule is pretty nice - 5am - 1pm most days. Mom’s is 6am-7/8pm every day and 8-12pm on Saturdays.
While these are personal and specific examples, I can empathize with people who don’t choose FP as a specialty since I see what my mom goes through. On the other hand, I’m sure there are FP positions that are less demanding time-wise, but I see the rural FPs being in such high demand.
Just my .02 and observations on that.
Thanks, Dave, for the input. Nothing worth having comes without hard work. It’s nice to know that people aren’t a product of their “numbers” at Dartmouth!
Quote:
For reasons of confidentiality, we do not get their profiles - big part of the “collegeal” atmosphere they rigorously maintain at Dartmouth. No quicker way to get canned as a staff physician than to act like like an a-hole to people…that includes ALL Dartmouth employess & not just other physicians!
But, as Nat pointed out, Gas has returned to its former status as one of the highly competitive specialties - was forever, had a severe downturn late-80s thrulate-90s & then an explosion in competitiveness beginning w/ the class 2001 match. My match year was the 3rd after it took off & it has done nothing but get stiffer each year.
To be competitive - be on top of your game & do the best you can to have the best clerkship grades (1st 2 years grades are not heavily emphasized by anesth programs), letter of recommendation & board scores. All three must be strong & you need to demonstrate balance - they like to see applicants who can do well with all of the above & still maintain some degree of extra-curricular involvement.
It is & will be tough.
Hi Folks,
We DO get the profiles of applicants that are interviewing at our insitution if we are doing the interviews. We do take grades and USMLE/COMLEX scores into consideration as they provide an insight into how applicants compare across the board. Different medical schools have very different grading systems.
For example, at Howard, you had to score 10% higher than the US passing score in order to pass the shelf exams for each clinical rotation. You also had to pass both the clinical and the shelf exam in order to pass a rotation. Most of my clinical rotations also gave an oral exam on which you had to score at least 75% in order to pass.
When you compare the rigors of Howard with another school that just required a pass on the shelf to pass a rotation, then you need to look beyond the grades. The higher standard of Howard translated to a 100% pass rate for USMLE Step II and much higher scores.
I look at letters of recommendation for residency applicants but you are not going to get a poor letter of recommendation so they carry less weight. I looked for a candidate with good board scores, high rank in class and honors in their General Surgery clerkship. Fortunately, our matched candidates received all of these.
I am not saying that you cannot match in General Surgery without the above, but you probably will not match. Some places like Virginia, want you to be AOA (Alpha Omega Alpha) either selected third year or fourth year (I was selected at the end of fourth year) in addition to high USMLE and grades. In short, its not the ranking of your medical school but how well you do that determines your fate. I ranked plenty of folks from state schools very highly because they did well.
Natalie
I read through this thread, and I’m a little taken back by the tone, Dr. Belle you are only in one program, there are many across the country and I do know that Caribbean grads match in Surgery in other programs. I personally know these people, they also did do well on Step one and two also.
I really think you can only speak for your program and then the stats from the Match (which does not include every FMG that gets a residency)
I also know a grad from my school who matched in 2006 in Radiology, supposed to be super hard for FMG’s.
I’m not interested in Surgery and want FP, I went to the Caribbean because I knew FP would work out fine. I have lined up a lot since I have been in school, clinicals, residency and a job offer in a Rurual area. It’s what I want at my age.
Not everyone wants what you do, and there are more than one way to “skin a cat”. I understand this.
Thank You.
By the way Dr.Belle I know you spoeak from the heart.
To me, I just think that it is good etiquette to send a thank you card.
Kris