As for why pediatrics, psychiatry, and Family Medicine (my specialty) are on the bottom of the list: Lousy reimbursement. Combine that with the fact that they’re hard, and often have long hours (at least in FM and peds), and suddenly they’re not real desirable occupations anymore, especially if you’ve committed about $300K+ to get your degrees and and board certification.
Internal Medicine programs are still popular, but most of graduates of those specialize further, and not many general internists are being turned out anymore, for the same above reasons.
At many universities, classes like organic chemistry are considered the “weed-out” classes, because the weeding out is done here with the pre-med majors. The undergraduate class is purposely made difficult so those that aren’t committed or can’t hack it will find some other interest.
I understand what you mean when you say such and such fields are the “least-desired.” However, I don’t think it’s a really fair statement to make.
I know a girl who made a 239 on her USMLE Step 1 (at least 95th percentile) and wants to go into family medicine. She could get into many more “competitive” residencies but this is her passion. FTR, she’s considering doing a very “elite” FM residency, but still.
Similarly, I know another dude, recent graduate, who was AOA (meaning top 10% of class) and decided to do peds.
I personally think that pathology is BY FAR the most difficult of all the fields I’ve studied, and that pathologists probably have the most comprehensive understanding of the human body, even if their knowledge of management is relatively less. I don’t understand why you would single them out as people who, “don’t like to talk,” when radiologists have a similar level of pt contact.
I know that anecdote is not the plural of data, but I just wanted to put it out there that there are a multitude of reasons people choose for going into whatever field, and implying that people who are very dedicated to and passionate about peds, psychiatry, or FM are only doing it cause they couldn’t get into anything else is unfair, and only furthers the snobbery and stratification that is endemic to the medical profession.
FWIW, the “ROAD” (or “RAPER” - Radiology, Anesthesiology, Pathology, ER medicine) acronyms refer to compensation levels and lifestyle considerations, not difficulty getting into the programs. Someone who has been aiming for a Radiology residency would have a very hard time getting into a good pediatric residency and visaversa. Many in medical school, believe it or not, actually are not primarily looking for a cushy lifestyle and mock those who are. Really. If you are academically able enough to get into medical school odds are you could have applied those smarts into something else that made any easy and comfortable life for yourself without having to invest as many years to do it. Most actually do want to make a positive difference in the world … at least at the start.
FWIW, in general the smartest students I knew were the MDPhDs, who were scattered across internal medicine and pediatric residencies, and those who were aiming for pathology programs, as that was the most intellectual field. Otherwise there was very little correlation between a student’s medical school class ranking or overall intelligence and how much there choice of field was motivated by perceived future compensation. In my very specialty academic focus medical school only a small fraction of us choose a primary care area, but they were clearly not the very bottom of the class. The few who went into Family Practice were clearly in the upper half and were very idealistic and strong willed about what kind of doctors they had always wanted to be. The student who I at least always perceived to be the bottom of my med school went into neurosurgery.
As to the op, indeed almost all who started the program completed it. As stated, the filter is at the getting in level. Part of this lack of attrition is I think due to the fact that the school is investing in you too and your space (and tuition) in a second to fourth year of the program would be hard to fill. You can’t just take an extra first year to make up for the loss.
I’m very sorry to nitpick, but these numbers aren’t exactly correct. A 239 is about the percentile 78th percentile for American medical graduates and AOA is roughly the top 18% of the class (the top quarter based on grades is considered, and then a substantial portion of those are elected based on extracurricular involvement, volunteerism, etc.)
This will be my last hyper-pedantic med-school post of this financial year.
Also, DSeid makes an excellent point regarding the intra-specialty variance in “competitiveness” being greater than the inter-specialty variance. People that go into pediatrics are probably doing it because they love kids, not because they can’t get into anything else. Only dermatology, plastic surgery, neurosurgery, and perhaps some other surgical sub-specialties are truly closed off to people graduating in the bottom third of their class.
Thanks for the corrections. Do you have a cite for the USMLE numbers? I have heard various things, although I recall seeing a publication from the NBME giving 239 to be about the range you say it is. However, there is a two-digit score given along with the three-digit score, and some think the two digit score represents percentiles. This girl keeps insisting she is 99th percentile, although that’s definitely not true with a 239, but “99” was her two digit number. I didn’t really believe it reflected percentiles until a prof of mine made a passing comment that it did.
Anyways, point being, a cite would be helpful, as there is tons of misinformation floating around and I don’t want to propagate it.
I didn’t mean to imply anything. Surely there are great doctors who go into psychiatry and lousy ones who go into radiology. And as others have pointed out, the popularity of certain fields doesn’t necessarily correlate with the quality of people who enter them.
I spent a brief time working on residency recruitment for a leading academic medical center. Graduating medical students apply for residency programs as part of a "matching " process, and they all find out on the same day (usually at a ceremony) where they are going. This particular facility I was working for had an overwhelming number of candidates for some of its programs (which were ranked top-25 nationally) and very few applicants for others. For Patholgy in particular, I was told by the department head that they had a lot of applicants from foreign born students who struggled with English, many of them otherwise very qualified, who wanted to disappear into a lab.
It’s possible that someone who flunked out of somewhere else - even medical school - would be refused admittance into a nursing program. Nursing programs are very competitive right now, with many, many more students applying than there are slots. This is due to the combination of the economic downturn and the nursing shortage - anyone with an RN is pretty much guaranteed to get a job -somewhere- as soon as they get their license. BSN programs are particularly hard to get into.
Nursing programs can afford to be picky, and they are. There’s also a rep - not sure how true it is - that doctors or med students just don’t do well if they try to switch over to nursing. The skills don’t carry over well. One group that does do well, though, and any nursing program will fight to get - paramedics. I’ve known a lot of former paramedics who went into nursing over the years, and they’ve all been spectacular nurses.
As anson2995 said, it is not a percentile, but a rather arbitrary number made up by the NRMP so that states which have legislation saying that, in effect, “licensed physicians must have received a score on a licensing exam greater than 75 on a 1-100 scale” can be satisfied. I do find myself cringing heavily when people brag about how smart they are with the two-digit number.
Here’s a recent statement from the NRMP: “For recent administrations, the mean and standard deviation for first-time examinees from US and Canadian medical schools are approximately 222 and 22, respectively…”
I then used an online Z-score to percentile calculator.
Here’s the AOA’s info: “At approximately 16 months before a given class will graduate from medical school, the Councilor must arrange with the dean’s office, with the students’ permission, to receive in confidence a list of the top quartile as measured by academic performance. From this top quartile of students, each chapter may elect to AΩA membership up to one-sixth of the projected number of students that will graduate. The Councilor then invites members of AΩA in the faculty who know students and their performance in the classroom and in clerkships to meet in confidence to select students for membership. The chapter may elect up to half of that one-sixth of students in the spring of the third year, and the remainder at any time from the fall of the fourth year until graduation.”