Tuesday, December 11, 2007

An Excellent Question

"TS - are you only interviewing at 5 schools? Do you think that's going to limit your match? ... is it worthwhile to interview at other schools as well, as "safe" backups? (or is that too undergrad application process-y?)"

Thanks for the question, Rach. I chose to answer it here because other people might have a similar question later. The short answer is that it varies widely from specialty to specialty and from person to person.

I am interviewing at 6 schools total. I applied to 10 and canceled/didn't schedule 4 interviews. I'm taking advantage of the fact that psychiatry is a non-competitive specialty. In psychiatry, 6 is kind of an intermediate number. I've had residents tell me they interviewed at only 3 schools, but I met an applicant yesterday who had scheduled 15+ interviews. Since I am "geographically limited", I limited the number of applications and interviews. Also, I need to go where my husband can get a job, so I'm only applying in one state.

I have friends entering psychiatry who wish to move to the East or West Coast, which would require many more applications and interviews (and often an away rotation to seal the deal). They may apply to around 20-30 programs.

I have a friend entering neurology (a low to intermediate-ly competitive specialty) who applied to 30+ programs because she wishes to escape the Gulf Coast and go to the East Coast. Another friend is applying to anesthesia and is applying wherever she can; she applied to 40-50 programs, ranging from state public to East Coast Ivy League.

If you are entering a very competitive specialty, you will be advised by most people to apply widely. When I was entering urology, the AUA said the average candidate applied to ~40 programs. Derm Guy applied to 75 derm programs. Also, many programs require a transitional or preliminary year in medicine or surgery, which often have to be applied to separately (Derm Guy applied to 10+ prelim programs).

So, why did I only apply to 6? I really need to go to a place where my husband can work. I will probably only rank 3 programs, which are all geographically equivalent for me. Yes, that leaves me the chance of going unmatched, but if that happens I will try to scramble for a prelim medicine spot in that area; if THAT doesn't happen, I'll try to get a research position or work at McDonald's for a year. In my situation, my first priority is to go there, and my next priority is to get into psychiatry. Other people's priorities are different.

In other words, I took 3 interviews that were "safe backups", if you will. If I chose to rank those programs, it would be as a backup to protect against going unmatched.

There is nothing wrong with applying widely and whittling down your list as the interviews roll in. Do keep in mind, however, that it will start costing you a great deal of money. My 10 programs cost me $110 for the application ($60 for the programs and $50 to release my USMLE transcript). From the ERAS website:

ERAS processing fees are based on the number of programs to which you apply. ERAS fees are: $60 initial application fee (includes up to 10 programs); $8 each for 11-20 programs; $15 each for 21-30 programs; and $25 each for program(s) over 30.

In other words, applying to 20 programs costs $140, 30 programs costs $290, and 75 programs costs $1415 (I think I did that right). Every interview may require all of the following: flight, hotel, rental car, parking, suit dry cleaning, etc. Some derm applicants can spend around $10,000 applying and interviewing; this cost is NOT included in your student loans for fourth year. Fortunately, you get a break when you rank programs (NRMP website):

There is no charge to programs or applicants for entering their rank order lists for the specialty matches. The registration fee covers registration, submission of rank order lists, and access to Match Results.

The NRMP registration fee is $40 so long as you get it paid on time; late is a $50 fee plus $40 to register. There is no extra fee for ranking a zillion programs (but you can only rank those you have applied with).

So, risks of not applying widely enough: going unmatched, or missing out on a great program you never knew about. Risks of applying too widely: $$$$$$$, interview burnout, time away from electives, family, friends, etc.

After this novella of an answer, it still comes down to this: it varies widely from specialty to specialty and from person to person. Hope this helps.


Rach said...

Great answer TS! Interesting how Psychiatry is deemed to be a non-competitive specialty- why is that anyways? it would seem to me that it's still a lifestyle specialty, although the long-term chronic nature of the patients' illness would lead to the specialty's higher burn out rate.

Care to comment? (Sorry, I just replied to my question-comment with another question-comment)

Tiny Shrink said...

My guesses as to why psych is non-competitive:

1) While the lifestyle is great (largely M-F 8-5, little/no call, especially in private practice), psych typically doesn't pay well compared to other specialties.

2) In recent years, the demand for MD psychiatrists to do "med checks" has increased substantially, so to keep up a LOT of FMG's have entered the field. American med students see this and think a) non-competitive and b) med checks are boring.

3) There is still a huge stigma against psych patients and by extension mental health providers. A lot of med students either believe this stigma or don't want to be on the receiving end of it.

4) It's not "real medicine".

Allison said...

HAHA... I don't have to pay to apply for jobs! In fact, I technically got paid to recruit. I am amazing.