tag:blogger.com,1999:blog-4968787219619380438.post8030407857843181793..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: A medical student says to abandon the matchSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger36125tag:blogger.com,1999:blog-4968787219619380438.post-30108261575390676162017-05-03T17:47:19.445-04:002017-05-03T17:47:19.445-04:00How do you know the program ranked both applicants...How do you know the program ranked both applicants? That information is not public knowledge.<br /><br />Here's how the process works http://www.nrmp.org/match-process/match-algorithm/<br /><br />This reddit thread offers more detailed explanations https://www.reddit.com/r/medicalschool/comments/3sb0ll/how_does_the_match_favor_students/<br /><br />Assuming what you described actually happened, the first program ranked the second applicant higher than the first applicant. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6764235926006154232017-05-03T14:43:30.311-04:002017-05-03T14:43:30.311-04:00Please explain this to me: A 4th-year medical stu...Please explain this to me: A 4th-year medical student ranks a program as #1; another 4th-year medical student, from the SAME medical school, ranks that same program #25. The "program" has ranked both applicants (we don't know their list/rankings). The student who ranked the program #25 matches there. The other future intern matches at his 8th choice somewhere else. If the match "favors the student", how did this happen?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-76401798057635979492014-05-06T07:53:23.432-04:002014-05-06T07:53:23.432-04:00Anon, that is a very interesting observation. I wo...Anon, that is a very interesting observation. I wonder what the people running family medicine would have to say.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-73992152877440518212014-05-05T23:47:01.206-04:002014-05-05T23:47:01.206-04:00I agree that "family medicine" is not a ...I agree that "family medicine" is not a real specialty, and stating otherwise has not encourage students in the field.<br /><br />A couple of years ago, I attended a week-long FM update course at a high-profile med school. All but 2 of the sessions were given by non-FM specialists. One of them was about unusual vaginal secretions, the course director's hobbyhorse, and I completely forgot the other topic.<br /><br />You can't be a medical specialty if you are completely dependent on others for knowledge.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-33322978647442128142014-05-02T12:33:22.808-04:002014-05-02T12:33:22.808-04:00Best, the situation you describe in psychiatry rem...Best, the situation you describe in psychiatry reminds me of one of my first blog posts [http://skepticalscalpel.blogspot.com/2010/07/shortage-of-primary-care-physicians.html] in which I described my plan to increase the number of med students going into family practice.<br /><br />I offered to help set my plan in motion, but the phone never rang.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-33364362337432893872014-05-01T20:48:04.134-04:002014-05-01T20:48:04.134-04:00There are far more non-competitive specialties tha...There are far more non-competitive specialties than competitive ones. I can't see why the doldrums of medicine like pathology and anything primary care couldn't band together to push this through.<br /><br />But I don't think it would be the ABOS or the AAD who'd get in the way - as long as the pay is high they're still gonna attract "the best". It'd be the AAFP. Making "everyone" into a general practitioner would remove the "specialty" designation from "family medicine". I for one think that family medicine is an artificial concept that has no meaning, and that such a field is not a specialty but what medical school should be like for everyone. They're not paid like specialists and produce no worthwhile research. Family is not a specialty.<br /><br />Med schools could charge the same tuition over three years that they do over four. It might be even better for them since they'd be getting bigger sums at once.<br /><br />You're right about the shrinks. My school used to have an anesthesia rotation in clerkship, until the moronic psychiatrists banded together to have it removed in favor of more psychiatry, since no students were interested in psych and they thought that more exposure would help. Well, it didn't. More students saw what kind of whiny, incompetent halfwits went into psych at my institution, and the match rate for psych dropped even more than before! <br /><br />The match is necessary only because the medical education system is extremely flawed.<br /><br />Were I some bigwig academic, I'd be riding the horse on this one. Yet I went into medicine to help patients, not do meaningless research and claw at academic appointments, so people will not experience the best ideas from the Best of the Best. What a sad world.Best of the bestnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-44399839734167226542014-05-01T14:15:12.606-04:002014-05-01T14:15:12.606-04:00Best, thanks for commenting. Your description of c...Best, thanks for commenting. Your description of clerkships is spot on. I agree with you about med school curricula being way outdated. I've written about that in a previous post. [See: http://skepticalscalpel.blogspot.com/2010/08/medical-school-and-surgery.html] Do you think the shrinks will every give up even a single week to ortho or rads? Not a chance.<br /><br />Your suggestion #2 will never happen. Do you think that med schools would give up a year of tuition, which by the way costs the schools nothing but some administrative work? [See: http://skepticalscalpel.blogspot.com/2012/04/medical-school-tuition-follow-money.html]<br /><br />Your suggestion #3 is of course a great idea. Unfortunately, it will never happen. If you were the American Board of Orthopedic Surgery or Dermatology or any other highly competitive specialty, why would you ever agree to change the system?<br /><br />I've said all I want to say about the match.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70877315888524921232014-05-01T13:56:12.909-04:002014-05-01T13:56:12.909-04:00I agree with "the best", although to a l...I agree with "the best", although to a lesser degree. I have written on Scalpel's blog elsewhere that I don't find much of medical school to be useful these days, save anatomy, some physiology, and some pharm. It could certainly by compressed in my opinion. <br /><br />I also agree it's time for a "new Flexner Report". artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-41551703930996994602014-05-01T12:34:32.645-04:002014-05-01T12:34:32.645-04:00I am happy that a primadonna like Amy Ho, as flawe...I am happy that a primadonna like Amy Ho, as flawed as some of her assertions are, has made a public denouncement of the artificial match process.<br /><br />I have a solution that, being so obvious, will boggle the minds of those who read it, because its obviousness should have been..well...obvious to everyone!<br /><br />MDs should be able to practice competently, without ANY residency training. <br /><br />Years ago, you could be a general practitioner (now called the lame term "family doctor") once you finished medical school. The training was rigorous, the standards and expectations were astronomical, and the curriculum was arranged in such a way as to be useful.<br /><br />Fast forward to now. Medical school is useless. Too many cooks are in the kitchen, pushing their left-wing ideals onto the students - the mandatory classes are all ethics and handholding seminars. Technology has changed the way we practice, yet we are still using the Flexner model from 100 years ago. Clerkship has devolved into a shadowing game where kissing up and shutting up is the way to an A. Medical students don't actually know anything anymore when they graduate, and as such, residency selection is more about how well one kissed butt than about how accomplished they are as physicians. It seems medical schools are just fine with using an outdated educational model and leaving real medical training to occur in residency.<br /><br />I propose the following:<br /><br />1. Medical schools change their damned curricula to be congruent with modern medical practice (we do 6 weeks of psychiatry but NO anesthesiology, radiology or orthopedics - how does that make sense?)<br />2. Didactic, non-MD medical school be shortened to 3 years: Two schools in Canada do this and frankly it works. We all know that the fourth "interview" year is a complete waste of time.<br />3. Everyone does a 2 year internship afterward, in the same thing: a general rotating internship. Once they come out, they can practice medicine as a GP. All medical students would have this behind their belts, and this would be a boon to society and to medical education.<br />4. Residency applications would be just like applying for jobs. None of this wasteful match process.<br /><br />Dentists are always ready to go be dentists when they finish training, and their school is no less rigorous than ours. Why can't we make medical school one where physicians are trained, not just rubber stamped into a residency?The best of the bestnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-26074706995098967502014-04-29T14:30:50.655-04:002014-04-29T14:30:50.655-04:00TD, thank you. I can confirm that her Twitter prof...TD, thank you. I can confirm that her Twitter profile was as you said. Despite her apparent feelings about your comment and her profile, she has deleted the vulgar reference from it. I share your concern about her lack of insight.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-30023659480140726822014-04-29T09:19:08.718-04:002014-04-29T09:19:08.718-04:00After the Twitter exchange I had with Amy Ho last ...After the Twitter exchange I had with Amy Ho last night, I understand her much better. Her Twitter profile had the quote: "The opposite of Tweet is tw*t. That is how I feel about people on Twitter sometimes. Understand the * is not an i, it was the more vulgar term. This is a twitter profile linked directly to her name, not a pseudonym. I tweeted her that using vulgarity in a twitter profile is unprofessional. She responded "Stop the personal attacks." I explained that calling her the vulgarity is a personal attack, pointing out its improper use is not. She told me I was being "a Mean Girl" From a movie of the same name, popular with young girls. <br /><br />The fact that she would use such a term in a public profile while at the same time having a published article in Forbes, shows a gross misunderstanding of the public nature of social media and how one should conduct herself in a professional setting.<br /><br />Further, it is a failure of her medical education that she is about to graduate, yet has the maturity of a middle school girl and very thin skin. How on earth can you make it through medical school if you respond to criticism as a personal attack? Was she so difficult to deal with that they just mollycoddled her through? God help her future colleagues. <br /><br />To sum up Amy Ho: I want to go to residency where I want to. I want you to pay me what I want to. I don't want to interview anywhere I don't want to work. Don't tell me I am wrong. TDintheEDhttp://twitter.com/TDintheEDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52426805048283043962014-04-25T08:45:35.411-04:002014-04-25T08:45:35.411-04:00Anon, you make some good points. I'm not sure ...Anon, you make some good points. I'm not sure the match and the med school application process are so similar. It is possible that outstanding students could negotiate higher salaries, but why would that be fair? Since the work of a resident is comparable across all hospitals, why should some residents make more money? But even more unfair would be that the top hospitals could easily pressure their residency applicants to take less money. Wouldn't you take less to train at MGH? <br /><br />Again, even if the match disappeared, the expenses and time associated with interviewing would still exist. Med schools don't pay applicants' expenses. I doubt residency programs would either.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75251204007338537652014-04-24T10:51:47.706-04:002014-04-24T10:51:47.706-04:00I think the real frustration expressed by the auth...I think the real frustration expressed by the author stems from a lack of choices arbitrated by the match. There are about 40,000 medical school applicants each year for 19,000 MD spots (see AMCAS data, 2013). The DO data is separate. The difference here is that medical school applicants often have several schools to choose among after shelling out $$ for traveling and interviews, holding several offers and with a final date to decide on one school to attend. While this system arguably is less efficient, with some schools only filling in their last couple of spots within days of starting medical school, somehow (miraculously) those 19,000+ MD spots are always filled. Roth's Match system isn't necessary to "fill residency positions" - we do it every year in a non-match system with medical school applicants. I think the author of the Forbes article laments the lack of choices among residency applicants - just as other professions often have many job offers (along with the free market opportunity to negotiate better salaries, benefits, etc among the offers the applicant receives). Even down-the-totem-pole medical students get to negotiate with their medical school acceptance offers - I know many, many students who came out on top with better financial aid packages because other, less competitive programs offered better scholarships to woo them.<br /><br />We don't "need" the NRMP match system - we do the same thing, each year, with filling the numerous medical school spots with diverse candidates, all without the match.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-10285711834082354692014-04-18T15:49:15.779-04:002014-04-18T15:49:15.779-04:00In 2015, the ACGME will consider DO graduates equi...In 2015, the ACGME will consider DO graduates equivalent to MD graduates which accounted for about 20,000 graduates in 2014. That number will rise sharply as expanded classes and new med schools pump out more doctors.<br /><br />I agree that it does not look good for IMGs, US or otherwise.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12803735910205281132014-04-18T15:44:16.166-04:002014-04-18T15:44:16.166-04:00@hope "I don't see a great solution t...@hope "I don't see a great solution to the problem. For now, the Match seems no better or worse than any of the other ideas about which I've read."<br /><br />Thanks for your insights; much appreciated.<br /><br />My understanding of Roth's contribution is that *no* individual applicant can do better outside the match. He/she may do the same, but not better. <br /><br />He or she may get together with others to get a sweeter deal, at the expense of those others. I don't know about the details, having not study game theory since college. But by that point, he/she should give up medcine and go for his/her own Nobel. : )<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-28901513384883419392014-04-18T15:17:32.012-04:002014-04-18T15:17:32.012-04:00I haven't look into the topic much. but if the...I haven't look into the topic much. but if there are 26k residency positions, that is still much more than the number of American MD grads (18.5k).<br /><br />The current rapid expansion of spots, and the curious position of DO's (unique to the US) complicates things, but at present and for the next few years an American MD is still pretty much a guarantee for a 6-figure job.<br /><br />IMG's are of course in a much worse position.<br /><br />Of course, we know things will get worse. It wasn't so long ago that a law degree from a no-name school usually led to a financially-lucrative, socially-prestigious career. It took only a few years for all that to crumble.<br /><br />If you look at moderately successful engineers or financiers or even lawyers, you see a combination of academic credentials, technical expertise, client service, peer networking, managerial skills. and pure luck. <br /><br />I suspect that purely having an MD won't be enough 10 years from now.<br /><br /><br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60989652459814654452014-04-18T07:53:37.657-04:002014-04-18T07:53:37.657-04:00Anon 1-I don't understand the math either, and...Anon 1-I don't understand the math either, and I agree that Roth won the Nobel Prize for more than just the match. I also agree that getting rid of the match would not decrease the number of interviews that applicants feel they must schedule.<br /><br />Anon 2-Thanks for following up. I'm sure there are still programs that don't want to take women and interview them just for show. I just read something somewhere that said only 4% of surgery programs have no women. I would point out that the match makes it difficult to completely balance the sexes. Even if a program ranked women in the first 10 on their list, it might not match with any of the women if they ranked another program higher. I agree that this has been a good discussion.<br /><br />Hope-Thanks for agreeing with me about the lack of added value that a dual degree brings to a residency program. And you are correct that networking for jobs occurs in all fields and that many people in other occupations are working for companies that were not their first choice. Let's also not forget about the PhD's are working as baristas.<br /><br />Anon 3-I wrote about the problem of insufficient numbers of residency positions last year. Here's the link http://skepticalscalpel.blogspot.com/2013/02/law-school-applications-are-way-down.html. As far as I know nothing has been done to address this problem. You are correct that the number of medical school graduates far exceeds the number of residency slots. Even if the match did not exist, the same number of medical school graduates would be unemployed.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-55831725563397372392014-04-18T06:02:06.860-04:002014-04-18T06:02:06.860-04:00That's true Anonymous, but how is that situati...That's true Anonymous, but how is that situation different from the majority of fields out there? Engineering, marketing, social work, psychology, journalism, even finance. Freshly minted college graduates in many fields have difficulty securing jobs in the profession of their choice. They're lucky to find jobs at all. While the Match does bind two parties into a contract that appears less flexible than the average person trying to obtain a job, when you're looking for a specific job in your field that you were trained to do, well, I think everyone has problems securing their first few choices, not just doctors.hopenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75204034202513731162014-04-17T22:19:09.688-04:002014-04-17T22:19:09.688-04:00I don't know if other people have brought this...I don't know if other people have brought this up, but it seems to me that the biggest problem with the match currently is the fact that there are way to many applicants (34,000) for too few spots (26,000). Fact is that residency positions in this country are ridiculously underfunded by the government, and probably causes all the trouble in the firstplace.<br /><br />The issues with the Match then follow inevitably. If you have a system that cannot provide for everyone, vicious competition, pointless bureaucracy, and a focus on meaningless attributes vs. competence of the applicant are bound to followAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-47330820243750257602014-04-17T19:37:07.611-04:002014-04-17T19:37:07.611-04:00I am not a huge fan of the Match myself, however, ...I am not a huge fan of the Match myself, however, I am a firm believer that harsh criticism should be followed up by well-argued suggestions for improvement. Without posing solutions to the problem, her arguments really lack a lot of strength. I'm actually an MD/PhD program graduate myself and in a specialized surgical residency. It's never occurred to me that residents with dual degrees should be paid more. My resident salary is actually quite a bit more than would be an entry-level post doc job at my institution, which is where I would have ended up without my MD. All of us dual degree residents were fully aware of the deferred gratification we were up for when choosing MD/PhD and when choosing surgery. The salary argument doesn't make much sense to me because, as Skeptical Scalpel has pointed out, having a JD (or even PhD) benefits day-to-day resident productivity very little. These degrees are useful for our destination jobs, and perhaps for giving us different ways of thinking and seeing the bigger picture, but honestly, in terms of resident job performance, there is probably little benefit to them (and thus no reason to be paid more, in my opinion). <br /><br />The Match is not great in that many programs and specialties don't rank applicants objectively...it's sometimes who you know and how much power they have. But tell me, which job ISN'T this way? No job search is really fair. Most jobs already have an internal candidate selected when the position is advertised. It's the real world. Success in this world will always be based to a certain degree on who you know and how you network. Medicine is no different. The outside world grapples with the problem of "more people than jobs" in a way that is often more critical than is the field of medicine. <br /><br />I don't see a great solution to the problem. For now, the Match seems no better or worse than any of the other ideas about which I've read. hopenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-53994098532421559312014-04-17T18:53:14.043-04:002014-04-17T18:53:14.043-04:00Thank you for posting my comments, SS.
Yes, the U...Thank you for posting my comments, SS.<br /><br />Yes, the University of Kansas experience was real. Very real.<br /><br />You make a good point about "the Good 'ol days". . .in that they were paid nothing more than room and board. But history, and statistics of the profession, tell us there were no poor blacks, or poor whites in medicine at the time--because they couldn't afford tuition or "room and board" as the only salary. Interestingly, my point is also flawed in that military service used to be required of physicians, too. Not a bad idea, but, that too is not without issues. In those "good 'ol days" rich white boys became doctors. Not women. Not blacks.<br /><br />I interviewed, also, in the midwest at the University of Oklahoma-Tulsa, where the "then" director told me point blank (after he'd just finished interviewing a woman), "I'll NEVER have a woman in this program. They get pregnant. . .take maternity leave and it screws up the rotational schedules and I have to re-do everything! They don't want to take call. NEVER I tell you, Never!" I wonder what the young lady who'd just spent her money traveling to that interview would have thought to have heard she wasted her money and was probably "selected" to interview to meet some kind of quota so the program could show they didn't discriminate against women.<br /><br />Yes, my program did have malpractice insurance. And there is so much more to this story--and I do not want to put the details here for fear I'd give too much identifying information. Let's just say the attending did not go to the National Practtioner Data Bank and I did. Why? Because only the "insured" can go to the Data Bank. . .and the Program Director was insured as an employee under the "University". . .and you can't report a "University" to the databank...only the "insured"...(Mayo Clinic his able to umbrella many of their doctors this way...so I'm told by attorneys and medical board members). "The Insured" is the "self-insured" entity. I was a resident "rotating" at that institution...and I had a "separate" policy covering "just me" (by name) as a "rider" to the policy with my name on it. As a non-employed physician, rotating to the University, from another institution (a rotation REQUIRED for me to complete my training), I was named to the DataBank.<br /><br />Years ago, Josef Fischer, MD, from the ACS wrote several articles in the Bulletin of the ACS about this problem. He unfortunately failed to solve it.<br /><br />But, I enjoy your blog and the back/forth input. We won't solve anything here, but it is good to hear others stories and arguments.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-62033815734669813052014-04-17T15:53:58.732-04:002014-04-17T15:53:58.732-04:00I don't understand the math, but I thought tha...I don't understand the math, but I thought that Roth proved (in a game-theoretic fashion) that the Match algorithm cannot be gamed on an individual basis. That is, the matching resident cannot do better on his/her own. It was the real-world application of game theory (not just the Match) which garnered him the Nobel.<br /><br />I agree that interviewing at 25 programs across the country is crazy expensive for a <br />med student, but that is his or her choice regardless if the Match is involved.<br /><br /><br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-7186859356596691592014-04-17T09:00:57.360-04:002014-04-17T09:00:57.360-04:00First anonymous, thank you for the comments.
If yo...First anonymous, thank you for the comments.<br />If your experience at the University of Kansas really happened, you have a right to be angry. I'm not sure what the legal case you were involved in was about, but your hospital should have covered you for malpractice. I don't think it's practical or feasible to expect residents to earn as much as a chief of surgery. I was a program director at three different community teaching hospitals. Not once was the match rigged. I'm sure there are deals made at times, but wouldn't they still be made if there was no match? Your plan to have the programs interview the 20 people they want sounds great, but what happens to people who only get invited to two or three places and get no offers?<br />I'll tell you how "legally binding" the match is. It's only binding on the programs. If you match to a program and then decide not to show up, your only penalty is that you will be barred from participating in the match for a year. This happened to me once. An applicant matched with my program and then disappeared for two months. She never returned the hospital contract we sent her. When she finally surfaced, she told me she had accepted a position in emergency medicine outside of the match. I then had to try to recruit a categorical resident in late May. The penalty issued by the NRMP meant nothing to her. If a program director reneged on the match, the program would be barred from participation, a much bigger problem for a program than for an individual like the one who bailed out on me.<br />"I prefer the good old days: Apply, interview, be paid well." You prefer the good old days? Perhaps you aren't aware that residents in the 1950s and before were not paid anything. They were given room and board at the hospital and maybe a few dollars per month. That's why they were called residents.<br /><br />Second anonymous, I had a little trouble following your line of thinking. I will agree that the match process is very expensive. The previous anonymous commenter had a point that most corporations pay interviewees' expenses. Unfortunately, I don't see the current system changing. Once again though, this problem would exist with or without the match.<br /><br />Vamsi, the idea of a residency fair works very well for the programs, but would you really want to take a job for five years without ever seeing the place where you were going to work and its environment? Also, I think it's very important that applicants at a chance to talk with the chairman of the department and the program director of the residency. Meeting a single faculty member and one or two residents is not enough.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-44489738919072568222014-04-16T23:27:49.594-04:002014-04-16T23:27:49.594-04:00I disagree with Ms. Ho.
Fundamentally, her econom...I disagree with Ms. Ho.<br /><br />Fundamentally, her economic analysis is flawed- it's not a case of residents just getting screwed over their salary. In the match, both sides give up something. Hospitals and residency programs give up (largely) their ability to select individual residents. Especially mid-tier programs may have no idea who they have coming to them. Meanwhile, students give up their (already low) ability to negotiate salaries. In exchange, they get the ability to consider ALL offers before making a decision- something they would not have otherwise.<br /><br />I am quite surprised Forbes printed this. It's really just her venting about the cost of flights.<br /><br />In terms of improvement, I see as a model the current regional efforts to recruit medical students. At least in the Western US, all the EM programs send a few residents and a program director to a conference once a year (rotating between USC and UCI). There, they talk with 3rd and 4th years at a "residency fair", and give lectures and workshops to 1st and 2nd years about the specialty in general.<br /><br />I don't see why in a similar manner, all the General Surgery programs in for example the Midwest couldn't get together in Chicago 4 times over the course of interview season. There, interviewees could go from room to room- for 30 minute interviews with the program director or a faculty member or designee. At the end of the night, a 2-3 hour social event at night with all the residents from the programs out in force.<br /><br />I hear pediatric surgery is already moving to something like this, what with 30 spots in the nation that every applicant applies to.<br /><br />Respectfully,<br />Vamsi AribindiVamsi Aribindihttps://www.blogger.com/profile/05182545135805006712noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-13761783971522882022014-04-16T21:01:34.731-04:002014-04-16T21:01:34.731-04:00Comment to Pamchenko:
Let's assume, just for ...Comment to Pamchenko:<br /><br />Let's assume, just for a minute, that $8,000 isn't much money to you. <br /><br />You argue, " nonetheless, most people would see it as an opportunity cost. Is this a process that hurts poorer students? Not necessarily...most students already accept that they are in debt around a quarter mil and another $8 is part of that. To spend a quarter mil in college/med school and not spend another $8,000 would be foolhardy; therefore, the monetary argument doesn't make alot of sense."<br /><br />$8,000.00, in after tax dollars, would be 21 Medicare gallbladders ($750 each). Now, if you're sharing office space with me, and we split all the overhead, I say, "I'm going to charge you $8,000.00 dollars more this year because you already paid me $75,0000 in office shared expenses."<br /><br />You'd come up for air.<br /><br />I have no "generational wealth." Here's what your forgetting about the intern paying his own air fare and interview expenses:<br /><br />Generational Wealth (in this scenario "Daddy" is a general surgeon who has been in practice for 20 years.):<br /><br />Son: $150K in debt from Medical School + $8K interview expenses. Graduates and joins "Daddy's practice"...starts out $158K in debt.<br /><br />Now, let's consider, no generational wealth:<br /><br />Son: $150K in debt, + 8K interviews + $50K (office equipment) + $lease of office, etc.<br /><br />It is a big deal. Because I'm doing 20 more gallbladders than the "other son" but the amount I must outlaw for my office, expenses, etc. that the "other son" doesn't have to.<br /><br />Relevance: The poor kid, without money, pays $8,000 + credit-card interest. . .and flies around the country to "match"...while the "other kid" can see light at the end of the tunnel...the poor kid is in so much debt, chasing a dream...only to realize what a sick joke medicine is. Oh, and let's not forget: "tail coverage". . .<br /><br />Now, I'd like to see how many "poor" doctors commit suicide vs. those who came from generational wealth.<br /><br />No wonder everybody hates us. Whining, crying, complaining...rich kids? I think there is SOME truth to this.<br /><br />Anonymousnoreply@blogger.com