Monday, November 19, 2012

How to be competitive

Ever since I made my post about why I didn't do dermatology, I've gotten responses reprimanding me for implying that dermatologists are all terrible people.

They're not. Back in the old days, it was much easier to match in derm. And I'm sure the people who trained back then are nice people. Just the new ones are terrible.

(I'm joking.)

(Or am I?)

One of the responses got me thinking about my own classmates who matched in derm. There weren't many of them, and yes, they were very very competitive. They were the ones who fought to have every exam postponed, who showed horrible behavior during clerkships that made everyone hate them. Future dermatologists: if you want people to stop saying you're terrible, stop doing things to make us hate you! (But you can't, because then you won't match in derm...)

Then I got to thinking about the people in my class who were junior AOA.

For those of you not in the field, AOA is the medical honor society. In most schools, a few people get elected early to AOA due to just being totally awesome. And these people are called "junior AOA."

In my class, there were five. Four of them were incredibly competitive, very cutthroat students. They actually had a fair amount of charisma as well, which meant that they weren't quite as hated as maybe they could have been. But believe me, if you were on a rotation with any of these students, you got to dislike them. Or possibly even refer to them as "the devil incarnate."

Those four matched in ortho, plastics, derm, and rad onc. Coincidentally, none of them had their interest sparked by peds or family medicine.

The fifth junior AOA member, the only female, was a little different. She was a little quieter and more studious. I never heard any horrible stories about her behavior on clerkships. And then when match came along, she failed to match in the surgical subspecialty of her choice and had to settle for general surgery.

Five students. All very smart. All very good at studying and getting high grades. Four matched in highly competitive specialties, one didn't. Apparently, being smart and studious isn't enough. Being a huge competitive jerk is requisite to getting what you want.


  1. Beware of generalizations! Although I am a generation before you, finishing Med School in the 1970s; I was AOA, had a post grad degree, and was selected as a Rhodes Scholar as a medical student (I went to Oxford after med graduation to do my post doc). I have been very satisfied in my career as a pediatrician and my goal is to attract the best, brightest, and most compassionate into my chosen field.

    1. Having several middle-aged family members who are physicians, I know things were very different back then. You could do any field you wanted with any grades.

      Hopefully, you attract the best, brightest, and most compassionate into your field. But you likely won't attract the students with the most honors and the highest grades. That's not necessarily a bad thing though.

    2. BKR -- We had two Rhodes scholars in my class, and one was a (very smart and superficially charming) total douchebag who went into derm, and the other was really nice and went into peds. I wonder if the douchebag who went into derm thought he was a nice guy? Maybe he didn't care either way.

  2. BKR and Fizzy -

    I graduated med school in 2008. While most of what Fizzy said applied to my class, not all the gunners in my class did competitive stuff. In fact, the #1, who was extremely cutthroat, matched into IM at our school (as could anyone in the class with a pulse), didn't subspecialize, and now works in general outpatient primary care. But plenty of the gunners did surgical specialties or rad. And a few who acted like gunners but weren't great at exams did poorly in the match.

    1. I have to say, I always wondered about the people who were crazy competitive and did a non-competitive specialty. It's like, why did you act that way? You really couldn't help it? But it was rare.

  3. I have to say it's generally true. Unfortunate, but true. Where I come from people compete for eye, ENT, derm and plastics. Fair enough that you need to put in effort to get into something competitive - but I wish people would just admit it. They want these specialties for a few main reasons - they are lucrative, they aren't as physically punishing as many other specialties and they are mostly glamorous. It's bad enough to be a gunner but it's worse to be a gunner + hypocrite. And don't even get me started on people who go on high profile mission trips to 3rd world countries to do cataract surgeries...

  4. Non-medical person here who needs an explanation. I get the desire for lucrative and not physically punishing, but what's glamorous about rad or derm? Diagnosing ringworm is glamorous? Reading xrays (or whatever comes out of the new machines) is glamorous?

    1. A field like rads, where there's little to no patient contact makes for an easier schedule, more flexible hours, etc. As for derm, the reimbursement is high due to the procedures, and the hours are good because there aren't many emergencies.

    2. Rad = 45-50 hours per week and 350K per year, very little call and no patient contact.
      Derm = 40 hours per week and 200K per year (more if you do mostly cosmetic derm), private insurance only, very little call
      Contrast that with:
      (any) Surgery = 70-80 hours per week, 300K per year with frequent call
      Family Med = 50 hours per week or more, 90-100K per year with frequent call

    3. I'm hauling 60-65ish hours a week as a radiologist and am on call q4. Definitely not that glamorous and definitely don't make anywhere near 350K. Annual decreasing compensation is making a lifestyle specialty a way of the past. I also have a stinkton more patient contact than imagined - biopsies, breast localizations, minor IR procedures and GI fluoroscopy.

      Private surgeons are working similar hours as I am. The smart ones have PAs to handle most of their call, non-OR work, and start/finish cases for them. A vascular surgeon friend of mine has his first case at 7:30 a.m., operates three days a week, and is on call one week a month. I don't think he minds having a "posh" lifestyle - none of us are immune to fatigue.

  5. I'm a burn nurse and I feel like I have to remind myself again and again that I'm working with Very Smart Doctors because they matched into plastics and plastics is a gunner specialty, right?

  6. A shocking number of my cohort (2004) slit throats and worked incredibly hard to match into the fields where they had to work the least (with higher pay a consideration to be sure). Many were quite open about this; a minority wanted to get paid fairly well to work part time for life (Rads comes to mind).

    Part of me understands this, but I just put in enough time to be an upper quarter student and now I put in my ~48 a week with monthly call. It just seemed the path of least resistance, it's a good gig and I make more money than I need, what the hell.

    Several - close to a dozen last I heard - of our more extreme "storybook" gunners were leveled with opportunistic chronic illnesses (MS, Lupus, Severe RA), some before finishing residency. There was talk of a study on it at one time.

    "Accumulated stress" theory or Karma at work?