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Annual Specialty Competitiveness Stats

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19 minutes ago, Radsinthefuture said:

CaRMS is a black box for many reasons. Anecdotal stories such as yours (and mine) don't really prove how competitive a field is per year.

So true. Connections, favors, politics etc. play a huge role for these people that we are describing, and they unfortunately don't help when trying to determine how competitive a field is... 

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1 minute ago, fiftyshadesofgreen said:

What makes optho so competitive? I thought there were no jobs..

Very cool surgeries and high income. I only did one 2 week selective in ophthal at one school, but man opthalmologists were some of the nicest people I have ever met. All the attendings would joke around with you and would sometimes come down to help the residents do scut work. I don't know if this experience is generalizable to all programs.

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Just now, hero147 said:

Very cool surgeries and high income. I only did one 2 week selective in ophthal at one school, but man opthalmologists were some of the nicest people I have ever met. All the attendings would joke around with you and would sometimes come down to help the residents do scut work. I don't know if this experience is generalizable to all programs.

Thanks! job opportunities are good too?

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8 minutes ago, fiftyshadesofgreen said:

What makes optho so competitive? I thought there were no jobs..

Insane income and great lifestyle. Lots of that income can be had without ORs, which means the job market can be great even you're going to be mainly "self-employed". Hard not to like.

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1 minute ago, PhD2MD said:

Insane income and great lifestyle. Lots of that income can be had without ORs, which means the job market can be great even you're going to be mainly "self-employed". Hard not to like.

I see. I was looking at a report which talks about 40% unemployed optho docs. But again i hear about these stats and see IMGs match back to tough specialties when some CMGs dont even get FM. Anything is possible!

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18 minutes ago, fiftyshadesofgreen said:

I see. I was looking at a report which talks about 40% unemployed optho docs. But again i hear about these stats and see IMGs match back to tough specialties when some CMGs dont even get FM. Anything is possible!

A lot of ophthos have unreported private side gigs

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Job market isn't great in large centers where many ophthos want to work, and hence many end up taking locums, fellowships...  There are probably more community jobs than in many surgical specialties.  It's a good lifestyle for surgery, but it's definitely not a home-call situation.    

OR cases/volume are usually constrained for recent graduates - and if "self-employed", then need to spend on equipment/staff  which adds to costs (though income is much higher than most specialties).  Income difference is probably minimal compared to a specialty like anesthesiology when overhead is accounted for.

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50 minutes ago, tere said:

Job market isn't great in large centers where many ophthos want to work, and hence many end up taking locums, fellowships...  There are probably more community jobs than in many surgical specialties.  It's a good lifestyle for surgery, but it's definitely not a home-call situation.    

OR cases/volume are usually constrained for recent graduates - and if "self-employed", then need to spend on equipment/staff  which adds to costs (though income is much higher than most specialties).  Income difference is probably minimal compared to a specialty like anesthesiology when overhead is accounted for.

Except there are things like medical retina, which pulls in as much as cataracts, but you don't need an OR, or much staff/fancy and expensive equipment. Lots of ways to make cataract-level money on the self-employed/private side of things.

And yes...ophtho is home call! Everything but globe rupture or a detached retina is "I'll see it in the morning". It's not just a better life style than most surgical specialties...it's better than most medical specialties too!

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1 minute ago, PhD2MD said:

Except there are things like medical retina, which pulls in as much as cataracts, but you don't need an OR, or much staff/fancy and expensive equipment. Lots of ways to make cataract-level money on the self-employed/private side of things.

Yes - these are lucrative.  Still, needs more investment than many other specialties.  

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6 minutes ago, tere said:

Yes - these are lucrative.  Still, needs more investment than many other specialties.  

Things like anti-vegf are not a heavy upfront investments..and even they were, the ROI is beyond insane.

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8 hours ago, tere said:

Very high-earning, I agree.  Not sure if the practice could be structured solely around that, but maybe could be..

Oh yea, not uncommon. Only restriction is personal interest, not demand. Waiting lists are huge. I know a few that do it.

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On 3/11/2019 at 2:31 PM, 1D7 said:

In general I think there are 3 factors with radiology's declining popularity.

1) Many students are scared about the future of radiology as a field because of the potential for AI to disrupt the field. For the most part, informed radiologists are not scared about the future of the field. It tends to be those with a vested financial interest in these platforms, or those who don't understand radiology who believe future radiologists will be negatively impacted.

2) There is decreasing representation of radiology and radiologists in medical school. Often dedicated teaching from radiologists are the first to be cut whenever time for didactics is decreased (which is the trend in most medical schools).

3) Shifting demographics of the medical student population towards a decreasing proportion of male students. Like most tech heavy fields, most applicants to radiology are males. Unless radiology is able to do what surgery has done and recruit more women into the field, it is likely that number of applications will continue to fall.

This is the right answer.

Edit: the shifting demographics part is huge in terms of what makes the most competitive specialties competitive. There are more girls than guys in med schools now, and if there is a specialty that females don't find attractive, right there you have 40-60% less applicants than you would have otherwise. I think rad is one of the only remaining specialties where the male to female ratio is 5:1.

This is likely to change though... in the US radiology made a come back in the past couple of years, back into the top 5 most competitive after some lull years.

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On 3/11/2019 at 5:49 PM, PhD2MD said:

Insane income and great lifestyle. Lots of that income can be had without ORs, which means the job market can be great even you're going to be mainly "self-employed". Hard not to like.

 

On 3/11/2019 at 7:26 PM, PhD2MD said:

Except there are things like medical retina, which pulls in as much as cataracts, but you don't need an OR, or much staff/fancy and expensive equipment. Lots of ways to make cataract-level money on the self-employed/private side of things.

And yes...ophtho is home call! Everything but globe rupture or a detached retina is "I'll see it in the morning". It's not just a better life style than most surgical specialties...it's better than most medical specialties too!

 

So you are telling us: 4 years of medical school, 5 years of residency, and 2 years of retina subspecialty to bet everything on injecting Anti-VEGF all day long? The billings for each injection has already been cut in the past four years in most provinces across the country, and more is sure to come. Even general ophthalmologists are picking up pitchforks in protest of how much out of whack retinalogist billings for anti-vegf injections are. So if you are going to bet everything on that, probably not a good gamble.

Also, how boring. In our mandatory ophtho rotation I sat in a retina clinic once, and watched a retinalogist inject 40 eyes in a day. Starting an IV is more exciting, and frankly, at times more technically challenging.

Edit: You are absolutely right about the lifestyle/work hours though, they have it REALLY good. Even the residents were telling me they don't do any overnight call. Then again, optho is kind of rad onc. It is a "surgical" specialty by tradition, but it is now much more procedural than surgical. Microscopes and lasers. At the end of 5 years of residency, they learn cataracts, strabismus, and some other small surgeries here and there. That is about it. You compare that to the hard core surgical specialties like gen surg and ortho, those residents operate all day and night on every conceivable body part, and learn so many surgical approaches during their 5 years that would be too long to list here. That is why the actual surgical residencies so brutally crushing. There is so much technique to learn that they make you use every possible waking hour (and sleeping hour) to operate as much as possible and learn as much as possible for when they are out there independent.

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On 3/19/2019 at 2:03 PM, humhum said:

This is the right answer.

Edit: the shifting demographics part is huge in terms of what makes the most competitive specialties competitive. There are more girls than guys in med schools now, and if there is a specialty that females don't find attractive, right there you have 40-60% less applicants than you would have otherwise. I think rad is one of the only remaining specialties where the male to female ratio is 5:1.

This is likely to change though... in the US radiology made a come back in the past couple of years, back into the top 5 most competitive after some lull years.

CMG pathology was about 95% male this year. Interestingly this is also the year the RC switched to digital pathology

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On 3/11/2019 at 5:00 PM, Bluecolorisnice said:

Opthamology is very competitive

On 3/11/2019 at 7:39 PM, fiftyshadesofgreen said:

What makes optho so competitive? I thought there were no jobs..

OpHthalmology, OpHtho .. sigh. sorry. this bugs me as much as those mixing up "then" and "than" :S. Remember this before applying :D 

 

 

On 3/20/2019 at 1:34 AM, humhum said:

So you are telling us: 4 years of medical school, 5 years of residency, and 2 years of retina subspecialty to bet everything on injecting Anti-VEGF all day long? The billings for each injection has already been cut in the past four years in most provinces across the country, and more is sure to come. Even general ophthalmologists are picking up pitchforks in protest of how much out of whack retinalogist billings for anti-vegf injections are. So if you are going to bet everything on that, probably not a good gamble.

Also, how boring. In our mandatory ophtho rotation I sat in a retina clinic once, and watched a retinalogist inject 40 eyes in a day. Starting an IV is more exciting, and frankly, at times more technically challenging.

 

5

Medical retina is 1 year long, not 2. Another year could be dedicated to another subspecialty, like uveitis.

They dont just do injections! A typical medical retina specialist can organize their week as follows: dedicate 1-2 days for retina follow-ups/injections, another day for cataracts (yes, medical retina still do cataracts),  A post-op/pre-op/general clinic, and a day of subspecialty uveitis. They can even work a call day covering emergencies during this week! 

Billings are not dropping everywhere, but they are dropping in certain regions people want to live. They aint hurting though, thats for sure. 

Also,  40 injections a day? I've heard of 100 a day and they still have unending waiting lists. 

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On 4/2/2019 at 8:36 PM, HailmadeMode said:

OpHthalmology, OpHtho .. sigh. sorry. this bugs me as much as those mixing up "then" and "than" :S. Remember this before applying :D 

I am not applying, so no worries there. Close family friend is ophthalmologist however, which is why I know so much about what goes on in that world.

On 4/2/2019 at 8:36 PM, HailmadeMode said:

They aint hurting though, thats for sure. 

Even as slang, it is spelled ain't, and thats is not a word. Don't use either in your applications :D 

You are right though, they aren't hurting for now. But the landscape is changing, for reasons stated above. That is the point. Someone thinking of making their life's work now, by the time they finish residency and finally have a clinic and job down, it will be 7-10 years down the line. The fees have been dropping, which sets a precedence for further fee drops. Also, the fee equity pressure is not just coming from other specialists against ophthalmologists, but rather from ophthalmologists versus retinalogists.

And obviously, medical retinalogists do supremely important diagnostic and therapeutic management besides just injections. The original discussion was on how the job situation in ophtho is not so bright for recent grads, and the dreams of owning yatchs is not really coming into fruition because they can't find OR time, which lead to this whole thing about injections as an alternative route to becoming an aristocrat MD. 

On 4/2/2019 at 8:36 PM, HailmadeMode said:

Also,  40 injections a day? I've heard of 100 a day and they still have unending waiting lists. 

That is a crazy high number, and I highly doubt it. 40ish injections a day is coming from one of the busiest retinalogist in one of the Canada's largest metropolitan centres. A 100 injections a day is $12,000 of billing for that day. There is such a thing as maximum daily billings and volume for every procedure in every specialty. 

40 injections a day is still astronomical amount of billings for a day at about $5000 for that day (more or less depending on province). 

Again, even doing 40 injections for a day's clinic means you are seeing about 80 patients for that day, majority of which are triaged with the basic question: bleeding or not?. Injections will be pretty much the main thing you are doing on that clinic. Supremely boring. These aren't the retinologists spending much brain power thinking about the interesting things like the weird and wonderful ocular vasculitis or uveitis presentations. 

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Thought it would be interesting to look at competitiveness over the last 3 years as a function of #quota/#first choice applicants. Not much new information added though. Only looked at specialties with >10 spots over last 3 years as the variability for small specialties is ridiculous.

Essentially this is: # of spots per applicant ranking the discipline as first choice (e.g. 0.5 = there are 0.5 spots for every 1 applicant for said discipline)

        Discipline                                          #Quota/#1stChoice

carms2.png

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13 minutes ago, thethirdlaw said:

Thought it would be interesting to look at competitiveness over the last 3 years as a function of #quota/#first choice applicants. Not much new information added though. Only looked at specialties with >10 spots over last 3 years as the variability for small specialties is ridiculous.

Essentially this is: # of spots per applicant ranking the discipline as first choice (e.g. 0.5 = there are 0.5 spots for every 1 applicant for said discipline)

Green are those specialties trending towards less competitive, red are trending more competitive (over last 3 years). Black shows little variation/no pattern.

 

carms.png

Not sure what data you are using for this but I tried to reproduce your results and I got vastly different numbers for the first three specialities on the list.

Also, I’m not sure how accurate it is to use only people who picked the discipline as first choice. Often times, for highly competitive specialties, students may not rank the specialty first as they did not receive any interviews. It skews the results and makes those specialties seem less competitive by only taking into consideration people who ranked it first.

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You're right, I posted a screenshot of a different calculation I had done, very sorry, post amended.

And yes, it's an imperfect measure. It doesn't capture those who applied but did not interview, only applied to 1-2 programs in said discipline etc, those who rank specialties they didn't interview for... but there is no perfect measure of the demand for specialties in CaRMS, I just used similar formulas common to this thread (but the inverse, I prefer thinking about it as #spots per applicant).

Also removed the trends characterization, looking 3 years back isn't enough to determine a meaningful change in applicant behaviours.

But... looking at #ALL unique applicants/#quota, regardless of whether an interview was received or whether the applicant ranked the program, we see the following:

        Discipline                     #Quota/#UniqueApplicants

all.png

But even this gets muddled as we clearly see an apparent unbalanced demand for family medicine, which simply reflects backing up. Especially compared to quota/first choice applicants posted previously.

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9 hours ago, thethirdlaw said:

You're right, I posted a screenshot of a different calculation I had done, very sorry, post amended.

And yes, it's an imperfect measure. It doesn't capture those who applied but did not interview, only applied to 1-2 programs in said discipline etc, those who rank specialties they didn't interview for... but there is no perfect measure of the demand for specialties in CaRMS, I just used similar formulas common to this thread (but the inverse, I prefer thinking about it as #spots per applicant).

Also removed the trends characterization, looking 3 years back isn't enough to determine a meaningful change in applicant behaviours.

But... looking at #ALL unique applicants/#quota, regardless of whether an interview was received or whether the applicant ranked the program, we see the following:

        Discipline                     #Quota/#UniqueApplicants

all.png

But even this gets muddled as we clearly see an apparent unbalanced demand for family medicine, which simply reflects backing up. Especially compared to quota/first choice applicants posted previously.

I guess my point was more that it is very difficult to assess competitiveness based on the information provided by CaRMS for a few reasons:

1. Total applicants for a specialty is relevant for highly competitive specialties but over estimates the competitiveness of less competitive specialties where a plurality of people will be backing up. Hopefully, this year we will have more insight into all this with CaRMS having interview data. The most important metric will be to determine how many applicants did not get interviews at all.

2. The stats in general are a poor reflection of the CaRMS process for one simple reason: Quebec and the rest of Canada are agglomerated together in the stats. I understand that CaRMS may not want to separate a province from the stats, but it is impossible to deny that the reality of the Quebec match and the rest of Canada are very different. Very few applicants cross polinate between the two systems in terms of interviews, and even less match. It would be ideal if CaRMS offered separate stats for english speaking institution vs french speaking institutions. For example, Ophthalmology is made to seem much less competitive than it actually is as there is a total of 13 spots in Quebec that most of the rest of Canada does not access. This means that in reality there is only 25 english speaking spots for anywhere between 50-75 applicants. Quebec is also more likely to apply to two competitive specialties int he match (plastics + ophtho) which further confuses the picture.

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Quota & # 1st choice specialty rank still probably makes the most sense for assessing competitiveness.

# Unique applicants is a pointless measurement. If I wanted IM, I would want to know how competitive it is amongst 'serious' applicants, i.e. those who rank IM first. I don't want to look at data that includes the guy who ranked 7 different specialties in Toronto, or someone who backed up with IM.

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