Dermatology

[popperhopeful]

How competitive is dermatology this year? I decided late in the game, so it's gonna be a long shot (My backup is IM)... I know it's always competitive, but does anyone know if there's particularly high interest this round? 

 

Also, does anyone know anyone who was able to switch after CaRMS?

 

Thanks  

[Fresh fry]

Derm is number 1 and this hasn't changed in a very long time. 

 

I am sorry, I don't get a thrill out of stepping on people's dreams but if you want a top 4 specialty it is rare that you can come in "last minute". Been doing this stuff a long time, seen all sorts of weird and wonderful things happen but I would be prepared for IM if I was you and wouldn't let it ruin my holidays.

 

Best of luck

http://www.royalcollege.ca/portal/page/portal/rc/common/documents/events/icre/2012proceedings/pgme_admissions_selecting_residents/a_bilbily.pdf

[ZBL]

I think everyone has confused application numbers with competitiveness. Yes, derm, and other specialties get relatively more applicants than space available and that's been known for a long time. But a lot of applicants is not the same as competitive applicants. Derm in Canada is not like the US - down there they have people with top grades in their class (whereas we have P/F here), outstanding USMLE scores (which we don't use here), and people regularly take a year off after 3rd year to pile on research. THAT is competitive derm where applicants are certainly top of their class, along with ortho and plastics. In Canada, we don't have any of these metrics and so defining "competitive" is not so simple. For sure publications factor in but the typical derm applicant (or applicant for any "competitive" specialty) here will not have tons of papers like many of the competitive applicants do in the US. On the basis of what specialty has the highest caliber of applicants in Canada, I'd actually wager that NeuroSx and Neurology probably have the most "competitive" applicants in Canada in terms of their CVs, mostly on the basis of the relative numbers with graduate degrees or other research experience in the area. Basically what I'm saying is that the typical derm applicant probably is no more competitive than a typical neuro (or other specialty) applicant in Canada - only difference is the relative pool of applicants you are being compared against, and this is where electives, face time and letters factor in. With that said, sure it's going to be a bit tougher to jump on the plastics or derm train when you're late in the game, as it would be for any specialty, mostly due to less elective/staff exposure and so not as relevant or strong letters, but far more possible in Canada than in the US since other major metrics are not really available - if you had a prior grad degree or some papers, and wove your personal statement nicely with your elective experience, that would probably already put you ahead of some derm applicants. Anyways, I agree with the poster above that assuming IM is probably correct given the late change, but I personally think you can have a bit more optimism than they have let on. Good luck!

[ralk]

I think everyone has confused application numbers with competitiveness. Yes, derm, and other specialties get relatively more applicants than space available and that's been known for a long time. But a lot of applicants is not the same as competitive applicants. Derm in Canada is not like the US - down there they have people with top grades in their class (whereas we have P/F here), outstanding USMLE scores (which we don't use here), and people regularly take a year off after 3rd year to pile on research. THAT is competitive derm where applicants are certainly top of their class, along with ortho and plastics. In Canada, we don't have any of these metrics and so defining "competitive" is not so simple. For sure publications factor in but the typical derm applicant (or applicant for any "competitive" specialty) here will not have tons of papers like many of the competitive applicants do in the US. On the basis of what specialty has the highest caliber of applicants in Canada, I'd actually wager that NeuroSx and Neurology probably have the most "competitive" applicants in Canada in terms of their CVs, mostly on the basis of the relative numbers with graduate degrees or other research experience in the area. Basically what I'm saying is that the typical derm applicant probably is no more competitive than a typical neuro (or other specialty) applicant in Canada - only difference is the relative pool of applicants you are being compared against, and this is where electives, face time and letters factor in. With that said, sure it's going to be a bit tougher to jump on the plastics or derm train when you're late in the game, as it would be for any specialty, mostly due to less elective/staff exposure and so not as relevant or strong letters, but far more possible in Canada than in the US since other major metrics are not really available - if you had a prior grad degree or some papers, and wove your personal statement nicely with your elective experience, that would probably already put you ahead of some derm applicants. Anyways, I agree with the poster above that assuming IM is probably correct given the late change, but I personally think you can have a bit more optimism than they have let on. Good luck!

 

It's a fair point that application numbers are not synonymous with competitiveness, but there is still a definite association and I'd say Derm is a fairly poor example to try to demonstrate the difference between the two. In Canada, clinical performance trumps everything, so it's possible in even Top 4 specialties like Derm to match without an overly impressive CV. Yet, the chances of matching to Derm with a mediocre CV are fairly low, certainly lower than the already-rockbottom 50% match rate overall. No, it's not like the US where people are taking years off to bump up their chances, but since that's rare in pretty much all specialties in Canada, it's not an overly meaningful consideration.

 

Because Canadian residency programs care mostly about clinical performance, don't care about CVs all that much, and don't have grades or standardized test performance to draw off of, application numbers serve as a much better proxy for overall competitiveness here than they do in the US, where specialties and even programs themselves are clearly stratified. Since most applicants aren't immediately disqualified from a specialty by any one aspect of their application, they tend to apply to the specialties they want without self-selecting out to nearly the same extent, making application numbers a reasonably good indication of competitiveness - that competitiveness might not show up on the CV, however.

[ZBL]

It's a fair point that application numbers are not synonymous with competitiveness, but there is still a definite association and I'd say Derm is a fairly poor example to try to demonstrate the difference between the two. In Canada, clinical performance trumps everything, so it's possible in even Top 4 specialties like Derm to match without an overly impressive CV. Yet, the chances of matching to Derm with a mediocre CV are fairly low, certainly lower than the already-rockbottom 50% match rate overall. No, it's not like the US where people are taking years off to bump up their chances, but since that's rare in pretty much all specialties in Canada, it's not an overly meaningful consideration.

 

Because Canadian residency programs care mostly about clinical performance, don't care about CVs all that much, and don't have grades or standardized test performance to draw off of, application numbers serve as a much better proxy for overall competitiveness here than they do in the US, where specialties and even programs themselves are clearly stratified. Since most applicants aren't immediately disqualified from a specialty by any one aspect of their application, they tend to apply to the specialties they want without self-selecting out to nearly the same extent, making application numbers a reasonably good indication of competitiveness - that competitiveness might not show up on the CV, however.

 

Exactly. I'm not saying derm is not competitive, just that the disparity between derm and something like NeuroSx, obgyn, uro etc is not so big despite what applicant numbers might suggest. I agree, clinical performance is key in Canada. However, on a 2 week elective, I also think the majority of applicants come off looking pretty similar, especially for specialties where education is minimal preclerkship. This is where the CV comes in to play, and probably it matters more for derm (some programs encourage applications from those with grad degrees). If you google derm residents, sure there are a few with grad degrees and impressive accomplishments, like any specialty, but they aren't the majority (maybe there are relatively more in derm, but certainly not everyone). Consequently, aside from those few, there are probably a bunch of applicants who are not much different from any other specialty. Only difference is what electives they did, making it easier to slip into derm late than it would be in the US. If you are an otherwise strong applicant with a grad degree, publications, good clinical evals etc, deciding late probably isn't a critical hit like it would be in the US.

 

Where do you glean this information from? I only ask because it isn't what I've heard.

Thanks,

GP

I've always heard derm is #1 for competitiveness too, and would agree that in general it probably is the most competitive. But it's not like everyone who matches is a rockstar like the US. As mentioned above, yes there will be a few with outstanding achievements, but this also occurs in other specialties and many still match to derm without a PhD or crazy CV. In absence of other metrics, I think the #1 competitiveness thing, while likely true, is part remnant from years prior when we had Canadian grades, and part crossover from what we see in the US.

[ralk]

Exactly. I'm not saying derm is not competitive, just that the disparity between derm and something like NeuroSx, obgyn, uro etc is not so big despite what applicant numbers might suggest. I agree, clinical performance is key in Canada. However, on a 2 week elective, I also think the majority of applicants come off looking pretty similar, especially for specialties where education is minimal preclerkship. This is where the CV comes in to play, and probably it matters more for derm (some programs encourage applications from those with grad degrees). If you google derm residents, sure there are a few with grad degrees and impressive accomplishments, like any specialty, but they aren't the majority (maybe there are relatively more in derm, but certainly not everyone). Consequently, aside from those few, there are probably a bunch of applicants who are not much different from any other specialty. Only difference is what electives they did, making it easier to slip into derm late than it would be in the US. If you are an otherwise strong applicant with a grad degree, publications, good clinical evals etc, deciding late probably isn't a critical hit like it would be in the US.

 

I've always heard derm is #1 for competitiveness too, and would agree that in general it probably is the most competitive. But it's not like everyone who matches is a rockstar like the US. As mentioned above, yes there will be a few with outstanding achievements, but this also occurs in other specialties and many still match to derm without a PhD or crazy CV. In absence of other metrics, I think the #1 competitiveness thing, while likely true, is part remnant from years prior when we had Canadian grades, and part crossover from what we see in the US.

 

I think you're putting far too much emphasis on the value of graduate work in Canada. For residency, grad studies mean very little, especially those done before medical school. Research can matter, especially research in a medical field, but graduate work is neither necessary nor sufficient to obtain that. Along those lines, Derm programs put research experience explicitly in their selection criteria more often than Neurosurgery programs. You don't need a graduate degree to become a Neurosurgery resident in Canada (though typically one is required for employment after residency).

 

I'm still not sure why you're drawing a contrast with US applications. Sure, switching into Derm last-minute might be tougher in the US than it is in Canada, but the same could easily be said for Neurosurgery. I would still say that making the last-minute switch into Dermatology is tougher than doing the same for Neurosurgery. The match rate partially captures this discrepancy in competitiveness. I agree that there are some examples where comparisons in match rate hide true competitiveness - for example, Pediatrics tends to have a match rate that is usually somewhat lower than the rate for Neurosurgery, yet Peds applicants can generally get away with less impressive CVs. However, Derm isn't one of those examples. It's competitive both in terms of match rate and on-paper applicant quality.

[ZBL]

Not saying derm isn't competitive in terms of match rate or on-paper applicant quality. Yes it has the most applicants per space available but all that says is that a lot of people want derm relative to spots offered. Note this is typically just 70-80 people across the country - a small fraction of the total applicant pool. So then what makes this group of 80 stand out? It's not grades, it's not board scores and it's not having a PhD/research as we don't have these metrics and plenty match without much more than a case report or small derm project. Yes some applying are great on paper but there are many applicants who are not, likewise for other specialties. My point is there is zero Canadian data to support that derm applicants are inherently better on-paper than applicants to many other specialties with more applicants than spaces like surgery, EM, obgyn etc. Find me a metric saying otherwise. Keep in mind that derm is unique in that there is great income/lifestyle associated with it - there are almost certainly a bunch of applicants who have tossed an application in as a wild card but fully expecting to match to something else.

[ralk]

Not saying derm isn't competitive in terms of match rate or on-paper applicant quality. Yes it has the most applicants per space available but all that says is that a lot of people want derm relative to spots offered. Note this is typically just 70-80 people across the country - a small fraction of the total applicant pool. So then what makes this group of 80 stand out? It's not grades, it's not board scores and it's not having a PhD/research as we don't have these metrics and plenty match without much more than a case report or small derm project. Yes some applying are great on paper but there are many applicants who are not, likewise for other specialties. My point is there is zero Canadian data to support that derm applicants are inherently better on-paper than applicants to many other specialties with more applicants than spaces like surgery, EM, obgyn etc. Find me a metric saying otherwise. Keep in mind that derm is unique in that there is great income/lifestyle associated with it - there are almost certainly a bunch of applicants who have tossed an application in as a wild card but fully expecting to match to something else.

 

You're right, there's no good data for Canadian applicants regarding what they look like on paper, but that's true of all specialties. Your claim that Neurosurgery applicants are strong on paper, for example, is equally without basis in evidence. Lack of data also means that the reality could swing in the other direction and Derm applicants could have uniquely stellar CVs. You're demanding data to support my assertions but are happily providing contrary assertions without any data either. The only hard data on competitiveness we have is the match rate, and that puts Derm at or right near the top of the competitiveness list.

[Fresh fry]

As fun as it has been watching the back and forth I think we have reached an impasse.

 

Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.

 

At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 

 

If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).

 

If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.

 

I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.

 

I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 

 

I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.

 

As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.

 

My two cents

[ZBL]

Excellent summary above. I fully concur.

[Economist]

Not saying derm isn't competitive in terms of match rate or on-paper applicant quality. Yes it has the most applicants per space available but all that says is that a lot of people want derm relative to spots offered. Note this is typically just 70-80 people across the country - a small fraction of the total applicant pool. So then what makes this group of 80 stand out? It's not grades, it's not board scores and it's not having a PhD/research as we don't have these metrics and plenty match without much more than a case report or small derm project. Yes some applying are great on paper but there are many applicants who are not, likewise for other specialties. My point is there is zero Canadian data to support that derm applicants are inherently better on-paper than applicants to many other specialties with more applicants than spaces like surgery, EM, obgyn etc. Find me a metric saying otherwise. Keep in mind that derm is unique in that there is great income/lifestyle associated with it - there are almost certainly a bunch of applicants who have tossed an application in as a wild card but fully expecting to match to something else.

I am just curious as to how accurate this last sentence is. Because I was thinking almost the opposite. If I pad my CV with derm-related research and rotations won't other specialties see that I am using them as a back-up? That's why I feel like people who are actually putting down derm as their 1st choice must have honestly thought that they have a decent shot. However, I've met some derm residents with zero to almost no derm-related research. 

 

But as you pointed out, there are no objective grading with these applicants. No objective measurements and the low match rate makes it seem like too much of a gamble IMO. 

[indefatigable]

As fun as it has been watching the back and forth I think we have reached an impasse.

 

Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.

Dermatology and radiology are two specialties where UG grades can be considered by various programs. So one can imagine those programs making the argument that they are using objective criteria to determine the best candidates. Of course, this might on average favour candidates from faculties where uGPA is taken more into consideration on admission, not to mention difficulties in comparing various undergrad degrees. Also, it's not clear if pre-med criteria can be effectively used as a proxy for medicine related comparisons.

[ralk]

Also fully agree with Fresh fry's post, well said.

 

I am just curious as to how accurate this last sentence is. Because I was thinking almost the opposite. If I pad my CV with derm-related research and rotations won't other specialties see that I am using them as a back-up? That's why I feel like people who are actually putting down derm as their 1st choice must have honestly thought that they have a decent shot. However, I've met some derm residents with zero to almost no derm-related research. 

 

But as you pointed out, there are no objective grading with these applicants. No objective measurements and the low match rate makes it seem like too much of a gamble IMO. 

 

Derm has a fairly favourable back-up match rate - that is, people who rank Derm first but don't get it tend to match to another specialty. My guess is that tends to be Family or maybe Internal. Programs will see that you had a large number of Derm electives, but that won't necessarily kill you for those specialties, especially Family as competition for those spots is low and Derm is very applicable to Family Medicine. CVs can be tailored to better fit the back-up specialties while personal letters can go a long way to explaining the electives distribution.

 

I fully agree that people putting down Derm as their first choice must think they have a decent, or at least non-trivial shot at the specialty. Derm programs in particular, because they have so many more applicants than spots, can afford to be very particular about who they interview. There's not much point to ranking a program first if you don't interview there, so I tend to assume anyone ranking Derm first at least got one interview to the specialty. That alone is a decent hurdle to pass in terms of showing some competence in Derm, though that may be as simple as doing a number of electives in the specialty.

[GrouchoMarx]

As fun as it has been watching the back and forth I think we have reached an impasse.

 

Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.

 

At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 

 

If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).

 

If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.

 

I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.

 

I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 

 

I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.

 

As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.

 

My two cents

 

Even I look down on pathology and I'm one of them!