Residency backlog could triple for medical school grads, report warns

[indefatigable]

Yes - absolutely.  It's an overall zero-sum game.  I mean looking at the numbers (excluding Québec), there were ~100 unmatched applicants with ~125 quota left over mainly consisting of lab specialties and FM in generally non-competitive locations (slides 7-8 & unfilled R-1).  There were ~25 FM spots left in what I'd consider more competitive locations (e.g. Montreal, Ottawa..), so I suppose this could make a dent in the unmatched rates.  

But I'd say that at best, faculties can improve their match ratios, but it's going to result in the exact same overall outcome, since people aren't likely going to jump at the opportunity to match to FM in Northern Manitoba (15 rural positions available).  And you're right that less competitive applicants are the ones who are probably getting squeezed out with the alternative plan strategies of more competitive applicants who are using more interview slots.  

[ZBL]

To play devils advocate, of all 2714 CMGs grads last year, 99 went unmatched, or an unmatched rate of 4.6%. If you consider residency as basically your first job as a doctor, that’s an unemployment rate of 4.6% for new grads. That’s still better than the national average unemployment rate for people age 25-29 with a university degree (http://www.statcan.gc.ca/pub/81-582-x/2013001/tbl/tble3.2-eng.htm). Not to mention, in the case of CaRMS, while certainly some of those students unmatched would have killed to match to anything, for sure some of them CHOSE to be unmatched over whatever other option for residency was on the table - in other words, they turned down the job offer. And statistically, about half end up matching to something the following year. Ultimately for those unmatched, some may not want a residency spot, some may not be happy doing whatever is left over, and a small number might not even be qualified or have professionalism issues that hindered a match. 

 

So I guess I’m wondering, why do we need to ensure a spot for everyone? No other educational program guarantees work for graduates, no less guaranteeing them work in a subdiscipline of their choice, so why should medicine be different? I would argue that if anything, it should just be made more clear to med school applicants that while job security is a nice perk of medicine, getting into medical school in no way guarantees you a job (I.e. residency spot), just like anything else in life. I see residency like every other job, and we are fortunate in medicine that for the most part we do all end up in something that goes on to pay well with pretty good job security. 

 

The fact that some specialties have a poor job outlook after residency is a different matter altogether, but I’d be curious to hear the rationale for why we must guarantee a residency spot for everyone when we don’t do that for any other educational program in Canada, to my knowledge at least. It’s certainly a (potentially) unfortunate and difficult issue for those unmatched. 

 

I think if if there’s a way to prevent the situation from getting worse that would be helpful, but I don’t know if it needs to be prevented entirely. 

[JohnGrisham]

The usual reply is because medicine is subsidized to much greater extent than other disciplines, and unlike other disciplines which have many different trajectories...there aren't many trajectories with an MD outside of clinical medicine. And unlike other disciplines, where you can move to where the work is... you can't do that to same extent in medicine(outside of applying very broadly, and ensuring you take SOME residency, especially the few remaining rural spots).  At some point with current trajectories, even those few remaining rural spots will be scooped up in round 1. 

I think it would be more reasonable to compare it with employability of related disciplines, like Dentistry, Pharmacy, PT, OT. All of which, have their licensure to practice at the end of their degrees, unlike medicine which has that at the end of the residency stage. So for those degrees, there is no gaurantee of job either, however they have the ability to simply move where the work is, and/or modify their work opportunities to make it work.  In medicine the best you can do is apply to as many residencies as possible, but as mentioned above its a zero-sum game since the pool of training spots is getting smaller and is finite.  In a sense, even though no one is gauranteeing these other health discplines work, they have that immediate portability right once they complete their degree. Medicine does not get its portability until 2-8year residency is completed. That said, once you do get to that stage(and as you said the vast majority do), it is obviously good for most fields.
 

I don't think we need to ensure a spot to everyone, but i think there needs to be the option of applying to a more reasonable ratio of spots to graduates. Remember, even if the ratio gets improved to 1.1 for example, programs are not required to rank an incompetent person. They always have the option of keeping a spot empty and moving it to round 2 and snipping a full trained IMG for example. 

It just doesn't make sense to be training and spending a very large amount of tax dollars on students, if you know from the outset that there is a mathematical based certainty that some of them simply can not match, regardless of the human factors.  Why would you simply not just reduce the number you are training and save those costs definitively. 

 

[indefatigable]

Firstly it's not an apples to apples comparison, as has been mentioned many times.  Med school is different: both for the trainees who take on very high debt loads and for the government that invests a lot more in the individual students.  So it's much more of a loss for both the individual and the government, especially considering that the MD doesn't really mean much outside of a residency position.   

Next, it's not a situation that's always existed.  In 2009, there were 11 students unmatched after both rounds; last year there were 68.  A lot of factors play into this, including the fact that Ontario reduced it's residency positions.  On top of this, the government restricts people's opportunities to go into other labour markets, for instance by capping J-1s for the US.  This doesn't exist or isn't a factor in other industries, like the software world.

Finally, there are clearly identified factors leading to the situation.  Although there's a need, rural FM is not popular, because many students from urban backgrounds and settings don't want end up in those locations.  Schools like NOSM recognize this, and select for admission based on rural suitability.  NOSM students seem to be more likely to work in these areas where's there's a need.  SWOMEN is another example of regional admission, although I'd argue the most compelling case is for the regions outside of London.   After Round-1 last year, many of the FM seats were in rural locations where urban graduates were reluctant to go.  Changing this balance, would be a win-win situation for both the regions and graduates.  

[NutritionRunner]

Medicine is not unique in requiring extra training to actually practice as a professional, however.  In dietetics, you need to complete a dietetic internship after completing your undergraduate education in dietetics, in order to become a dietitian, at least in Ontario (other provinces incorporate the internship into the undergraduate program).  Ontario graduates many more students from dietetic programs than there are dietetic internship spots available.  So plenty of students end up with a degree in dietetics, but without the necessary dietetic internship in order to qualify to write the professional practice exam and become a registered dietitian.  You can also only apply for dietetic internships for 3 years after completing your undergraduate studies.  After that, if you still haven’t acquired a dietetic internship (or a graduate program that incorporates the internship), you have to upgrade your education if you want to keep trying.

Those graduating from a dietetic undergraduate program don’t really have true mobility either.  In your fourth year, you are allowed to apply to only 3 stand-alone internship programs (although you can apply to as many graduate programs that include the internship as you like, only limited by finances).  The match system is similar to CaRMS - students rank their programs and programs rank the candidates.  If you match to a stand-alone internship, if you want to become a registered dietitian, you go where you have matched. Of course, if you are accepted to a graduate program that includes the internship, you have more options.  I was fortunate - I had interviews at all three of the stand-alone internships I had applied to, plus the two graduate programs I had applied to.  I was accepted to my top choice internship and both graduate programs.  I chose one of the graduate programs.  However, many of my classmates were not so lucky - some didn’t receive a single interview.  Some ended up doing a research-based masters degree before re-applying to internships (i.e. they didn’t get in to an internship or a graduate program that included the internship, so they did a typical research-based masters for two years before re-applying to the combined graduate-internship programs or stand-alone internships). I know one person who now has two master’s degrees due to this face - her research-based master’s, completed first, and the master’s that included the internship, completed second.

It’s interesting that most other health professions acquire eligibility to earn their license (i.e. through an exam) upon graduation from their degree.  Medicine and dietetics seems to be two of the exceptions, although obviously very different careers!

[Egg_McMuffin]

6 hours ago, NutritionRunner said:

Medicine is not unique in requiring extra training to actually practice as a professional, however.  In dietetics, you need to complete a dietetic internship after completing your undergraduate education in dietetics, in order to become a dietitian, at least in Ontario (other provinces incorporate the internship into the undergraduate program).  Ontario graduates many more students from dietetic programs than there are dietetic internship spots available.  So plenty of students end up with a degree in dietetics, but without the necessary dietetic internship in order to qualify to write the professional practice exam and become a registered dietitian.  You can also only apply for dietetic internships for 3 years after completing your undergraduate studies.  After that, if you still haven’t acquired a dietetic internship (or a graduate program that incorporates the internship), you have to upgrade your education if you want to keep trying.

Those graduating from a dietetic undergraduate program don’t really have true mobility either.  In your fourth year, you are allowed to apply to only 3 stand-alone internship programs (although you can apply to as many graduate programs that include the internship as you like, only limited by finances).  The match system is similar to CaRMS - students rank their programs and programs rank the candidates.  If you match to a stand-alone internship, if you want to become a registered dietitian, you go where you have matched. Of course, if you are accepted to a graduate program that includes the internship, you have more options.  I was fortunate - I had interviews at all three of the stand-alone internships I had applied to, plus the two graduate programs I had applied to.  I was accepted to my top choice internship and both graduate programs.  I chose one of the graduate programs.  However, many of my classmates were not so lucky - some didn’t receive a single interview.  Some ended up doing a research-based masters degree before re-applying to internships (i.e. they didn’t get in to an internship or a graduate program that included the internship, so they did a typical research-based masters for two years before re-applying to the combined graduate-internship programs or stand-alone internships). I know one person who now has two master’s degrees due to this face - her research-based master’s, completed first, and the master’s that included the internship, completed second.

It’s interesting that most other health professions acquire eligibility to earn their license (i.e. through an exam) upon graduation from their degree.  Medicine and dietetics seems to be two of the exceptions, although obviously very different careers!

The stakes involved in med residency vs internship applications aren't even comparable though. Anyone with a decent hs average can enter an undergrad in nutrition. There's no $100,000 price tag and fewer opportunity costs associated with doing a nutrition degree. And let's be honest- the calibre of the average med student is much higher than that of the average spiring dietitian. I actually think BSc Nutrition grads (even if they don't get an internship) have it pretty good- they have more options than the typical BSc grads.

[NutritionRunner]

12 hours ago, Egg_McMuffin said:

The stakes involved in med residency vs internship applications aren't even comparable though. Anyone with a decent hs average can enter an undergrad in nutrition. There's no $100,000 price tag and fewer opportunity costs associated with doing a nutrition degree. And let's be honest- the calibre of the average med student is much higher than that of the average spiring dietitian. I actually think BSc Nutrition grads (even if they don't get an internship) have it pretty good- they have more options than the typical BSc grads.

The stakes may not be the same (obviously an undergraduate degree in dietetics doesn’t cost the same as a medical degree) but I have seen students absolutely devastated because they didn’t acquire an internship.  I have seen students who end up doing a research-based master’s when they have no interest in research, but want to do something to improve their internship applications. As I said, I know people with two master’s degrees - one a research-based degree, one an internship-based degree.  If that isn’t a waste of time and resources, I don’t know what is.

Yes, the stakes are different.  But I was pointing out that medicine is not unique in requiring a period of practical training after completion of a degree in order to be allowed to practice independently.

In my current role, I mentor and supervise both dietetic students and medical students (the local medical school has a wonderful program where the medical students actually work with and observe allied health practitioners, so they gain an appreciation for our knowledge and skills).  The dietetic students and medical students, at least the ones I work with, are equally stressed out over internship / CaRMS applications.  The stakes may be different, but the students are feeling similar amounts and types of stress, at least to an outside observer.

[rmorelan]

1 hour ago, NutritionRunner said:

The stakes may not be the same (obviously an undergraduate degree in dietetics doesn’t cost the same as a medical degree) but I have seen students absolutely devastated because they didn’t acquire an internship.  I have seen students who end up doing a research-based master’s when they have no interest in research, but want to do something to improve their internship applications. As I said, I know people with two master’s degrees - one a research-based degree, one an internship-based degree.  If that isn’t a waste of time and resources, I don’t know what is.

Yes, the stakes are different.  But I was pointing out that medicine is not unique in requiring a period of practical training after completion of a degree in order to be allowed to practice independently.

In my current role, I mentor and supervise both dietetic students and medical students (the local medical school has a wonderful program where the medical students actually work with and observe allied health practitioners, so they gain an appreciation for our knowledge and skills).  The dietetic students and medical students, at least the ones I work with, are equally stressed out over internship / CaRMS applications.  The stakes may be different, but the students are feeling similar amounts and types of stress, at least to an outside observer.

Ha - that reminds me: 

Stress and impact cannot be measured on a linear scale - that may sound like it is a trivial point to make but I think it is important. Particularly important because medical doctors are prone to do this all the time and it can seriously impact relationships with people. 

When a doctor has a bad day or a bad outcome in absolute terms that is probably a really bad day - someone likely died and so on. If you compare that to anyone else - your spouse's day and so on you are going to win in terms of absolute score. That however is completely meaningless because both parties are relatively speaking have an equally bad day (they feel equally stressed) and if you don't realize that you will develop the classic problem of assuming your problems are automatically worse than everyone else's ha  That is a great way to end up in a divorce. 

Not matching sucks and probably costs you a year. Not getting that internship sucks and probably can cost you a year. The stakes may be different but the degree of suckage can be the same. 

[Organomegaly]

2 hours ago, rmorelan said:

Ha - that reminds me: 

Stress and impact cannot be measured on a linear scale - that may sound like it is a trivial point to make but I think it is important. Particularly important because medical doctors are prone to do this all the time and it can seriously impact relationships with people. 

When a doctor has a bad day or a bad outcome in absolute terms that is probably a really bad day - someone likely died and so on. If you compare that to anyone else - your spouse's day and so on you are going to win in terms of absolute score. That however is completely meaningless because both parties are relatively speaking have an equally bad day (they feel equally stressed) and if you don't realize that you will develop the classic problem of assuming your problems are automatically worse than everyone else's ha  That is a great way to end up in a divorce. 

Not matching sucks and probably costs you a year. Not getting that internship sucks and probably can cost you a year. The stakes may be different but the degree of suckage can be the same. 

I would agree on all counts, except for the obviously increased financial stakes for medical students. Average LOC debt is now $150,000. There are more than just career prospects that are affected with an unmatch result. There is also the possibility of financial calamity for that student which adds a whole new dimension of stress. 

[rmorelan]

Just now, Organomegaly said:

I would agree on all counts, except for the obviously increased financial stakes for medical students. Average LOC debt is now $150,000. There are more than just career prospects that are affected with an unmatch result. There is also the possibility of financial calamity for that student which adds a whole new dimension of stress. 

well except that the end pay is also so much higher, almost certainly eventually you will get something, and you have access still to that magic LOC. The person that doesn't get that internship also has a not a small level of debit, no access to a huge 250K-275K LOC etc, and similarly no job in their area and are unlikely to get another job easily that meets their debit load with the education they have. 

Going unmatched is terrible financially of course - but  someone in many other fields are in the most immediate sense are under MORE financial stress - as a doctor with 150K you still have 100K at least to work within. It sucks, but imagine not being able to similarly work or advance to the next level but you have 30 dollars in your chequing account and you don't exactly have access to convenient credit. How would the next year look like now?

Financial stakes really come to bear within you don't have enough money for lunch

[Organomegaly]

6 hours ago, rmorelan said:

well except that the end pay is also so much higher

that's what I mean though for the unmatched graduate. they may not get anything. I know most WILL but for the small proportion who don't I don't even know how they would begin to pay that off. especially since you may not be able to go bankrupt with student loans 

[indefatigable]

47 minutes ago, Organomegaly said:

that's what I mean though for the unmatched graduate. they may not get anything. I know most WILL but for the small proportion who don't I don't even know how they would begin to pay that off. 

Agreed.  Pharm reps in Canada pay about the same as residents (including tax advantages) - assuming they could get the job, not to mention most people don't pay off debt in residency.  Aside from that, I'm not sure what other job a MD could lead to.

[rmorelan]

1 hour ago, Organomegaly said:

that's what I mean though for the unmatched graduate. they may not get anything. I know most WILL but for the small proportion who don't I don't even know how they would begin to pay that off. especially since you may not be able to go bankrupt with student loans 

yeah you won't be able to go bankrupt as long as the medical degree holds value - I have seen it take a long time before someone gets something and that risk would I am guessing only increase with what is going on now. It is you are absolutely right - terrifying prospect even if it effects a tiny minority. There are other options for MDs that don't go into residency -  beyond the usual research pathway but you are twisting the usual intent of your training for sure. 

same in a sense with the other apprenticeship stuff too - they may not ever get anything either, and similarly may not go bankrupt although at least in theory you could get a non related job and have a better chance perhaps of paying it off (although you could argue there are many management/sales positions that doctors can do that also pay quite well which most people would have a harder time getting access to). 

 

[indefatigable]

16 minutes ago, rmorelan said:

yeah you won't be able to go bankrupt as long as the medical degree holds value - I have seen it take a long time before someone gets something and that risk would I am guessing only increase with what is going on now. It is you are absolutely right - terrifying prospect even if it effects a tiny minority. There are other options for MDs that don't go into residency -  beyond the usual research pathway but you are twisting the usual intent of your training for sure. 

same in a sense with the other apprenticeship stuff too - they may not ever get anything either, and similarly may not go bankrupt although at least in theory you could get a non related job and have a better chance perhaps of paying it off (although you could argue there are many management/sales positions that doctors can do that also pay quite well which most people would have a harder time getting access to). 

 

Research and sales jobs wouldn't come close to physician's pay - more like a resident's salary.  Plus research jobs are especially hard to get - at least the ones that pay decently.  Other apprentices have much lower financial risk.

[rmorelan]

54 minutes ago, marrakech said:

Agreed.  Pharm reps in Canada pay about the same as residents (including tax advantages) - assuming they could get the job, not to mention most people don't pay off debt in residency.  Aside from that, I'm not sure what other job a MD could lead to.

More than you might expect - I was surprised. I mean for instance (and granted I am a bit weird) but I was offered to return to create medical software out of medical school - now that I am graduating the same thing came up yet again during my fellowship search. People often still have that core undergraduate degree and that can be in a lot of things. There are a lot sales positions that are medically related, and a lot of companies would like some one that can definitely talk the talk with other doctors etc. A lot of people do research for a time - if for no other reason than that always seems to be the default holding position for people in medicine while they try to get to the next level.  

Still that isn't in any way to diminish the impact of this - most of those will pay less than a doctor would earn etc and it is not the expected path.  

Also a lot people won't pay off any of the loans in medical school because the salary does start off low (and for 35% of us about who are in family medicine it never really gets a chance to increase before you are out there), and because they are just deferring it by choice (suffer now to pay of 15K of it a year when you are staff you can suffer less and pay off 100K a year - not saying i completely agree with that but you can see the logic). 

For those of us that really want to pay it off - the debit adverse as it were - you can pay off quite a bit of it in 5 years (I and others are about the 80K mark), and that is with all the extra expenses in residency (just like med school there are all these bloody 1000s of dollar expenses - like 7500 in exam fees alone ha).  

[goleafsgochris]

1 hour ago, marrakech said:

Agreed.  Pharm reps in Canada pay about the same as residents (including tax advantages) - assuming they could get the job, not to mention most people don't pay off debt in residency.  Aside from that, I'm not sure what other job a MD could lead to.

I always thought this was a really scary point for people who don't match or don't finish residency for whatever reason.  Its very rare but you have to think, theres almost nothing else we can do.  Research often pays less than even residency, and good luck if you don't have a research degree getting those jobs.  Pharm reps...sure, I guess, MAYBE you have an advantage in that job because you can say youre an MD?  But I agree those jobs are not that easy to get, and don't pay that well.

rmorelan got an offer to create medical software, but he/she must have additional skillsets for that, I would not even remotely know how to do that lol

[snapmoster82]

On 2/25/2018 at 1:16 PM, ZBL said:

To play devils advocate, of all 2714 CMGs grads last year, 99 went unmatched, or an unmatched rate of 4.6%. If you consider residency as basically your first job as a doctor, that’s an unemployment rate of 4.6% for new grads. That’s still better than the national average unemployment rate for people age 25-29 with a university degree (http://www.statcan.gc.ca/pub/81-582-x/2013001/tbl/tble3.2-eng.htm). Not to mention, in the case of CaRMS, while certainly some of those students unmatched would have killed to match to anything, for sure some of them CHOSE to be unmatched over whatever other option for residency was on the table - in other words, they turned down the job offer. And statistically, about half end up matching to something the following year. Ultimately for those unmatched, some may not want a residency spot, some may not be happy doing whatever is left over, and a small number might not even be qualified or have professionalism issues that hindered a match. 

 

So I guess I’m wondering, why do we need to ensure a spot for everyone? No other educational program guarantees work for graduates, no less guaranteeing them work in a subdiscipline of their choice, so why should medicine be different? I would argue that if anything, it should just be made more clear to med school applicants that while job security is a nice perk of medicine, getting into medical school in no way guarantees you a job (I.e. residency spot), just like anything else in life. I see residency like every other job, and we are fortunate in medicine that for the most part we do all end up in something that goes on to pay well with pretty good job security. 

 

This is the precise mentality of the current government in Ontario.  It's been a recurrent theme in all areas of the job market. Ensure a buyer's market, and gaslight applicants that it's their fault for not finding employment.  I think the government would love faculties telling  medical students that their future job market is uncertain and that students must be prepared to accept remote locations in third or fourth choice specialties. 

Yet, the government is not fully aware of medicine, and its small community. Unlike the US match, we cannot absorb additional unmatched applicants constantly reapplying in the first round.  This trend makes competition more unreasonable, bordering on unfair. In addition, the skills set of medicine is highly regulated by the government. The practical skills and knowledge have little benefit in other professions.  In addition, there's no private system for residency training or private health care system. 

Perhaps most concerning for me is that there is little traction to intervene. The Toronto Star article made headlines for 1-2 days but idissipated. I hope Canadian medical students protest. However, this is a profession built on hierarchy. I am sure the medical student collective is apprehensive to outwardly criticize a system that plays a huge role in their future. 

[insomnias]

11 hours ago, goleafsgochris said:

I always thought this was a really scary point for people who don't match or don't finish residency for whatever reason.  Its very rare but you have to think, theres almost nothing else we can do.  Research often pays less than even residency, and good luck if you don't have a research degree getting those jobs.  Pharm reps...sure, I guess, MAYBE you have an advantage in that job because you can say youre an MD?  But I agree those jobs are not that easy to get, and don't pay that well.

rmorelan got an offer to create medical software, but he/she must have additional skillsets for that, I would not even remotely know how to do that lol

 

Actually, food for thought as I'm backing up my med school apps with consulting: consulting firms love MDs. This is a greater trend in the US than Canada, admittedly, but presumably an unmatched grad could also apply to one of the big management consulting firms like McKinsey, BCG, or Bain. What's to stop a first-year student from spending their summer doing an internship at, say, McKinsey instead of traveling (my presumption is that what you do your first summer doesn't matter at all to CaRMS, so it's either travel or internship) so that they have some sort of employability if all else fails?

[indefatigable]

51 minutes ago, insomnias said:

 

Actually, food for thought as I'm backing up my med school apps with consulting: consulting firms love MDs. This is a greater trend in the US than Canada, admittedly, but presumably an unmatched grad could also apply to one of the big management consulting firms like McKinsey, BCG, or Bain. What's to stop a first-year student from spending their summer doing an internship at, say, McKinsey instead of traveling (my presumption is that what you do your first summer doesn't matter at all to CaRMS, so it's either travel or internship) so that they have some sort of employability if all else fails?

It's not a bad idea, but the same general criticism applies - the MD training time and cost wouldn't be compensated by the job.  They're also known to go after PhDs, so I don't think there's anything specific to a MD degree.   

If anything, consulting firms would place much more of a premium on a MBA than a MD (or PhD).  It's possible that R. Chu was thinking about this type of work - however, the debt load would be extremely high for pursuing two consecutive professional degrees.  

[la marzocco]

44 minutes ago, marrakech said:

It's not a bad idea, but the same general criticism applies - the MD training time and cost wouldn't be compensated by the job.  They're also known to go after PhDs, so I don't think there's anything specific to a MD degree.   

If anything, consulting firms would place much more of a premium on a MBA than a MD (or PhD).  It's possible that R. Chu was thinking about this type of work - however, the debt load would be extremely high for pursuing two consecutive professional degrees.  

Many big consulting firms have been quite interested in MDs/JDs/PhDs and this interest is only growing as they try to tap into the healthcare consulting/biotech spaces. They have opened an advanced professional degree (APD) pathway into the firm - I think at BCG? effectively allowing you to skip a few bottom analyst ranks and jump right into engagement manager/associate. Starting is around $175K I believe + handsome bonuses. Agreed with you that the comp may not be aligned with the training time and costs required, but in light of the circumstances, this may not be a bad gig.

MD/MBA or an MBA following at the heels of an MD may not be as useful. MBA training is only useful if you have an existing business background, which arguably many med students do not have. Not saying it is hard to learn the material, it is just the MBA is not worth as much if you don't have the necessary experiences. Also, the ROI for an MBA is highly dependent on the school you go to. INSEAD/HBS have great ROIs. Reputation for MBA schools do really come into play. 

Then there are gigs like venture capital, angel investing etc. 

[rmorelan]

6 minutes ago, marrakech said:

It's not a bad idea, but the same general criticism applies - the MD training time and cost wouldn't be compensated by the job.  They're also known to go after PhDs, so I don't think there's anything specific to a MD degree.   

If anything, consulting firms would place much more of a premium on a MBA than a MD (or PhD).  It's possible that R. Chu was thinking about this type of work.     

They do seem to love MDs - I don't want to over sell it but having someone that can actually speak medical language. Just very useful to have around in some many ways. Lawyers like them to for consulting

These jobs don't pay the same as an MD for sure in clinical practice. Still they pay  100K+ and have all those wonderful benefits. Not ideal - but at least with the interest rates where they were you can pay off a 150K loan in 5 years if you want to focus on it, which is the length of most residency programs.  There are worse things than a 120K a year job in a glass 1/2 full sense.

 Again one day before the match day in particular I am not trying to diminish the importance of the match and its impact. It is great saying that all of this would only apply to a handful of people (usually those that don't make in their primary first round, the following second round and typically an other entire year in the match process) - say less than 1% of applicants - but if it happens to you it will not be that much fun. Survivable but not fun.   

[JohnGrisham]

10 minutes ago, la marzocco said:

 

Many big consulting firms have been quite interested in MDs/JDs/PhDs and this interest is only growing as they try to tap into the healthcare consulting/biotech spaces. They have opened an advanced professional degree (APD) pathway into the firm - I think at BCG? effectively allowing you to skip a few bottom analyst ranks and jump right into engagement manager/associate. Starting is around $175K I believe + handsome bonuses. Agreed with you that the comp may not be aligned with the training time and costs required, but in light of the circumstances, this may not be a bad gig.

MD/MBA or an MBA following at the heels of an MD may not be as useful. MBA training is only useful if you have an existing business background, which arguably many med students do not have. Not saying it is hard to learn the material, it is just the MBA is not worth as much if you don't have the necessary experiences. Also, the ROI for an MBA is highly dependent on the school you go to. INSEAD/HBS have great ROIs. Reputation for MBA schools do really come into play. 

Then there are gigs like venture capital, angel investing etc. 

Sorry but no one is paying a med school grad 175k starting in consulting unless they already had decent relevant prior experience BEFORE med school or somehow gained it during med school(unlikely). Nothing in med school is very relevant for consulting other than good work ethic and the MD title. Sure some medical knowledge and lingo helps in some realms, but not that substantially to be a game changer. That alone is not enough to command that starting salary in that space, without applicant specific prior experience and translatable skills in that space.

[la marzocco]

14 minutes ago, JohnGrisham said:

Sorry but no one is paying a med school grad 175k starting in consulting unless they already had decent relevant prior experience BEFORE med school or somehow gained it during med school(unlikely). Nothing in med school is very relevant for consulting other than good work ethic and the MD title. Sure some medical knowledge and lingo helps in some realms, but not that substantially to be a game changer. That alone is not enough to command that starting salary in that space, without applicant specific prior experience and translatable skills in that space.

You will be very surprised. A few friends of mine realized medicine was not really for them at the end of 4th year, and steered into consulting and were able to command that starting salary. Not much business background in their CV (if at all), and the consulting firm was also very willing to send them to the US for their MBA.

I was recruited by a few consulting firms right after law school and the salary was handsome, but a JD is nothing without articling, which is why I passed on that opportunity in order for me to pass the bar. One could argue JD is more "translatable" than an MD into consulting, but I don't see it that way, either way consulting firms are trying hard to get their hands on niche areas.

[indefatigable]

21 minutes ago, rmorelan said:

They do seem to love MDs - I don't want to over sell it but having someone that can actually speak medical language. Just very useful to have around in some many ways. Lawyers like them to for consulting

These jobs don't pay the same as an MD for sure in clinical practice. Still they pay  100K+ and have all those wonderful benefits. Not ideal - but at least with the interest rates where they were you can pay off a 150K loan in 5 years if you want to focus on it, which is the length of most residency programs.  There are worse things than a 120K a year job in a glass 1/2 full sense.

 Again one day before the match day in particular I am not trying to diminish the importance of the match and its impact. It is great saying that all of this would only apply to a handful of people (usually those that don't make in their primary first round, the following second round and typically an other entire year in the match process) - say less than 1% of applicants - but if it happens to you it will not be that much fun. Survivable but not fun.   

I'm not convinced that 120K/year is at all achievable without further qualifications, like a MBA.  The additional degree would definitely add to the debt load, if it weren't covered by an employer.  

5 minutes ago, la marzocco said:

You will be very surprised. A few friends of mine realized medicine was not really for them at the end of 4th year, and steered into consulting and were able to command that starting salary. Not much business background in their CV (if at all), and the consulting firm was also very willing to send them to the US for their MBA.

That's an extraordinary starting salary, even higher than MBAs for consulting firms.  Maybe there's a niche market for the MD/MBA there?  I'd guess it's probably only available in larger/expensive cities in the US.  175K/year is still a good salary no matter where, but definitely doesn't mean the same thing in NY.    

[la marzocco]

4 minutes ago, marrakech said:

I'm not convinced that 120K/year is at all achievable without further qualifications, like a MBA.  The additional degree would definitely add to the debt load, if it weren't covered by an employer.  

That's an extraordinary starting salary, even higher than MBAs for consulting firms.  Maybe there's a niche market for the MD/MBA there?  I'd guess it's probably only available in larger/expensive cities in the US.  175K/year is still a good salary no matter where, but definitely doesn't mean the same thing in NY.    

Completely agree - geography plays a big factor, but this is precisely it. Many consulting firms find healthcare consulting very lucrative. Large consulting firms have consolidated many boutique consulting practices that specialize healthcare in order to bolster that pillar. It is a massive cash cow when you sign a consulting contract with a government and render professional services over a long-term period.