How Your Medical School Might Limit Your Chances At Top Residencies

By Lindsey July 9, 2021 College Search Medical School Admissions Consulting Press

Medical schools in the U.S. are notoriously difficult to get into, and that doesn’t appear to be changing any time soon. Out of the 118 ranked allopathic medical schools that reported their fall 2018 acceptances to U.S. News, the average admittance rate was 6.8%. According to the Association of American Medical Colleges (AAMC), just 40.9% of applicants in 2018 matriculated into an allopathic medical school. 

With the increasingly competitive acceptance rates, some students consider themselves lucky if they get into even one medical school. With their medical school acceptance in hand, many students might confidently believe that countless opportunities are now open to them, allowing them to pick any specialty they wish when they match with a residency program at the end of their fourth year. 

However, this isn’t always the case. Once a student enters medical school, they may realize that the specialty they want to pursue will require them to have highly competitive grades, test scores (especially the USMLE Step 1) and performance evaluations. Many students only become aware of this additional level of competition once they have arrived at medical school.

According to the American Medical Association (AMA), the most competitive medical specialties in 2018 were:

  1. Integrated interventional radiology 
  2. Orthopedic surgery 
  3. Integrated plastic surgery 
  4. Radiation oncology 
  5. Neurological surgery 
  6. Otolaryngology  
  7. Thoracic surgery 

If you want to receive a coveted spot in one of those specialties, which tend to have the highest average annual salaries, where you go to medical school might limit your chances. Here’s how.  

1. Choosing A School Not Ranked In the Top Ten

Out of the programs surveyed by the National Resident Matching Program (NRMP), 50% said that being a graduate of a highly-regarded U.S. medical school was a citing factor in decided to interview a candidate. 

Being from a top-ranked medical school does have an impact on matching with a competitive residency program. For example, Harvard Medical School is ranked as the number one medical school by U.S. News and World Report. A review of recent medical students who graduated in 2019 found out that of the 163 total students, 27 students matched with one of the most competitive specialties. That included six students who matched in radiation oncology, eight students in neurological surgery and five in otolaryngology. Roughly 16.6% of the graduating class matched with one of the most competitive specialties. 

When looking at the students that graduated from the School of Medicine at Wake Forest University, ranked 50th by U.S. News and World Report, the gap between the top medical schools and the lower-ranked medical schools grows larger. Out of the 117 students who graduated in 2019, 14 of those students matched with one of the seven most competitive specialties. Seven students matched with orthopedic surgery, but zero with integrated plastic surgery. In total, 12% of the students matched with one of the most competitive programs. 

And for the Robert Larner, M.D. College of Medicine at the University of Vermont, which ranked 67th on U.S. News and World Report, the gap grows even wider. Just nine of the 114 students matched with the most competitive specialties. Four students in 2019 matched with orthopedic surgery, but the other most specialties had only one or zero students matching in that type of program.

When looking at the list of students matching into neurosurgery, 27% were from the top 25 schools, showing that the ranking might have an impact on student’s specialty. 

2. Attending A School In The Caribbean

Some pre-medical students apply to medical schools in the United States but unfortunately don’t get into any of them. Therefore, they might turn to schools in the Caribbean to help them start on their path towards medicine. Upon graduating, the students will then return in hopes of matching with a resident program stateside. 

One of the top universities in the Caribbean is St George’s University (SGU) School of Medicine in Grenada. Students at SGU have a 96% first-time pass rate on the USMLE Step 1, which is equivalent to U.S. medical schools. However, when students from SGU graduate, they have a harder time matching with more competitive residency programs. 

In the past ten years at SGU, 4,645 students have graduated from the school. However, within the past ten years, only 28 students, less than 1%, have matched within the most competitive residencies. In that period (2009-2019), zero students matched with residencies in integrated interventional radiology, integrated plastic surgery, otolaryngology, and thoracic surgery. 

Elite Medical Prep’s evaluation of the results from the NRMP Program director survey from 2018 suggests that foreign medical graduates (including Caribbean grads) will have a hard time interviewing and matching in the most competitive specialties. Marcel Brus-Ramer, MD, Ph.D., one of the founders of Elite Medical Prep, saw this firsthand as a resident in Radiology at the University of California, San Francisco, the highest-ranked radiology residency. He believes these lower numbers are because the most competitive specialties only have enough space to match a few medical students a year. Brus-Ramer says, “When faced with excellent applicants from a higher and lower-ranked medical school, they will default to choose the student from the more prestigious medical school.” 

3. Attending An Osteopathic Medical School 

On the path to medicine, a student can choose to go to allopathic (MD) or osteopathic (DO) medical school. The school they end up attending might have an impact on their specialty choices in the future.

According to data published by the National Resident Matching Program, seniors who attend allopathic medical schools tend to gravitate towards neurological surgery, radiology, plastic surgery and radiology. They were less likely to apply for residencies in family medicine, pathology, or internal medicine.

Seniors graduating from colleges of osteopathic medicine tend to pursue psychiatry, physical medicine and rehabilitation, family medicine and pathology. None of these popular choices for osteopathic students were the most competitive residencies. Out of the students who matched with neurosurgery in 2019, just 4% of the matches came from osteopathic students. 

In general, 91.8% of U.S. allopathic seniors matched with their preferred residency, and 82.6% of osteopathic seniors matched with their preferred residency. 

It is possible that attending a DO school will no longer be as limiting to your choice of residency in the future. Currently, many DO students match into specialty programs through the American Osteopathic Association’s (AOA) National Matching Service. This matching service is only for DO students entering into AOA-accredited residencies. However, starting in 2020, both MD and DO graduates will be in the Accreditation Council for Graduate Medical Education (ACGME) single graduate medical education (GME) accreditation system (SAS).

4. Type Of Curriculum Taught 

Students at some medical schools might not be exposed to certain specialties until it is too late. For example, the otolaryngology curriculum is sometimes not taught at certain schools. For example, otolaryngology has been removed for the curriculum at Ohio State University, which causes fewer students at that particular school to be interested in pursuing this small, specialized field. Having that exposure to otolaryngology in the first two years of medical school is critical because students must start preparing for the match by then. If they don’t have any experience in a specialized field, then they will be missing those necessary components and won’t be able to compete against students at schools that do teach the curriculum. 

A Large Consideration – Medical Debt 

Students might pick their specialties based on financial motivations. Medical school students from the class of 2018 graduated with a median student loan burden of almost $200,000. However, if you attended a private school, the average cost was $322,767, and 21% of students graduate with a debt of $300,000 or more. On average, medical students will have to pay back $2,212 a month on the standard, 10-year federal repayment plan.

According to data from the AMA, the most lucrative careers in medicine are often procedure-based. A survey found that the highest-paid specialties are:

  • Plastic surgery: $501,000 annual salary
  • Orthopedics: $497,000
  • Cardiology: $408,000
  • Radiology: 401,000

On the other side, the lowest-paid specialties include primary care fields like internal medicine ($230,000), family medicine ($219,000) and pediatrics ($212,000).

Because of mounting student loans, some medical students might make the financial decision to stay away from the relatively lower-paying specialties like pediatrics and family medicine, and choose to apply more frequently to the higher-paying specialties. This makes those specialties all the more competitive.

When applying to medical school, it might not seem like the school you choose to go to will have such lasting implications on your career. But if, as a pre-med student, you already have an idea of what field of medicine you would like to enter, do your research to make sure the school is setting you up for success and not limiting your chances at obtaining certain specialties. 

*Read the full article and more from Moon Prep on our Forbes column.