SS 11 : Looking at Anesthesiology Match Data and Other Surveys

Session 11

Today we break down the match data, compensation surveys and lifestyle reports for Anesthesiology. If you're interested, this is a must listen.

Transcript

Introduction

Dr. Ryan Gray: Specialty Stories is part of the Med Ed Media network at www.MedEdMedia.com.

This is Specialty Stories, session number 11.

Whether you’re a premed or a medical student, you've answered the calling to become a physician. Soon you'll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.
Welcome to the Specialty Stories Podcast, my name is Ryan Gray, and I am your host. I also host many other podcasts; The MCAT Podcast, The Premed Years, and the Old Premeds Podcast to name a few. So if you are a premed student, go check out www.MedEdMedia.com. If you're a medical student, welcome and thank you for joining me on this journey as I gather information for you for the first time. All the other podcasts are dedicated to premed students, and Specialty Stories is really the first one that branches into the medical student world. And I appreciate all of the medical students that are reaching out to me through email, Twitter, Facebook, wherever and saying, ‘Hey I'm a medical student and I listen.' So thank you for that.

Today's episode is going to be a little bit different. I'm not going to interview a specialist. I thought I would intersperse the discussions with the specialists with the actual data from the NRMP, the match basically program, to actually take a look at each of these specialties to see what the match shows for people. And so that's what I'm going to do today. And I'm going to dig into- I'm going to go in alphabetical order to make it a little bit easier, and since this is the first one, we'll see how it goes. But I'm going to dig into anesthesia for this first one. And all of this information, if you Google ‘NRMP match data,' you'll find all of this information available for you. So what I'm going to do is I'm going to go over some of this data, and talk about it, and hopefully break down some of this information for you.

Alright so the first big data comes in table one in this NRMP match data, and this is match data from 2016. So as we're going through this it'll probably transition to 2017 data for other programs as I go through. But I'm not expecting a huge change in numbers- I sounded a little Donald Trump-ish there by saying, ‘huge.' Sorry. It's like I'm not allowed to bring politics into this discussion. Anyway so table one. So if there are- if I notice once the 2017 data comes out, if there's a huge change in the match data for programs that I've already covered, I'll go back and update them and mention those in future episodes as well.

Anesthesiology PGY1 Positions

So let's talk about anesthesiology PGY1 positions. So PGY1 means postgraduate year one, so this is internship basically. So anesthesiology, if you are applying for anesthesiology right out of medical school, you are applying for a PGY1 program. There were 119 programs in the country and there were 1,127 spots at those 119 programs. So roughly ten spots at each program, a little bit less. There were 23 programs that went unfilled, and this is always a huge thing that I like to point out to students, that especially for a very competitive specialty like anesthesiology, there were a lot of programs that went unfilled. So the question is where were those programs? Were they more rural areas? More of a rural academic hospital where students don't want to be? Or is it a newer program that people don't know about? Or what is the deal there? So that's something to think about, if you're interested in anesthesiology, 23 programs went unfilled.

So the NRMP also gives data that breaks down the number of applicants that are US-based and the number of applicants total for matching. So you have US seniors and total applicants, so let's break that down. So there were 1,127 positions offered, and 1,107 US graduating seniors that applied, and 1,748 total applicants applied. So there were almost 650 applicants, non-US applicants applying, and it kind of skews a little bit too because the data shows US seniors. So it could be somebody maybe that didn't match their senior year and is re-applying for a PGY1 spot, they could be included in this roughly 650. It could be graduates from- international graduates- non-US citizen international graduates, right? Or US citizen international graduates, meaning a lot of students that go to the Caribbean for medical school, so those are included in that roughly 650. The number or matches- so 1,107 US seniors applied, 774 matched. Roughly 70% match rate. And then 1,072 total matching. And so percentage filled when you look at it, 68.7% of the programs were filled by US seniors. 68.7% by US seniors.

And the last column in table one talks about ranked positions. I'm not really sure the usefulness of that column, so I'm not really going to talk about it.

Anesthesiology PGY2 Positions

Table one also covers PGY2 positions. So if you are applying for a PGY2 spot, I guess some programs that if you do a prelim surgery year, or a prelim medicine year meaning just a one year internship, it's a separate match that you go through- not a separate match but a separate program that you are applying to, some anesthesiology programs want you to apply to a PGY1 spot and then you start your PGY2 year in anesthesiology. There are some programs that are like that. Dermatology is mostly like that where you apply to dermatology for your PGY2 year, and you start your PGY1 year doing a transitional year or a prelim medicine year, or prelim surgery year.

So there are more programs, and it kind of skews it a little bit. So you have to kind of look at both of these totals. So as we talked about before, there are 119 programs for PGY1, meaning you apply directly to anesthesiology and you’re in that one program for the entirety of your residency. And then there are 77 PGY2 programs for anesthesiology for PGY2 spots. So those 77 programs, you apply there as you're going through the match process, you're applying as a PGY2, but you're also trying to match another program for PGY1. So it just complicates things and adds a lot of stress. And there were 481 positions available for that, and again, more unfilled programs. 16 unfilled programs, 952 US senior applicants, 1,540 total applicants, and then 290 matches for US seniors to a PGY2 anesthesia program, and 441 total.

So it's interesting for the PGY2 anesthesia programs that the US seniors filled 60.3% of those programs, but the PGY1 was 68.7%. So something's a little off there, that's a big difference to have almost an 8% difference- an 8.4% difference in US seniors filling programs for PGY1 versus PGY2. And I hope this isn't super confusing for you as I talk about PGY1 and PGY2, and all these percentages and numbers. Again as you- it's probably best to listen to this episode which you have table one in front of you. Again search for ‘NRMP match data,' and pull up the 2016 match- the residency match results, and look at table one which we're breaking down right now.

There is one other spot on here that has physician positions. So these are for people that have prior postgraduate training, I'm not going to go into that because it's very specific to people that- to physicians who already have some postgraduate training. So I'm going to skip over that part.

Breaking the Numbers Down by Applicant Type

Now table two in this NRMP match data, again 2016 match data for anesthesiology, table two is interesting because it breaks down the specialty by applicant type. So this is telling you who is applying to these spots. And it actually says ‘Applicant Type' but this is people that matriculated or were matched. So this is who is matching in this program. So if you look at anesthesiology PGY1, again this is table two in the NRMP 2016 match data, there were 1,072 positions filled, and of those 1,072, 774 were US seniors meaning MD. If it just says specifically for NRMP, if it says US senior, they are specifically referring to allopathic graduates, MD graduates. So there 774 US seniors, there were 19 US grads, so these are people that maybe took a gap year before applying to anesthesiology, maybe they didn't match their first time around and did maybe some research or something in between. But these are US graduates, again MD graduates applied for anesthesiology but they weren't seniors, so they were applying past their normal time. 154 of the 774- so a little over 14% of total matching, the total matches, were osteopathic graduates. So that's kind of interesting, and as we dig through more data, as we go we'll see if around 14% is a good number or not. Zero were Canadian, zero were fifth pathway- and we haven't really talked about fifth pathway in the Specialty Stories, or even in The Premed Years Podcast so I'm not going to talk about that much. We had US- so US citizen international medical graduates, there were 70. So if you look at- there's always this discussion of ‘should I go to a Canadian MD school or a US DO school?' If you just look at these numbers, 154 osteopathic matches and 70 IMG matches for US citizens. There were 55 non-US citizen international medical graduates, so a pretty big number, and then 55 unfilled spots.

So it's important to remember these numbers. You can't just look at the numbers and go, ‘Oh obviously if I want to be an anesthesiologist I need to go to a US MD school,' because the numbers are skewed. If you look at 774 for US seniors, and we'll add the other US grads in there too. So if you add the US grads you're looking at 793 US seniors, or US graduates from MD schools versus only 154 for DO, you're like, ‘Oh it's a no-brainer. Go to an MD school.' But it's not that easy because there were only in 2016, the latest AACOMAS profile for applicants and matriculates, there were 6,778 matriculates to DO medical school, and there were 21,030 matriculates to MD school. So there are a lot more MD students than DO students. Now if you look at just the raw numbers here, the numbers of applicants, if we say that DOs and MDs are equal for anesthesiology matching in an MD program, then you would expect possibly that the numbers of osteopathic students would equal the same percentage that there are students in the schools, if that makes sense. So if there were- it's about 30% of DOs versus the MD schools, or MD students, and so you would expect about 30% for the anesthesiology matching as well for osteopathic students, but that's not the case. It's only- what did we say, 14.3% roughly, so it's less. But then you have to look even further and go, well if the students who are going to osteopathic schools are truly going to osteopathic schools because they are interested in the osteopathic philosophy, and the osteopathic philosophy, and the programs typically gear towards more primary care than you would expect less than what you would look just looking at total numbers of students. And so it would kind of make sense. So as- I'll go off on a tangent a little bit. This is the problem that I have when you're on Student Doctor Network, or you're on Reddit, or whatever forum that you're on and discussing this and you go, ‘Oh,' and they just show raw numbers but they don't talk about the numbers like I'm doing right now and saying, ‘Well okay you have basically 14% are osteopathic students matching for all of the spots.' Yet it should be near 30% if we want to look at total students, MD and DO. But it's not always the case because what if those DO students truly are going to a DO school, and wanting to be primary care physicians, which is great because we need primary care physicians. And so sure, it's not going to look the same because the philosophy- and if you listen to my Premed Years Podcast you know I'm not a true fan of the philosophy sales pitch of osteopathic schools, but I am a true believer in that they want to train primary care physicians. And so if those students are going in wanting that, then yeah there's going to be less that are matching in the match.

So take these numbers with a grain of salt. As you're staring at them, as you're talking about them with other people, and thinking about them, and if you're a premed listening to this and you're thinking, ‘DO or MD, and what am I interested in?' You go, ‘Oh there are only 154 osteopathic students matched for PGY1 spots, so I don't want to go to an osteopathic school.' It's kind of rubbish to think that way. So just take that with a grain of salt.

Alright so again, table two lays out PGY2 spots. Again we talked about PGY2 positions are programs that you have to apply separately to a PGY1 program. There were 481 positions available, only 40 were unfilled, 290 were US seniors, 28 were US grads non-seniors, so students again taking gap years, or not matching their first time around. 54 were osteopathic students, so a little bit less percentage than the PGY1 spots; 12.2% versus 14.3%. We had zero Canadians, zero fifth pathway, 44 US IMGs- so again US citizen international medical graduates, again Caribbean or some of these other programs overseas, and 25 non-US citizen international medical graduates.

Numbers of Positions Available

Table three of the NRMP match data talks about the increase or decrease of positions from year over year, and anesthesiology increased 4% from 2015 looking at 2016 data, so there were 4% more programs or more positions offered in 2016 than there were in 2015. There were 4% more in 2015 than 2014. 3.9% in 2014 than 2013. So it's a continually growing specialty which is good if you're interested in anesthesiology, which is interesting if you go back and listen to the anesthesiology discussion that I had, the question comes up about CRNAs and are CRNAs going to be taking jobs from anesthesiologists. And if you look at this data, we're training more and more anesthesiologists, so if that was a concern, hopefully that would take into account- or it would be taken into account the number of programs that are offered. And you may see a decrease, but again when I talked to the anesthesiologist he really wasn't worried about the CRNA discussion at all.

Table seven of the NRMP 2016 match data digs into US seniors, and the position offers, and numbers filled by US seniors looking from 2012 to 2016. And it just shows a trend that in 2012, 725 spots were filled by US seniors, and in 2016, 774 were filled by US seniors. It looks like the trend, because there were less spots offered in 2012 than in 2016, that there are percentage wise- the percentage of US seniors filling those spots is actually going down a little bit. And just doing the math it's about 10% it actually went down, the number of US seniors filling anesthesiology for PGY1 positions, it went down about 10% from 2012 to 2016. And again, for PGY2 spots, there again was a decrease here, a pretty big decrease. In 2012 397 US seniors filled 557 spots, so the spots decreased, but again a much bigger decrease in 2016 percentage wise. There were only 290- again 397 versus 290 for 481 spots. And it's about an 11% difference from 2012 to 2016. So I wonder where- we talked about this decrease for PGY2 spots. I wonder if there's just a lack of awareness about these PGY2 spots, or we've just become so lazy that we only want to apply to PGY1 spots because it reduces the number of programs that we have to interview at and apply to, and it obviously is a much bigger hurdle, and it seems like the non-US seniors are more willing to do that extra work. Kind of interesting.

So table- or figure five actually, again 2016 NRMP match data talks about the number of positions offered and filled for selected specialties. Again in 2016, anesthesiology here has categorical positions listed, and advanced positions, and also the physician positions. So it has everything listed here. There were 1,696 positions offered, only 1,590 filled, and 1,064 of those filled by US allopathic seniors; so MD graduates. So 66.9% of all of the program slots that were filled for anesthesiology in 2016 were US MD graduates- or US seniors actually.

So table eight has an interesting trend here. Table eight, again 2016 NRMP match data talks about the positions offered and percent filled by US seniors and all applicants, again 2012 to 2016, so you see a nice trend. 78.9% of all programs, all anesthesiology programs- or all PGY1 anesthesiology programs, 78.9% in 2012 were filled by US seniors. 74.8% in 2013, so it went down 4%. It went up- excuse me it went down again in 2014, 71.9%, so down another 3% almost. And then it went up a tad in 2015, it went up 1.1%. And then it went down in 2016 to 68.7%. So you see a general trend from 2012 to 2016 of less US seniors matching or filling positions in anesthesiology for PGY1 spots. So the question comes, is this because there's less interest, or are students worried about the CRNA thing maybe? Are more people going into primary care maybe? Again we're just looking at anesthesiology here so can't make any predictions or draw any conclusions just based on the raw numbers, but it shows a general trend downward. Again PGY2 positions, 2012 had 71.3 US seniors filling all of the spots. 2013 had 68.6 so a big decrease. In 2014, 63.5, another big decrease, almost 5% or a little more than 5%. In 2015, it went down more than a percentage again to 62.3 and then 2% in 2016 it went down. So 60.3% of PGY2 anesthesiology programs were filled by US seniors. So again, another big decline, big decrease in US seniors matching or filling these PGY1 and PGY2 spots for anesthesiology.

Tables nine, ten, eleven and twelve are interesting to look at because they tell you the percentage of the specialty based on the total percentage of all of the programs offered, so all of the other specialties combined are going to add up to 100. And anesthesiology accounted for 4% of all matches to PGY1 positions. So 4%, that's not bad, that's actually one of the larger ones on the list. Just to give you an idea, obviously the primary care ones are going to be the largest, you have family medicine 11.5, internal medicine almost 26%, you have pediatrics at 10%. So it's right up there. Some other surgical sub-specialties, you have OB-GYN at 4.7, and let me look for orthopedics on here, is 2.7. So it makes sense that anesthesiology would be more than orthopedics because anesthesiology is doing all of the surgeries and not just orthopedic surgery. So 4% of all applicants that are matching are in anesthesiology.

Osteopathic versus Allopathic Applicants

And then it breaks down table ten, breaks down for US seniors, 4.5% of all matching US seniors are to anesthesiology. Table eleven looks at osteopathic students and graduates, so it doesn't specifically say osteopathic seniors which is interesting, but what is interesting here is 6.4 of all osteopathic students that are filling an MD program, 6.4% are for anesthesiology. And again looking at the other MD programs just to give you a sense, almost 16% are family medicine, almost 21% internal medicine, pediatrics almost 15%. So anesthesiology is right up there. It seems to be a good one for osteopathic students which is interesting.

So what about students that don't match in anesthesiology? What are the numbers that those look like? And if you look at figure six in the data here, the NRMP 2016 data, there are 8.9% total unmatched, and it's actually the second lowest in this figure, and there are- there is a note here that says specialties with fewer than twenty matched applicants are excluded from this figure. So this is pretty thorough, and again anesthesiology has the second lowest non-match rate for all of the NRMP data. 8.9% for all applicants, 0.8% for unmatched US seniors. So US seniors that are only ranking anesthesiology, and going into the match only wanting to match in anesthesiology, less than 1%- 0.8% are not matching. Independent- what they call independent applicants, so anybody who's not a US MD senior is 23.8%, again second lowest. Actually the lowest, lowest on this list. Internal medicine and pediatrics which is the lowest overall has a 30.8% for unmatched independent applicants, so that's kind of interesting to see.

Table seventeen talks about the number- the average number of ranked applicants per position. So looking at anesthesiology for PGY1 spots, there were 8.4 ranked applicants per position, so there are a lot of people applying for these programs, and if you look at PGY2 spots there are 19.4 average number of ranked applicants per position.

The SOAP program, the Supplemental Offer and Acceptance Program which used to be called ‘scrambling,' you would scramble into a spot if you didn't match through your normal ranking system. There were- table eighteen talks about the participating programs and positions for the SOAP, and for anesthesiology there were twenty programs that were participating, meaning those twenty programs had open spots after the normal match algorithm did its thing, and there were 51 positions, and 48 of those went filled through the SOAP program. Those are for PGY1 spots, and then eleven programs- 34 spots for PGY2 positions.

NRMP Charting for Anesthesiology

Now again being the first time that I'm digging into this data, there's a lot more data that I could dive into. Again if you look at NRMP match data, they have what's called charting outcomes in the match for US allopathic seniors, so this is very specific to allopathic, so MD seniors. They break down into the board scores and everything else, and actually I'll talk about board scores because I know that's always a big discussion here; board scores kind of dictating how competitive something is. So if you look at board scores, so USMLE Step 1 for anesthesia, it looks like their median number here is about 232 maybe, 231 for matched applicants, and unmatched it's much lower around 208 maybe. It doesn't talk about specific numbers on here, just a range. And then Step 2 CK, so the clinical knowledge, again matched anesthesiology is around 241, so about ten points higher which is normal. It seems like the average trend is people do better on Step 2 CK. It's more medicine based and not just memorization like Step 1, and the unmatched for anesthesiology is about 222 roughly; so a bigger jump than the unmatched for Step 1. But again it digs into research experience, and abstracts, and publications, and much more data. So it's all out there.

MedScape Numbers for Anesthesiology

I think one other thing I wanted to talk about was MedScape data and their reviews that they do- the surveys rather, sorry, of physicians. So MedScape every year has a physician lifestyle report, and then a physician compensation report. So I wanted to talk about the lifestyle report for MedScape. It's a 2017 lifestyle report for MedScape. Again if you just do a quick Google, very easy it comes up right away.

So anesthesiology, one of the first slides on here is which physicians are most burned out, and anesthesiology is right in the middle of the pack at 51%. Emergency medicine the highest at 59% and psych and mental health the lowest at 42% according to, again the 2017 MedScape report- lifestyle report. So anesthesiology right in the middle. How severe is the burnout on a scale from one to seven, where one is it does not interfere with my life, and seven is it is so severe I'm thinking of leaving medicine altogether. Anesthesiology is at a 4.1, again kind of a little bit lower than the middle of the pack. Urology leading the pack at 4.6, and infectious disease at 3.9.

Slide eighteen talks about which physicians are the happiest, and anesthesiology a little bit higher up- it breaks it down at work and outside of work, anesthesiology has 33% happiness in work, and 69% outside of work. And just to give you an example, it looks like most of it is based off outside of work just looking at the trend line. 76% for urology, they're happiest outside of work, 31% inside of work.

And if we look at the MedScape physician compensation report, which a lot of students would like to know like, ‘How much money am I going to be making?' Let me just- I'll give the disclaimer, don't choose your specialty based on income. Money will not buy you happiness if you're not doing what you like. Anesthesiology is unsurprisingly near the top at an average of $360,000 a year, which is not too shabby. That is only about a 1% increase from the prior compensation report, which is interesting, not a big increase. It's one of the lower increases.

Interesting slide here on the compensation report, slide twelve says, ‘Which specialties have the most female physicians?' Anesthesiology is one of the lower ones at 21%, OB-GYN unsurprisingly and pediatrics far and away the majority are females at 55% and 53%.

And a good slide, slide fifteen, which physicians feel fairly compensated. Anesthesiology near the top at 55%. Dermatology is the highest at 66%.

Difference in earnings between physicians who feel fairly versus unfairly compensated. Anesthesiology is lower at $44,000. So physicians who thought they were not being fairly compensated versus physicians who were, the difference in pay was about $44,000. Interesting number.

One of my favorite slides to always look at is slide seventeen, how do physicians rank by overall career satisfaction. Anesthesiology overall career satisfaction, 54%. They were satisfied with their income at 55%, they would choose medicine again, 59%, and choose specialty, only 48%. Interesting number. So one of the things when you're looking at these surveys, is there's an obvious selection bias for those- I don't know if selection bias is the right term, but the ones that are filling out these surveys are going to possibly be ones that are more dissatisfied with their job. So take these numbers with a grain of salt, and look into these specialties as you go through your training, and figuring out what you want to do, and break these numbers down, and everything down based on what you want, and what you need for your career.

They have one more slide here, kind of a redundant one here, slide 31, I would choose medicine again, and anesthesiology is kind of lower at 59%. 73% for family medicine, 47% for plastic surgery. And it's interesting, it'd be interesting to kind of get somebody to break down these numbers and go, ‘Well family medicine and internal medicine, those are people going into primary care wanting to treat patients, so yeah they're going to choose medicine again because that's what they're going into.' And then when you look at some of these other specialties like plastic surgery, radiology, the lower ranked ones, or the surgical sub-specialties and ones that are higher paid; so were these people going into the field because the money was there? Interesting to think about. Again choosing the same specialty, anesthesiology ranked the middle pack at 48%.

And just to give you an idea for this survey, 6% of all of the respondents were anesthesiologists, so a pretty good number.

Final Thoughts

Alright so I think I will end there. We talked about the match data specifically for the MD match data. The osteopathic match data isn't as easy to read, and you have to break it down by state, and so I'm not going to dig into those unfortunately. It's just harder to read, they don't make it as pretty and easy to look at and talk about as the NRMP data.
So things to take away. Just because there are less osteopathic students matching into anesthesiology overall compared to the total number of students for osteopathic and MD doesn't mean that your chances are lower, it just means that maybe there are less osteopathic students that want to go into anesthesiology. So it didn't break down the total number of applicants that I saw, if I missed that, let me know.

I hope this was useful. It may be confusing, again first time I'm trying this so let me know how it goes. Email me, Ryan@medicalschoolhq.net. Again it would be easier to have all this information in front of you, so maybe not the best episode while you're at the gym, or driving in the car, or whatever you're doing listening to this podcast now. But I hope it was hopeful and I look forward to your feedback. Coming up I have a lot of interesting people lined up; a physiatrist, a neuro-radiologist, a very sub-specialized ENT surgeon, a general ENT- I think he's general ENT. I have a forensic pathologist coming on, and one of my best ones coming on but it won't be for later, later, later is BJ Miller, a palliative care physician so I'm excited about that. He's an amazing palliative care physician. Look him up, he's got an amazing Ted Talk, he agreed to come on Specialty Stories. So I'm excited for what is to come, again let me know- give me some feedback on this episode to see if you were able to keep track of all these numbers and things that I talked about.

I hope you have a great week. If you liked this episode, do me a favor, go tell a friend. If you're in medical school, go tell your class about this podcast and have them subscribe. Help them figure out what they want to do on their journey to becoming a physician.

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