I’ve decided to apply for a neurosurgery residency. (Readers: please feel free to ask me questions about my decision or my decisionmaking process)
Scary for me to even say, but there, I said it. Nothing like changing to an extremely competitive field late in your third year. So much to do: away electives, letters of recommendation, new research projects, just to be competitive.
Why so much stress? Well, according to the most recent (2011) Charting Outcomes in the Match, the average successful NSGY applicant has a Step 1 score of 239 (~0.75 SD above the mean), 3 research experiences, and 8 papers/abstracts/publications. 25% of successful applicants are AOA (no applicants who were AOA failed to match, giving it a LR of a kajillion).
Let’s talk about the Step 1 score game for a second. There’s a tendency for medical students to obsessively focus on Step 1 as though it is all that matters. Frankly, in neurosurgery that’s just not the case. Even those who had essentially average Step 1 scores (the 221-230 bracket) had just over an 80% chance of matching. Those are pretty good odds. It means that other factors are much more important in neurosurgery – like being AOA. Having a lot of publications, in and of itself, doesn’t seem to make that much of a difference – but I’d bet that on an individual applicant basis, and at particular programs, it most certainly can.
Another interesting factoid, looking back over the 2009 and 2011 data: the number of contiguous ranks required to have a 90% chance of matching was ~17.5 in 2009, but declined to ~14.5 in 2011. Paradoxically, while only a third (56/215) of applicants ranked more than 16 programs in 2009, half of applicants (91/202) did so in 2011. Maybe applicants are applying more broadly, maybe top programs are being more generous so that top applicants get more interviews, who knows. But the matching curve is changing, and it was significantly worse to get <8 interviews last year (20-60% chance of matching) compared to two years ago (50-70% chance). My sense is that the overall understanding of the neurosurgery match game has improved particularly as the applicant pool has thinned out a bit.
So what does this all mean for me? Well, here are my strengths vs. weaknesses as an applicant:
Strengths: Step 1 score >250, 9 published papers (in neurology, lets say) before and during medical school, (supposedly) strong letters from home chairman, interview well (meaning that I am not a serial killer and people seem to like me rather than hate me on first impression)
Weaknesses: No neurosurgery publications, no home neurosurgery program (so I don’t have a true “back up”), came to neurosurgery late in life so I’m behind on the away rotation apps and such, couples matching (so we both have to somehow match into programs within 30 minutes of each other by car/train/helicopter)
For all of those reasons, I’m also afraid of “having” to go to a relatively poor program with little opportunity to advance in academic medicine, difficulty getting a fellowship, etc. etc. I have a few dream programs, and choosing neurosurgery only puts those farther and farther away (out of reach?).
So, onwards with away applications, shelf studying trying to grind out those last couple H’s, and so on and so forth. What else is there to say?