Is this considered good placement or bad for MDs?

85bears46 · March 2018

http://pritzker.uchicago.edu/news/2018-match

I have absolutely no clue about medical school but of course I have been hearing for a couple of years that BSD and Pritzker have been on major decline. So can someone much more knowledgeable in medical field tell me whether this 2018 result is considered good or bad residency placement for medical school grads?

FStratford · March 2018

Not impressed with the distribution of specializations. The institutions they are going to are superb though.

Tiglathpileser · March 2018

My wife is an MD and I used to be an engineer (retired now). For both of these professions doesn't matter where you got the basic degree (MD) or residency (unless you are going academic). She is desperately trying to hire two newbie hemo-oncs for their practice and looking where they went to college is interesting..but not determinative.

JBStillFlying · March 2018

"The most popular categorical and advanced specialties chosen this year by our 97 matching students were internal medicine (26), pediatrics (12), psychiatry (10), emergency medicine and general surgery (8 each), and anesthesiology and obstetrics-gynecology (7 each)."

@Fstratford, isn't the distribution a function of specialty interest? Are you thinking that Pritzker graduates too many primary-care physicians as opposed to sub-specialists?

Wondering if there is a correlation between interests in internal medicine and academia. My dad, an internist and nephrologist (retired now), was also on faculty at a medical school for a number of years. What's interesting is that he was always interested in academia and now I'm wondering if he chose IM in order to make that happen. He also opted for nephrology because dialysis was this new thing at the time and demand for trained kidney docs was very high. It certainly helped in his career as he had a couple of offers to head of the dept. of Kidney Disease in addition to his academic work. So it's possible that IM is a gateway to more interesting diseases. Just speculation - would be great to get more feedback on this.

Tiglathpileser · March 2018

well IM is the required basic qualification before one can get into most any subspecialty eg GI, hemo-onc, and on...so to the extent a budding MD wants to go into most academic subspecialties they need to eke out 3 yrs in an IM residency first.
Work life balance seems to be the key criteria these days for selecting a focus area. Thats why Dermatology (no emergencies, 8-5 gig) is the hardest residency to get into.

FStratford · March 2018

@JBStillFlying Yes it is a function of student interest. It is also a function of the ability of the school to support student interest in other specializations. That high of a proportion of internists, pediatrics and family medicine does not reflect well on "cutting edge" medical research at UChicago. Although where they are placed can substantially alter what they really will end up doing, so there is that factor (and why I commented on it as well).

I was hoping to see more cancer, old-age, and ortho-related tracks. (Or placements to special clinics like Sloan Kettering, Mayo or Cleveland). These career paths can still change though so I am not reading too much into it, only that on its face, it could be better.

JBStillFlying · March 2018

@FStratford, the previous poster is saying that IM precedes hemo-onc. so that's one type of cancer sub-specialty that starts with IM. Orthopedics is a great field with increasing demand and geriatrics has it's own set of issues for research (Alzeimers etc.). However, UChicago seems to be a niche player with a large preference for turning out those who are interested in the subspecialties of Internal Medicine. It does well what it does. Now, perhaps infectious disease, the endocrine system, gastroenterology and research into diabetes (also a growing field!) aren't so very sexy or on the front pages of the NYT but they ARE crucial to overall health and well-being, not to mention fascinating to the more scholarly among the physician set.

I'm reminded of a good friend of mine who, when looking into med schools (and ended up at Stanford) was appalled by Pritzker's philosophy at the time: rather than use medicine to cure social problems or bring about world peace, apparently all they cared about was identifying the disease and finding a cure!

FStratford · March 2018

Makes sense. It is a small school, so as long as it is tops on some niches, and allows its students access to cutting edge facilities post-grad like it does now. With its size, it cant possibly dominate every specialty.

bigreddawgie · March 2018

it is pointless to look at match lists and examining the distribution of specialty and location of matches. this is all based on student preferences. many of my classmates ranked less prestigious programs over top hospitals based on their preference/location/spouse. pritzker also has no problem matching into any specialty, again this is all based on student preference. people might self select if they arent competitive enough for a specialty, but for the most part, people go for what they want.

Tiglathpileser · March 2018

100% true. There is a high probability you will practice in the geo region you went to school, because you build local relationships/networks during residency...so many will pick based on where they want to end up practicing. Of course the matching system whereby you get only one offer for residency may change your plans..

aokiki · March 2018

These programs are very prestigious, academic-oriented institutions (as expected from a research powerhouse like UChicago).

In regards to OP, BSD and Pritzker haven't really declined at all -- rather, other institutions are catching up, and the research prowess of the institution is dragged down by the fact that UChicago doesn't have a good hospital (relative to its peers).

A concern is the large percentage of students placing into UChicago itself, but many schools do this. There should be a full 2018 match list floating around somewhere though. My guess is that Pritzker's match is much better than most schools at its current ranking (18).

Poplicola · March 2018

A current MD/PhD student at a top 5 institution here. Pritzker's match list is fine. Much better than Feinberg's at least.

Typically when evaluating a match list, we look for the number of students matching into known competitive specialties (dermatology, orthopedic surgery, ophthalmology, urology, neurosurgery - radiology and anesthesiology remain highly competitive but not as competitive as a few years back) as well as the number of top programs in internal medicine, ob/gyn, etc etc etc. It's not uncommon for universities to have a lot of "in-breeding," meaning medical students matching into their own hospital. This of course, doesn't take into account of students' own preferences and the "personality" of each class. Some classes might gravitate toward surgery but others might disproportionately match into medicine.

Poplicola · March 2018

Ranking-wise, Pritzker is not on major decline. Remember, the medical school was ranked about the same (#18~19) before the admin deliberately shrank its class size from 101 students or so to 88 per class with the sole purpose of boosting its selectivity and rank. That effort obviously had failed (or rather, it worked just for a few years). Their ranking peaked at around #10 in 2013, and now they're just back at where they began.

In terms of research funding (NIH funding specifically), BSD is in serious trouble. This is what's affecting Pritzker's ranking. They've managed to boost their selectivity (their median MCAT score peaked at 38 or so a few years ago) but that has been offset by weakness in other areas of the ranking, especially research funding. They're getting destroyed by their peers. While overall funding from NIH appears to have stabilized ($162~170 million to UChicago per year), BSD as a division is getting smaller and smaller part of the pie.

On the clinical side, the Medical Center has performed poorly in the past few years. When I entered UChicago as an undergrad (slightly more than a decade ago), its medical center was considered the best in Illinois and easily top 20 nationwide. Just to show how far they've fallen, they've since dropped to #8 in Illinois and UNRANKED nationally. Something is very wrong at the hospital. I have my theories but they're just speculations.

kaukauna · March 2018

Poplicola would you mind sharing your theories? You seem as well informed as anyone regarding the goings on at the medical complex / school.

Poplicola · March 2018

@kaukauna: this is what I wrote last year (with some minor changes). I predicted then that Pritzker would likely drop down to #18~20 again going forward. Also said something along the lines of: "Making superficial, cosmetic changes isn't a sustainable way to improve your ranking."

I can only speculate based on my observations and the anecdotes I've heard:

1) Lack of an engineering school
Before creation of IME, the lack of an engineering school did hurt UChicago's ability to attract talent. I know of one promising chemistry faculty member who left for Northwestern a few years back precisely because UChicago didn't have the people he could collaborate on his research interests, which were related to engineering. This is not to say that UChicago hasn't poached acclaimed scientists in recent years. Yusuke Nakamura is an excellent example of the kind of faculty this institution has been able to attract.

2) Deteriorating culture
Since Zimmer became President, there has been leadership change at every level of the University, not just the undergraduate admissions office which seems to get all the attention on this forum. The department chairs he brought in have all been the "corporate type" (i.e. focusing solely on revenue, cost-cutting, patient volume, accepting/welcoming only "lucrative" research with potential industrial or therapeutic applications). The new administration has unnerved faculty members across the board, especially those whose research doesn't fit the profit-driven "vision" of these new chairs (PM me for specific examples).

Don't get me wrong. I think cost-cutting measures are necessary in this health care/funding climate (see yesterday's Wall Street Journal article about similar reform taking place at Mayo and other top hospitals), but if done wrong, they can do real damage to a department and even instigate faculty exodus. Disgruntled faculty members are vulnerable targets for poaching by competing institutions. I know of physicians and physician scientists leaving for competitors in Cali, Mayo, Penn, greater Chicago area (and all their rankings reflect that) etc.

In the Zimmer epoch, there's now increasing divide/tension between the administration and faculty. The two parties are no longer working cordially and in concert with each other. Us-versus-them mentality is evident throughout BSD, and this brings me to my next point.

3) Great facilities, incompetent administration
Because research dollars are so limited nowadays (and competition so fierce), those with the fewest mistakes are the ones who get NIH grants. Institutional/administrative support - having professional "editors" pouring over not just your scientific ideas but also budgeting (I've done budgeting myself and it is incredibly complex; mistakes here and there can easily sink a grant) - is now paramount. The incompetent administration at BSD was late to the game. For many a year, BSD administration had failed to provide its faculty with the necessary support to land NIH grants.

This strategic mistake (negligence?) will haunt BSD for the years to come. Shuttered labs are commonplace in the hospital complex, and it's a sad sight to see at my beloved alma mater. Vandy did a phenomenal job in providing institutional support, and their NIH dollars reflect that.

I also found the info that @Cue7 dug up awhile back (below). I understand that the Medical Center has been doing a lot of M&A lately, and acquiring then integrating a new clinic or hospital inevitably has bumps. However, it shouldn't cause disruption this disastrous.

In 2015, here are UChicago's rankings:

Cancer #34 (down from #11 in 2010)
Diabetes - Not in Top 50 (down from #18 in 2010)
Ear Nose Throat - Not in Top 50 (down from #38 in 2010)
Gastroenterology #25 (down from #6 in 2010)
Gynecology - Not in Top 50 (down from #34 in 2010)
Neuro #43 (down from #26 in 2010)
Nephrology #50 (a bright spot! was unranked in 2010)
Kidney - Not in Top 50 (#21 in 2010)
Pulmonology - Not in Top 50 (#21 in 2010)
Urology - Not in Top 50 (down from #28 in 2010)

Poplicola · March 2018

In the 2017-18 issue, here's UChicago Medical Center's report card:

Cancer - #31 (down from #11 in 2010, up from #34 in 2015)
Diabetes - Not in Top 50 (down from #18 in 2010, unchanged since 2015)
Ear Nose Throat - Not in Top 50 (down from #38 in 2010, unchanged since 2015)
Gastroenterology - #42 (down from #6 in 2010, down from #25 in 2015)
Gynecology - #46 (down from #34 in 2010, up from unranked in 2015)
Neuro - Not in Top 50 (down from #26 in 2010, down from #43 in 2015)
Nephrology - Not in Top 50 (unranked in 2010, down from #50 in 2015)
Kidney - Not in Top 50 (#21 in 2010, unchanged since 2015) - I think @Cue7 meant to say Cardiology here? since neph = kidney
Pulmonology - Not in Top 50 (#21 in 2010)
Urology - Not in Top 50 (down from #28 in 2010, unchanged since 2015)

I normally don't put much emphasis on rankings, but when the changes are this drastic and this consistent across specialties, something is wrong.

BiffBrown · March 2018

@Poplicola Where are you finding these rankings?

Poplicola · March 2018

US News Hospital Ranking (by specialty). While I understand that rankings fluctuate from year to year, its poor performance across the board suggests that something is going on.

kaukauna · March 2018

Poplicola - thank you for your detailed and thoughtful response.

IWannaHelp · March 2018

@Poplicola I am not in the medical field. Why did you say its match list is "much better" than Feinberg's? I looked at Feinberg's and it looks like there are many top medical centers on it. Inbreeding alone would be better for Feinberg's given NMH is highly ranked?

Poplicola · March 2018

@IWannaHelp Different people have different ways of evaluating a match list. I tend to focus on Internal Medicine since gives me the largest sample size. Here's Pritzker's complete match list (by specialization; if you just control + F "Pritzker"): https://****/threads/official-match-lists-2018.1301986/

Pritzker's internal medicine match list is substantially stronger. I don't tend to pay attention to in-breeding because it is common at top 20~30 institutions. Also keep in mind that Feinberg's class size (161) is almost twice the size as Pritzker's. I find it hard to believe that nobody at Feinberg is interested in ENT or vascular surgery this year, or neurosurgery last year. Don't get me wrong - Feinberg's match list is still good, but I just like Pritzker's a bit more.

As mentioned, judging a school's match list doesn't take into account of students' personal preference (geographic, etc etc etc) so it's not exactly an accurate way to judge a school.

Is this considered good placement or bad for MDs?

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