Time to ditch the ERAS application photo

Pretty damning results about the impact of perceived attractiveness on residency application success. Suffice to say, what came up didn’t exactly make into the NRMP Program Director’s Survey.

There’s a new paper in Academic Medicine titled “Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive?” coming out of Duke. Hint: the rhetorical question posted in an academic paper title is always answered with a yes. But while the study used their own radiology program, I have zero doubt that this is universal and probably substantially worse in other fields.

The idea was to grade mock applications and see who you’d invite:

Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive versus unattractive, B = 0.30 [SE = 0.056]; neutral versus unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (versus not obese) (B = -0.14 [SE = 0.024]).

The breakdown:

  • Facially attractive and nonobese applicants had a 24% chance of getting an interview
  • Less attractive, nonobese applicants had a 12% chance
  • Obese and unattractive has a 10% chance,

At the end of the day, the top three factors for selecting candidates were Step 1 > Race > Facial attractiveness. And being skinny and attractive literally doubled your chances.

Awkward.

While programs will always eventually meet their applicants and may always “like” applicants who are easy on the eyes, I don’t think any residency (except derm kidding not kidding) actively wants to screen their applicants by appearance.

Is there really any legitimate justification for having access to an ERAS photo in the first place prior to selecting interview candidates? I don’t need to know what you look like.

In the meantime, this study just further confirms the advice I’ve given before: you want your ERAS photo to be good.

Review: The Physician Philosopher’s Guide to Personal Finance

Back in May, I had the chance to sit down with The Physician Philosopher’s Guide to Personal Finance: The 20% of Personal Finance Doctors Need to Know to Get 80% of the Results.

The Pareto approach is a good conceit and is most of what people need. Real personal finance for most people is two things: simple and behavioral. Save a significant amount of your income by living on less than you earn and then do something really boring with it. Then, stay the course no matter what.

Add in bits about how important it is to buy own-occupation disability insurance and term (not whole) life insurance, and that’s the meat of the book.

My main beef, unsurprisingly, is the chapters dedicated to student loans. One, there are some factual inaccuracies (e.g. about eligibility criteria for the PAYE program, the fraction of physician jobs that qualify for PSLF, the common misconception that losing a partial financial hardship in IBR or PAYE boots you out of IDR and into the standard plan [it doesn’t, the payments just cap at that amount]), and the notion that all doctors should leave REPAYE after training and switch to PAYE in order to minimize payments [it depends!].

Two, the Pareto principle applies well to most people’s retirement finances but less well to nitty-gritty loan details, especially once you get into PSLF-territory. For the former, there is no evidence that a complicated portfolio outperforms a simple one when it comes to your investment accounts. As author Rick Ferri recently advised on the White Coat Investor podcast:

Regarding your portfolio: make it simple, make it automated, and just let it do its thing. Don’t touch it. That’s the best financial advice I can give. Simplicity, automation, hibernation.

But, there can be a big difference with small details when it comes to loans, which can easily change result in swings of tens to hundreds of thousands of dollars. I see what should be simple mistakes cost thousands constantly. Technicalities are the lifeblood of the system, but I do agree with TPP’s overall thrust though. Luckily, there’s a free book that knocks that particular topic out of the park.

Overall Jimmy is a solid writer and the book is readable and reasonably concise. The first editions of my books had small errors too (okay, I’m sure they all still do–I’m a very fallible human). The beauty of self-publishing is that Jimmy has probably already fixed the errata I found.

It’s a great book for students, residents, and early career physicians.

Updated Student Loan books

Nice, productive holiday weekend. I also got around to making some minor revisions and 2019 updates to Medical Student Loans and Dealing with Student Loans, both of which you can always download for free right here. Yes, these beloved best-in-class books are completely free, because student loan debt is crippling generations of Americans, and that outweighs every other consideration.

If you already have a copy, you can still drop your email on the download page and get this most recent edition in your inbox. (And of course you’re always welcome unsubscribe immediately.)

While I would recommend reading one of the two books to literally anybody with a student loan from current college students to seasoned physicians, I strongly recommend any graduating students to take a few hours this month and get your financial house in order.

This is literally the perfect time.

Updated Guide to Fourth Year

I’ve just updated my guide to being a senior medical student, Fourth Year & The Match. It remains awesome and free as well as being up-to-date for 2019-2020.

Even if you’ve downloaded the old version, you can still receive the new one by dropping your email address here.

 

Get your free book download (ebook and PDF) of Fourth Year & The Match.

 

I have yet to actually start that planned infrequent/sporadic newsletter, and even if I had, I have no interest in cluttering your inbox. But if you just want the freebie, no sweat: just click the friendly unsubscribe link in the download email.