Tuition Dollars at Work

From Dr. Daniel Barron’s “Why Doctors Are Drowning in Medical School Debt” in Scientific American’s Observations blog.

Each year, only 41 percent of applicants are accepted into medical school. Because demand outstrips supply, medical schools have the economic upper hand and, because lenders invariably approve loans to cover tuition, schools can effectively set the price of tuition to be whatever they want. College kids who don’t like it need not apply—somewhere in the remaining 59 percent, an applicant is willing to pay.


Each year a class of new doctors graduates with a total of $2.6 billion in loans, with a median student debt of $194,000. And no one—not even the regulator tasked with protecting students—can say where this money goes.

He interviews the dean that made NYU tuition-free, who provides some interesting quotations. Also, if you read the article, please note that the Barrons need a new accountant.

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 it 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 both skinny and attractive literally doubled your chances.


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.

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.

Neverending oil and water optics of corporate for-profits and healthcare

Mednax, Inc.’s CEO Roger Medel on their Q1 2019 Earnings Call:

Looking across our service lines. Volumes increased modestly in most of our women and children specialties. In neonatology, the underlying trend of births at the hospitals where we provide services remained negative, but our volumes increased based on rate of admission into the neonatal intensive car unit and length of stay.

Thankfully, despite birth rate decreases at our hospital, either the babies were coincidentally sicker or we managed to squeeze more kids into unnecessary NICU admissions and longer stays, so we were still able to grow our profits.


Explanations for the 2018 Official Step 3 Practice Questions

There was a practice material update for the official free Step 3 materials back in November 2018.

The previous set, which I explained here, was revised November 2017.

Most the questions are the same with the same order, but there were a few changes, mostly to fix some outdated questions. Questions 7, 8, and 133 were replaced. Questions 55 and 56 were swapped, and the stem for 56 was replaced to give you a chance to see a patient note-based question.

You can find my thoughts on preparing for Step 3 here. In short, I think the free materials and UWorld should be enough for most folks. If you want books recs, they’re in that post. If you need another question source, I haven’t tried any of them, but you can get 10% off BoardVitals if you’re interested by using code BW10.

As for this free practice exam, Blocks 1 and 2 are “Foundations of Independent Practice” (FIP). These should take up to 1 hour each. Blocks 3 and 4 are “Advanced Clinical Medicine” (ACM). These should take up to 45 minutes each. Total practice time should be no more than 3:30 if taking under test-day conditions.

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