Monday October 8, 2018
Tune in to hear as Josh talks to Dr. Jacob Kuperstock about Residency Matching and how Doc Odds can help you! Also learn:
- Costs associated with applying for residency.
- How Doc Odds can help with international medical graduates.
- U.S physician shortage and how Doc Odds can help!
Josh Mettle: Hello and welcome to the Physician Financial Success Podcast. My name is Josh Mettle, and this is the podcast dedicated to advising physicians how to avoid financial landmines. Today we’ll be talking with Dr. Jacob Kuperstock, CEO and co-founder of Doc Odds LLC. Jacob and his team at Doc Odds specialize in helping medical students plan and improve their odds of matching into their preferred residency specialty, while minimizing their residency application expense.
This is going to be a great podcast. I’m excited for it. Jacob, welcome to the show, and how you doing today?
Jacob K.: I’m doing great, thanks for having me.
Josh Mettle: Yeah, my pleasure. What you do, I’ve not heard of anything like it at all, so when we were first introduced and I came across what you do, I had to have you on the podcast, and this is going to be great.
Let’s kick off with just a little bit of background. Tell me a little bit about the history of Doc Odds, and how did you get started down this path?
Jacob K.: Yeah, no problem. Doc Odds as a company was founded in 2017. We’ve just actually passed our year mark, which is exciting.
Josh Mettle: Congratulations.
Jacob K.: Thank you very much. I think the inspiration behind Doc Odds was due to my personal experience with going through the residency match process. I graduated undergraduate from the College of William and Mary in Virginia, and then went on to Stanford University School of Medicine in Palo Alto, California. Then I decided after my clinical years in med school that I was going to pursue a residency in otolaryngology, which is colloquially known as ear, nose and throat, and it’s one of the more competitive specialties.
Stanford is excellent at advising their medical students when they’re going through the residency process, but most of that advising is anecdotal or past process. There’s not too much evidence-based statistics that are available to students when they go through this process, and so I was looking, as a resident, was looking to be able to help additional med students out, and I realized that there really was a need to get some evidence-based statistics behind that match process, and what could help students improve their chances of matching.
That’s where the problem was focused, and the solution that we were able to come up with was able to use aggregate data that’s publicly available and to run some pretty fancy and high level statistics to be able to help our students understand which variables matter the most.
Josh Mettle: I think it’s amazing that we live in a world where you can take probably data that’s public but so hard to make heads or tails of, create some sort of an algorithm and almost appafy it to the point where now somebody can utilize it and actually get attainable results through it, so really cool technology, and what a just a fun time to be alive, right?
Jacob K.: Oh yeah, it’s amazing, and one of the major partners in Doc Odds, he got his PhD at Boston University, which is where I did residency and so that’s how we got connected, but it is just incredible, the tools that … His name’s Michal Horný, and he’s now an assistant professor at Emory University, but just incredibly capable human, brilliant and I’m glad he’s a part of the Doc Odds team.
Josh Mettle: Yeah, really cool. You mentioned a little bit about the cost associated with the whole process. Tell us how Doc Odds aims to minimize those costs, and what kind of cost savings might someone expect?
Jacob K.: Absolutely. I’ll just mention a little bit first, there is certainly thousands of medical students who do not match into residency each year, and so it can be a very expensive endeavor to apply to residency programs, to then fly around to the different hospitals and residency programs all over the US for the outcome of not being able to progress through your training, aka go to a residency position.
I guess the first cost that’s usually associated with this would be applying through the electronic residency application system. That’s also known as ERAS, and that application system has a base fee, but then also has an additional fee per program applied, so for the first 10 programs, it’s about $100. For programs 11-20 that you apply to, it’s about $13 for an additional program, and then it goes up in increments from there. 21-30’s about $26 a program, and then anything from 31 on is also an additional expense. If you’re applying to a very competitive specialty and you’re applying to 200 programs, it can become a very expensive endeavor for you with no guarantee that you will become a resident in the US.
Josh Mettle: And did you quantify what … This whole idea came from your experience of application. Did you quantify what that cost was to you personally?
Jacob K.: Yeah, so we spent in total between I think ERAS and also the National Residency Match Program fees to match at about $5-6,000, and we were pretty frugal in regards to our flights and trying to time that. In addition, I went through something called the couples match, which allows two physicians, in this case my wife, to be able to try to match in the same location, or in some instances separate locations, so it really did apply to us that we needed some better data to know how many programs we should apply to without crushing our checking account.
Josh Mettle: Yeah, no doubt. I get it. You talked about a certain percentage of the applicants not matching at all, and I know that’s one of the other aims that … Aim number one I believe for Doc Odds is, “Hey, let’s bring down the cost and focus on the best specialties,” but then the other is to make sure that you do match, so can you talk to us just a little bit about what percent don’t match, and how Doc Odds helps in that area?
Jacob K.: Yeah, absolutely. In 2018, there are about 43,000 total applicants, and that includes both US-based students at US med schools and then also international students who are trying to match either into medical or surgical specialties in the US. However, the total number of first year residency positions is only about 30,000, so that that leaves anywhere from 13-14,000 depending on the year of medical students who could go on to be board certified physicians in the US who don’t.
That’s a staggering number, and especially in the context that there is a predicted physician shortage in the United States of anywhere from about 40,000 to 100,000 by 2030, and that was recently published by an independent survey company that was sponsored by the American Association of Medical Colleges, and so there’s a problem in this country in that we don’t have enough physicians certainly for our aging population, but we’re also restricting the number of physicians that could go on through their training.
Josh Mettle: What happens to those 13,000 applicants who don’t match? Where do they go from there?
Jacob K.: That’s a good question. A lot of them can go and try to go through something called a supplementary match program, and that’s also run by the NRMP, which is the National Residency Match Process, and sometimes they get immediately filled into spots that just happen to go unmatched. That’s a pretty small number of them.
I would say that most of them would either try to continue their education in some way, whether that’s another graduate program. There are also a number of research associated programs that they can work in a lab or do their own studies and try to publish, which would help their chances of matching in the following year, but once again, when you reapply the next year, there’s no guarantee. It’s also an additional expense on the order of thousands of dollars, and most of these research positions don’t pay that well, and so that’s actually a pretty big chunk of the expense for your salary of that one year.
Josh Mettle: Your process, and you and your wife matched, but you were still into the endeavor $6,000. Imagine you don’t match. Now you’ve got to fill your time for the next year before you re-qualify. I’m imagining in most situations, student loans are going up. Another year where you’re not contributing to a retirement account, what does that cost you at the end of your 40 year run when you don’t have compound interest on that first year’s income? That’s a sizable expense when you total it all up.
Jacob K.: Absolutely. I can say personally that the expense of our travel expenses at a very minimum in addition to the application fees certainly were budgeted into our student loans, and so I’m paying back the government and my loan servicers on a monthly basis for interviews that I completed over five years ago.
For anyone who has any financial literacy, that just makes it more painful over time, and I think from a Doc Odds perspective, we have the data to help our applicants know which variables matter the most to match, including the number of ranked programs, so if you can figure out using our services the total number of programs that you really need to apply to in order to maximize your chances of matching without necessarily overpaying for a number of programs, I think you could save a lot of money, somewhere on the order of probably $500-1,000.
Josh Mettle: Awesome. What a noble endeavor, just the whole idea of this. If you help a couple people each year or 100 or a couple hundred people each year get into the specialty they wanted to get into, and not have to wait another year, that’s a huge impact on the people you serve, so just virtual high five for that. I think it’s just a really cool business idea.
Jacob K.: I appreciate that. We like to think that we’re helping out a lot of med students, and we’ve had a tremendous number of users already register with us, and also some med schools that will be signing up with us to start using our services.
Josh Mettle: Awesome. You also had mentioned in one of the things that I read on your website about a lot of international medical graduates, and this is something I knew absolutely nothing about, so help me understand how Doc Odds can help international graduates.
Jacob K.: That’s a great question. The statistics in regards to matching into residency are pretty much separated into two groups, and I think they’ll actually tease out a little bit more as we get some additional data, but you really want to think about it is whether you have trained in a US medical school or whether you have trained in a medical school that’s outside the United States.
That doesn’t necessarily mean that you are not a US citizen. There are plenty of US citizens who are medical students that choose to go to actually abroad schools, whether that’s in the Caribbean or India, and then they try to come back and match into residency in the US, but because those medical schools aren’t licensed by the same accreditation bodies as the US med schools, it just seems to be a lot tougher for them to get into the residency positions that they are interested in.
Just to give you some numbers, approximately 50% of all internal medicine spots for residency are actually filled by international medical graduates, so it’s actually a very important body of physicians who are coming to the US to train and continue their practice in the US. If we lost 3,000 internal medicine doctors, our aging population would be in big trouble fairly quickly. And then about 15% of family medicine spots, which is a little over 1,000 spots, are international medical graduates, and these are probably the two largest specialties that are filled by international medical graduates.
And then going back to the cost perspective for international graduates, these individuals tend to have to apply to over 200 programs, and so they don’t get very many interviews despite the high cost associated with applying to those number of programs. I mentioned the cost of applying just through ERAS before. You can imagine if you’re just multiplying 26 by 100, that’s just to apply, not even interview or not even fly from the country that you’re living in to get to the US and then interview for those positions.
Josh Mettle: Yeah, not to mention the cost of international travel. It’s got to be an astronomical expense to not match and then have to go back home and … Man.
Jacob K.: Yeah, so we have about 50% of Doc Odds users are actually international graduates right now, and I think we haven’t collected the data quite yet or analyzed it, but we have a post-residency match survey to find out how our international users are doing, and we’re hoping to find out that they are doing better than the average applicant who hasn’t used Doc Odds.
Josh Mettle: I think this might be a cool time. Before the show started you showed me your website and a little bit about what a report might look like, and I just think this would be a great segue into showing that. Do you mind sharing your screen, and can we look at that together?
Jacob K.: Yeah, absolutely. Let me pull up the site here.
Josh Mettle: As you do that, we’ve never done this on a podcast before, so we’re actually doing this podcast on a Zoom meeting, so for those of you that are listening on the podcast, we’ll try and create a link for you where you can go and watch the video, and Jacob’s going to go through and try and explain it clearly, but he’s actually going to take us to the website and talk us through the results, because if you’re like me, I’m thinking, “Well how is it exactly that Doc Odds increases the odds of these international students matching?” I think by the visual will really help, and even if Jacob walks us through it orally, I think it’ll help.
Jacob K.: Absolutely. The first process, what you want to do to go to our website, is just visit us at www.DocOdds.com, and from there you can register with our website. It will be important when you register to have an active email in order for us to verify that account, and then we’re going to guide you through the profile, and I will show you the profile in a couple minutes here.
And the profile asks you a number of questions in regards to your academic history, where you go to medical school, what are your test scores, and all of those factors are associated with your real residency application, and so you want to be very honest with yourself about what your achievements are in regards to assessing your chances of matching into med school.
Once you have purchased reports on the website and your profile is complete, we’ll then ask you what specialty you would like to run the report, and you’ll see that initially on our selected specialty here, which in the example case is otolaryngology, which is my specialty, that’s also known as ear, nose and throat. And then the report gives you an immediate answer of what your percent chance of matching is, and that’s the 82% that you see on the screen here.
Very important for medical professionals to understand that statistics are an estimate. This is not a guarantee, but this is the best data that we have available in regards to your chances of matching, and so we provide something called a 99% confidence interval, and what that means is that if a user entered into the match 95 times, that their chances of matching would be between this range, and this is an average of what that range is.
I’m going to move down to the columns that give a little bit more information in regards to what your chances of matching are. I’m going to bring attention to a very important part of this, which is your expected residency match date, which for this example report is March 2020, and that date has an impact on one of the variables that we’ll talk about in a few minutes since you can obviously plan and improve your chances more depending on how much time you have between your residency application date and the match date.
The first column on the left deals with all the factors that are associated with your residency application, so reading those off, those are the number of ranked programs. Academic achievements include your USMLE Step 1 score, which stands for United States Medical Licensing Exam. Next would be research projects, abstracts, presentations, publications, work experiences, volunteer experiences, medical school, AOA Honor Society, PhD degree, and then other graduate degrees, which could be like a Masters of Public Health.
The input value that’s associated with the report is the actual data the user entered into the profile, so that is basically an automatic input into our algorithm that’s reflected on the report. The influence of chance of matching is an important statistic and a column that the user will want to know about, and we have three labels for that column. What that column means is what is the impact of that variable on the chance of matching?
The number of programs for otolaryngology and the USMLE Step 1 score have a very strong impact on your chance of matching, so if you’re a second year med student and you are still planning to take your USMLE, you might want to know this ahead of time so that you can adequately prepare for that exam to do the best on that exam prior to taking it so that you give yourself the best chance of matching into the specialty that you want.
Research projects is a little bit lower, but otolaryngology actually values having abstracts, presentations quite a bit, so you might be able to publish those or send in an extra abstract before you apply in order to improve your chances. And then the rest of the column are varying from low to medium to unclear, which means there is no statistical significance in our calculation.
Ease of improvement, I previously mentioned in relationship to the match date of March 2020, so ease of improvement is reflected by the total time between when the user runs this report and when they have to submit their application, because once the application is submitted, you can’t really change the variables on the application, and therefore you can’t improve your chances of matching.
March 2020 is over a year away, and so it’s very easy to increase the number of ranked programs because you haven’t applied yet and you can just apply through ERAS to more programs, but I have already taken the USMLE Step 1 score, so I cannot change that value, and so I wouldn’t be able to improve on that. The research projects, it’s actually pretty easy to improve and so I would be able to do a project, potentially complete it, and even get it published before I have to apply, but it takes usually six months to really run a research project and get it published, so it’s not a trivial amount of time.
For example, if I was to match in March of 2019, my application would be due in September of 2018, and so it’s not a lot of time between almost July 1st here and September for me to complete a research project and submit it for publication. And then finally we have a notes column that’s associated with the report, and that’s basically a descriptive recommendation that Doc Odds provides for all their users for recommendations on what you should focus on per variable in order to try to improve your chances of matching.
Josh Mettle: For those of you who can’t see the screen, this is like seeing through the Matrix. You’re seeing the code. It’s cool. You’re taking this thing that’s completely murky and you really can’t wrap your arms around, and then via the algorithm, if you started a year early like you’re showing now, it just makes this thing simple. “These are the steps I need to follow to make sure that I match.” It’s really a cool, easy to follow along website and output that you’ve put together here, so nice work.
Jacob K.: Thank you very much. We always talked about the match process as being a black box, and the applicants could never really see into it, and it’s a big decision to get a letter on match day which shows one program that you’re going to move to, whether it be across the country or right next door, for the next anywhere from 3-7 years of your life. It’s a big decision, and if you’re couples matching, it’s even larger that it can impact your family.
Josh Mettle: It’s a dose of reality, right? I remember reading a statistic one time that 93% of people believe that they’re above average.
Jacob K.: Yeah, yeah.
Josh Mettle: This gives you the reality of, “No, you’re really average, and you’ve got a year, so now here’s the things you can do to really bring yourself above average.” And I would sure love to know that in June of ’18 if I’m going to be matching in 2020, there’s knowing next year. You want to do this as early as humanly possible.
Jacob K.: Yeah I agree. I think it is the biggest advantage as a planning tool. If you’re a fourth year med student and you’re about to apply for residency, it’s probably more of almost a curiosity tool. “These are my academic credentials, what are my chances of matching? Maybe the only variable that I can really change in my timeline would be I’m going to apply to 20 more programs just to see if I can get an additional interview.”
If you’re a second year med student and you haven’t taken your licensing exam yet, you haven’t gotten all your clerkship grades yet or finished your research projects, you can really load the boat before you get to that residency application in order to improve your odds. It’s not shown on this example report, but dermatology is a really interesting, very interesting and difficult specialty to match into, and having that AOA Honor Society on our calculation has almost an 18x more chance of matching if you have that on your application than not.
Josh Mettle: Wow.
Jacob K.: If you knew that ahead of time before thee AOA Awards were given out and you’re a second year med student, it would be absolutely to your advantage to know that as compared to someone who isn’t using our services.
Josh Mettle: That is so cool. That was my next question. You ran this on one specialty, but if you were to run it on 10 different specialties, are you noticing that the advice is distinctly different?
Jacob K.: Yeah. I think some of the variables have some commonality. I think your USMLE Step 1 score is a common variable that can really help your chance of matching, but some specialties don’t value it nearly as much as others. For more competitive specialties, neurosurgery, radiation oncology, otolaryngology, plastic surgery, research and publications matter a lot, and so if you can be very productive during medical school, there’s a value to each publication that you have and that can increase your odds of matching by anywhere from I’d say 3-7% just depending on the specialty.
If you think you might not be into research and you still want to go into a very competitive specialty, you might have a very poor outcome when it comes time to match day, and it would be better to know that up front I think than later.
Josh Mettle: No doubt, no doubt. Listeners, go to www.DocOdds.com, check out what examples they have there on the website. That was really a cool visual. I want to wrap with this, and then I’ll ask if you have any other ideas, but you talked a little bit about the US physician shortage, and one of the ways that you see that Doc Odds can be relevant and contribute is by helping to take a chip away from that. Tell us a little bit about that challenge, and then how Doc Odds could be potentially part of the solution.
Jacob K.: I’m going to go back to the statistic that about 13,000 medical student applicants don’t match each year, and I think some of that ability to match has to do with expectation, so whether a medical student understands that they need to do certain things to get into a competitive specialty, and if they don’t know that or aren’t getting good advice for that, then they’re applying to a specialty that they’re set up to fail in regards to the residency match.
Then we have an MD who cannot progress to the training portion of their residency and therefore contributes to the physician shortage even though it’s a potential physician that could be in our healthcare marketplace, so I think what Doc Odds wants to do is to really help match those expectations from a planning standpoint so that medical students understand what they need to do to match into the specialty that they want, and if they notice using our statistics and our services that their expectations are off, that they can change their specialty or move into a specialty that they are still interested in, but have a better chance of matching in and also contributing to our health care workforce.
And I think if they’re able to match those expectations that we can try to solve some of the gap that’s going to be growing in our physician shortage.
Josh Mettle: That’s great. I’m a business guy, and I own several small businesses, and I’m always looking for the bottleneck. How do you get the toothpaste out of the toothpaste container faster? You need a bigger opening, but the same thing applies with business, and that’s really what you just explained. “Hey, we’ve got this need, and we’ve got to get these medical school students in the right specialties and properly prepared,” and that’s one of the bottlenecks. Your whole business idea is how do we make that opening a little wider or a little more efficient to help get rid of or alleviate the bottleneck there.
Jacob K.: It’s really interesting you say that, because over the last 10 years, there have been more medical schools that have opened up producing additional medical students, but the real bottleneck to being able to practice medicine in the US is actually going through a residency and getting that board certification in whatever specialty that you want. Residency is partly funded through the hospital organizations, but a large part of the funding is actually through CMS and the federal government, and they actually cap the number of residency spots that were being funded in the late 90s, I believe.
There’s some legislation recently to see if they could uncap that, but I think if we really want to expand residency and really try to widen that rate limiting step of going from med school to residency, I think some legislation will be needed in order to help that out.
Josh Mettle: Well until then, you just coach the medical students on which specialties they should be going for and how they stack the deck to get into the specialties they want.
Jacob K.: Exactly.
Josh Mettle: Yeah, love it. We’re coming towards the end here. This has been awesome. Tell us and share with our listeners anything else that you think would be important for them to know about increasing their odds of matching or anything else you want to close with that you think would be really valuable to the listeners.
Jacob K.: Sure. I really encourage all the medical students to head to our website www.DocOdds.com. I think one of the most important things that medical students can take advantage of is just really knowing which variables for a specialty matter the most. We don’t want you to waste your time doing volunteer experiences if it’s not needed for your residency application.
We want you to focus on the variables that matter so that you can achieve the goals that you want and become the specialist or the primary care physician that you really want to be and at the program that you want to be, so we really encourage you to visit us, use our statistics to the best of your abilities, and if your medical school wants to use us on an institutional level, we’re happy to work with them as well.
Josh Mettle: Great. Thanks so much for sharing so generously with me. I think this was one of the funnest podcasts we’ve done. If people want to reach out, you’ve given them the website, www.DocOdds.com. Is there any other way that they can contact you or someone to get additional advice?
Jacob K.: Yeah, absolutely. You can feel free to email us as email@example.com or you can email me personally which is firstname.lastname@example.org, and we’ll get back to you as soon as we can.
Josh Mettle: Thanks again man. This was a great podcast. Appreciate you being with us today.
Jacob K.: Thanks so much Josh. I appreciate it too.
Learn more at www.docodds.com