MD Low Tier MD with low 230s on Step 1, what specialties should I exclude now?

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RejectedMD

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Going into 3rd year with a completely open mind, I wanted to give myself a list of realistic specialties to make sure to explore throughout the year whether through electives or shadowing experiences. Here are my lists so far:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, IR (?), EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho

Please let me know if you have any feedback on changing these lists or additions/subtractions! These lists are made with the assumption that I am not taking a gap year.

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I think it's pretty reasonable based on Charting Outcomes.

Can Match: I'd add Child Neuro, and some of the combined program like med/peds

VS might be tough without strong research or a gap year because of how few spots there are, so I think the ? is fair. The difference between matched and unmatched Step 1 isn't very high for it though, so I think low 230s shouldn't stop you from getting interviews.

I was under the impression that integrated IR/DR was up there with surgical sub-specialties for competitiveness, and DR Step 1 is median 240 already (DR has really high match rates with lower Step 1 scores due to increase in spots and worry over the job market, but those don't really apply to IR/DR).

Probably Cannot: It's hard to know because people self-select, but most applicants with low 230s seem to match surgical sub-specialties and derm. 2/3 odds would be "probably can" in my book, but I'd guess those applicants are the ones taking gap years.
 
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Going into 3rd year with a completely open mind, I wanted to give myself a list of realistic specialties to make sure to explore throughout the year whether through electives or shadowing experiences. Here are my lists so far:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, IR (?), EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho

Please let me know if you have any feedback on changing these lists or additions/subtractions! These lists are made with the assumption that I am not taking a gap year.

IR would be next to impossible, I would add that to the no list
Vascular could be in range with great letters and some research. You probably wouldn't be screened out by step 1 alone. Still an uphill battle
Rad Onc could theoretically be in range with significant research. They had high match rates in 2016 and I believe in 2017 as well. Very uphill battle and you would need a massive amount of research to stand a chance. Would probably need a research year, and I know you said you didn't want to do one.
 
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Going into 3rd year with a completely open mind, I wanted to give myself a list of realistic specialties to make sure to explore throughout the year whether through electives or shadowing experiences. Here are my lists so far:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, IR (?), EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho

Please let me know if you have any feedback on changing these lists or additions/subtractions! These lists are made with the assumption that I am not taking a gap year.

Could you at least provide some details on your grades,background in research, and what you're interested in because what you're describing is literally what happened to the average MD student who will successfully match.
 
Could you at least provide some details on your grades and background in research because what you're describing is literally what happened to the average MD student who successfully matches.

I'm confused by your question. What kind of detail? Detail about myself? I don't have clerkship grades yet nor have I taken step 2. As far as extracurricular, by the time I apply, I'll have 4-5 publications total and a couple leadership/volunteering experiences. Sorry not sure what you're asking but let me know if you need any other info! As far as the "interest" part, like I stated in my original post, I am completely open so therefore wanted to get a list of viable specialties to explore during third year.
 
IR would be next to impossible, I would add that to the no list
Vascular could be in range with great letters and some research. You probably wouldn't be screened out by step 1 alone. Still an uphill battle
Rad Onc could theoretically be in range with significant research. They had high match rates in 2016 and I believe in 2017 as well. Very uphill battle and you would need a massive amount of research to stand a chance. Would probably need a research year, and I know you said you didn't want to do one.

So add my name to the list of ignorant people who aren't up to date on intricacies of the IR pathways people keep talking but wouldn't IR as a career be reasonable given the DR -> IR move.
 
So add my name to the list of ignorant people who aren't up to date on intricacies of the IR pathways people keep talking but wouldn't IR as a career be reasonable given the DR -> IR move.

Honestly I think a lot is still up in the air with IR and the pathways. The one thing we learned from 2017 was that the match rate for direct IR was astoundingly low. You'll have to look up the exact ratio, but it was orders of magnitude worse than even derm/plastics. As for DR to IR fellowships, they still exist, but are being reduced for direct spots and I'm sure competition for these spots are fierce as well especially now that they're dwindling. IR seems like the only field where even superstars would still have terrible odds of matching.

29 PGY1 spots and 221 total applicants...
95 PGY2 spots and 342 total applicants...
 
I'm confused by your question. What kind of detail? Detail about myself? I don't have clerkship grades yet nor have I taken step 2. As far as extracurricular, by the time I apply, I'll have 4-5 publications total and a couple leadership/volunteering experiences. Sorry not sure what you're asking but let me know if you need any other info!

You gave about the average matched Step score, gave the SDN consensus, and then asked us for thoughts. In before someone posts NRMP data link and someone else posts an anecdotal story it's much more useful if we knew what you were leaning towards because that will tell us how motivated you are to get research, etc. With 5 publications (excellent, btw) you're in great shape research-wise even if they're not in a specific field. Knowing that I can tell you that you're list is pretty reasonable and that you shouldn't necessarily rule out Ophthalmology if you've passionate due to my own anecdotal evidence but I'm sure others may say the same about even Derm or ENT. Also, what are your chances of Jr. AOA if your school offers if? Your first two years are not just Step 1 score as some people think.

In other words, there's a huge difference between an applicant who gunned for ENT/Derm, did tons of field specific research, is Jr. AOA (most places base it mostly off Y1/2 grades) has made mentors in the field and gets a 230 on Step 1 vs. someone who did nothing unrequired at their medical school and didn't honor anything and scored 230 on Step 1.
 
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You gave about the average matched Step score, gave the SDN consensus, and then asked us for thoughts. In before someone posts NRMP data link and someone else posts an anecdotal story it's much more useful if we knew what you were leaning towards because that will tell us how motivated you are to get research, etc. With 5 publications (excellent, btw) you're in great shape research-wise even if they're not in a specific field. Knowing that I can tell you that you're lost is pretty good and that you shouldn't necessarily rule out Ophthalmology if you've passionate due to my own anecdotal evidence. Also, what are your chances of Jr. AOA if your school offers if? Your first two years are not just Step 1 score as some people think.

ahh I see. Thank you for your input! And I honored quite a few courses during M1/M2 and still have a shot at senior AOA but its a long shot. I think regardless of what I apply to I need to try to Honor and kill step 2 (250+) and hopefully that will be enough to put me in contention for senior AOA.
 
ahh I see. Thank you for your input! And I honored quite a few courses during M1/M2 and still have a shot at senior AOA but its a long shot. I think regardless of what I apply to I need to try to Honor and kill step 2 (250+) and hopefully that will be enough to put me in contention for senior AOA.

Yeah, you are in very good shape! If you want a competitive field you listed in your rule-out column, it's an uphill but attainable goal. Plan to take CK early and score in the 255+ range. Your clinical grades are a huge factor as you know, and senior AOA would be great too and often missed is your LORs which can really help get you an interview if it's a strong letter from a well-known faculty.

I just think too much emphasis is placed on Step 1 after the fact (@failedatlife as a perfect example). At the end of the day I think PDs look at it and say good ✅ maybe, or no . I don't even think these cut-offs are that high either. I don't think any are higher than 240 and I would bet that 230 would is a cut-off at very competitive places. I mean, why as a PD would you cut out a 240 for Derm at MGH if his research is literally pioneering the future of Derm? He can still take exams and score very well.
 
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Going into 3rd year with a completely open mind, I wanted to give myself a list of realistic specialties to make sure to explore throughout the year whether through electives or shadowing experiences. Here are my lists so far:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, IR (?), EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho

Please let me know if you have any feedback on changing these lists or additions/subtractions! These lists are made with the assumption that I am not taking a gap year.

The 'tier system' has me befuddled. I am the first medical student in my family. I have heard that 'if the best you can do is match in (x town - the one I am presently in) is the best you can do, well pfff on you.

I did go to a 'southern ivy' and I did get exposed to the 'rank order lists' through the fraternity sorority system. So I did learn that professions were an extended sort of social system.

But then I did the 'out of the box' thing. I went to peace corps Africa. As an 'advanced age' student, I got embroiled in more setbacks such that I became 'out of phase' and am still. One lawyer friend of the family went so far as to send me a messenger note saying that he thought my biggest problem would be 'age discrimination'. Unmarried, childless; trying to fit into 'any tier'?

What is the 'tier system' anyway?
Top tier residency programs; maybe those top 15 in the world American hospitals.
But low tier'? Is that where I am?


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DR/IR is a pipe dream I'd say. As is many of the better DR programs that have ESIR. That aside, you can probably easily match at a good community DR program. All that being said, the gap because of job market fear in DR is closing..the DR job market is currently booming.
 
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The 'tier system' has me befuddled. I am the first medical student in my family. I have heard that 'if the best you can do is match in (x town - the one I am presently in) is the best you can do, well pfff on you.

I did go to a 'southern ivy' and I did get exposed to the 'rank order lists' through the fraternity sorority system. So I did learn that professions were an extended sort of social system.

But then I did the 'out of the box' thing. I went to peace corps Africa. As an 'advanced age' student, I got embroiled in more setbacks such that I became 'out of phase' and am still. One lawyer friend of the family went so far as to send me a messenger note saying that he thought my biggest problem would be 'age discrimination'. Unmarried, childless; trying to fit into 'any tier'?

What is the 'tier system' anyway?
Top tier residency programs; maybe those top 15 in the world American hospitals.
But low tier'? Is that where I am?


Sent from my iPhone using Tapatalk

There is no tier for you because you aren't currently enrolled in med school.
 
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There is no tier for you because you aren't currently enrolled in med school.

I started in a top tier, got booted to a low tier; and trying to get myself back into the tier system.


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IR / DR can be tough but not possible. A lot of it is about who you know. If you became the chairman of a section (like a student section) of SIR and have research, you may have a fighting chance.

I was told that one of the fellow who matched at a top fellowship program is a foreign grad. He made it to a leadership position in the SIR and had some influential people calling for him.

I agree if you don't have significant SIR involvement (even research arent enough without connections), you will likely not match IR/DR. You should be good for DR.
 
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say you wanted to be an orthopod. you go to page 131 of charting outcomes, look at the low 230s and see that about 2/3 of applicants with that step 1 score matched into ortho. so the question is: do you think you could be in the top 2/3 (at least) of ortho applicants with that score (including step 2, clinical grades, AOA, dean's letter, research, etc)? if yes, then you have a reasonable shot.

and so on for the other specialties

https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf
 
Going into 3rd year with a completely open mind, I wanted to give myself a list of realistic specialties to make sure to explore throughout the year whether through electives or shadowing experiences. Here are my lists so far:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, IR (?), EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho

Please let me know if you have any feedback on changing these lists or additions/subtractions! These lists are made with the assumption that I am not taking a gap year.
Read this:
 

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I understand that the charting outcomes and program director surveys will show that there are people who can and will match with my step score (or even lower). I haven't seen any data on what these applicants have done to get there: whether they took a research year, went to a top school, had connections within the field or a bunch of research specific to the field with the desire to enter it from the beginning of medical school. Hence, I put "probably cannot match anymore" meaning specialties that are unlikely for me considering I haven't set my mind on a specialty from the start. The point of this thread was to create a list of viable specialties that I could explore given limited amount of elective space and free time as a third year. For example, why would I schedule an elective in plastics when I have no intentions of taking a gap year and have no research or connections specific to the field? And now based on feedback, I've received I should probably put IR in the second list. So here's my updated list:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho, IR

Thank you all for the feedback! This has been really helpful thus far!
 
I understand that the charting outcomes and program director surveys will show that there are people who can and will match with my step score (or even lower). I haven't seen any data on what these applicants have done to get there: whether they took a research year, went to a top school, had connections within the field or a bunch of research specific to the field with the desire to enter it from the beginning of medical school. Hence, I put "probably cannot match anymore" meaning specialties that are unlikely for me considering I haven't set my mind on a specialty from the start. The point of this thread was to create a list of viable specialties that I could explore given limited amount of elective space and free time as a third year. For example, why would I schedule an elective in plastics when I have no intentions of taking a gap year and have no research or connections specific to the field? And now based on feedback, I've received I should probably put IR in the second list. So here's my updated list:

Can Match Still:
IM, FM, Psych, Neuro, OB/Gyn, Peds, Gen Surg, Anesthesiology, PM&R, Vascular surgery (?), DR, EM, Pathology

Probably Cannot Match Anymore: Derm, ENT, Plastics, Uro, Ophtho, Rad Onc, Neurosurgery, Ortho, IR

Thank you all for the feedback! This has been really helpful thus far!

Which med school? If you give me a school by naming a school within 10 of the us news rankig I can probably eyeball something for you.
 
Ignore all this.

Find what you love. Do that. Nobody but you will wake up every day to do your job.

People matched into neurosurgery this cycle with a step 1 in the 200s.

There's always a path forward.
 
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Basically you're looking at podiatry assistant residencies in North Dakota at this point...after a research year, that is.
 
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Basically you're looking at podiatry assistant residencies in North Dakota at this point...after a research year, that is.

Nah, I'll pass. Personally not much of a foot person like yourself.
 
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