Prospects/chances for a non-traditional applicant to residency?

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Linecom

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Hello, long time lurker first time poster. I have quite an unusual background and training path and would greatly appreciate feedback on my prospects for interviews this year.

I graduated from a low-mid tier allopathic medical school in the US roughly 5 years ago. I had an undiagnosed/untreated mood disorder throughout medical school that interfered with my performance as evidenced by a failed 2nd year, failed attempts at step 1, and having to retake around 3 3rd year shelf exams.

USMLE step 1: 201 (3rd attempt); USMLE step 2 ck: 203 (1st attempt);CS: passed (1st attempt).

However, received honors on my home institution’s PM&R rotation, and a HP on an away elective rotation.


I did not match as an MS4 applicant, but also was unable to really apply to any programs (complicated story; due to my health at the time). Right after medschool I completed a postdoctoral clinical research program in PM&R, which initially went well, but subsequently went poorly due to an exacerbation of my (still undiagnosed, untreated) disorder.

After finally getting properly diagnosed, I took a year off to receive full time treatment, which was eventually successful. Since then, I have completed a couple of very productive years as a postdoctoral research fellow in PM&R-related research, including more than 10 publications, many of them 1st author in high level journals, more than 10 posters, and 10 oral presentations.

In summary:

Cons: low board scores, history of failures in medschool, several years since graduation, history of illness

Pros: outstanding research (both in quantity and quality), clear and un-wavering passion and interest in the field, prior failures are explainable by a single issue that has been fully addressed, good grades in PM&R rotations, US graduate, strong LORs, was able to maintain clinical experience and skills after graduation (reflected in my LORs), and resilience to both overcome adversity and advance my training.

I’m literally the stereotypical person who eats, sleeps, and drinks PM&R, and am passionate about developing a career as an academic clinician and researcher. I have strong LORs from attending physiatrists from my medical school and current postdoctoral institutions, and am confident in my ability to convey my interest and capabilities during an interview. My primary questions is will the complexity of my background come through and be considered, or will most programs likely filter me out from interview invites based on my red flags? My ‘home’ institutions know me well and know my abilities. I am taking a conservative approach by applying to all programs, and am genuinely interested in just about every program out there. I’m just curious to hear the thoughts of some of the experienced people out there.


Thanks very much.

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Hello, long time lurker first time poster. I have quite an unusual background and training path and would greatly appreciate feedback on my prospects for interviews this year.

I graduated from a low-mid tier allopathic medical school in the US roughly 5 years ago. I had an undiagnosed/untreated mood disorder throughout medical school that interfered with my performance as evidenced by a failed 2nd year, failed attempts at step 1, and having to retake around 3 3rd year shelf exams.

USMLE step 1: 201 (3rd attempt); USMLE step 2 ck: 203 (1st attempt);CS: passed (1st attempt).

However, received honors on my home institution’s PM&R rotation, and a HP on an away elective rotation.


I did not match as an MS4 applicant, but also was unable to really apply to any programs (complicated story; due to my health at the time). Right after medschool I completed a postdoctoral clinical research program in PM&R, which initially went well, but subsequently went poorly due to an exacerbation of my (still undiagnosed, untreated) disorder.

After finally getting properly diagnosed, I took a year off to receive full time treatment, which was eventually successful. Since then, I have completed a couple of very productive years as a postdoctoral research fellow in PM&R-related research, including more than 10 publications, many of them 1st author in high level journals, more than 10 posters, and 10 oral presentations.

In summary:

Cons: low board scores, history of failures in medschool, several years since graduation, history of illness

Pros: outstanding research (both in quantity and quality), clear and un-wavering passion and interest in the field, prior failures are explainable by a single issue that has been fully addressed, good grades in PM&R rotations, US graduate, strong LORs, was able to maintain clinical experience and skills after graduation (reflected in my LORs), and resilience to both overcome adversity and advance my training.

I’m literally the stereotypical person who eats, sleeps, and drinks PM&R, and am passionate about developing a career as an academic clinician and researcher. I have strong LORs from attending physiatrists from my medical school and current postdoctoral institutions, and am confident in my ability to convey my interest and capabilities during an interview. My primary questions is will the complexity of my background come through and be considered, or will most programs likely filter me out from interview invites based on my red flags? My ‘home’ institutions know me well and know my abilities. I am taking a conservative approach by applying to all programs, and am genuinely interested in just about every program out there. I’m just curious to hear the thoughts of some of the experienced people out there.


Thanks very much.

Much of the match comes down to risk. You are high risk in my book. You have a history of poor academic performance and a significant history of mental illness...in remission, but that is being away from medicine which is inherently stressful and often soul-crushing.

Your best chance is finding a PD who will trust that you won't become a liability once the sleep-deprived stressful days and nights return...your home program and auditions. Apply to every program under the sun...and I'd also have a very good less competitive plan B which you should also apply broadly.

Good luck.
 
Much of the match comes down to risk. You are high risk in my book. You have a history of poor academic performance and a significant history of mental illness...in remission, but that is being away from medicine which is inherently stressful and often soul-crushing.

Your best chance is finding a PD who will trust that you won't become a liability once the sleep-deprived stressful days and nights return...your home program and auditions. Apply to every program under the sun...and I'd also have a very good less competitive plan B which you should also apply broadly.

Good luck.


Thanks for the reply. You bring up some helpful insights that will be important for me to address. As you mention, medical residency is inherently stressful and abnormally soul-crushing. It is not an environment tenable to physical or mental well being. Although not a direct comparison, the training that I currently receive as a postdoctoral fellow is not unlike that of medical residency, in that I a work roughly 90 hours/week on equivalent compensation as that of a PGY2-3. Further, although my current 'remission' is outside of medical practice, it is not outside of medicine, in that I regularly learn and train in concepts of medical research that are as rigorous if not more than that which was trained during medical school. This, of course, is communicated in my personal statement and LORs, but the extent to which my thriving in my current environment allay these concerns may likely depend on the PDs. It was for this reason that I was very careful to make sure my home programs are well aware of my current capabilities and circumstance. Here's hoping others will see it similarly.

On another note, you bring up an ethical quandary in the general 'human resource' sense that is still pervasive in medicine, which is the stigmatization of psychiatric illness. It's certainly insightful that, as a physician, you immediately categorize a resolved unspecified mood disorder as being 'in remission' based on the information presented. Furthermore, I'd be curious to know if history with other illnesses with known stages of 'remission', e.g. hematologic-based cancer, is typically held against prospective applicants as well. While technically illegal to base a selection or hiring decision based on an applicant's medical history, it would not be surprising if it still regularly occurs. Either way that's a topic for a different discussion.

Thanks again for the feedback.
 
small, but very belated update: I was able to match into my first choice in PM&R. I ended up having to scramble to find a prelim spot but was lucky to find a really solid prelim surgery internship. Am currently completing orientation for my intern year. Received very few interviews, but the few that I got all went really well. I got a lot of support from key contacts within a strong network of support that I worked very hard to cultivate. Good luck guys. PM&R is still a field where concrete enthusiasm and interest in the field can go a long way. By concrete, I mean more than just a well-written PS or a good story, but actual evidence of productivity related to the field. One can overcome red flags so long as you have a clear and justifiable explanation and evidence (if possible) for what happened and how you plan to address them, and at least 1 program that truly 'knows' you and your current capabilities.
 
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