Reality Check Time: Step 1 (214) Level 1 (565) for Internal Med

[firewalker]

Long time lurker here.

I'm reaching the end of my third year and was hoping that I could get some general advice from the group.

My board scores are in the title. My goal was to stay in the Pacific Northwest (outside of Seattle/Portland is fine) to be close to family and friends. Given the lack of DO programs for IM in the region I was planning to do MD match more out of necessity than anything. I have one IM audition rotation in region set up and am waiting on a few others (though if they had good news I probably should have heard from them at this point).

With that Step 1 score I feel like I'd be pretty high risk to scramble and obviously I'd like to avoid that crap shoot.

1) Is my original goal feasible at this point?

2) If not, what kind of expectation should I have, and programs should I be looking at in the DO match?

Thanks for the help.

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[HooliganSnail]

Internal medicine is not that competative. It has by far the most slots

Also, your USMLE are slightly below average. Guess what 50% of medical students taking the test have scores below the median! You are not alone.

Your COMLEX score is pretty good though.

I will concede that if there is a certain location that you are dying to be in, and not that many programs in that location, you may not get the spots there if it is competative.

 

[Señor S]

Internal medicine is not that competative. It has by far the most slots

Also, your USMLE are slightly below average. Guess what 50% of medical students taking the test have scores below the median! You are not alone.

Your COMLEX score is pretty good though.

I will concede that if there is a certain location that you are dying to be in, and not that many programs in that location, you may not get the spots there if it is competative.

His USMLE isn't "slightly" below average, it's ~1 SD below the average for ACGME IM applicants. Being a DO will hurt as well.

OP, I don't really know much about the Pacific Northwest but intuitively I'd guess it's pretty competitive. Looking at the ERAS list there are only 4 IM programs in Oregon (all in Portland) and 3 in Washington (2 in Seattle, 1 in Spokane)? Two of those are obviously no chance (UWashington and OHSU) so that leaves 5 programs. At a minimum you need to also apply to every low-end community program in California as well as UWashington's IM affiliate in Boise. I'd also apply to all the community programs in AZ. If you do all that I'd guess (with low confidence) that you'll probably match.

 

[hallowmann]

So you got a couple replies on here that are on opposite ends of the spectrum from each other, but that both have some solid truth/advice to them.

IM is a spectrum. There are a ton of IM programs that will take you, and there are a decent number that will just filter you out. You don't always know which is which, but obviously community programs will show you more love than university ones.

That said, given your scores, you need to apply more broadly than the Pacific NW. With a below average score and a very limited region (WA and OR), you basically have a perfect recipe for SOAPing/scrambling. You should include CA and probably the programs throughout the WWAMI region. I agree that if you do that and have a nice broad app that offers you 12-15 interviews, you have a good shot at matching, especially if those include some less competitive programs.

At this point, you should do a few things:

1) Study hard and do well on Level/Step 2, show clear improvement

2) Get electives set up at places in the region and to get a university LOR. It might be too late already for this, but try as hard as you can

3) Really evaluate what you want. Do you want a fellowship. How competitive is it? How realistic is it that you'll be able to get it if it's competitive? Could you love just being IM trained? If you can then all that matters is getting the best program you can in the region you want. If you find that you would want to specialize and potentially into something competitive, then unfortunately you're going to have to expand your search to programs in different regions (community ones with in-house fellowships, university affiliates with decent fellowship placement that take DOs, maybe even dual-accredited ones through the DO app side, think more midwest gems than coastal, etc.).

4) Start researching programs. I would start with ALL the IM programs in the states I listed. Go on Freida and look at cutoffs and averages as a guide to compare your competitiveness for them. Check their websites. Do they take DOs? Do they explicitly state cutoffs that you don't meet on the websites? You don't have to eliminate every program whose cutoffs you don't meet, but it will help having expectations and maybe reaching out to programs to get a feel for how hard those cutoffs are. You should end up with a lot of programs (maybe 60), and maybe more if you find that they seem more competitive than you're comfortable with. You want a range of programs where 1/3 are reaches, 1/3 are right around your scores, and 1/3 are below it/regularly take DOs and IMGs. I would also consider applying to dual-accredited programs. Your COMLEX score is pretty solid for IM, and if you apply on the DO side, you might have a good shot at a solid dual-accredited program that won't even see the Step 1 score.

5) Make sure everything in your app is ready before the season opens

6) Reach out to local programs and make as many connections as you can in the region

Goodluck! I think you'll be OK, but don't shoot yourself in the foot by limiting your app to just one confined region (e.g. WA and OR).

 

[firewalker]

Thanks for the replies everybody. I appreciate the different perspectives and advice.