Will I get into a FM residency?

[Zoogie Ba Zaga]

Hello everyone,

Sorry if I am asking a question that has been asked before. I am really nervous about my situation.

Here is a snapshot of my medical school career:

Step 1: 197/81, first attempt
Step 2 CK: 217/93, THIRD attempt
Step 2 CS: Pass, first attempt

Had to take a year off during my M2 year because I became depressed (now well controlled on a SSRI)

After finally passing the USMLE in September of 2011, I became an MD from a school in the Midwest. Now I am studying in a Masters program in Bioethics (which is really interesting if anyone is curious).

Also, I was a board member for FMIG and APAMSA. And I was a member of my classes Lottery Committee (help sort out third year clerkships, etc). And I participated in a program where I shadowed a family doc for 1 month during the summer after my M1 year.

Applied to 44 programs (All family of course ). 4 rejections . No interview invitations yet .

I know I may have to scramble (or I guess go through the SOAP process) given my poor test grades. I am really starting to panic, though, that I may not get a job as a FM resident next year.

What do you all think my chances are? Any other advice?

Thank you for reading and for help,
Zoogie

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[brats800]

you probably will be a good doctor when all is said and done but the deck is certainly stacked against you right now with that 3rd attempt board score. i don't remember seeing anyone interview at our program who had a 3rd attempt at boards...

i think you are doing everything correct:
1) apply broadly. take any interview you can get. ace your interview - know about the program, act interested, ask questions.
2) be prepared for the SOAP (formerly scramble) match - have all your info ready and free up your schedule to get everything done early
3) take whatever you can get

At the end of the day, a family medicine residency is only 3 years and then you'll be a family med doc just like any other family med residency grad.

 

[Zoogie Ba Zaga]

Thanks Brats. Things are pretty bad right now for the home team. Will try talking to my dean and see what he says. Though I imagine what he says cannot be much better. =-D

Feeling less panicked now and will just focus on taking in the good (with the more apparent bad).

Thanks again,
Zoogie

 

[smq123]

Applied to 44 programs (All family of course ). 4 rejections . No interview invitations yet .

With TWO failed attempts at Step 2 CK (which have a reputation of reflecting your true clinical knowledge much better than Step 1 does; so a failure on Step 2 is very very concerning), why did you only apply to 44 programs?

 

[lowbudget]

You're a risky candidate, especially when it comes to clinicals; not just because of your scores but also because you've already graduated (if I'm interpreting your OP correctly).

Don't forget to apply for prelim positions in Medicine and Surgery. Those slots almost always go unfilled. Even if you don't land a residency, make sure you get an internship position so you can sit for your Step 3, and get licensed. It'll give you a chance to work on your clinical skills, and it's a low risk proposition for programs because it's only a 1 year commitment. One consideration because of your personal experience would be to go into Psych to help others in the same situation. Worst comes to worse, you have your Masters to fall back on.

 

[ghost dog]

You're a risky candidate, especially when it comes to clinicals; not just because of your scores but also because you've already graduated (if I'm interpreting your OP correctly).

Don't forget to apply for prelim positions in Medicine and Surgery. Those slots almost always go unfilled. Even if you don't land a residency, make sure you get an internship position so you can sit for your Step 3, and get licensed. It'll give you a chance to work on your clinical skills, and it's a low risk proposition for programs because it's only a 1 year commitment. One consideration because of your personal experience would be to go into Psych to help others in the same situation. Worst comes to worse, you have your Masters to fall back on.

I'm a Canadian staff MD, and just curious - do the number of times applicants take these standardized tests show up on their applications ? From the way this is being discussed, I am assuming this is the case.

 

[Zoogie Ba Zaga]

Hello all,

SMQ- I applied to 44 programs because I am following the conventional wisdom that says if one is a weak candidate one should spread one's net wide. I also know that people in other fields may apply to at least 50 programs. I know this is a unique idea in family as I have talked to other family residents who have matched after only interviewing in as few as 4 places and ranking as many (most wisely rank more, I think). I have heard that statistically one should rank 11 programs in our field to guarantee a match (link to this info is below). In the end, I should have done things right the 1st time around instead of the 3rd, so it is my own fault. O=-)

https://depts.washington.edu/fammed/mse/advising/applying/assessing_how_many

lowb and SMQ- Yes. I gathered that I am a risky candidate, so I am just happy if someone will give me a chance. I did just graduate this year so I will be 1 year away from clinicals when I start next summer as a tern. Not terribly far from my M4 clinicals though. All in all, I know my situation calls for humbleness. O=-)

Also, thank you for the idea about taking a prelim year and doing Step 3.

Ghost- I double checked, and yes all scores are present once released to ERAS. Here is the link with that info. Thanks for asking.

https://www.aamc.org/students/medstudents/eras/residency/248510/usmle.html

Regards,
Zoogie

EDIT: Oh SMQ, you are asking why I ONLY applied to ## programs. Point well taken.

 

[Zoogie Ba Zaga]

Hello all,

Also, as an aside. If anyone else is in a similar position to me, it may be a good idea to check if your school sent out your transcript, MSPE, LoRs, etc. to ERAS.

Just a thought,
Zoogie

 

[brats800]

also, if you apply for a prelim / TY / first year position...if you got a 1st year medicine position and then did an intern year in FM, your FM program would not get $$ from the government for your 3rd year (you only get paid for the # of years of the specialty you first entered). this means that you'd find it easier doing a surgery intern year followed by 3 years FM than an intern med year followed by 3 years FM. if that is confusing, do a search for "Initial Residency Period" and "graduate medical education"...sorry, i couldn't find a good link.

 

[ghost dog]

Hello all,

SMQ- I applied to 44 programs because I am following the conventional wisdom that says if one is a weak candidate one should spread one's net wide. I also know that people in other fields may apply to at least 50 programs. I know this is a unique idea in family as I have talked to other family residents who have matched after only interviewing in as few as 4 places and ranking as many (most wisely rank more, I think). I have heard that statistically one should rank 11 programs in our field to guarantee a match (link to this info is below). In the end, I should have done things right the 1st time around instead of the 3rd, so it is my own fault. O=-)

https://depts.washington.edu/fammed/mse/advising/applying/assessing_how_many

lowb and SMQ- Yes. I gathered that I am a risky candidate, so I am just happy if someone will give me a chance. I did just graduate this year so I will be 1 year away from clinicals when I start next summer as a tern. Not terribly far from my M4 clinicals though. All in all, I know my situation calls for humbleness. O=-)

Also, thank you for the idea about taking a prelim year and doing Step 3.

Ghost- I double checked, and yes all scores are present once released to ERAS. Here is the link with that info. Thanks for asking.

https://www.aamc.org/students/medstudents/eras/residency/248510/usmle.html

Regards,
Zoogie

EDIT: Oh SMQ, you are asking why I ONLY applied to ## programs. Point well taken.

That sucks ( the residency board seeing your past scores). At the risk of stating the obvious, when (not if !) you get some interviews make sure you have a clear and resonable answer (not an excuse), should these peeps ask what happened in regards to this exam (i.e. failing x 2).

Good luck.

 

[Zoogie Ba Zaga]

Brats: Thanks. I think I got the jist of your post. Will try looking that up in the future, as needed, or may hit you up for your expertise. Thanks again.

Ghost: Thanks for the advice and encouragement!

Really appreciate the support everyone.

 

[lowbudget]

I'm a Canadian staff MD, and just curious - do the number of times applicants take these standardized tests show up on their applications ? From the way this is being discussed, I am assuming this is the case.

Ghost,
Yes it does. You can't take it again if you pass, so the transcript lists each time you took the exam, your pass/fail, and your score.

Each state designates its own laws regarding licensure, but to obtain a license, you must complete all 3 steps within a certain time period or else you have to start over. It varies state by state. Also, each state designates how many times you can fail your exams. If you took the test more than the state allows, you can't obtain a license, even if you finally pass it.

Most residencies stipulate that they will only recruit students who are able to obtain an unrestricted license in that state. If there's anything that would prevent the student from obtaining a full license or a training license, the residency will not (and in my opinion, should not) accept them. Many of these what-are-my-chances posts with failing Steps really depends on the residency, but if there are enough failures, your chances goes to zero percent by law for that particular state. That candidate may need to go to another state where the laws aren't so strict.

 

[lowbudget]

I have heard that statistically one should rank 11 programs in our field to guarantee a match (link to this info is below).

You have to be very careful in the way you use these statitistics. If you glance FRIEDA in general, some programs will disclose how many candidates they interview per slot. In family med, the numbers range but you're mostly looking at 7-10. The higher the number, theoretically, the more competitive it is, by numbers.

So, if the ratio is 1:10, by statistics, and the probability of 100% placement in 1 program should be 1/10 + 1/10 + 1/10.... then you would need 10 programs to add up to 100%, right? Wrong.

That assumes a *random* candidate and it assumes independence. Random, meaning, assuming no one reads your application, no one screens your board scores, and no one interviews you; that people just start listing names on a list. No one does that, so the assumption of randomness is not real world.

Secondly, there are interactions that affect your ability of getting into Program A that would affect your ability to get into Program B. Put another way, if Program A is likely to reject you, there's a hidden probability that Program B would too. Real world example. Say, your Dean wrote in your MSPE that you cheated on an exam and got caught. What is the probability that Program A will reject you, given that Program B rejects you? If it's zero, then your acceptance into these programs are independent and you can use the 1/10 + 1/10 etc formula. But, that's illogical.

If you cheat, for example, there's a probability that Program A&B will reject you, and a probability that B&C will reject you, and a probability at A&B&C will reject you. So these probabilities must be theoretically calculated into the formula. So, in reality, you have to assess *to what extent* are my applications independent? If there's a high chance that multiple programs will reject you for whatever reason, you need to increase the number of programs you apply to.

Obviously, you can't apply to an infinite number of programs (because of cost and time), so you'll have to settle for a probability that's less than 100%.

Put another way, the take home message is, nothing is guaranteed in the Match, even if you are a great candidate. You're not going to get to 100%, so the question is how many programs will you need to apply to to get to a probability that you can live with? It's not just those who are obviously high risk who should take caution in the Match; even those who *think* they're average candidates need to take caution in the Match because it's difficult to achieve 100%. At some point, you just have to say, well, the number of programs I applied to is good enough.

 

[Zoogie Ba Zaga]

Hey Lowbudge!

Appreciate your insight.

I got that information from the Univ of Wash Fam Med sight that I cited in an earlier post (and I am not sure where they got there information). I think that what that information meant is that, of the family med applicants that were able to and did indeed rank 11 or more programs, all of them matched. That is what I meant when I used the word "statistically."

I absolutely agree with you though. Even if I was a superstar and found 11 programs that I ranked, that is NOT a guarantee of me getting a job next year. Your last paragraph is wisdom for all applying candidates from superstars to angels with broken wings like a certain writer in our string.

Thanks again,
Zoogie

 

[jakstat33]

Yes, you'll get in though I've been out of the loop with the trend of quality of FM applicants

Last time I checked a few yrs ago it was about 50/50 FMG to US-trained applicants

You are a US-trained MD, you have passed all the requirements, and you even have strong extra-curriculars on your application

You will definately need a good explanation why you failed step 2 a couple of times

Of course the 3 attempts at step 2 will limit your choices, but 44 is plenty for FM. I had a classmate who passed step 1 on 3rd attempt and the others on 1st attempt who matched comfortably

 

[smq123]

Yes, you'll get in though I've been out of the loop with the trend of quality of FM applicants

I'm not as optimistic, to be honest.

The quality of applicants has gone up markedly in the past few years. I've met a number of very strong FMGs who, in past years, would most likely have gotten a spot, but did not match last year.

I'm in a small community program. Even though we're small and not that well-known, our program will not interview anyone who had to repeat a USMLE or COMLEX step. This is pretty much a hard-and-fast rule, according to our coordinator.

So I wish I could be certain that the OP will match but...I'm not.

 

[Zoogie Ba Zaga]

And I'm back!!

I wanted to thank everyone for their interest in my "plight." I also wanted to thank everyone for their input. I particularly wanted to thank those who gave me words of kindness and encouragement, including Jakstat, Ghost Dog, Brats, and anyone else I unintentionally missed.

I frigging matched!!!!

I am not sure what it was. The personal statement, extracurriculars, teethy goofy smile on my ERAS pic. I am grateful though, and I am especially grateful to the programs who were willing to give me a shot.

SMQ123, I can see your point. I think a lot of programs use a "no fail" or a "1 only fail" on the steps as a hard and fast rule to weed through the numerous applications that they have received. I certainly did not have numerous programs knocking at my door.

Also, I am glad the quality of applicants have gone up in the past few years. I know I am taking a few steps forward in the thought process than I may be allowed given the information at hand. But this signals to me that physicians and students-physicians must be becoming more interested in our field. Such a thing can never be bad.

Regards,
Eugene

 

[smq123]

And I'm back!!

I wanted to thank everyone for their interest in my "plight." I also wanted to thank everyone for their input. I particularly wanted to thank those who gave me words of kindness and encouragement, including Jakstat, Ghost Dog, Brats, and anyone else I unintentionally missed.

I frigging matched!!!!

I am not sure what it was. The personal statement, extracurriculars, teethy goofy smile on my ERAS pic. I am grateful though, and I am especially grateful to the programs who were willing to give me a shot.

SMQ123, I can see your point. I think a lot of programs use a "no fail" or a "1 only fail" on the steps as a hard and fast rule to weed through the numerous applications that they have received. I certainly did not have numerous programs knocking at my door.

Also, I am glad the quality of applicants have gone up in the past few years. I know I am taking a few steps forward in the thought process than I may be allowed given the information at hand. But this signals to me that physicians and students-physicians must be becoming more interested in our field. Such a thing can never be bad.

Regards,
Eugene

Congrats! I'm glad that you proved my pessimism wrong.

 

[cabinbuilder]

I'm a Canadian staff MD, and just curious - do the number of times applicants take these standardized tests show up on their applications ? From the way this is being discussed, I am assuming this is the case.

Yes it does show up because there are certain states who will not license you if you have too many attempts and failures on your board exams. Like in Texas if you fail step II 3 times you will not even be allowed to do a residency in that state. let alone be licensed. So residency program directors won't take anyone they think won't be able to finish and pass the boards to be licensed.

 

[brats800]

congrats on matching!

 

[ghost dog]

And I'm back!!

I wanted to thank everyone for their interest in my "plight." I also wanted to thank everyone for their input. I particularly wanted to thank those who gave me words of kindness and encouragement, including Jakstat, Ghost Dog, Brats, and anyone else I unintentionally missed.

I frigging matched!!!!

I am not sure what it was. The personal statement, extracurriculars, teethy goofy smile on my ERAS pic. I am grateful though, and I am especially grateful to the programs who were willing to give me a shot.

SMQ123, I can see your point. I think a lot of programs use a "no fail" or a "1 only fail" on the steps as a hard and fast rule to weed through the numerous applications that they have received. I certainly did not have numerous programs knocking at my door.

Also, I am glad the quality of applicants have gone up in the past few years. I know I am taking a few steps forward in the thought process than I may be allowed given the information at hand. But this signals to me that physicians and students-physicians must be becoming more interested in our field. Such a thing can never be bad.

Regards,
Eugene

Hi Eugene,

Well done on matching. Make sure you stay on top of your rotations, and don't leave things to the "last moment." You may want to get some study partners ahead of time to keep you on track.

Cheers and congratulations.