Dismissed from one school. Applying to another.

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I have hit some roadblocks in my medical education and I am seeking advice in how to proceed. Here is the story. My fiancée and I met during undergrad at a university in my home state. She was a resident of a neighboring state. We both wanted to go to medical school and were hoping to go together. I graduated with honors in neuroscience and got a 32 on my MCAT. The only school that accepted us both was in her home state and so that is where we went. It didn’t take long before I realized that I was unhappy in this new location and that this institution did not feel like a good fit for me academically. I have struggled with ADHD all my life. I was able to muscle through until medical school but I struggled at several points during medical school.

Fast-forward to present day and here is the situation. My fiancée (we have been engaged forever but are kind of waiting to figure all this out before we actually get married) and I live in Pittsburgh, where she is finishing up her transitional year. She matched into a radiology spot in Albany, NY and will start her residency there this summer. I made it through year 1 of med school without having to remediate any coursework but second year was a different story. I did eventually make it through year 2 but I failed step1 on my first attempt. On my second attempt I passed with a 210. I began third year rotations with family medicine (it was ok) and scored well above 10th national percentile on the shelf exam(10th percentile is the cutoff set by the school for successful completion of the clerkship). My second rotation was ob/gyn (hated it). I completed the entire clerkship but scored under 10th percentile on the shelf. At this point the school made it clear to me that I was on thin ice and that any further academic shortcomings would result in dismissal. I then completed the entire surgery rotation (absolutely loved it) but scored 9th percentile on the shelf. The associate dean gave me the option to voluntarily withdraw before the academic committee officially dismissed me and that is what I did. It has been about a month now since my withdrawal.

I believe that special testing accommodations for ADHD were available but I never requested them (I have principal problems with the fairness of this practice plus I was reluctant to carry the ADHD label). In hindsight I probably should have swallowed my pride and requested these accommodations. I would feel competent at each point of the curriculum but as the pressure built I became more prone to test anxiety. I went into the surgery and ob/gyn exams knowing that it was my last desperate chance to redeem myself and not be kicked out. This do-or-die pressure was just too distracting for me to read those long question stems effectively.

Since withdrawing I have given serious consideration to starting a new career path outside of medicine. I am still certain though that I want to be a physician and I am confident that I can be an excellent one. I am not going to give up.

Adding to my desire to continue is the depressing financial situation I face after paying 4+ years of out-of state tuition. I have received some good advice in another thread about Income Based loan repayment programs but that still seems like an uphill battle. I know that having a radiologist wife means that I will eventually live comfortably regardless, but I am already dying a little bit inside after one month of doing the stay-at-home-husband thing.

So my plan now is to apply to different medical schools as an advanced standing student. Given my academic history, I don’t think I can realistically expect any LCME accredited U.S. medical school to take me on but I will still try. My understanding of how Caribbean/international medical education works is limited but it sounds like I would probably be able to gain acceptance at one of these programs. I have a somewhat indirect connection to the owner of one particular off-shore school and initial communications with that school have me hopeful.

The odds are certainly stacked against me at this point but it seems like the M.D. is still attainable, even if it has to come from a foreign school. I was hoping to get some feedback on my decision to continue in medicine and if there are any major obstacles that I am overlooking. Of course matching into a U.S. residency will be challenging, but that was going to be the case anyway with all the blemishes in my academic file. Please also let me know if anyone has advice on where I should or should not apply.

Thanks

Hello again! I read your previous thread, and I really feel for you in the tough position you're in. Rather than rehash that thread, I'll just say again that I think going to the Caribbean is a terrible idea at this point. I wish you the best of luck with everything.

Not knowledgeable enough to offer any advice - I'd just say I'm sorry for your situation and hope you achieve your dreams. I have friends that went the Carribean route and are at well-respected residency programs in the U.S. Don't let a lot of elitist people sway you. Medical school in the Carribean definitely probably makes it harder to get residences that you want but no hard work goes unpunished. You already saw how getting into a school gains you nothing and it's all about how you perform. I just say this so that if carribean is where you have to go you do not be discouraged. Good luck!

Originally Posted by chasing5

Not knowledgeable enough to offer any advice - I'd just say I'm sorry for your situation and hope you achieve your dreams. I have friends that went the Carribean route and are at well-respected residency programs in the U.S. Don't let a lot of elitist people sway you. Medical school in the Carribean definitely probably makes it harder to get residences that you want but no hard work goes unpunished. You already saw how getting into a school gains you nothing and it's all about how you perform. I just say this so that if carribean is where you have to go you do not be discouraged. Good luck!

I'm not against the Caribbean in all cases, but I'm definitely against the Caribbean in a case like this. OP, if you do go the Caribbean route, make sure you maintain your relationship so if you come home with even more debt and still no MD (or an MD but no residency) you'll have a decent chance of paying off your debt and still having money to eat.

Originally Posted by SteinUmStein

Hello again! I read your previous thread, and I really feel for you in the tough position you're in. Rather than rehash that thread, I'll just say again that I think going to the Caribbean is a terrible idea at this point. I wish you the best of luck with everything.

I appreciate your opinion. I was hoping you could be a bit more specific on which part of my plan to go to the Caribbean you think would be problematic. (1)That I will not get in? (2)That I will not make it to graduation? (3)That I will not match? (4)That even if I do match that I will have so much debt at that point that it won't have been worth it?

Here is how I'm justifying it to myself
(1) seems like I don't have too much to lose (aside from some application fees) by at least trying.
(2)I have been able to make progress in med school it just takes me a few attempts at some points. I do not think I would want to start all over again but if I was accepted as a third year I feel like the hardest part (especially step 1) is behind me. I understand that many schools (definately a lot of the D.O. and Caribbean programs) don't even have shelf exams for MS3 so it seems like the main thing between me and the M.D. would be step2. If could work my butt off and pass step2 then I don't see anything else that would keep me from being successful in a MS3 and MS4 curriculum.
(3) In my mind this is the biggest issue with the plan. I gave up my dreams of Ortho or EM a long time ago so I feel like I could get in somewhere if I was completely flexible on specialty as well as location. Even if I didn't match, I feel like having the M.D. after my name could potentially be a springboard into a research or academic career. At the very least I would feel like less of a failure being a jobless M.D. after 6 years then a jobless nothing after 4.
(4)Yeah, the amount of debt I will have will be astronomical but at least I would have the prospect of a salary able to eventually pay it off. It seems like I could either (a)quit now and live modestly wile working some low paying job and letting IBR take care of my loans for the next 10 or 20 years or (B) live modestly while using a physician's salary to pay off the loans myself. With option B I would at least have some fulfillment in life and at the end of 20 years would be set up to actually put some doctor money in the bank.

I am just trying to think this all out and it would be helpful if you could point out flaws in this rationale. I was also curious about your prospective is on this if you care to divulge that info. Are you at an international school and regret going there. Are you at a U.S. school and would never consider going to the Caribbean? When I withdrew a month ago, going to the Caribbean seemed so undesirable that I didn't even consider it as an option. I guess I was spoiled by being a student at a U.S. school. Now that I've had some time away to think about it I am thinking that Caribbean M.D. > no degree at all.

If you have a minute, let me know what you think.

Thanks a lot!

[deleted quote to ease wall-o-text pain, see above]

No problem, I'm just a medical student so take this with a shaker of salt. An entire shaker.

(1) You will get into a Caribbean school if you apply.

(2) If you want it badly enough I could see you graduating. You almost made it to graduation here in the States, so I don't see why with a lot of effort you couldn't get through. There may be things you need to repeat. I'm not sure what exactly, you'd need to contact the schools or find someone who has done this before to find out.

(3) Here's where it starts getting tricky. Matching from the Caribbean is an entirely different ballgame. I don't know enough about this to help you, but suffice it to say that it will be a huge challenge to match without good board scores. I also don't know that you can bank on this only taking 2 years, again I would ask the schools to see what you may have to repeat to meet their requirements (they want you at their school as many years as possible, $$$). I have no idea what an MD from the Caribbean is worth in an academic or research setting without residency training and board certification. My guess would be about as much as the paper it's written on. I would definitely find that out BEFORE you go though. Anyone care to chime in?

(4) This is your life, I can't even guess what your priorities are right now or what they will be in 10/15/20 years. This has to be a discussion with your fiancee. If you're going to get married it affects her as much as you, and you'll be away for at least 2 years if you go to the Caribbean (although clinicals may bring you back to the US, you have no idea where or when).

Best of luck, I hope it all turns out and you find fulfillment somewhere.

Edit: I missed the last part of your post, you wanted my perspective. I'm at an American allopathic school, but I do NOT think the Caribbean is necessarily a bad idea for everyone. The combination of your wife's career, your current debt level, and your shaky academic history all point toward staying away from digging yourself a deeper hole at a Caribbean school. However, if you think you will be eternally unhappy without an MD, talk to your fiancee and see if you can figure out a way to make it happen. It's definitely not impossible.

I like this one better:

Have you talked to your former school? They should be able to offer you some advice and you will probably need a recommendation from someone over there.

I would also talk to Albany - since your fiancée will be a resident there, they may try to accommodate you if you can convince them you can cut it.

If you can get into any of the big 4 Caribbean schools, Sgu, Ross, AUC, Saba..Go! Anything outside of these four be careful. Those four are Cali approved and although you may have no plans to ever practice in Cali, many programs including mine in new jersey use this list, you have two more years, Do it! You will make it. Just buy the Kaplan step 2ck books and in rotations just read that section while you are doing the rotation along with usmle world or qbank through your rotations for that subject and you will pass the third and fourth year with flying colors and boards,.mdomt forget shelves are only for cores so you should only have one challenging year ahead. Then 4th year will be much better. You have to give it a shot I think. You've come too far. 32 on your MCAT Proves to me you have what it takes to be a great doc. pm me and I'll try to answer any questions you may have. Good luck man

Hey. I read your story and it sounds like you're in a pretty tough situation. My main question is why you failed what you did in the first place? I know you mentioned having ADHD for years, but you seemed as though you had it well under control since you graduated and got a good MCAT score. I ask because the last thing you want to do is just jump into another medical school without fixing whatever deficiencies caused you to fail in the first place. One of your pros of a Caribbean school was that you wouldn't have to face any more shelf exams. Caribbean schools, as far as I know from people I have spoken to, still have exams during clinical years, so it's not as though you'll be escaping exams by going off to the Caribbean. Good luck.

Originally Posted by Apollo8

I appreciate your opinion. I was hoping you could be a bit more specific on which part of my plan to go to the Caribbean you think would be problematic. (1)That I will not get in? (2)That I will not make it to graduation? (3)That I will not match? (4)That even if I do match that I will have so much debt at that point that it won't have been worth it?

Here is how I'm justifying it to myself
(1) seems like I don't have too much to lose (aside from some application fees) by at least trying.
(2)I have been able to make progress in med school it just takes me a few attempts at some points. I do not think I would want to start all over again but if I was accepted as a third year I feel like the hardest part (especially step 1) is behind me. I understand that many schools (definately a lot of the D.O. and Caribbean programs) don't even have shelf exams for MS3 so it seems like the main thing between me and the M.D. would be step2. If could work my butt off and pass step2 then I don't see anything else that would keep me from being successful in a MS3 and MS4 curriculum.
(3) In my mind this is the biggest issue with the plan. I gave up my dreams of Ortho or EM a long time ago so I feel like I could get in somewhere if I was completely flexible on specialty as well as location. Even if I didn't match, I feel like having the M.D. after my name could potentially be a springboard into a research or academic career. At the very least I would feel like less of a failure being a jobless M.D. after 6 years then a jobless nothing after 4.
(4)Yeah, the amount of debt I will have will be astronomical but at least I would have the prospect of a salary able to eventually pay it off. It seems like I could either (a)quit now and live modestly wile working some low paying job and letting IBR take care of my loans for the next 10 or 20 years or (B) live modestly while using a physician's salary to pay off the loans myself. With option B I would at least have some fulfillment in life and at the end of 20 years would be set up to actually put some doctor money in the bank.

I am just trying to think this all out and it would be helpful if you could point out flaws in this rationale. I was also curious about your prospective is on this if you care to divulge that info. Are you at an international school and regret going there. Are you at a U.S. school and would never consider going to the Caribbean? When I withdrew a month ago, going to the Caribbean seemed so undesirable that I didn't even consider it as an option. I guess I was spoiled by being a student at a U.S. school. Now that I've had some time away to think about it I am thinking that Caribbean M.D. > no degree at all.

If you have a minute, let me know what you think.

Thanks a lot!

You're talking about being a Carribean grad with a dismissal from a US allo program with a fail and a low pass Step 1 on your record. You are going to have an extraordinarily difficult time trying to match. It do not think it makes sense for you to take on an extra ~100k in debt.

The whole ADHD / testing accommodations thing is moot at this point. The time to play that card was before you got dismissed from your school -- it's not going to hold water as a justification later down the road explaining away your earlier performance.

Take this with a grain of salt, but I believe you have two reasonable options:

a) See a physician specializing in learning disorders and get thorough documentation of your learning issues and effective treatment, then appeal to your original school for readmission based on the fact that you've solved your medical problem and will be able to be successful from that point forward. It's certainly not even close to a guarantee that they'll readmit you, but I believe that this is your only reasonable option for continuing toward becoming a physician -- period.

b) Give even more serious consideration to a non-medical (or at least non-physician) career path and decide what alternative you feel would suit you best.


I'm not trying to be harsh with my assessment, but I honestly believe that you would be making a huge mistake by taking on considerably more debt and committing to two more years of hard work. If you really do think you're going to go the Carribean route, you should PM aProgDirector here on the SDN forums and get his advice/opinion on matching in your situation.

Finally, good luck -- you've got some tough decisions ahead of you.

One factor to consider is the increasing number of US allopathic and osteopathic schools and spots. This might make it harder for a Carribean grad to match in the future (as residency spots are not increasing at the same rate.)

http://www.nytimes.com/2010/02/15/ed...edschools.html
https://www.aamc.org/newsroom/newsre...54/110620.html

I guess another thing to consider is you being in the Carribean while your wife is in Albany. Are you opposed to the DO route? It might be best to find a DO school near Albany.

Originally Posted by chasing5

I guess another thing to consider is you being in the Carribean while your wife is in Albany. Are you opposed to the DO route? It might be best to find a DO school near Albany.

DO schools are going to be leery of your track record like any other US med school.

Originally Posted by amaprez

cliffs please.

also, have you tried to see a psychiatrist about your ADHD? you can try to get people to accomodate you but it's more effective to seek treatment.

Originally Posted by sanityonleave

You're talking about being a Carribean grad with a dismissal from a US allo program with a fail and a low pass Step 1 on your record. You are going to have an extraordinarily difficult time trying to match. It do not think it makes sense for you to take on an extra ~100k in debt.

The whole ADHD / testing accommodations thing is moot at this point. The time to play that card was before you got dismissed from your school -- it's not going to hold water as a justification later down the road explaining away your earlier performance.

Take this with a grain of salt, but I believe you have two reasonable options:

a) See a physician specializing in learning disorders and get thorough documentation of your learning issues and effective treatment, then appeal to your original school for readmission based on the fact that you've solved your medical problem and will be able to be successful from that point forward. It's certainly not even close to a guarantee that they'll readmit you, but I believe that this is your only reasonable option for continuing toward becoming a physician -- period.

b) Give even more serious consideration to a non-medical (or at least non-physician) career path and decide what alternative you feel would suit you best.


I'm not trying to be harsh with my assessment, but I honestly believe that you would be making a huge mistake by taking on considerably more debt and committing to two more years of hard work. If you really do think you're going to go the Carribean route, you should PM aProgDirector here on the SDN forums and get his advice/opinion on matching in your situation.

Finally, good luck -- you've got some tough decisions ahead of you.

I think this is pretty spot on. Your best bet at still having a medical career is going to involve getting back into the good graces of your original school. No other US school is going to touch you. Your odds of matching from a Caribbean school after having been asked to leave a US school as well as two tries on Step 1 are low. I guess it's possible that with a Caribbean degree you could conceivably land a prelim surgery year and get enough training in to get licensed and try to eek out a living doing temp work without a full residency, but you probably won't catch up to your debt. I also suggest that few offshore students are able to finish rotations in two years because they are not formal rotations, but instead are offered at various community hospitals with limited space, and fill up quickly. You probably will take 3+ years to manage to schedule whatever cores they are going to require of you.

Finally I would suggest that offshore schools probably have more, not less, hoops to jump through before you can graduate -- they have more incentive to milk out one more year of tuition. So I wouldn't really say --there are no shelf exams, I am home free. I doubt that.

Finally the elephant in the room. Are you really going to pack up and leave your wife for 2-3+ years? Is your relationship solid enough to take that?

Originally Posted by johnnydrama

...
I would also talk to Albany - since your fiancée will be a resident there, they may try to accommodate you if you can convince them you can cut it.

with his track record I'd be nervous involving her good name.Also It actually is a negative for most programs if med students on rotations are married to residents or faculty -- it creates favoritism problems. It's totally different than if they were both residents.

I ask you this sincerely:

What do you think the chances are of you keeping a radiologist fiance while you go off to the carribean for 2-3+ years and then end up god knows where after that for 3-4 years? Because the chances of you being able to pick where you want to do residency are about as good as the chances of you actually matching somewhere...slim.

Sorry to be so brutal but the only option for you to continue in medicine that doesnt end up in bankruptcy and heartbreak is to somehow be readmitted to your original school.

Unfortunately, I'm going to have to agree with much of the advice here.

Yes, the carib can be a reasonable option for some. Some people don't make it into medical school but actually would have done fine in a US medical school. They go to the Carib, get high USMLE scores, do great on their rotations. Even with that, it can be a struggle to get into a residency program -- but they do.

In your case, going to the carib is not going to be a "do over". Your prior medical school problems will always be part of your history. You'll have multiple red flags on your application -- failed out of a US school, failed Step 1, now in a carib school. You point out that now there won't be any shelf exams, so you'll do better -- don't forget that PD's will know this also. Everything will be riding on your Step 2 score, and just getting an average (or passing) score will not be enough. We'll be afraid you'll have trouble passing your specialty boards at the end of training (something we are evaluated on).

As mentioned, this will potentially seperate you from your fiancee for some time. I don't think any of the carib schools have rotations in Albany, so you'd be in NYC (if you're lucky) and perhaps somewhere else, not driving distance.

Assume that works out, then you need to match. Your chances of matching in Albany are not great. You could easily get seperated for all of her residency. Then, she would need to move to where you are (which might not be where she wants to live).

A carib MD without a residency is useless. Do not fool yourself into thinking that you can get a "research" spot with it, or some "administrative" job. Not going to happen (or, your chances of getting any such job are equivalent if you don't have an MD).

I really worry that more tuition, esp in the Carib, will only leave you further in debt. Don't forget that this will create all sorts of problems should you marry her -- your debt will count when looking at mortgages, credit scores, etc. Or, you can try and keep your finances seperate -- but if things go south in the marriage and all of the assets are in her name, you could be in a pickle. As others have said, your best chance is to try to get back into your prior school, or try to convince Albany med to give you a chance. Neither is likely, though. If that fails, come up with a plan B that doesn't involve an MD.

hmmm, i feel like you need to start looking at different pathways to "medicine." I've told people to do the BSN-MSN accelerated programs to be a nurse practitioner, most or all of the courses can be done online -> you can live with your significant other in Albany. Sorry about your situation but there is no way that any medical school will take that chance again.

settle for the next best thing at this point. physician assistant programs might take you in but that's probably next to impossible too as they would probably ask you about prior medical school.

if your wife wants to do IR, you can do her pre- and post-op management.