Bombed Step 1/Level 1, do I have a shot?

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Propofol7

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I'm a DO who would love to go into Anesthesiology, but I got the lowest possible score on Step 1 of 193, and 423 in Level 1. I think I know what went wrong and am trying to fix that for Step 2, obviously hoping to do much better and taking it early.

But having said that, do I stand a chance for this field? I struggled the first 2 years, but my 3rd year grades have been mostly A's. I think I'm much better clinically, which is why I have higher hopes for Step 2.

As of now I'm planning on doing 4 auditions and working my ass off for them. But I've heard from people that for Anesthesiology, auditions don't even matter so much, while others have told me you can very much make them like you/consider you by getting along with them/being a team player.

I know the field has become less competitive over the past few years which is good for me but even then I know my scores are way below the average applicant, plus I'm a DO.

Any advice would be much appreciated.
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Propofol7 said:
I'm a DO who would love to go into Anesthesiology, but I got the lowest possible score on Step 1 of 193, and 423 in Level 1. I think I know what went wrong and am trying to fix that for Step 2, obviously hoping to do much better and taking it early.

But having said that, do I stand a chance for this field? I struggled the first 2 years, but my 3rd year grades have been mostly A's. I think I'm much better clinically, which is why I have higher hopes for Step 2.

As of now I'm planning on doing 4 auditions and working my ass off for them. But I've heard from people that for Anesthesiology, auditions don't even matter so much, while others have told me you can very much make them like you/consider you by getting along with them/being a team player.

I know the field has become less competitive over the past few years which is good for me but even then I know my scores are way below the average applicant, plus I'm a DO.

Any advice would be much appreciated.
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What makes you a qualified applicant for anesthesia?...i mean you almost failed both exam
 
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aimedicine said:
What makes you a qualified applicant for anesthesia?...i mean you almost failed both exam
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As far as I know, passing = having a license to practice medicine. I'm qualified because I'm passionate about the field, am a great people person/team player, and I think I can do significantly better on Step 2.
 
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Doctor4Life1769 said:
Unless you destroy USMLE Step 2CK, go AOA and do auditions at AOA programs.
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Hey, doc4life, thanks for the reply. Do you think auditions can help a lot for Gas? Like I said in my OP, I've heard mixed things about this, esp for ACGME. I worry that in Anesthesiology it's hard for a student to really get involved like it is in most of the other fields.
 
Propofol7 said:
Hey, doc4life, thanks for the reply. Do you think auditions can help a lot for Gas? Like I said in my OP, I've heard mixed things about this, esp for ACGME. I worry that in Anesthesiology it's hard for a student to really get involved like it is in most of the other fields.
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Means not much for ACGME, but it means a whole lot for AOA and hence why I said to apply to AOA programs.
 
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Propofol7 said:
As far as I know, passing = having a license to practice medicine. I'm qualified because I'm passionate about the field, am a great people person/team player, and I think I can do significantly better on Step 2.
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Those are great qualities however they are very subjective. Objectively you are at a disadvantage your aim should be board certification not just a medical license. I would consider other fields. The certification process is more difficult now then ever. Good luck!
 
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I am not sure you can get any interview with a score of 193 because your application will be weeded out by secretaries or computers.
 
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Apply to Temple University. The chairman is on sdn and he doesnt care much about your step scores.

Your application may be weeded out before it gets to his desk though.
 
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Mac4 said:
I am not sure you can get any interview with a score of 193 because your application will be weeded out by secretaries or computers.
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Would a high Step 2 score stop from being weeded out by a low Step 1 score, or that's not how it works?
 
Doctor4Life1769 said:
Means not much for ACGME, but it means a whole lot for AOA and hence why I said to apply to AOA programs.
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So after your suggestion I did some quick research and noticed there are mixed reviews regarding AOA residencies. Is not having ABA certification a significant impediment for AOA Anesthesiologists? If anyone is AOA only certified, please feel free to chime in. I'm also concerned that with the merger, the lack of ACGME accreditation will force some of these programs to shut down. In that case what happens to the residents who are already there?

I know I don't have a good hand to play with but just considering all pros and cons of AOA vs ACGME.
 
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Propofol7 said:
Would a high Step 2 score stop from being weeded out by a low Step 1 score, or that's not how it works?
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That's typically not how it works. Most programs weed based at least on Step 1. So they won't even look at your application unless you can convince them to download it manually. For that, your Step 2/resume has to be rockstar level, which is extremely difficult for anybody who's knowledge level is so low in basic sciences. My guess is that you will have a tough time to find a spot in anything, not just anesthesia.

My advice is to either think about a different specialty altogether, or pray that in 1-2 years (due to the specialty's free fall) the standards will drop enough that you will qualify for some weak anesthesia program, right before the dead people. I honestly don't think that will happen.

Having said that, I know of at least one person who has gone into anesthesia at a good program with this level of scores, but it was an "insider track". The person was also a very attractive female, who then promptly failed all her ITEs and written boards, but graduated. Never underestimate the look factor. This was a program that also hired what would be 260-level people today, in the same generation. So if you are very likeable, you still have a chance, and you might even have a successful career in anesthesia (where it matters less and less what you know, and more and more that you are liked by surgeons and management).
 
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You do have a shot! For a family practice residency in Minot, ND.
 
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realistically I would say your chances are pretty much shot with a score like that. unfortunately there are too many applicants with higher scores who are also "very good" clinically. I don't think aceing step 2 means much. do you have an advisor in med school? ask them for advice.
 
FFP said:
Having said that, I know of at least one person who has gone into anesthesia at a good program with this level of scores, but it was an "insider track". The person was also a very attractive female, who then promptly failed all her ITEs and written boards, but graduated. Never underestimate the look factor. This was a program that also hired what would be 260-level people today, in the same generation. So if you are very likeable, you still have a chance, and you might even have a successful career in anesthesia (where it matters less and less what you know, and more and more that you are liked by surgeons and management).
Click to expand...

please tell me you made this story up.
 
FFP said:
If a CRNA can do it...
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Except he would be expected to be a consulting anesthesiologist not a protocol following CRNA...you can't have a crna level anesthesiologist leading or supervising another crna...his poor step scores means he has a gross lack of basic knowledge in medicine...thats a recipe for disaster.
 
My advice would be to study extremely hard for the USMLE 2/ COMLEX 2. Do a lot of questions from Uworld and Combank and try and get at least 240+ / 550+-600+. Also, try your very best to get the grades in before ERAS opens up so you can send everything in at the same time in September. There will be programs that will filter you out based on USMLE/COMLEX I grades but some programs may still look at you if you have a great step 2 score. Some programs will also give you courtesy interviews if you do audition rotations (And it might be easier to explain your situation to them in person). I have also heard AOA programs only granting interviews for people that rotate with them (But I am not sure if this has changed). If you do plan on doing 4 audition rotations I would do 2 at ACGME places and maybe 2 at AOA places. It was not competitive this year and I know 2 people who just scrambled into a spot. However, due to your USMLE scores you may not get a lot of interviews so try and think about a back up too. Good luck with everything!~
 
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A potential path is get a residency in internal medicine. Tell your peers you want to do ccm. Rock your IM boards be the best resident you can be. And apply to anesthesia.
 
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All you can do is apply broadly, hope for the best, and have a plan B.

Also, more importantly, make an honest assessment of why you scored poorly and what you're going to do as a resident to change. This is not something where you can hope for the best and expect things to work out well.


You're not completely hopeless. You passed the exams. I was not a great medical student, and had a below-mean USMLE Step 1. There were a number of factors, but when I objectively looked at myself before starting residency, I had to admit that undisciplined/poor study habits were a big part of it. I made major and deliberate changes to my study time and methods, and I was a far better resident than med student.

You can excel going forward, but something needs to change, whatever field you end up in. Figure out what that something is, and change it, right now.
 
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Im a DO who just matched so this might be helpful to you.

Step 1 226
COMLEX 1 611

Step 2 244
COMLEX 2 594

I applied to about 35 programs, got 6 interviews and matched at my #2.

Based on my experience you have a tough road ahead.

Slaughter step 2 (think 260 +) and line up as many aways as you possibly can. Then pray.

Good luck!
 
Propofol7 said:
So after your suggestion I did some quick research and noticed there are mixed reviews regarding AOA residencies. Is not having ABA certification a significant impediment for AOA Anesthesiologists? If anyone is AOA only certified, please feel free to chime in. I'm also concerned that with the merger, the lack of ACGME accreditation will force some of these programs to shut down. In that case what happens to the residents who are already there?

I know I don't have a good hand to play with but just considering all pros and cons of AOA vs ACGME.
Click to expand...

Well, I presented to you a realistic option. I don't know how all that plays out.
Beggars can't be choosers. That or pick a different specialty.
 
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Family medicine or IM ain't so bad. In a few years, anesthesiologists will make close to what primary care make. Plus I bet primary care isn't as stressful since you don't have to deal with administrators and surgeons.
 
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Propofol7 said:
As far as I know, passing = having a license to practice medicine. I'm qualified because I'm passionate about the field, am a great people person/team player, and I think I can do significantly better on Step 2.
Click to expand...

To be blunt, you don't have a prayer unless you get 245+ on step 2. Even with that, there's going be a significant weeding out just based on being a DO and not meeting step 1 cutoffs.

It's great and all that you're a team player and passionate, but program directors don't want to accept applicants who have even the remotest possibility of requiring remediation/probation for super low ITE scores (as you can imagine, there are multiple studies across multiple specialties showing that step 1 performance is correlated with ITE).
 
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NOsaintsfan said:
Im a DO who just matched so this might be helpful to you.

Step 1 226
COMLEX 1 611

Step 2 244
COMLEX 2 594

I applied to about 35 programs, got 6 interviews and matched at my #2.

Based on my experience you have a tough road ahead.

Slaughter step 2 (think 260 +) and line up as many aways as you possibly can. Then pray.

Good luck!
Click to expand...

NOsaintsfan said:
Im a DO who just matched so this might be helpful to you.

Step 1 226
COMLEX 1 611

Step 2 244
COMLEX 2 594

I applied to about 35 programs, got 6 interviews and matched at my #2.

Based on my experience you have a tough road ahead.

Slaughter step 2 (think 260 +) and line up as many aways as you possibly can. Then pray.

Good luck!
Click to expand...

How can you expect someone with very poor step scores and basic science grades to recover and score 260 on step 2...the avg increase from step 1 to 2 is about 10 points...it would be unfathomable to score 260 after barely failing the test. I think his/her ceiling for stel 2 is 230 and that will require BEASTMODE study.
 
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aimedicine said:
How can you expect someone with very poor step scores and basic science grades to recover and score 260 on step 2...the avg increase from step 1 to 2 is about 10 points...it would be unfathomable to score 260 after barely failing the test. I think his/her ceiling for stel 2 is 230 and that will require BEASTMODE study.
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I don't disagree one bit.

I also don't "expect" the OP to score a 260. I know the chances are pretty low but are not zero..

I basically gave him/her a realistic idea of where they stand and what they need to do in order to get into an ACGME program. They virtually have not shot but then again anything is possible.
 
There's a difference between being a not very competitive field, like anesthesia, and not competitive at all. I don't think you have any chance at all. They'll almost certainly look at you as a serious failure risk. Nobody wants or needs those headaches, and they can still happen to people with average scores. Shoot for at least 1SD over the mean for step 2 and get walking on water level evals and LORs and you might have a chance. Though someone with such significant knowledge deficits from the basic sciences is likely to fold quickly during your ward presentations/pimping sessions. It's obvious who was a superstar and who was not once you ask a few questions. You can read about your new patient with renal failure, but will fall flat on the follow up physiology questions, Med decision making, etc.
You can shoot for the stars, but you better be working on plan B as well.


--
Il Destriero
 
Chloroform4Life said:
Family medicine or IM ain't so bad. In a few years, anesthesiologists will make close to what primary care make. Plus I bet primary care isn't as stressful since you don't have to deal with administrators and surgeons.
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Serious question: do you really believe that anesthesiologists will be making CRNA wages in "a few" years?
 
amLOLdipine said:
Serious question: do you really believe that anesthesiologists will be making CRNA wages in "a few" years?
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Well, I said primary care docs, not CRNA. Hospitalists are averaging 250k, many making in the 300k range. Their salary has been going up while ours has been going down. Most anesthesiology jobs on gas work are in the 300k range. Sure there are anesthesiology jobs that pay better, but those are getting fewer and farther in between.

If compared to CRNA, we don't make that much more per hour. CRNA salary + benefits probably around 180k to 200k. Working 40 hours a week....

I honestly don't know what will happen to our salary with some big changes to healthcare coming up in the next few years, but I'm not optimistic.
 
Chloroform4Life said:
Well, I said primary care docs, not CRNA. Hospitalists are averaging 250k, many making in the 300k range. Their salary has been going up while ours has been going down. Most anesthesiology jobs on gas work are in the 300k range. Sure there are anesthesiology jobs that pay better, but those are getting fewer and farther in between.

If compared to CRNA, we don't make that much more per hour. CRNA salary + benefits probably around 180k to 200k. Working 40 hours a week....

I honestly don't know what will happen to our salary with some big changes to healthcare coming up in the next few years, but I'm not optimistic.
Click to expand...

Nor should you be; especially when they shove the Perioperative Surgical Home down your throat when bundled payments are fully implemented. I feel so sorry for all these optimistic youngsters - they haven't the foggiest.
 
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Chloroform4Life said:
Well, I said primary care docs, not CRNA. Hospitalists are averaging 250k, many making in the 300k range. Their salary has been going up while ours has been going down. Most anesthesiology jobs on gas work are in the 300k range. Sure there are anesthesiology jobs that pay better, but those are getting fewer and farther in between.

I honestly don't know what will happen to our salary with some big changes to healthcare coming up in the next few years, but I'm not optimistic.
Click to expand...

Thanks for the clarification. When I hear the term "primary care", I usually think of FM, general outpatient IM, or general outpatient pediatrics, all of which tend to average around 200k.

I've been following the IM forums on SDN pretty closely and the general consensus over there is that hospitalist jobs are getting increasingly saturated and there has been a drop in salaries compared to 5 years ago. So I'm not sure how rosy things are on the other side, either. Medicine in general seems to be in a rut.

Consigliere said:
Nor should you be; especially when they shove the Perioperative Surgical Home down your throat when bundled payments are fully implemented. I feel so sorry for all these optimistic youngsters - they haven't the foggiest.
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What else can we do? Many of us have made sacrifices to get this far, and quitting medical school now isn't exactly a good idea. Things might not be going so well in anesthesia, but besides derm and a couple of surgical specialties like ortho, what fields are actually doing well? Plenty of IM docs have told me how much they hate recent "innovations" like physician reimbursement based on outcomes (A1c, lipids, etc). They basically feel that they are being punished for taking on difficult/noncompliant patients.
 
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NOsaintsfan said:
Im a DO who just matched so this might be helpful to you.

Step 1 226
COMLEX 1 611

Step 2 244
COMLEX 2 594

I applied to about 35 programs, got 6 interviews and matched at my #2.

Based on my experience you have a tough road ahead.

Slaughter step 2 (think 260 +) and line up as many aways as you possibly can. Then pray.

Good luck!
Click to expand...
http://matchapplicants.com/anesthesiology/viewprofile?id=13968

this person is a DO with almost identical scores and # of applications, but got 12 interviews. I wonder why you received so few interviews...
 
I think you should consider doing some away rotations
 
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aimedicine said:
Obviously location/programs, timing of application, grades, LOR....pick 1
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Correct, the bolded was my story. I was limited geographically due to family.

Apply broadly and you should be fine. I'm very happy with how things turned out for me so no complaints.
 
Caribbean grad, step 1 211, step 2 248, pursued prelim surgery with a goal of cat surgery x 2 years...... Got no love, heard of position opening at my institution and jumped at it (best decision of my life).

There are some FMGs and others with middling resumes in my program who were able to get a position by being research monkeys for two years. But it may be easier as noted above to go through IM>CCM and then apply again (but now you're talking ~7 years of residency). I'm at a big workhorse program which is not particularly desirable, and we don't interview anyone with Step 1 below 220 unless they have some connection
 
You have a chance, albeit relatively low-moderate. But that doesnt mean dont apply. Make sure you take BOTH parts of step 2 before you apply, get >240 and pass CS on the first attempt. Get stellar letters. Also great clinical grades will held offset that step score. Enter your app ON THE FIRST DAY IT OPENS. Call in ANY favors you can at institutions where you may have contacts (do not underestimate the power of knowing even a clerical worker at a program, trust me). Also, apply EVERYWHERE, and dont expect to get interviews at top tier programs. Make sure you have a backup specialty to apply to in case you dont get anesthesia, so you dont get stuck with no job. And godspeed.
 
Given the information in your original post, your chance of matching to anesthesia is somewhere around 40%, according to charting outcomes of the match 2015. The match has gotten more competitive over time, especially for independent applicants. While programs do look beyond test scores, you're going to be screened out at the vast majority of programs you apply to.
 
I'm a third year DO with a 213. How shot are my chances at matching anesthesia nonetheless a half decent program? Any advice would greatly be appreciated
 
Chip N Sawbones said:
Here's a similar thread with some good advice: http://forums.studentdoctor.net/threads/low-step-1-what-programs-do-i-have-a-shot-at.1014994/ It's a few years old, but if anything gas has only gotten less competitive since then. Hopefully you find it as encouraging as you did; I'm in a similar situation after failing Step I and only getting a 201 on the retake.
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Most large university programs (like mine) have actually gotten much more competitive. We have a hard stop on Step 1 scores, and went up by 10 full points this past year given applicant interest. The OP may have a chance at a community-based program, but I think University-based settings would be out of the question to be honest.

The only exception is for advanced spots (people simply do not want to potentially move twice after medical school, understandably), so most programs are converting to more categorical spots if they are able to.
 
ToKingdomCome said:
Curious of this posters chances
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Taken alone, that step score wouldn't get much consideration from an MD school - close to absolutely not for DO. Community-based program will be his/her best bet in my opinion.

Of course this is taken alone, but with so many high step scores coming through ERAS it will be tough. Need a much, much improved Step 2
 
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