Grad from med school a while ago, looking to get prelim/intern

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VargoHoatsGoats

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Hi there, was hoping someone might be able to give me some insight and info. If there are better threads for my questions, please shoot me a message or feel free to cross post.

My situation is a bit odd, but I'll lay it out as best I can. I got my MD from a top 20 US medical school. After graduation, I did not pursue a residency or internship. I was fried, and in my mind, I was done. I disregarded all advice that I should at least get my internship and license; I couldn't possibly take another minute of medical education.

Fast forward a few years, I am currently employed and paying the bills, but I am starting to regret my decision. I do not believe that I would like to enter clinical practice and complete a whole residency, but I've learned that a lot of career opportunities I'm looking for require at least some clinical experience and licensure. I'm wondering what my options might be to start down this path.

To recap: -US citizen, US undergrad, and MD from top 20 US medical school. -passed step 1 (barely, 2004). I realize I may have to take this again. -passed step 2CS and CK, (2009; pass, and 2010; 210 (I think) respectively). -MD awarded 2010. -I want to get a prelim/intern year so I can take step 3 and get a license.

I have unfortunately lost contact with the majority of staff at my medical school, and am starting from scratch. I don't have anyone I could ask for letters of recommendation at the moment.

I realize this is a difficult road to travel, but I feel like my degree from a US school should at least put me on the level with some FMGs who are looking to get their foot in the door as well. I'm trying to keep this vague as to my demographic info and personal details, but can add that if it's relevant to advice.

Thanks in advance for any insight.

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Hard to be sure since like you said, it's an odd situation. USMLE scores are good for 7 years I think, so if your Step 1 was in 2004 (and you didn't mean you got a 204), then you'd have to retake that. Your best bet is to search out that info on the USMLE website or call them. And if you did take it in 2004, why was there 5 years in between that in CS? As far as applying, it certainly won't help you that you didn't pursue anything post-graduation, but if you went to a top US school, that should put you above an FMG with questionable English who also had considerable time in between graduating and applying (including multiple failed Match/SOAP cycles). You MAY need to find some sort of observership(s) to get some LORs if you don't have any from 3rd + 4th years. As long as you're willing to put up with an undesirable prelim year in IM or Gen Surg or a transitional year, I wouldn't be surprised if you could find something. And if you only plan on doing it for a year anyway, I'd hope you can stomach a bad program.
 
Thanks for the response. Extended time in between step 1 and CS was a 2 year medical leave of absence, 3rd year, then research year, then 4th year. I do have to retake step 1, for sure. As far as not pursuing anything after graduation, no, I didn't pursue anything clinical, but have been working in a medical related field since 2010 (health news). I'm game for anything, to be honest. I feel much more mature, ready for the challenge than when I was younger. Never should have gone to med school right out of college. I wrote to my former dean of students, so I hope to hear back from him soon about a meeting request.
 
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I will go ahead and say what many are thinking, even though it will be pretty blunt:

None of the things you describe - taken in isolation - will necessarily prevent you from getting a position somewhere. However, taken together, they very well may be fatal.

If I understand your history correctly it is basically a series of one year of medical school followed by one year off. Then "burn out" after finally graduating.

This is the question that will go through the mind of every faculty member anywhere you apply: "Given this history, can I even hope s/he will complete even a year of the program?" Remember, residency is much harder than medical school. The absolute worst thing that can happen in almost any training program is for someone to drop out during the year. It dramatically increases the workload of every other resident and also the faculty members.

So you are going to need an incredibly convincing answer to that question - "How do I know that if we hire you, you will not drop out after a few months?"

I see basically two options. First, get a research-type position associated with a medical school somewhere and after a few years of incredibly hard consistent work - never taking a day off - you may be able to get someone to vouch that currently you are a good risk. And/or find a program that did not fill during the match so that in the worst case scenario, they wouldn't be any worse off than they already were.

But it boils down to that one question - until you have an incredibly convincing answer, you will be in deep trouble.
 
Hi there, was hoping someone might be able to give me some insight and info. If there are better threads for my questions, please shoot me a message or feel free to cross post.

My situation is a bit odd, but I'll lay it out as best I can. I got my MD from a top 20 US medical school. After graduation, I did not pursue a residency or internship. I was fried, and in my mind, I was done. I disregarded all advice that I should at least get my internship and license; I couldn't possibly take another minute of medical education.

Fast forward a few years, I am currently employed and paying the bills, but I am starting to regret my decision. I do not believe that I would like to enter clinical practice and complete a whole residency, but I've learned that a lot of career opportunities I'm looking for require at least some clinical experience and licensure. I'm wondering what my options might be to start down this path.

To recap: -US citizen, US undergrad, and MD from top 20 US medical school. -passed step 1 (barely, 2004). I realize I may have to take this again. -passed step 2CS and CK, (2009; pass, and 2010; 210 (I think) respectively). -MD awarded 2010. -I want to get a prelim/intern year so I can take step 3 and get a license.

I have unfortunately lost contact with the majority of staff at my medical school, and am starting from scratch. I don't have anyone I could ask for letters of recommendation at the moment.

I realize this is a difficult road to travel, but I feel like my degree from a US school should at least put me on the level with some FMGs who are looking to get their foot in the door as well. I'm trying to keep this vague as to my demographic info and personal details, but can add that if it's relevant to advice.

Thanks in advance for any insight.


First of all, are you trying to get an internship so that you can take step 3 or a full residency? I am not clear on that given your post. Second, I think it's possible, but it's unlike that you would get a competitive program. Likely it would have to be IM/FM/peds/psych.

So you took 2 years off after first year of med school? I think you have to make a good case regarding why. If you can make that case, I don't think it would be terribly difficult to get a 1 year spot. If you are looking at a longer residency, then I think it's still possible, but be ready to apply widely across the country an perhaps focus on lower tier programs. Plenty of spots are available in community, lower tier programs. I disagree with the poster who suggested you have to give yourself to some sort of research gig for "years" before someone would vow that you are "worth the risk."

If you are not in any terms with people at your school, then you would have to do some sort of observership type thing in order to get rotation letters. You are not the only person in the world who has ever left medicine and has wanted to come back. With appropriate, realistic expectations, I think it's doable.
 
I was in a similar situation as you. I graduated from medical school nearly 10 years ago. I did an IM prelim and took Step 3 before leaving for a medically-related career in finance. I applied for an anesthesiology residency and matched this year. I will be repeating intern year though. I completed two observerships with the intent to receive rec letters. Fortunately, I didn't need them to match, but I would recommend doing that. I only got interviews from lower-tier program and I would expect the same for you. I would apply wide. However, make custom personal statements for those programs outside your geographical area. YOu need to convince them why you want to work at those programs. I did not get any interviews from places more than an hour drive away.
 
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I was in a similar situation as you. I graduated from medical school nearly 10 years ago. I did an IM prelim and took Step 3 before leaving for a medically-related career in finance. I applied for an anesthesiology residency and matched this year. I will be repeating intern year though. I completed two observerships with the intent to receive rec letters. Fortunately, I didn't need them to match, but I would recommend doing that. I only got interviews from lower-tier program and I would expect the same for you. I would apply wide. However, make custom personal statements for those programs outside your geographical area. YOu need to convince them why you want to work at those programs. I did not get any interviews from places more than an hour drive away.

How/where did you get letters from since you graduated 10 years ago and didn't have any gas letters?
 
How/where did you get letters from since you graduated 10 years ago and didn't have any gas letters?
I hit up the people who wrote me letters for the prelim and had them write me LORs again. The LORs did include one gas letter. I also reached out to some of my attendings I worked with during my internship. I actually decided to apply relatively late. I did the observerships during interview season in case I didn't match. If that happened, I would have asked the attendings at the observerships for LORs when I reapplied. Fortunately, I matched, so I did not have to do that.
 
I hit up the people who wrote me letters for the prelim and had them write me LORs again. The LORs did include one gas letter. I also reached out to some of my attendings I worked with during my internship. I actually decided to apply relatively late. I did the observerships during interview season in case I didn't match. If that happened, I would have asked the attendings at the observerships for LORs when I reapplied. Fortunately, I matched, so I did not have to do that.

That's pretty good, you must have had high board scores. I know several people who applied and failed to match anesthesia even as recent grads!
 
That's pretty good, you must have had high board scores. I know several people who applied and failed to match anesthesia even as recent grads!
Thank you. I consider myself lucky. However, the program I did match into has a good history of residents who left medicine for another career after receiving their MD only to come back after several years. It also has gotten some really negative press which probably improved my ability to match there, although every resident I spoke to about the program had few complaints.
 
I will go ahead and say what many are thinking, even though it will be pretty blunt:

None of the things you describe - taken in isolation - will necessarily prevent you from getting a position somewhere. However, taken together, they very well may be fatal.

If I understand your history correctly it is basically a series of one year of medical school followed by one year off. Then "burn out" after finally graduating.

I appreciate the bluntness, I'd rather have honesty from people with experience than false hope from people telling me things they think I want to hear.

However, I will clarify, just to keep things straight. I did my first two years consecutively, then had 2 years off for medical leave. I did my third year, then the research year was something sanctioned by the medical school for research. I then did my fourth year, and did not pursue clinical medicine after that. I have no ego in this, and have complete humility in where I stand. I have to hope that my work experience for the last few years, getting some decent scores, and letters will help.

I will be repeating intern year though. I completed two observerships with the intent to receive rec letters. Fortunately, I didn't need them to match, but I would recommend doing that. I only got interviews from lower-tier program and I would expect the same for you. I would apply wide. However, make custom personal statements for those programs outside your geographical area. YOu need to convince them why you want to work at those programs. I did not get any interviews from places more than an hour drive away.

Can you give me some info on how to get an observership? I had my meeting today with my dean and unfortunately he didn't know much about how to go about getting them. I am going to write letters to some physicians who I think I had decent relationships with in school, to pick their brain.

I have no grand aspirations about getting into a top program, at this point the goal is to 1) retake step 1 with a decent score, 2) get observerships that will allow me a to at least get someone to look at my prelim year app, and 3) get a prelim year and take step 3 for licensure. I have no problem with traveling or living somewhere "undesirable" for a year while I do this.
 
I appreciate the bluntness, I'd rather have honesty from people with experience than false hope from people telling me things they think I want to hear.

However, I will clarify, just to keep things straight. I did my first two years consecutively, then had 2 years off for medical leave. I did my third year, then the research year was something sanctioned by the medical school for research. I then did my fourth year, and did not pursue clinical medicine after that. I have no ego in this, and have complete humility in where I stand. I have to hope that my work experience for the last few years, getting some decent scores, and letters will help.



Can you give me some info on how to get an observership? I had my meeting today with my dean and unfortunately he didn't know much about how to go about getting them. I am going to write letters to some physicians who I think I had decent relationships with in school, to pick their brain.

I have no grand aspirations about getting into a top program, at this point the goal is to 1) retake step 1 with a decent score, 2) get observerships that will allow me a to at least get someone to look at my prelim year app, and 3) get a prelim year and take step 3 for licensure. I have no problem with traveling or living somewhere "undesirable" for a year while I do this.
I literally just called the local residency programs and asked the program coordinators. I didn't pay anything so don't do any services that require you to pay.
 
Your story raises three questions for me, that you would need to answer:

1. Your performance wasn't that great in medical school (at least on the steps). You haven't mentioned your clinical grades. Now you've been out of medicine for years. What can you tell me to convince me that you haven't forgotten everything? Or learned what's new (although not that much has changed in 4 years)? Writing medical news doesn't really cut the mustard, as much of what's reported in medical news often glosses over the real issues.

Which yields a sub-question -- whether your medical news writing is any good. If the pieces you've written are superficial / one sided / schlocky then that will not be good.

2. How can you convince me that you really want to do this, and will put in the time and effort that is needed to succeed in a PGY-1? If your journalism experience has required 70+ hours of work per week over the last few years, that would be helpful. If its mostly a part time gig, not so much.

3. Why exactly do you want to do a PGY-1? What job do you think you will be able to get after completing a PGY-1 and getting a license? I worry that you overestimate how useful this will be.
 
Forgot to mention in my post about retaking Step 1. It's not so easy. You can't just say "My step 1 is >7 years old, so I need to take it again". You need to actually apply for a license, and have that licensing authority state that they won't license you because of the dates of your steps. Then, you can use that to get the USMLE to let you take the Step again. So it's complicated, you'd need to get into an internship first, finish it, apply for a license, get rejected, then apply to retake Step 1. At least that's the way I think it works -- to be honest it's never an issue any of my residents have had to face.
 
Your story raises three questions for me, that you would need to answer:

1. Your performance wasn't that great in medical school (at least on the steps). You haven't mentioned your clinical grades. Now you've been out of medicine for years. What can you tell me to convince me that you haven't forgotten everything? Or learned what's new (although not that much has changed in 4 years)? Writing medical news doesn't really cut the mustard, as much of what's reported in medical news often glosses over the real issues.

Which yields a sub-question -- whether your medical news writing is any good. If the pieces you've written are superficial / one sided / schlocky then that will not be good.

2. How can you convince me that you really want to do this, and will put in the time and effort that is needed to succeed in a PGY-1? If your journalism experience has required 70+ hours of work per week over the last few years, that would be helpful. If its mostly a part time gig, not so much.

3. Why exactly do you want to do a PGY-1? What job do you think you will be able to get after completing a PGY-1 and getting a license? I worry that you overestimate how useful this will be.
I would think that doing an observership would help answer concerns 1 and 2. I completely agree with you on concern #3 though.
 
Your story raises three questions for me, that you would need to answer:

1. Your performance wasn't that great in medical school (at least on the steps). You haven't mentioned your clinical grades. Now you've been out of medicine for years. What can you tell me to convince me that you haven't forgotten everything? Or learned what's new (although not that much has changed in 4 years)? Writing medical news doesn't really cut the mustard, as much of what's reported in medical news often glosses over the real issues.

Which yields a sub-question -- whether your medical news writing is any good. If the pieces you've written are superficial / one sided / schlocky then that will not be good.

2. How can you convince me that you really want to do this, and will put in the time and effort that is needed to succeed in a PGY-1? If your journalism experience has required 70+ hours of work per week over the last few years, that would be helpful. If its mostly a part time gig, not so much.

3. Why exactly do you want to do a PGY-1? What job do you think you will be able to get after completing a PGY-1 and getting a license? I worry that you overestimate how useful this will be.

Also regarding your following post, according to the information I have, I will have to take Step III first, which I can do without being in an internship by taking it through a state that doesn't require me to be in a PG program (Delaware, for example). After that, you're correct, I would apply for a license and be rejected because of an out of date Step 1 score. I would then retake step 1.

If (and I realize it's a big 'if') I can successfully pass steps III and I again, ideally this would show at least some level of dedication to a program director that I am reasonably serious about getting into a program and practicing medicine (basically quitting my job, studying full time for a year, and passing these exams). I would also be looking for observerships to regain clinical skill.

When I originally wrote this, I was under the impression that getting a PGY-1 year would be easier than a whole residency, but have since learned that's not the case. If I can pass these exams again, I would be applying likely for a full FM or IM program. For your first question, I don't expect that my current work experience would have any real impact on my application, but it's not like I've been sitting on my ass doing nothing. My medical school did low pass, pass, high pass, honors; I recall getting mostly passing marks, with a few high passes in there. I never failed any major rotations in third or fourth year. To your second question, I don't really know how to answer that yet. I've had lots of life experience since I graduated, I've worked, I've matured, and if I were ever in the position where I was sitting across from you as a program director, I think the work of retaking those brutal exams would have to count for something. I have complete humility about my position. I won't be applying to top tier programs, so I hope that there will be a match for me in a community program that needs good people who have life experience and are ready to work.
 
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