IMG step 1:250, advice

[delusional]

Hi,

IMG here, just finished my step 1 last summer got a 250. I have just started my clinical rotations so I am basically at MS-3 level. I have some research experience, 2 poster presentations(not 1st author) from ENT research in the US.

Basically my q is how well am I doing so far?? Should I just stick to what most IMGs end up going for (IM/Peds/FM) or do I have a shot at pursuing a surgical specialty??

Thanks

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[Robotman]

your username fits you well.

 

[Loser17]

Hi everyone ,
I am in a pickle here. I took CS n CK n have not taken step 1 yet! Can anyone who took the exam on saturday tell me whether they got their result by third wednesday?
I tried scheduling my exam sooner but there is no date avalaible until 10/18 ( sat), i really need the score latest by 11/5( wed).... I know they say if u take the exam between wed to fri it comes on the third wednesday n if u take on monday/tuesdayt comes on the fourth wednesday... There is no accurate data/ post about exam takers on saturdays...
Please someone who has taken either step 1 or CK on a Saturday please give me accurate info.. Im going crazy here.. Thanks a lot

 

[NontradCA]

You should probably post in the GS forums, as you'll likely only get idiotic derailments and replies here. GL

 

[Loser17]

You should probably post in the GS forums, as you'll likely only get idiotic derailments and replies here. GL

Thanks a lot NotradCA! But i dont know GS forums? Could u kindly give me a link ? Thanks a ton!

 

[DermViser]

Hi everyone ,
I am in a pickle here. I took CS n CK n have not taken step 1 yet! Can anyone who took the exam on saturday tell me whether they got their result by third wednesday?
I tried scheduling my exam sooner but there is no date avalaible until 10/18 ( sat), i really need the score latest by 11/5( wed).... I know they say if u take the exam between wed to fri it comes on the third wednesday n if u take on monday/tuesdayt comes on the fourth wednesday... There is no accurate data/ post about exam takers on saturdays...
Please someone who has taken either step 1 or CK on a Saturday please give me accurate info.. Im going crazy here.. Thanks a lot

Was it necessary for you to derail someone else's thread?

 

[Loser17]

Was it necessary for you to derail someone else's thread?

It kinda was! I dint know where else to post this, when I dint get any response on my thread.. Im pretty stressed, sorry about the trouble

 

[Winged Scapula]

You should probably post in the GS forums, as you'll likely only get idiotic derailments and replies here. GL

No, since he's a medical student the post belongs here not in the residency forum.

 

[Winged Scapula]

It kinda was! I dint know where else to post this, when I dint get any response on my thread.. Im pretty stressed, sorry about the trouble

There is a whole forum devoted to the USMLEs.

 

[Loser17]

There is a whole forum devoted to the USMLEs.

Kindly help me find that usmle forum... I would really appreciate it, thanks

 

[Winged Scapula]

Kindly help me find that usmle forum... I would really appreciate it, thanks

I would venture if you were able to find this forum on your own, you can look 3 fora down without me providing a link.

Or:

http://lmgtfy.com/?q=SDN+USMLE+forum

Seriously. I'm getting too old for this. Doesn't anyone do anything for themselves anymore?

 

[Loser17]

I would venture if you were able to find this forum on your own, you can look 3 fora down without me providing a link.

Or:

http://lmgtfy.com/?q=SDN USMLE forum

Seriously. I'm getting too old for this. Doesn't anyone do anything for themselves anymore?

Thanks a lot man.. God bless

 

[DermViser]

I would venture if you were able to find this forum on your own, you can look 3 fora down without me providing a link.

Or:

http://lmgtfy.com/?q=SDN USMLE forum

Seriously. I'm getting too old for this. Doesn't anyone do anything for themselves anymore?

Yes, it's truly amazing the people who won't even Google the simplest of ****. It's not like the SDN USMLE forums are way in a far off land.

 

[Loser17]

Can you both do anything but taunt?

 

[DermViser]

Can you both do anything but taunt?

It isn't taunting. You were being lazy. Plain and simple.

 

[Loser17]

It isn't taunting. You were being lazy. Plain and simple.

U have no idea what i have been thru in the last 3-4 years! I got depressed , lost important years of my youth to that, just trying to pick up pieces bit by bit even after so much to deal with! Thts y i have been struggling lately and this stress of not hving exam availability earlier has further demoralized me... It wud not hv killed you to say wth u had to without being nasty!

 

[DermViser]

U have no idea what i have been thru in the last 3-4 years! I got depressed , lost important years of my youth to that, just trying to pick up pieces bit by bit even after so much to deal with! Thts y i have been struggling lately and this stress of not hving exam availability earlier has further demoralized me... It wud not hv killed you to say wth u had to without being nasty!

Never mind.

I realize this is a very trying and stressful time for you. I am not trying to delegimitize that in any way. All I am saying is that the USMLE forum is like a few steps down on the front page. It's not that difficult to find as you obviously found the Allopathic forum without a problem.

http://forums.studentdoctor.net/

 

[Loser17]

Tha

Never mind.

I realize this is a very trying and stressful time for you. I am not trying to delegimitize that in any way. All I am saying is that the USMLE forum is like a few steps down on the front page. It's not that difficult to find as you obviously found the Allopathic forum without a problem.

http://forums.studentdoctor.net/

Thanks! I found the usmle forum after winged scapula helped!

 

[DermViser]

Tha

Thanks! I found the usmle forum after winged scapula helped!

Yes. She did. I realized you likely found it after her link. Just showing you the front page of the forums. She's actually quite helpful and hardly the "taunting" type.

 

[NontradCA]

No, since he's a medical student the post belongs here not in the residency forum.

Interdasting. Look what happened.

 

[DermViser]

Interdasting. Look what happened.

Bc someone hijacked someone else's thread.

 

[NontradCA]

Bc someone hijacked someone else's thread.

I know. It was quite funny.

 

[alpinism]

To answer the OPs original questions:

1. Assuming you did well in your preclinical classes, yes you're doing good so far.

2. Would this surgical subspecialty happen to be ENT?

Considering ENT is now the most competitive specialty out there and surgical subspecialties have traditionally been very difficult for IMGs, your chances at ENT (and other surgical subspecialties) would be very low. You have a decent shot at rural primary care programs and maybe some lower tier nonsurgical academic programs in the midwest or south if you get lucky.

 

[DermViser]

To answer the OPs original questions:

1. Assuming you did well in your preclinical classes, yes you're doing good so far.

2. Would this surgical subspecialty happen to be ENT?

Considering ENT is now the most competitive specialty out there and surgical subspecialties have traditionally been very difficult for IMGs, your chances at ENT (and other surgical subspecialties) would be very low. You have a decent shot at rural primary care programs and maybe some lower tier nonsurgical academic programs in the midwest or south if you get lucky.

 

[username456789]

It kinda was!

No, it wasn't. Loser.

 

[delusional]

To answer the OPs original questions:

1. Assuming you did well in your preclinical classes, yes you're doing good so far.

2. Would this surgical subspecialty happen to be ENT?

Considering ENT is now the most competitive specialty out there and surgical subspecialties have traditionally been very difficult for IMGs, your chances at ENT (and other surgical subspecialties) would be very low. You have a decent shot at rural primary care programs and maybe some lower tier nonsurgical academic programs in the midwest or south if you get lucky.

Thanks for the reply,

Forget ENT I know how insanely competitive thats becoming, how about gen surg???

 

[Bancrofti]

Yes, it's possible. General surgery is about the only surgical specialty any IMG has a shot at matching into. You've done well to hit 250. If you can improve with your step 2 score, do well third year and on a surgery sub-I then you'll be fine.

 

[Winged Scapula]

Can you both do anything but taunt?

I wasn't meaning to taunt.

But my frustration was because you are seemingly bright enough to get into medical school, to do an internet search for SDN, register an account and then post your query. Most people who can do that are fairly savvy and would be able to find the USMLE forums. Therefore, I was a bit stymied that you were unable to find different forum on here or look for it yourself using a search engine.

 

[SouthernSurgeon]

Yes, it's possible. General surgery is about the only surgical specialty any IMG has a shot at matching into. You've done well to hit 250. If you can improve with your step 2 score, do well third year and on a surgery sub-I then you'll be fine.

Probability of matching as an IMG in general surgery with a 250 is 50%

Even if you get a bunch of interviews as an IMG, that's not a sure sign that you're safe - IMGs with 10-12 ranked programs still had a 50-70% match rate

General surgery is an uphill slog for IMGs and DOs. It's just the way it is. It may not be near-impossible (which is what I'd consider ENT/Plastics to be). But it is extremely tough to match.

 

[DermViser]

Probability of matching as an IMG in general surgery with a 250 is 50%

Even if you get a bunch of interviews as an IMG, that's not a sure sign that you're safe - IMGs with 10-12 ranked programs still had a 50-70% match rate

General surgery is an uphill slog for IMGs and DOs. It's just the way it is. It may not be near-impossible (which is what I'd consider ENT/Plastics to be). But it is extremely tough to match.

Why is General Surgery like that, but not IM? Is it an ego thing or just there really are that many people going for General Surgery (or using it as a backup, but that's much harder to do). Don't want to think Surgery is a white man's club, but have always wondered that. You don't see that many Asian surgery attendings now that I think about it.

 

[SouthernSurgeon]

Why is General Surgery like that, but not IM? Is it an ego thing or just there really are that many people going for General Surgery (or using it as a backup, but that's much harder to do). Don't want to think Surgery is a white man's club, but have always wondered that. You don't see that many Asian surgery attendings now that I think about it.

Just a question of slots.

General surgery, despite largely being considered "not that competitive" by the numbers, has only an ~85% match rate for US seniors, which is pretty low compared to other fields (esp IM).

There are only about a thousand categorical slots available through the match, and usually about 1000 US applicants vying for them.

Why match an IMG when there are qualified US seniors available to fill the spot?

(General surgery: 1029 US senior applicants, 158 unmatched vs Medicine: 3405 US senior applicants, 105 unmatched)

 

[Winged Scapula]

Why is You don't see that many Asian surgery attendings now that I think about it.

Really? We had a few and I see several out in practice. Definitely a "white mans club" traditionally but I haven't seen a dearth of Asians. Hispanics, NA and AA yes.

 

[DermViser]

Just a question of slots.

General surgery, despite largely being considered "not that competitive" by the numbers, has only an ~85% match rate for US seniors, which is pretty low compared to other fields (esp IM).

There are only about a thousand categorical slots available through the match, and usually about 1000 US applicants vying for them.

Why match an IMG when there are qualified US seniors available to fill the spot?

(General surgery: 1029 US senior applicants, 158 unmatched vs Medicine: 3405 US senior applicants, 105 unmatched)

It seems like a lot of General Surgery spots are prelim spots also which are essentially dead ends. It seems like it's much much easier to do a prelim IM and then be picked up by the SAME program, rather than the scenario of doing a prelim Surgery and then getting picked up by that same program.

 

[DermViser]

Really? We had a few and I see several out in practice. Definitely a "white mans club" traditionally but I haven't seen a dearth of Asians. Hispanics, NA and AA yes.

I guess I'm more referring to an academic medical center, but yeah, on General Surgery not one attending was of Asian descent. Same for Ortho, Neurosurg, ENT faculty as well. Stark contrast to say Internal Medicine where there were. Maybe it depends on the city also?

 

[Winged Scapula]

Why is General Surgery like that, but not IM? Is it an ego thing or just there really are that many people going for General Surgery (or using it as a backup, but that's much harder to do

Like southernIM said, most programs have enough applicants to accept only the cream of (their) crop. Fair or not, a GS AMG PD knows the quality of grads from US Allo med school X and it takes more work to ascertain whether the quality of an IMG or DO is the same. That and ego because even the AMG, whether DO or MD, still perceives programs with DOs and IMGs as substandard, so programs react to that.

 

[SouthernSurgeon]

It seems like a lot of General Surgery spots are prelim spots also which are essentially dead ends. It seems like it's much much easier to do a prelim IM and then be picked up by the SAME program, rather than the scenario of doing a prelim Surgery and then getting picked up by that same program.

Well for surgery prelims - the odds can be decent if you're coming from a decent program. U of F just published a study of their institutional experience with prelims, MGH did the same a year or so ago. Mayo I think is also known for doing well placing their prelims.

The problem is most of them are definitely NOT known for being decent.

At my program, of all the prelims who have been here since I've been an intern - I think all but one of them are currently in categorical residency positions (however only ~5 or so in categorical surgery or surgical subspecialties - the rest in anesthesia, PM&R, and medicine). But also our prelims are usually unmatched plastics/ortho/ent/uro applicants who all have like 260+ board scores and AOA.

But as for programs keeping their own prelims - it's really hard for surgery where your program may only have 4-6 categoricals per year. Keeping someone means either you need to have an opening (from someone else quitting) or need to petition the ACGME/ABS for an exemption and permission to have an extra categorical resident that year.

 

[Winged Scapula]

I guess I'm more referring to an academic medical center, but yeah, on General Surgery not one attending was of Asian descent. Same for Ortho, Neurosurg, ENT faculty as well. Stark contrast to say Internal Medicine where there were. Maybe it depends on the city also?

I was talking about my experience in academic medical centers not my current practice.

It might just be your location which has a reputation for being more shall we say racist. In Pennsylvania and New Jersey we had many ethnic minority surgery attendings.

 

[DermViser]

Well for surgery prelims - the odds can be decent if you're coming from a decent program. U of F just published a study of their institutional experience with prelims, MGH did the same a year or so ago. Mayo I think is also known for doing well placing their prelims.

The problem is most of them are definitely NOT known for being decent.

At my program, of all the prelims who have been here since I've been an intern - I think all but one of them are currently in categorical residency positions (however only ~5 or so in categorical surgery or surgical subspecialties - the rest in anesthesia, PM&R, and medicine). But also our prelims are usually unmatched plastics/ortho/ent/uro applicants who all have like 260+ board scores and AOA.

But as for programs keeping their own prelims - it's really hard for surgery where your program may only have 4-6 categoricals per year. Keeping someone means either you need to have an opening (from someone else quitting) or need to petition the ACGME/ABS for an exemption and permission to have an extra categorical resident that year.

I wonder if that's more due to the faculty than bc of the program itself (MGH and Mayo). I'm guessing you're saying most of the prelims looking for a categorical spot are not from decent programs. Good god, 260+ and AOA and not matching plastics/ortho/ent/uro?!? and then having to go to anesthesia/PM&R/IM? That's ridiculous.

I thought programs had a lot more than 4-6 categoricals, for some reason.

 

[SouthernSurgeon]

I wonder if that's more due to the faculty than bc of the program itself (MGH and Mayo). I'm guessing you're saying most of the prelims looking for a categorical spot are not from decent programs. Good god, 260+ and AOA and not matching plastics/ortho/ent/uro?!? and then having to go to anesthesia/PM&R/IM? That's ridiculous.

At least they are getting jobs. And we've had some end up at really good programs. Most of the ones who end up in anesthesia or something like that realized pretty quickly intern year that surgery wasn't for them.

I thought programs had a lot more than 4-6 categoricals, for some reason.

250 ish programs, total number of slots right around 1000. There are a few really big programs (UTSW 13 cats per year, OHSU 12, Emory 12, Vandy 9, MGH 9) but most are around that 4-6 number. Plus some small community programs with only 2-3.

 

[DermViser]

At least they are getting jobs. And we've had some end up at really good programs. Most of the ones who end up in anesthesia or something like that realized pretty quickly intern year that surgery wasn't for them.

I guess you're right. It's just hard I imagine for someone getting 260+, getting AOA, and "doing all the right things" for Plastics/Ortho/ENT/Uro and not getting it and then having to switch to something totally different that they weren't even thinking of. The truth is in those scenarios, General Surgery was not for them (which they didn't even want in the first place). I know, I'm quibbling.

 

[SouthernSurgeon]

I guess you're right. It's just hard I imagine for someone getting 260+, getting AOA, and "doing all the right things" for Plastics/Ortho/ENT/Uro and not getting it and then having to switch to something totally different that they weren't even thinking of. The truth is in those scenarios, General Surgery was not for them (which they didn't even want in the first place). I know, I'm quibbling.

Well the flip side of it...after working with them for a while...you often realize why they didn't match...

 

[DermViser]

Well the flip side of it...after working with them for a while...you often realize why they didn't match...

You mean personality? I'm surprised that can't be gamed at an interview. It obviously worked well enough on clerkships to get AOA.

 

[SouthernSurgeon]

You mean personality? I'm surprised that can't be gamed at an interview. It obviously worked well enough on clerkships to get AOA.

Some of them yes, had absolutely irredeemable personalities.

Some are fine too, I don't mean to say they are all horrible.

The usual reason someone doesn't match, even for the competitive subspecialties, is poor application strategy - not enough programs, trying to geographically limit themselves, etc. Or sometimes its a marginal candidate who knew they were at risk of not matching or who didn't apply to a backup field.

 

[DermViser]

Some of them yes, had absolutely irredeemable personalities.

Some are fine too, I don't mean to say they are all horrible.

The usual reason someone doesn't match, even for the competitive subspecialties, is poor application strategy - not enough programs, trying to geographically limit themselves, etc. Or sometimes its a marginal candidate who knew they were at risk of not matching or who didn't apply to a backup field.

To this day, I still don't understand why people do that. It takes quite bit of narcissism and hubris to say yes, I want to do Ortho, but I only want to do it on the East/West Coast or I'll only do it at a university program, (insert whatever restriction here). Same for geographically limiting themselves. I understand people have spouses that move with them, but for goodness sakes just apply to all the Ortho residencies, go to all the interviews and then rank them based on geography if geography is really that important to you.

 

[Wordead]

There are a few IMGs in ENT, but they are people who did 1-4 years of research with the institution they matched at in my experience.

 

[DermViser]

There are a few IMGs in ENT, but they are people who did 1-4 years of research with the institution they matched at in my experience.

I was going to say those are usually the ones who do get ENT as IMGs. They serve as a postdoc for several years pumping out publications and then apply, and then usually match at their home program. Cleveland Clinic is known to do the research year(s) trick (not sure about ENT though).

 

[Bancrofti]

Probability of matching as an IMG in general surgery with a 250 is 50%

Even if you get a bunch of interviews as an IMG, that's not a sure sign that you're safe - IMGs with 10-12 ranked programs still had a 50-70% match rate

General surgery is an uphill slog for IMGs and DOs. It's just the way it is. It may not be near-impossible (which is what I'd consider ENT/Plastics to be). But it is extremely tough to match.

That's why I said possible and should be fine, assuming OP isn't completely inept socially. That being said, I wasn't aware of the only 50% match rate for 250 plus, that's actually pretty interesting. My post was more so to say that if anything is possible as an IMG, it would be GS as opposed pretty much any of the other surgical specialties for which I'm sure the match rate is significantly worse across all step 1 ranges.

There are a few IMGs in ENT, but they are people who did 1-4 years of research with the institution they matched at in my experience.

A few IMGs (typically single digits) make it in to every specialty yearly. There's no way to know how though. I would assume that for things like Plastics, it's a connection that got them there. For most others, as you mentioned a research year or multiple is needed before they can actually match. For a majority of people I know that made it in to Ortho via the IMG route, a research year was done after graduating.

 

[SouthernSurgeon]

That's why I said possible and should be fine, assuming OP isn't completely inept socially.

I don't really consider 50% odds "fine" which was why I cited the data.

The IMGs who match in general surgery, from my anecdotal experience, also do several years of lab work (often unpaid) before applying with their mentor's blessing. It is a brutal uphill slog.

 

[Bancrofti]

I don't really consider 50% odds "fine" which was why I cited the data.

The IMGs who match in general surgery, from my anecdotal experience, also do several years of lab work (often unpaid) before applying with their mentor's blessing. It is a brutal uphill slog.

Which form are you citing? I have a few different ones on my computer. I know there's 2014 NRMP data that came out, but it isn't as clear cut as the ECFMG NRMP data from January 2014 for the preceding year.

For US IMG's there were only 5 total US IMG students in the 251-260 range, of which 3 matched and 2 didn't.
For non-US IMG's of the same range, 20 matched while 7 didn't.

Then when you take a look at CK scores, from the same range, US IMGs had 12 matched with 3 going unmatched.
Non-US IMG's went 29 and 9.

So the data that I would refer to does not suggest a 50% rate. The step 1 rate for US IMG students is close to that, but I don't think 5 is a large enough sample size to really base anything off of.

OP already has 2 poster presentations, adding research to the already solid score. I wouldn't argue with you too much. I would never tell someone it's guaranteed and didn't mean for it to come off as meaning OP has nothing to worry about. However, I think the OP is in a good enough position to match given the current standing. I don't think there is any harm in focusing on GS if that is his/her interest as long as a back-up plan is put in place. I just normally reserve the harsh reality bit for people who are asking if as an IMG they can do something competitive with a 220, no research and what will likely be an average clerkship experience.

 

[SouthernSurgeon]

I'm just looking at charting outcomes. The number of independent applicants are higher since it includes DO, IMG, FMG all in one basket. But it's always going to be a low number when looking at these things, such is the nature of the data given the size of the applicant pool.

But the numbers are also stable over time, from 2014, 2011, back to 2009. Right around half of independent applicants with a 250-260 step 1 match (2009: 12 matched, 17 unmatched; 2011: 16 matched, 21 unmatched; 2014: 41 matched, 34 unmatched).

The more worrisome aspect of the data is the probability of matching by contiguous ranks - this shows that even IMGs who get 10 interviews still have an abysmal match rate. Which suggests that even if you get an interview, you are not making it to the top of the programs' rank lists.

What I would also say is that this data cognitively meshes with what I've seen over time - both here on this site and IRL - about the odds of matching for even high scoring IMGs.

I'm not saying the OP shouldn't apply. But I think if they do, they need to bust their butt to do everything they can between now and then to improve their application. They also need to be realistic about the odds.