Just don’t know what to do, like so many others on despair

[MDK05]

So, some background: I am a US local, graduated from one of the big 4 Caribbean medical schools in 2018 and applied for the Match in Internal Medicine but didn’t match this year. I got a couple of interviews (5) in my home state and passed all 3 steps (first attempts, average scores). MSPE/Transcript and LOR I assume are pretty average.

Since January 2019, I have been working at this Urgent Care center where the doctor only seems interested in billing patients and really doesn’t allow for any type of patient interaction. Recently, I applied to another urgent care center and they seem nicer and better. They actually want me to do patient care stuff like take an actual history, physical, asses and plan and teach. The only problem is that it’s already April and I don’t know how it would reflect on my ERAS CV on changing centers so quickly? Another question I have is about obseverships/externships. I did all my clinical rotations here in the US (2 years worth) but haven’t had any “real” direct patient contact since I graduated in May 2018. What do you guys think, would it be worth it to do an observership/externship for building up resume and maybe getting newer Letters of Recommendation for IM? Thank you for your thoughts. All the best.

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[NotAProgDirector]

per your description, you went to a known/solid Carib school, didn't mention failing anything, average scores, only 5 interviews and didn't match. Something sounds wrong, I would have expected you to do better than that. You haven't posted anything else, so there's no other details. Unless you do something different, your next match attempt is likely to yield the same result. Are you sure this is the whole story? Why graduate in 2018 but then not try to match until 2019? Late graduation?

 

[gyngyn]

Did you apply to a sufficient number of programs known to consider folks from your school?
The mean number of programs ranked by successful US IMG's was about 8. You weren't too far off.
Average USMLE scores are consistent with success.

http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

 

[MDK05]

Ok to clarify and provide additional details, I graduated in May 2018 and have gone through the Match TWICE now. I was hoping with 5 interviews that I would have Matched this year. I know passing Step 3 in October helped and calling programs directly after I received the score.
I applied to FM and IM, about 125 in each specialty. My school advisers have told me my scores are very consistent for FM but I haven't
done anything in particular for FM other than do 3 rd year FM rotation and 4 th year FM Sub I rotation with good grades and MSPE comments, BUT....
I don't have an LOR from a FM physician and I have never been wait-listed or offered an interview for any FM program either (in both match cycles).
In terms of IM, I did well in my 3 rd year IM rotation but messed on my 4 th year IM Sub I with pretty bad comments. So I made it up by taking another IM Sub I with a good grade, good MSPE comment and an LOR. My school advisers have told me its my MSPE comments that are bringing me down, though they show improvement over time. Also my "avarage-ish" step scores (not horrible, but not great either).

So I am wondering, should I try to get more hands on experience as a medical scribe at the new place and/or would it be worth it to "refresh" my clinical experiences with externships/obseverships (particularly in IM) and get fresher LOR's in IM? I think I have given up trying for FM now.
There really is nothing I could do to change my MSPE comments or Step scores. Maybe take a class in interviewing better (not the best interviewer here) and try to get some research done in the new few months (would it even count)?....

I know people who have been stuck in the same cycle for years and I just don't want to be that. Truly do appreciate the input and thanks again.

 

[scarletgirl777]

Ok to clarify and provide additional details, I graduated in May 2018 and have gone through the Match TWICE now. I was hoping with 5 interviews that I would have Matched this year. I know passing Step 3 in October helped and calling programs directly after I received the score.
I applied to FM and IM, about 125 in each specialty. My school advisers have told me my scores are very consistent for FM but I haven't
done anything in particular for FM other than do 3 rd year FM rotation and 4 th year FM Sub I rotation with good grades and MSPE comments, BUT....
I don't have an LOR from a FM physician and I have never been wait-listed or offered an interview for any FM program either (in both match cycles).
In terms of IM, I did well in my 3 rd year IM rotation but messed on my 4 th year IM Sub I with pretty bad comments. So I made it up by taking another IM Sub I with a good grade, good MSPE comment and an LOR. My school advisers have told me its my MSPE comments that are bringing me down, though they show improvement over time. Also my "avarage-ish" step scores (not horrible, but not great either).

So I am wondering, should I try to get more hands on experience as a medical scribe at the new place and/or would it be worth it to "refresh" my clinical experiences with externships/obseverships (particularly in IM) and get fresher LOR's in IM? I think I have given up trying for FM now.
There really is nothing I could do to change my MSPE comments or Step scores. Maybe take a class in interviewing better (not the best interviewer here) and try to get some research done in the new few months (would it even count)?....

I know people who have been stuck in the same cycle for years and I just don't want to be that. Truly do appreciate the input and thanks again.

Why didn't you try to get FM LORs?

 

[MDK05]

When I was applying for Match the first time, I tried to get LOR's from my 3 rd FM rotation preceptors but I was told by the program coordinator at that time it was basically impossible. The 2 preceptors hardly ever wrote or even signed off pre - written LOR's. I didn't think it was too much of a big deal at that time and let it go. During the 4 th FM Sub I, I asked the preceptor for an LOR and he said he would but he never did. Good comments on the MSPE and good grade, though. Anyway, I really did enjoy my FM experiences but after having applied to over 250 programs (between both match cycles) and never hearing anything back... I don't know if it's worth it to pursue it anymore.

 

[scarletgirl777]

When I was applying for Match the first time, I tried to get LOR's from my 3 rd FM rotation preceptors but I was told by the program coordinator at that time it was basically impossible. The 2 preceptors hardly ever wrote or even signed off pre - written LOR's. I didn't think it was too much of a big deal at that time and let it go. During the 4 th FM Sub I, I asked the preceptor for an LOR and he said he would but he never did. Good comments on the MSPE and good grade, though. Anyway, I really did enjoy my FM experiences but after having applied to over 250 programs (between both match cycles) and never hearing anything back... I don't know if it's worth it to pursue it anymore.

I don't know anything about applying to FM specifically but in general I'd think not having an LOR would be a big red flag? And usually you ask multiple people if they can write "a strong letter" soon after the rotation so you can get their fresh thoughts and so you can figure out who will flake out and plan accordingly.

 

[MDK05]

I do have LORs from like 2017ish and they are written for IM. Don't have any specific letters for FM, (maybe that's why I never got any interviews for FM). So I guess would it be worth it to do an externship in FM and get a FM LOR? OR just do externships in internal medicine to refresh my clinical experience and get newer LORs. Mind you, that I already have 2 years worth of US experience. (Last US clinical experience was in 2018). Don't know how much research at this point might help my application.

 

[scarletgirl777]

I do have LORs from like 2017ish and they are written for IM. Don't have any specific letters for FM, (maybe that's why I never got any interviews for FM). So I guess would it be worth it to do an externship in FM and get a FM LOR? OR just do externships in internal medicine to refresh my clinical experience and get newer LORs. Mind you, that I already have 2 years worth of US experience. (Last US clinical experience was in 2018). Don't know how much research at this point might help my application.

Personally I'd think externships and fresh LORs in both would be helpful and considering applying to friendly prelims as well. The scribe thing you are describing and working in a doctor's office sounds more like a premed type experience.

 

[Piebaldi]

When I was applying for Match the first time, I tried to get LOR's from my 3 rd FM rotation preceptors but I was told by the program coordinator at that time it was basically impossible. The 2 preceptors hardly ever wrote or even signed off pre - written LOR's. I didn't think it was too much of a big deal at that time and let it go. During the 4 th FM Sub I, I asked the preceptor for an LOR and he said he would but he never did. Good comments on the MSPE and good grade, though. Anyway, I really did enjoy my FM experiences but after having applied to over 250 programs (between both match cycles) and never hearing anything back... I don't know if it's worth it to pursue it anymore.

I think a scribe type thing might be helpful, it would allow you to get more "clinical" type experience and obviously you'll interact with attendings, and you can provide your input, etc so you might be able to get a letter or two. I would try this, not to mention it will provide some $$. IF you are going to do an observership, it has to be productive. For example when I was switching to PM&R I did an observership at Spaulding - rotated there 3 weeks, with essentially 1 attending the vast majority of the time (I think I saw one other attending another day but otherwise same guy) and I rounded with him, saw patients with him in clinic, etc. I bombarded him with questions, was interested, etc etc and I got a great LOR. So again just doing an observership for the sake of it is not going to be helpful - it has to be one where you can actually get a GOOD letter. I think an urgent care type situation is not bad at all, I think if the new one seems like you can get a letter or two it would be better. I don't think anyone will care that you switched.
Right now time is of utmost importance, so you are correct in that you can't change your scores, your MSPE, etc but you can add some experiences that can be of value. I don't think FM is that competitive particularly for a US citizen even if you went to the Caribbean and as someone else pointed out 5 IVS is not terrible - not great but not terrible. I would apply even more broadly - this advice I give to most people who are having trouble matching - apply to as many programs as you can, even if it hurts your wallet!!! It will hurt far more to not match again. Get parents, family to help out if needed. Yes it sucks, but at the end of the day it's better to match.
Interviewing skills are also important - so if you can take some type of mock type interview (frequently med schools give them) that might be beneficial

 

[GoSpursGo]

Just want to echo what others are saying that you're not going to match FM without a letter from at least one, preferably two FM docs. That's probably why you've never gotten an interview.

At this point, I think you have enough data points to conclude it's not going to happen for IM--if you applied to 125 programs, managed 5 interviews (maybe only because you went through the effort of calling when you got step 3 finished), and couldn't match, I don't see how applying again will change your outcome. If you can get FM letters, I'd throw all of my effort into trying to match there.

 

[MDK05]

Sorry, it's been awhile but thanks for the advice guys. I am going to stick the medical scribe position I am at for a little while longer and see if anything beneficial can come out of it (like an LOR). I am looking into externships (provide hands on experience) and most likely will do them in IM. Interestingly, I just don't know how much an LOR from an FM externship would count towards attaining interviews. I applied to over 250 FM program over the past 2 match cycles but have never received anything close to an FM interview (not even being waitlisted). I like FM and I liked IM too, would have been happy with either one but at this moment, I am thinking to bet on IM...?

 

[Ironheme]

It's about getting your foot in the door. If they like you enough, that program may consider offering an interview. No specialty wants to feel like it's the second choice for someone. Did you write a personal statement specific to FM or did you just use your IM one? Also, I'd put more effort into programs close to home - 'local' connections, which may be easier to get interviews at than a place you have no connections with. As in, personalized essays about 'why this program/state particularly.' I agree with the above posters on applying to as many programs as you can.

I've read LoR from scribe supervisors, and while most have been fine, they generally don't add much to your clinical abilities. It's more meaningful to read one from a clinician that says something like: 'Student doctor x had a longer list of ddx than residents, always started earlier than everyone else, stayed later than everyone else, read around all the cases, and on one of the patients, came up with management that we hadn't considered. Student doctor x was a strong and valuable member of the team, and we'd be happy to have them at our program. We don't want them going anywhere else, but we're happy to support their application as student doctor x will be an asset to the profession.'

vs

'X was a scribe at the ER that worked here for 9 months. During that time, they showed up on time, put in full effort to work, and was a pleasure to be around. I wasn't able to see much of their clinical abilities as the ER was very busy but they showed promise and was interested in the cases.'

You're getting more IM interviews likely because your app is more IM than FM. Imo, IM is harder to get into than FM, and if you're not getting any FM interviews, there's a large chance that you're not convincing any of the FM programs that you want FM. Whether it's because you're using the same LoRs from IM that say 'so and so is very interested in IM' or your personal statement. I would not be wishy washy at this point, which is what it seems like you're doing (for the upcoming 3rd time). Either fully commit to doing FM externships/observerships with the intent on getting 1-2 STRONG FM letters, or get new IM letters, but don't do this thing of I'll sort of be a scribe, then maybe 1 IM observership and hope I get better results with a similar approach.

 

[NotAProgDirector]

You're in a tough spot. Poor comments on a SubI are going to be difficult to overcome. SubI's are basically a "test run" of being an intern, so if you have a poor evaluation programs are going to be worried you're not going to do well. Another SubI with a "good" grade may not cut it.

If you want an FM spot, I agree you'll need some sort of FM experience and letters.

Applying again to IM is likely to result in the same outcome unless you do something differently. Ideally, you want experience at programs where you have a chance of matching. If there are programs in your local area where you'd be a reasonable candidate, that's where you need to focus. Scribing is fine as a source of income, but it's not going to help your application.

 

[GoSpursGo]

Interestingly, I just don't know how much an LOR from an FM externship would count towards attaining interviews. I applied to over 250 FM program over the past 2 match cycles but have never received anything close to an FM interview (not even being waitlisted).

You did not get any FM interviews because you did not have any FM LORs and they didn't really believe you wanted to go into their specialty. It's possible that getting an FM letter STILL wouldn't get you interviews, but there's no way to know without trying.

I think your first IM sub-I sunk your IM ship. If the second sub-I with better grades didn't help, I'm not sure how an externship (which is less rigorous than a subI) would--I think you topped out at 5 interviews last year coming fresh off completing step 3 and being a year closer to graduation than you will be this year, and still weren't successful in convincing a program to take you. There is nothing substantial that you can do at this point to appreciably improve your application for IM--as you said, the MSPE, subI grades and step scores are what they are, and your stated plans make it sound like you're just kind of crossing your fingers and hoping for the best.

I know it's tough to try and shift gears and get new letters in a specialty you've never gotten letters in before, but I honestly think you're wasting time with continuing to go down the IM route. Your own school advisors have TOLD you as much, yet while you claim that you'd be happy with FM you seem unwilling to put in the time and effort to really try for it.

 

[MDK05]

Again, thanks for the advice. Since it's almost May already, I am going to stick the medical scribe position for just a little while longer and see if anything beneficial can come out of it (like an LOR). In terms of IM I guess I was thinking that because I received my Step 3 Scores in October (after ERAS opened), that many programs didn't have the chance to look at it and that's why I was thinking to apply to IM again. But from the much advice here and having spoken to a few others, might seriously consider doing a few (costly) externships in FM over the summer. And I agree, I don't know what else I could really do to help my chances in IM. I contacted and applied to a few House Physician positions in IM but haven't heard back. If you guys think of anything else other than externships in particular that would be really helpful for IM/FM, let me know. As always, thanks!

 

[DokterMom]

"To Whom it May Concern,

@MDK05 has worked at Acme Urgent Care as a scribe for the past six months and has done an excellent job. As a graduate of XYZ Medical School, he has considerably more medical knowledge than the average scribe. He has been consistently punctual, personable and professional in his interactions with staff and patients.

Sincerely,
Dr. Whoever"



How much can this really help?

 

[bkzdragon]

I'd personally do some extra FM rotations and get new LORs from them if you're planning to apply for both. While you can also try to get a LOR from a doc via your scribe position, I don't think it'll hold the same weight as an attending from an externship. Its harder and harder to get a spot every year so look at the best possible ways of improving your application.

 

[MDK05]

I wasn't originally even considering applying to FM this year but given all the responses, I'll probably shift my strategy and put most of my weight behind FM. Like I said, I would be happy with either one and had good experiences in both. I just didn't know it was this competitive to get into a residency, this is taking too long (3 rd time applying)! As usual, any advice is appreciated. Thank You.

 

[collegestud2013]

Look for positions that open up outside the Match. In large fields such as IM, new programs open up frequently, including after the Match occurs and need to fill spots by July 1st. Those that open up last minute usually need to find many incoming residents to fill, so there's less competition for those spots. The main downside with this approach is that these new IM programs will not be big name places, which could significantly limit your chances of getting a competitive IM subspecialty fellowship (eg cardiology, GI) if that's what you're planning to do afterwards.

 

[GoSpursGo]

Since you opened a new thread to create a poll, I'm going to close this one to prevent multiple threads being open on the same topic.