Step score- options

[ihopetobeadoctorsomeday]

Hi everyone. Thanks for taking the time and hopefully to reply. I didn't do too great on step 1 and comlex. I got a 49x and a 21x. I realize that kind of makes my bed in terms of specialties that I can get in to, but I was wondering what are my options for specialties? More so, how much can a solid step 2 score help me? Can it open some doors to specialties or am I stuck with what I have through my step 1? Unfortunately I also had to remediate my first year of medical school due to failures. My grades after remediation were almost all A's and B's. I felt confident in getting a halfway decent score on Step and Comlex but I think I was either a little too overconfident (more likely explanation) or I burned out by postponing my exam too many times in hopes that I could maximize my score. Brutal honesty is appreciated. Thank you

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[ihopetobeadoctorsomeday]

Depends on what kind of connections you have. Are you DO or DO/PhD? That can make a difference. Are you geographically flexible? You can match semi-competitive specialties in the midwest and south.

I know someone with <480/no USMLE/bottom quartile who matched rads (family connections). People with 21x who matched their top 3 EM and gas. We're gonna need to know a bit more about what you WANT and what you're willing to give up (location, prestige, etc)

Oops, sorry, I accidentally put DO/PhD. Just a regular DO medical student. No connections. Geographically flexible. I don't mind giving up location. I have an interest in gas, psych, and PM&R. At this point I feel like beggars can't be choosers so I would probably give up most things if I could get gas or PM&R

 

[ihopetobeadoctorsomeday]

PM&R is pretty much a DO specialty and easily attainable for you (even Harvard PM&R director is a DO). You will need to crush third year and impress on an away if you want gas. Rumor is that gas will get more competitive as EM hopefuls are jumping switch due to saturation. Your best bet is to see where people from your school end up and start networking.

You don't think my scores disqualify me from PM&R?

 

[Ho0v-man]

Low scores and a repeat year don’t look good. Gas is likely out. Can’t speak to psych as competition is up per number of applicants per spot, but they don’t seem to care too much about scores. PMR is probably safe. Neuro might be okay too.

If you apply outside of primary care, I’d strongly consider applying to a backup in FM/IM. If you’re interested in PM&R, there’s always sports med after.

 

[hallowmann]

You don't think my scores disqualify me from PM&R?

PM&R is a niche specialty with most students not knowing a ton about it. You need to demonstrate interest (make connections, go to conferences, try for research/poster), apply broadly, and avoid the tippy top places. I would apply to a backup to be safe (e.g. FM to have the Sports Med option open), but if you have a broad app and no other redflags (I'd call your step score more of a yellow flag and the repeat year is obviously a redflag) then I think you have a chance. Look at Charting Outcomes from 2020, 90% of DOs with a step 1 from 211-220 matched, but you also have the repeat year to contend with.

Overall, I think it was still worth it for you to take Step 1, and if you can show improvement and have a Step 2 in the high 230s, I think it'll open more doors than it closes.

 

[ihopetobeadoctorsomeday]

Low scores and a repeat year don’t look good. Gas is likely out. Can’t speak to psych as competition is up per number of applicants per spot, but they don’t seem to care too much about scores. PMR is probably safe. Neuro might be okay too.

If you apply outside of primary care, I’d strongly consider applying to a backup in FM/IM. If you’re interested in PM&R, there’s always sports med after.

PM&R is a niche specialty with most students not knowing a ton about it. You need to demonstrate interest (make connections, go to conferences, try for research/poster), apply broadly, and avoid the tippy top places. I would apply to a backup to be safe (e.g. FM to have the Sports Med option open), but if you have a broad app and no other redflags (I'd call your step score more of a yellow flag and the repeat year is obviously a redflag) then I think you have a chance. Look at Charting Outcomes from 2020, 90% of DOs with a step 1 from 211-220 matched, but you also have the repeat year to contend with.

Overall, I think it was still worth it for you to take Step 1, and if you can show improvement and have a Step 2 in the high 230s, I think it'll open more doors than it closes.

Thank you. Your replies are really appreciated

 

[Prehealth1011]

FM, IM, Peds, Psyc (interest and heavy Psyc involvement > scores), EM (SLOE over everything) are all possible. PMR and Neuro is a maybe

Gas is out based on what my friends went through this cycle. It’s a stats heavy speciality that isn’t as DO friendly as the ones above, especially in the virtual interview world

 

[BoneWizard]

Agree with the above plus path, child neuro and rad onc. Also PM&R and adult neuro are definitely doable.

 

[Chicken Bone]

PM&R is pretty much a DO specialty and easily attainable for you (even Harvard PM&R director is a DO). You will need to crush third year and impress on an away if you want gas. Rumor is that gas will get more competitive as EM hopefuls are jumping switch due to saturation. Your best bet is to see where people from your school end up and start networking.

their residency has no DOs

 

[Surgeon D.O.]

Agree with the above plus path, child neuro and rad onc. Also PM&R and adult neuro are definitely doable.

What happened with Rad Onc lol? I remember when I was in undergrad it was like the pinnacle of competitiveness

 

[BoneWizard]

What happened with Rad Onc lol? I remember when I was in undergrad it was like the pinnacle of competitiveness

Oversupply apparently.

 

[futureapppsy2]

What happened with Rad Onc lol? I remember when I was in undergrad it was like the pinnacle of competitiveness

Residencies over-expanded, so now the job market is awful.

 

[SurgDoc95]

Residencies over-expanded, so now the job market is awful.

Maybe we don't suggest people go into it then? That's just me though

 

[MDMechEngr]

PM&R is pretty much a DO specialty and easily attainable for you (even Harvard PM&R director is a DO). You will need to crush third year and impress on an away if you want gas. Rumor is that gas will get more competitive as EM hopefuls are jumping switch due to saturation. Your best bet is to see where people from your school end up and start networking.

Doximity shows Kevin C OConnor, MD is their PD for PMR at MGH. All PMR residence and fellows are MD. I do not see any DOs.

 

[BoneWizard]

Doximity shows Kevin C OConnor, MD is their PD for PMR at MGH. All PMR residence and fellows are MD. I do not see any DOs.

I don't think Harvard's taken a DO for residency. Their chair of PM&R and the chief of PM&R at mass general and brigham is a DO though: Ross Zafonte, DO - MGH Physical Medicine and Rehabilitation Service

Majority of Hopkins PM&R residents are DOs so I'd agree the ceiling for PM&R for DOs seems to be higher than other speciaties.

 

[Ho0v-man]

This thread is so typical of sdn.

“Hey guys. I’m not a super competitive applicant but I was hoping someone could give me some insight.”

sdn:
“Well the best applicants to field go here.”

useless.

OP, my buddy who just matched pmr with a 220 had great interviews in the Midwest like U Missouri, case western. Improve on step 2. I think the repeat year is a bigger issue than the scores.

 

[Neopolymath]

No anesthesia (waiting for the inevitable disagreement), rads, OB, GS, etc.

Go for FM, IM, Neuro, path, PMR, Psych etc depending on what you enjoy. PMR is a small field that is rising in competitiveness because it is a good field but it is a field like psych that favors strong commitment to the specialty over scores. Honestly your scores aren't the worry here for some of these fields. It's the remediation that is a big problem.

 

[DOVinciRobot]

Apply broadly. I agree the remediation is a much bigger red flag than the lower scores unfortunately. I know someone that matched Rads with a 21X score and one class remediation, but they didn’t get very many interviews and were pretty realistic about their chances.

Whatever you do apply to I would heavily consider dual applying to FM or Peds as a back up

 

[DameJulie]

If you had to remediate, do you need to email each program to see if they would screen you out or not? I know applying broadly is going to cost a lot more $$$, and sometimes just to be screened out. Can OP avoid some of these unnecessary costs?

 

[Ho0v-man]

If you had to remediate, do you need to email each program to see if they would screen you out or not? I know applying broadly is going to cost a lot more $$$, and sometimes just to be screened out. Can OP avoid some of these unnecessary costs?

Most likely not. Programs will always encourage you to apply. They like the idea of having a full wait list and none of them care about our personal financial circumstances.

 

[Prehealth1011]

If you had to remediate, do you need to email each program to see if they would screen you out or not? I know applying broadly is going to cost a lot more $$$, and sometimes just to be screened out. Can OP avoid some of these unnecessary costs?

Don’t bother. They’ll most likely say something vague like “we consider all applications holistically” so you’ll end up applying there and spending $ anyway

Their priority is to initiate the hunger games of filling up their interview slots ASAP and no one gives two shts about our finances or our anxiety of being too late to book an ERAS time slot

 

[NotAProgDirector]

Don’t bother. They’ll most likely say something vague like “we consider all applications holistically” so you’ll end up applying there and spending $ anyway

Their priority is to initiate the hunger games of filling up their interview slots ASAP and no one gives two shts about our finances or our anxiety of being too late to book an ERAS time slot

I get many emails with lots of attachments saying that someone wants me to review their application but doesn't want to pay the ERAS fee unless I'm going to invite them. And HR makes it clear to us that all apps need to come in the same way and be evaluated the same to avoid claims of discrimination or favoritism. So that's why you get an empty response. We get none of the fees you pay ERAS.

I do agree with you about interviews. We only invite people to the number of slots we have.

 

[djiboutiman]

Just take a look at the 2020 DO Charting Outcomes. DO seniors with your scores matched PM&R (27/30 students) and Psych (39/44) at a pretty good rate. Anesthesiology would be a bit tougher (42/62), but not impossible. However, the remediation is gonna drop your chances a bit. PM&R and Psych value genuine interest in the field (see 2020 Program Director Survey), so if you see yourself doing one of those, then you’ll have to work on that.

 

[Surgeon D.O.]

Just take a look at the 2020 DO Charting Outcomes. DO seniors with your scores matched PM&R (27/30 students) and Psych (39/44) at a pretty good rate. Anesthesiology would be a bit tougher (42/62), but not impossible. However, the remediation is gonna drop your chances a bit. PM&R and Psych value genuine interest in the field (see 2020 Program Director Survey), so if you see yourself doing one of those, then you’ll have to work on that.

I noticed that Psych still has a strong match rate too, why is it being called "the new Derm" on SDN?

 

[djiboutiman]

I noticed that Psych still has a strong match rate too, why is it being called "the new Derm" on SDN?

Psych was very competitive this year(2021) with 332/484 (~69% match rate) DO seniors matching into general psych. While for Dermatology the overall match rate into a PGY-1 program was 5/37 and 31/66 into a PGY-2 program. The thing with Psych is that they really want people committed to the specialty and fit in well. So even If you have lower board scores and average pre-clinical grades, you can still match if you show that interest and fit well as a psychiatrist. Compared to Dermatology, where you have to have everything going for you to match.

Edited: The dermatology match rates based on below posts from BoneWizard and DOVinciRobot

 

[BoneWizard]

Psych was very competitive this year(2021) with 332/484 (~69% match rate) DO seniors matching into general psych. Dermatology matched 36/103(~35%) DO seniors. The thing with Psych is that they really want people committed to the specialty and fit in well. So even If you have lower board scores and average pre-clinical grades, you can still match if you show that interest and fit well as a psychiatrist. Compared to Dermatology, where you have to have everything going for you to match.

I don't think you can use that table to determine match rate for derm since it defines applicant as anyone who ranks at least one program in that specialty with no delineation towards whether they applied to multiple specialties or even categorical vs advanced program types. For derm it's conceivable that applicants would apply for both the PGY-1 and PGY-2 positions in the same ERAS cycle which would lead to them being counted twice as applicants.

The match rate for derm would need to account for the 3 applicants who ranked it as not first choice and applicants who applied to both advanced and categorical program types. This would be a range between 36/63 to 36/100 with the latter assuming no one applied to both program types and the former assuming all categorical applicants applied to both.

For psychiatry 30 students listed it as not first choice so the match would be around 332/454 (73%) again not accounting for the 141 students who dual applied psych and another specialty or other outside the match offers.

I noticed that Psych still has a strong match rate too, why is it being called "the new Derm" on SDN?

I think people are realizing it's a more "lifestyle" specialty with regular 40-50 hours weeks. Especially now with the 2021 CMS increases to medical decision making/evaluation and management reimbursement (which increased established patient MDM/E&M by 20-40%). Psych gets a 7% average RVU increase which bumps their median compensation to just shy of $300k. Derm is sitting at $450k.

 

[DOVinciRobot]

The match rate for derm would need to account for the 3 applicants who ranked it as not first choice and applicants who applied to both advanced and categorical program types. This would be a range between 36/63 to 36/100 with the latter assuming no one applied to both program types and the former assuming all categorical applicants applied to both.

Just a note, No one only applies to only pgy1 derm spots. The 36/63 is almost 100% the match rate to derm and not 36/105

 

[Surgeon D.O.]

Psych was very competitive this year(2021) with 332/484 (~69% match rate) DO seniors matching into general psych. While for Dermatology the overall match rate into a PGY-1 program was 5/37 and 31/66 into a PGY-2 program. The thing with Psych is that they really want people committed to the specialty and fit in well. So even If you have lower board scores and average pre-clinical grades, you can still match if you show that interest and fit well as a psychiatrist. Compared to Dermatology, where you have to have everything going for you to match.

Edited: The dermatology match rates based on below posts from BoneWizard and DOVinciRobot

I don't think you can use that table to determine match rate for derm since it defines applicant as anyone who ranks at least one program in that specialty with no delineation towards whether they applied to multiple specialties or even categorical vs advanced program types. For derm it's conceivable that applicants would apply for both the PGY-1 and PGY-2 positions in the same ERAS cycle which would lead to them being counted twice as applicants.

The match rate for derm would need to account for the 3 applicants who ranked it as not first choice and applicants who applied to both advanced and categorical program types. This would be a range between 36/63 to 36/100 with the latter assuming no one applied to both program types and the former assuming all categorical applicants applied to both.

For psychiatry 30 students listed it as not first choice so the match would be around 332/454 (73%) again not accounting for the 141 students who dual applied psych and another specialty or other outside the match offers.


I think people are realizing it's a more "lifestyle" specialty with regular 40-50 hours weeks. Especially now with the 2021 CMS increases to medical decision making/evaluation and management reimbursement (which increased established patient MDM/E&M by 20-40%). Psych gets a 7% average RVU increase which bumps their median compensation to just shy of $300k. Derm is sitting at $450k.

As "anti-surgery" as it may sound, since I haven't even started rotations yet, Psych has always been one of my biggest back ups if I turn out to not vibe with the OR as a med student lol.

 

[Neopolymath]

As "anti-surgery" as it may sound, since I haven't even started rotations yet, Psych has always been one of my biggest back ups if I turn out to not vibe with the OR as a med student lol.

This is actually common.

 

[Surgeon D.O.]

This is actually common.

Really?! I honestly did not know that lol.