Step 2 - 244. Is Ortho, IR, Gen Surg, Anesthesia all out?

[racewithnolegs]

Just got my score back and I need some realistic advice.

USMD, HP every rotation, Step 1 Pass, Step 2 244, 3-5 pubs, no conferences.

What should I not bother applying to? How would you approach specialty selection/refinement? I enjoy anything procedural but I want to make sure I don't apply to something I have a minimal chance of matching into. I plan on applying widely and dual applying. Is a couples match worth it (don't want to hold partner back)?

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[LucidSplash]

What specialty are your pubs in?

 

[m1redsox]

Gen surg and anesthesia are definitely still realistic. Just play your signals smart. Ortho and IR may be tougher. Still possible, but hard.

 

[purpledoc1]

First of all, that is a decent score. Don't beat yourself up.
Ortho may be out depending on the program. You are competitive for low-end ortho programs (echo LucidSplash's advice re: what specialty are your pubs in)? Do you have any ortho mentors/friends who can vouch for you?

I would say that general surgery is probably your best option if you want something with lots of OR time/procedures and anesthesia is on par with that. I would avoid anesthesia if you want to be the one doing the operating. It can be really boring sometimes if you are a hands-on person just standing there titrating stuff.

Couples match can be limiting. Like surgery, I wouldn't do it unless there aren't really any other options.
Best of luck with everything <3

 

[LunaOri]

Whether you should do couples match depends on whether being with your partner at any program is more desirable than having one or both of you matching at preferred programs but potentially being far apart. If you end up in gen surg, or your partner is in a similarly demanding residency, you will rarely see each other if you are not in the same city.

 

[odyssey2]

If you can match DR, you can do IR, it's easy to get an ESIR spot and do a one year fellowship since the DR residents don't want to touch it.

 

[NotAProgDirector]

You should ABSOLUTELY consider the couple's match. The couple's match allows you to combine your rank lists such that you can maximize your chances of being together, or you can still rank mostly on your preferences but when you have programs that are tied/similar, you can preference those that are together.

You have the OPTION of announcing you are in a couple's match in ERAS. You are welcome to use the couple's match and not alert programs to that in ERAS if you're worried that programs might decline to invite your partner because you are not getting invited. Since ERAS and NRMP are separate, you can use the couple's match in NRMP without telling any program at all.

There really are only two situations where you might not use the couple's match:
1. You get too many interviews between the two of you. Your outcome from the couple's match will be equal to or better than matching separately as long as you rank all possible combinations. Since the NRMP now limits ROL's to 300 ranks, if you have too many options you'll run into this limit. That happens around 16 interviews each. If that happens, you need to decide to use the couple's match and increase the chances of not matching at all (but with 300 ranks, that's less likely), or just submit individual lists and maximize the chances of matching but have no control over being together.
2. You really don't want / care to be together at all.

 

[racewithnolegs]

What specialty are your pubs in?

Current plan is to aim for mid/low-tier Ortho with Gen Surg as my dual application choice. I am happy being anywhere in the US.

Pubs:
2 in Medicine
Currently obtaining research in Gen Surg
Will be obtaining 2 more mostly in Surgery

Im not sure how to gain connections and find a proper Ortho mentor - and I worry it may be too late. This is the part of the medical school process where I find myself lacking.

First of all, that is a decent score. Don't beat yourself up.
Ortho may be out depending on the program. You are competitive for low-end ortho programs (echo LucidSplash's advice re: what specialty are your pubs in)? Do you have any ortho mentors/friends who can vouch for you?

I would say that general surgery is probably your best option if you want something with lots of OR time/procedures and anesthesia is on par with that. I would avoid anesthesia if you want to be the one doing the operating. It can be really boring sometimes if you are a hands-on person just standing there titrating stuff.

Couples match can be limiting. Like surgery, I wouldn't do it unless there aren't really any other options.
Best of luck with everything <3

Needed to hear this, thank you.

 

[purpledoc1]

Could you see yourself being happy in general surgery?

 

[racewithnolegs]

Could you see yourself being happy in general surgery?

Absolutely. If im not operating I won't be happy. Anesthesia seems incredibly attractive to me (on paper), but I know it will truly bother me if I am not making the cuts despite the lifestyle and pay reservations when comparing the two specialties.

 

[racewithnolegs]

You should ABSOLUTELY consider the couple's match. The couple's match allows you to combine your rank lists such that you can maximize your chances of being together, or you can still rank mostly on your preferences but when you have programs that are tied/similar, you can preference those that are together.

You have the OPTION of announcing you are in a couple's match in ERAS. You are welcome to use the couple's match and not alert programs to that in ERAS if you're worried that programs might decline to invite your partner because you are not getting invited. Since ERAS and NRMP are separate, you can use the couple's match in NRMP without telling any program at all.

There really are only two situations where you might not use the couple's match:
1. You get too many interviews between the two of you. Your outcome from the couple's match will be equal to or better than matching separately as long as you rank all possible combinations. Since the NRMP now limits ROL's to 300 ranks, if you have too many options you'll run into this limit. That happens around 16 interviews each. If that happens, you need to decide to use the couple's match and increase the chances of not matching at all (but with 300 ranks, that's less likely), or just submit individual lists and maximize the chances of matching but have no control over being together.
2. You really don't want / care to be together at all.

Incredible advice, thank you. I will be couples matching Ortho (mid/low tier) + Gen Surg as my portion of the couples match. Partner will be considering IM. I will apply widely and if anything as a last resort a SOAP in the location for Gen Surg may seem like a safety net plan.

Whether you should do couples match depends on whether being with your partner at any program is more desirable than having one or both of you matching at preferred programs but potentially being far apart. If you end up in gen surg, or your partner is in a similarly demanding residency, you will rarely see each other if you are not in the same city.

Makes sense. Partner and I greatly prefer being in the same area. Its the reason we are couples matching.

 

[ontiquicuo]

could you explain point 1 to a noob. i've re-read like 5 times on separate days and I still don't get it fully.

appreciate it brah

Suppose you each get 20 interviews and want to rank all the sites you interviewed at. That's 20*20 = 400 combinations between the two of you. You're only allowed 300 on your list.

So you'll have to decide if you want to eliminate some combos or not use the couples match.

 

[MatchpalResidencyAdvising]

forsure possible to match into any of those fields with 244 we see it all the time; just need to network very effectivly, crush SubIs, clinche strong LORs and publish alot within the specialty.

 

[VincentAdultman]

Current plan is to aim for mid/low-tier Ortho with Gen Surg as my dual application choice. I am happy being anywhere in the US.

FWIW I think dual applying is a mistake.

 

[LunaOri]

Disagreeing with Vox here. Your current plan is solid. You may end up at a community program, but residents operate more in community programs than they do at most academic programs. As far as couples match, if one of you gets an interview at a particular site to which you have both applied, the interviewee can let the PD know that they are planning to couples match; this may result in an interview invite for the other partner. Best of luck!

 

[Nontrad_FL_LGBT]

I’m sorry to be disrespectful and I’m not sure if this is because many of the posters on here are older (ie step 2 didn’t matter) but 244 is a very low score. Even for gen surg the average is 255. Everybody from my school who marched GS or Anes had a 255+. Median for entire country is 250. For subs it’s approaching 260s. That’s why I asked about school tier. Obviously if you go to Hopkins with a 230 you can match gen surg but if you go to Toledo it’s a much different story

244 is not "very low" when the average is 255. The nature of averages is that some people are above and below and 244 is within less than one standard deviation afaik. It's an infinitely matchable score for Gen Surg. This guy's stats are fine, his connections or aways are what would improve his chances more than another 9 points on step.

 

[medschoolaspirant]

Step 2 is low for today’s applicant. It indeed is below average for 2026 applicant. It indeed is part of today’s equation. But step 2 is not only part of equation. It is only 1 part of equation. General surgery as back up dual application, with ortho as main ( very minimal chance) is good route. Good luck !

 

[GoSpursGo]

Several recent posts have been deleted, as they were either unreasonably pessimistic or responding directly to that post.

 

[amoxicillin_resistant]

Step 2 is low for today’s applicant. It indeed is below average for 2026 applicant. It indeed is part of today’s equation. But step 2 is not only part of equation. It is only 1 part of equation. General surgery as back up dual application, with ortho as main ( very minimal chance) is good route. Good luck !

 

[VincentAdultman]

Step 2 is low for today’s applicant. It indeed is below average for 2026 applicant. It indeed is part of today’s equation. But step 2 is not only part of equation. It is only 1 part of equation. General surgery as back up dual application, with ortho as main ( very minimal chance) is good route. Good luck !

Again I would not dual apply.

Dual applying means two different applications so two sets of letters of rec, two personal statements annd I would assume two sets of away rotations. If you’re gonna apply for ortho doing aways is all but mandatory and if you’re applying for gen surg I would assume the same but I’m not sure.

You’ll also have to balance two sets of interviews. Programs only offer x interview days so if there’s a conflict between days for different programs you’re kind of stuck.

As a medical student you are at your most competitive. Pick one and go all out for that. This is only a tiny sliver of time relative to your whole career. Don’t give yourself opportunities to regret.