Applying to FM/IM after 2 years out of DO school

[cooldown]

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Hello everyone,


I would really appreciate honest advice on how to move forward.


I recognize that as trainees and applicants, we are often in vulnerable positions. I’ll try to keep this concise and focused. I would value both practical and psychosocial guidance.


I have felt quite isolated and unsure about my direction recently, but I am now trying to re-engage and move forward constructively.

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Background​

• Graduated from a DO program in 2023
• Did not apply for residency during or immediately after graduation

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Strengths​

• No board failures (COMLEX scores ~500)
• No repeated years
• Remediated 3 courses (all successfully within the same semester)
• Passed all clinical rotations (completed during COVID)
• Strong foundational knowledge (recent dedicated Step 1 preparation using First Aid)

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Challenges​

• Bottom quartile academically (though improved over time)
• Took a leave of absence after 2nd year due to not feeling prepared for COMLEX Level 1
• Took a second leave after 3rd year for research at a large cancer institution and to pursue USMLE Step 1 (at the time scored, initially aiming for radiology)
• Delayed decision-making and lack of structured mentorship regarding residency planning

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Personal Context (brief for context)​

• First-generation immigrant (moved to the U.S. at age 12)
• Limited family guidance in navigating medical training
• Significant personal and family stressors, including caregiving responsibilities
• Previously worked as a high school teacher in an underserved community
• Engineering degree from a top-tier university
• MCAT ~90th percentile

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Additional Context​

Early medical school was largely a “survival mode” experience due to academic and personal stressors. I was placed on academic probation early on, which significantly affected my confidence and mindset at the time. However, I ultimately stabilized academically and completed the program.


I also recognize in retrospect that I did not have the right mentorship and pursued radiology initially without fully understanding fit or competitiveness. I now believe Internal Medicine (and possibly Family Medicine) aligns better with my skills and interests.


Living at home with parent after graduation also negatively impacted my focus and productivity.

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Recent Turning Points​

• Took on primary responsibility for coordinating care and relocation of an elderly female family member (with cognitive impairment/medical issues) to assisted living in Canada from developing country. I am still the full time caregiver remotely
  → This experience significantly deepened my interest in patient care, complexity, and longitudinal management
• Through studying, I have regained confidence in my foundational medical knowledge
• I am now committed to pursuing residency training (IM primarily, likely dual applying IM/FM). IM because feel excited and enjoy the IM rotatio and the critical thinking/care-coordinating role of an internist. Yes, it's more challenging and need strong knowledge-base so that's what Step1/Step2 recent scores can show?

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My Questions​

1. Would it be advisable to:
   • Take USMLE Step 1 and Step 2, and apply to IM/FM in the next cycle?
2. Alternatively:
   • Apply this September to preliminary positions using COMLEX only
   • Then take Step 1 and Step 2 during the year
   • Reapply in the following cycle (Sept 2027) with updated scores and letters?
3. More broadly:
   • Given my background, what would be the most realistic and strategic path to entering residency?

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Thank you for taking the time to read this. I truly appreciate any thoughtful guidance.

 

[Smurfette]

If you are applying for next year's match, you will be 4 years out from med school.
The further out from school that you apply, the harder it is to even get an interview. Programs may screen you out and not even look at your app.
If you have been doing nothing medical in the last 3 years since you graduated, that also is problematic.
How are you going to get LORs for your app that are relevant?
Honestly, you will have a very hard time getting a position.
Prelim positions might be more likely to consider you; if you impress them, it gets you LORs and opens up the possibility of them offering you a categorical position.

 

[NotAProgDirector]

I would not bother with USMLE. Your COMLEX scores are "OK" but below average. The chances of you doing well on USMLE is just not good, and the longer you delay the bigger the problem.

You should apply for spots ASAP. You can still hunt around for a spot this July. I agree that getting LOR's at this point is going to be a challenge. I'm hoping you got some long ago that can be reworked. Prelim, IM, FM. The pause in your education is going to be an issue, and people are going to want to know what you did / what the issue was. There's no way to keep this secret, so you need to figure out how to tell your story. If your prior medical school has a program, definitely reach out to them.

 

[dozitgetchahi]

You may have a shot at prelims as well as low competitiveness IM and FM programs. I would also suggest EM, as that has become very uncompetitive recently. (You might even have a shot at grabbing an EM slot in the current SOAP process, as there were quite a few open EM spots in the current match.)

However, programs are going to have the same questions: what happened in medical school? And what were you doing the last 3 years? I’m a DO, so I’m fully aware of how bad the advising can be at DO schools, but you must have realized that the rest of your class was applying to residency, right? It’s not clear from your post - did you ever apply to radiology?

Also, how are you the “full time caregiver” for someone remotely? I’m not sure how you’re doing this now, but what is the plan for caring for this person if you enter a residency program?

I agree with not bothering with USMLE. You passed the COMLEX, so that isn’t going to be the problem here.

 

[cooldown]

1. I did the EM rotation in 2023 - and didn't love it in some ways. So ruled out EM.


RE: Also, how are you the “full time caregiver” for someone remotely? I’m not sure how you’re doing this now, but what is the plan for caring for this person if you enter a residency program?
>>>>>They are in assisted living facility and will move to full-care if needed. Its all sorted now.

2. RE: I agree with not bothering with USMLE. You passed the COMLEX, so that isn’t going to be the problem here.
Thank you!

3. We can be good residents and professionals if we are committed to our self learning/improvement even without USMLE right? Study a little at home if possible for each type of ppt encounter in residency, etc.

You may have a shot at prelims as well as low competitiveness IM and FM programs. I would also suggest EM, as that has become very uncompetitive recently. (You might even have a shot at grabbing an EM slot in the current SOAP process, as there were quite a few open EM spots in the current match.)

However, programs are going to have the same questions: what happened in medical school? And what were you doing the last 3 years? I’m a DO, so I’m fully aware of how bad the advising can be at DO schools, but you must have realized that the rest of your class was applying to residency, right? It’s not clear from your post - did you ever apply to radiology?

Also, how are you the “full time caregiver” for someone remotely? I’m not sure how you’re doing this now, but what is the plan for caring for this person if you enter a residency program?

I agree with not bothering with USMLE. You passed the COMLEX, so that isn’t going to be the problem here.

 

[cooldown]

@notdirect

I would not bother with USMLE. Your COMLEX scores are "OK" but below average. The chances of you doing well on USMLE is just not good, and the longer you delay the bigger the problem.

You should apply for spots ASAP. You can still hunt around for a spot this July. I agree that getting LOR's at this point is going to be a challenge. I'm hoping you got some long ago that can be reworked. Prelim, IM, FM. The pause in your education is going to be an issue, and people are going to want to know what you did / what the issue was. There's no way to keep this secret, so you need to figure out how to tell your story. If your prior medical school has a program, definitely reach out to them.

1. Where can I look for a spot now? 2. I scored 65 % on a NBME a few months ago and have been doing 2 blocks uworld 60+% so I feel I should grind out and take STEP1 just for completion/finish it off. Bc. it is the. last chance. I don't ever want STEP1 studying again to lose momemtum.

 

[NotAProgDirector]

If you want to attempt the USMLE, you certainly can. There isn't much downside -- if you fail/do poorly then you simply don't report/release it. I'm not certain it will help you much, but I agree that if you're going to do it, you should do it now.

Getting a spot now is just hard work. Reach out to programs, explain your situation, tell them you plan to enter next year's match but are able to start now. It's possible that some people who matched will be unable to start -- visa falls through, fail a drug test, have some emergency that leads to a match waiver, etc. Some programs might be expanding and then have new slots. Or a new program might open. Those types of changes can be seen on the ACGME website (I think?). Expect 98+% rejections. You're hunting for the needle in the haystack.

 

[cooldown]

If you want to attempt the USMLE, you certainly can. There isn't much downside -- if you fail/do poorly then you simply don't report/release it. I'm not certain it will help you much, but I agree that if you're going to do it, you should do it now.

Getting a spot now is just hard work. Reach out to programs, explain your situation, tell them you plan to enter next year's match but are able to start now. It's possible that some people who matched will be unable to start -- visa falls through, fail a drug test, have some emergency that leads to a match waiver, etc. Some programs might be expanding and then have new slots. Or a new program might open. Those types of changes can be seen on the ACGME website (I think?). Expect 98+% rejections. You're hunting for the needle in the haystack.

1. Able to start now--> meaning I have scores, got the DO degree, and just need the essay and LORs to send to them right?

2. Yes, sometimes the Visa fall through, etc. Yes it's possible.

3. You are right, it will not help much but atleast recent scores is evidence of "Current" knowledge and increase some confidence?

yes, it's really an awful position to be in., but I'm trying not to let all this "Get" to me. It can really take a toll on me (physiologically) and drive me to some extreme stress-induced health problems, sleeping problems, and it is not worth it. A friend said to think about this period in 20 years's time. I was gung-ho on radiology and despite my background being a better fit for IM/FM, did not consider it or did not think through it and then did not or could not course correct in time. It's awful

 

[NotAProgDirector]

1. Yes.
2. Yes
3. Maybe

 

[cooldown]

If you want to attempt the USMLE, you certainly can. There isn't much downside -- if you fail/do poorly then you simply don't report/release it. I'm not certain it will help you much, but I agree that if you're going to do it, you should do it now.

Getting a spot now is just hard work. Reach out to programs, explain your situation, tell them you plan to enter next year's match but are able to start now. It's possible that some people who matched will be unable to start -- visa falls through, fail a drug test, have some emergency that leads to a match waiver, etc. Some programs might be expanding and then have new slots. Or a new program might open. Those types of changes can be seen on the ACGME website (I think?). Expect 98+% rejections. You're hunting for the needle in the haystack.

They would need resume, or the ERAS application deal with MSPE?

 

[NotAProgDirector]

I assume you're referring the the process of applying to spots outside the match. You would reach out with a CV alone. If a program is interested, they will ask for your MSPE and you'd have your school forward it to them, as you usually wouldn't have a copy of it. If you have an unofficial copy (some schools do this with a watermark), you could include that -- they will want an official copy somwhere along the line and you can request that when needed. You'll need LOR's for ERAS anyway, so you should be getting those now -- and if needed letter writers can send them directly to a program. Don't drive your LOR writers nots by having them send letters to 100's of programs -- only do that once a program voices interest. Feel free to state on your CV that "references available upon request" -- but be sure you actually have them ready to go.

 

[cooldown]

Thanks a lot.. I know i'm in a perfect ****-storm, but appreciate the guidance a lot. I was incredibly delusion about things... pfff...

 

[cooldown]

Update: Contacted my school's advising team. Very professional. They will help me