A question I'd like to throw out:
What happens to the bottom 30% of US allopathic grads? Honestly, all my NBME performances thus far (Step I 209/86 and shelf exams around -1 SD) put me in this group.
What I would really like is to match an IM program with a good name in a good city. I'm not talking top tier here, but more like the mid-tier/well-respected ones with relatively impressive fellowship matches. If it makes a difference, I go to a mid-tier medical school in a desirable city right now. Currently a 3rd year. I'm hoping to take step II early and do well, but for arguments sake, let's just say I stay in the same general percentile.
Thanks for the help.
From the 2007 209 is near the 25th Percentile (207) for Step 1 for those who matched in internal medicine, so roughly 25 percent of people with a Step 1 less than yourself matched into IM, which I guess is good news.
I think it is hard to divide IM programs into mid-tier and top-tier, which sort of assumes there is a lower-tier (but applicants always just say they are applying to "middle-tier" IM programs and residents of poor programs might describe their program as "middle-tier"). I basically divide residency programs generally into:
CATEGORY 1. Top University Programs, i.e. Hopkins, Mayo, MGH . . . maybe there are about 20 or so of these.
CATEGORY 2. University Programs which I divide into two categories:
2 a. University Programs with solid reputation. These are obviously not the MGH's, but also obviously not poor university programs either; i.e. such as a good IM program such as Baylor. Such programs are non-malignant, and produce happy residents.
2 b. University Programs that fall short in many respects, i.e. malignant atmosphere, problems with applying for fellowships, unhappy residents, but are still a "University Program" and therefore still get a ton of good applicants for better or worse. You get to have graduated from a relatively well known residency program, but you paid a price with a malignant atmosphere or plans for fellowship not working out. These are sort of the Lehman Brothers of the residency world, i.e. they are well known IM powerhouses, but because of perhaps changes in leadership or just losing good faculty have been through tough times. For some, taking a 3 a IM program, i.e. a community affiliated IM program that is more stable and produces good fellowship matches is worth it over many 2 b IM programs.
CATEGORY 3. University affiliated/community programs: Many internal medicine programs are more loosely affiliated with an academic institution than others, and community IM programs offer more obstacles in terms of getting a fellowship and just are not seen as prestigious. I subdivide these into:
3a - IM programs that while being community programs or loosely affiliated do a good job educating their residents and many residents get the fellowships they want. THESE ARE THE REAL GEMS IN THE IM RESIDENCY MATCH, THEY ARE NOT OBVIOUSLY AFFILIATED OR WELL KNOWN BUT ARE GREAT PLACES TO TRAIN!
3b- These are the "Whoops" IM programs, where they may have looked great on paper and during interview, but perhaps have a high percentage of IMGs OR DO's (often indicates a weakened academic environment and poor fellowship placement) OR there are malignant aspects or problems getting fellowships for residents. Graduates of these programs with some frequency say they would liked to have gone elsewhere for residency.
Judging by your NBME scores and Step 1, Category 1 is likely a long shot, i.e. I don't think you will get into Hopkins IM program. I think you may, with an emphasis on may, have a shot at some university programs with a solid reputation. Your sure bet is the group in 3, which don't necessarily fit with "well respected", i.e. most people have never heard of, but could get you your fellowship with a lot of hardwork.
Obviously the top candidates go for category 1 IM programs. People who come up short and some top candidates who couldn't get a spot at category 1 IM programs compete intensely for Category 2 IM programs. I.e. at Baylor's IM program you will have a ton of folks with AOA, Step 1 235+ interviewing with you, and these programs generally aim to get top candidates too, but there are more of them, so if you emphasize other aspects of your application you will have a chance.
HOWEVER, a big problem for you is Step 2. It is very very similar to NBME examinations, which if you are one SD below the mean on these (much worse than you Step 1 showing which isn't as bad as below 200), you run a real risk of failing this examination or doing very poorly which will, I would guess, sink you at many Category 2 institutions who may have granted you an interview if not for a poor Step 2. My advice? Since your Step 1 is "decent" i.e. not disasterous, apply to a ton of Category 2 IM programs and take Step 2 only when you are confident you can blow it away. Don't take it if you figure you will do as well as Step 1, more likely you will do the same as your NBME as Step 2 tests clinical diagnosis and treatment scenarios.
Big question though is how did your IM clerkship go? If you aced this, besides your NBME, and maybe even got honors, then you have a leg up for many Category 2 IM programs in terms of getting your shoe in the door, i.e. an interview.
Category 3 is a grab bag of IM programs, hard to differentiate via just looking at their published information and you should talk to residents during the interview process as these programs are happy with residents who got within 20 points of the average for Step 1.
A nice Category 3 IM program ( 3a ) in a community setting with good placements post residency and friendly faculty ranks way above a similar institution with "academic affiliations", i.e. not a real university hospital but associated with maybe two other medical schools/academic centers, but which has bad fellowship placement and is malignant (3b,. . . the worst). For many Category 3 IM programs half the residents did worse than you on Step 1 and you stand out as some sort of medical genius, no kidding.
