An Interesting Dilemma...

[gin and tonic]

So here I am 2 years post internship as a flight doc and considering taking USMLE Step II. Let me back up and explain why I am thinking about doing this. First of all I am a DO so I took COMLEX and because I was doing the HPSP route I decided not to take USMLE. As it turns out I failed both COMLEX I and II but passed both the second time around. After med school I didn't match for either AF or civilian residency and so I scrambled and got a Traditional DO spot in Cleveland (civilian). During my internship year I decided I would take USMLE Step I (which I passed) to bolster my application. I also took COMLEX III (which I also passed) because the AF required it. Right after internship I became a flight surgeon.
As many have mentioned on here before being out of medical school/residency has been devastating to my medical knowledge. There has been an upside to this of course and that is I know what I want to do now and that is Emergency Medicine. The downside is that I will be extending to do this for 3 more years before pursuing a residency in EM (on the civilian side). Reason? Japan
So now to my questions (finally): I am currently deployed so I have a lot of down time and I was wondering if the risk to reward ratio of studying and taking USMLE Step II CK is worth it in terms of making myself more competitive for EM? After 5 years of this job will residency programs really care about USMLE/COMLEX scores? Will my experiences make up for my deficiencies in standardized testing? Please let me know what you think. And sorry about the long windedness!

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[Gastrapathy]

So here I am 2 years post internship as a flight doc and considering taking USMLE Step II. Let me back up and explain why I am thinking about doing this. First of all I am a DO so I took COMLEX and because I was doing the HPSP route I decided not to take USMLE. As it turns out I failed both COMLEX I and II but passed both the second time around. After med school I didn't match for either AF or civilian residency and so I scrambled and got a Traditional DO spot in Cleveland (civilian). During my internship year I decided I would take USMLE Step I (which I passed) to bolster my application. I also took COMLEX III (which I also passed) because the AF required it. Right after internship I became a flight surgeon.
As many have mentioned on here before being out of medical school/residency has been devastating to my medical knowledge. There has been an upside to this of course and that is I know what I want to do now and that is Emergency Medicine. The downside is that I will be extending to do this for 3 more years before pursuing a residency in EM (on the civilian side). Reason? Japan
So now to my questions (finally): I am currently deployed so I have a lot of down time and I was wondering if the risk to reward ratio of studying and taking USMLE Step II CK is worth it in terms of making myself more competitive for EM? After 5 years of this job will residency programs really care about USMLE/COMLEX scores? Will my experiences make up for my deficiencies in standardized testing? Please let me know what you think. And sorry about the long windedness!

Your prior board failures will be a problem regardless of the subsequent success. Its unlikely you will score dramatically higher on Step 2 CK than you did on Step 1 or your passed COMLEX and another failure would undoubtedly sink your chances. I would not take any more tests.

I would strongly consider completing a residency inside the military (FP, anything). If you get out without a residency, you may find that most doors are closed. I'd recommend apply to AF EM this year and then AF EM and FP next year. You need to maximize your chances of getting to be part of the US medical system.

If you can't stomach staying in, just understand the risks of this strategy. Google Charting Outcomes in the Match 2011 to get a sense of where you fit in the bell-curve. Its hard to know because DOs are lumped with IMGs but you shouldn't assume that you compare favorably to the other people in the non-allopathic senior group with your history of academic difficulty. Sorry this is harsh, I just think you aren't getting great advice if people are encouraging you to get out before you train.

 

[Doctor Bob]

I just think you aren't getting great advice if people are encouraging you to get out before you train.

Indeed. The problem the OP is going to run into is that a civilian place is going to look at the exam failures (even with future passing attempts) plus the long time out of training as a significant downside. Especially for EM.

The military system at least will give you points for your GMO tour.

 

[gin and tonic]

First of all thank you for you advice (even if it is harsh)! I guess I should briefly describe what it is that I do. I am not a traditional AF flight doc but am operationally focused (line-side). Most of what we do is train to provide point of injury care i.e., CASEVAC. Our focus is not clinical (although we see clinic when we are in garrison); rather it is training - mostly operational emergency medicine - and deployments.
At the moment I plan on continuing my current job for 3 more years but in Japan. I think the experience has been good overall (including training minus AMP) even with the bureaucracy. I have learned valuable EM skills and have had awesome hands-on training (again very atypical for most med group flight docs).
I have considered an AF EM program but they are pretty limited in terms of geography and if I do go through with it I will owe them more time afterwards. I do not see myself as a career military physician.
With the experience of this job I was hoping to negate some the issues I had when I was "younger". Interestingly I didn't have trouble with medical school. No, I wasn't stellar by any means but I wasn't at the bottom of my class. For some reason I struggled with the standardized tests. Unfortunately for me I understand that that will haunt me but will my experiences help negate those past failures? What can I do to help make myself a better EM candidate at this time? Any feedback is appreciated.

 

[eschott]

How do I get your job...sounds like fun

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[244913]

First of all thank you for you advice (even if it is harsh)! I guess I should briefly describe what it is that I do. I am not a traditional AF flight doc but am operationally focused (line-side). Most of what we do is train to provide point of injury care i.e., CASEVAC. Our focus is not clinical (although we see clinic when we are in garrison); rather it is training - mostly operational emergency medicine - and deployments.
At the moment I plan on continuing my current job for 3 more years but in Japan. I think the experience has been good overall (including training minus AMP) even with the bureaucracy. I have learned valuable EM skills and have had awesome hands-on training (again very atypical for most med group flight docs).
I have considered an AF EM program but they are pretty limited in terms of geography and if I do go through with it I will owe them more time afterwards. I do not see myself as a career military physician.
With the experience of this job I was hoping to negate some the issues I had when I was "younger". Interestingly I didn't have trouble with medical school. No, I wasn't stellar by any means but I wasn't at the bottom of my class. For some reason I struggled with the standardized tests. Unfortunately for me I understand that that will haunt me but will my experiences help negate those past failures? What can I do to help make myself a better EM candidate at this time? Any feedback is appreciated.

I agree with Gastrapathy. You need to stay in the military and get a residency out of it, then serve the remainder of your time and get out.

I was also a 4 year flight surgeon, operational with another service, with 2 deployments to Afghanistan and a lifetime of harrowing experiences/combat stories to tell interview committees. From your post I'm assuming your working with the PJ's/PEDRO or something similar.

Your stories, unfortunately, will only really help you once you've been granted an interview. In that sense you definitely stand apart from most other 4th year medical students. But with your board exam issues, not taking all the USMLE exams, and being a DO, you are going to have a tough time even getting interviews on the civilian side.

I went to a good allopathic medical school, had decent grades, but my Step 1 and 2 were sub-par. Obviously no failures or anything of the sort. I applied for a competitive specialty (similar to EM) and still had a tough time getting enough interviews to be assured of matching. With your background and stats, aside from the military stuff, I doubt I would have been granted maybe more than 2-3 interviews, including my home institution. They say you really need 8-10 to have a >95% chance of matching BTW.

I would stay in the military system for residency training if I were you. In there, your points accrued as a flight doc give you far more leverage than you would have as a 5 year GMO exiting into the civilian match. You also need to consider that residencies no longer give spots outside the match, which used to be a significant advantage for ex-GMO's and flight surgeons. Also, on the civilian side all residencies across the board are getting more competitive every year.

My two cents as someone who's been there and done that. Good luck.

-61N

 

[deuist]

What can I do to help make myself a better EM candidate at this time? Any feedback is appreciated.

Don't forget publications. Peer-reviewed research gives significant bonus points on the military match.

 

[NavyFP]

I concur with the others, your best chance at a residency of YOUR choosing is to stay in.

 

[orbitsurgMD]

Are you deployed in a billet stationed elsewhere and have you already accepted orders to Japan? Do you presently have an application in process? I understand the appeal of the OCONUS tour, but training should be a priority, and I doubt you will be more competitive in three years' time than you are now with a GMO tour down.

 

[gin and tonic]

I have accepted orders to Japan. For both my wife and myself this was an opportunity that was too good to be true. The timing was such that I would have not had an opportunity like this again. And because of the high ops tempo that this job entails this is the time in my life to do this.

 

[a1qwerty55]

I have accepted orders to Japan. For both my wife and myself this was an opportunity that was too good to be true. The timing was such that I would have not had an opportunity like this again. And because of the high ops tempo that this job entails this is the time in my life to do this.

So you have marginal test taking ability which predicts a marginal fund of knowledge, you completed what likely was a very marginal PGY1 year and now will be out of clinical medicine for 5 years because Japan was just to great to pass up. Scary on so many levels.

 

[pgg]

So you have marginal test taking ability which predicts a marginal fund of knowledge, you completed what likely was a very marginal PGY1 year and now will be out of clinical medicine for 5 years because Japan was just to great to pass up. Scary on so many levels.

Trouble ahead, indeed.


OP, it sounds like you're PCS'ing to Japan this summer? What's so great about Japan / what makes it such an opportunity? Family or personal connection there?


Your best odds for getting your career back on track is, as others have said, the military match. You should apply through this year's military match when the application opens up in a few months. The best possible outcome would be selection at the Nov 2013 board and an early departure from Japan to start residency July 2014. You may or may not have trouble getting your CO's endorsement for the GME application since you'd be asking for it about 20 minutes after arriving this summer. Ask anyway. GME orders trump all others and can get you out of your 3 year stint in Japan.

Your odds on the outside are grim. There's no reason to believe that you'd do well enough on USMLE Step II to help at this point, given your distance from med school and previous test taking difficulty. Every year that goes by it will be harder to get to residency.

Honestly, with your plan, you're looking at getting out of the Navy in 2016 (?) and looking for shift work at a doc-in-the-box. There ain't no future there.

 

[IlDestriero]

So you have marginal test taking ability which predicts a marginal fund of knowledge, you completed what likely was a very marginal PGY1 year and now will be out of clinical medicine for 5 years because Japan was just to great to pass up. Scary on so many levels.

I agree 100%. As noted above, for some people, their GMO time was full of interesting clinical experiences and could fill 10 interviews. Based on what you said, your non clinical GMO time coupled with your test proven marginal baseline clinical ability are the kiss of death for civilian GME. I would seriously question your ability to finish residency, provide safe care, and ultimately pass your specialty boards. You would never be granted an interview. Cashing in on your vet status and possible leadership skills can only get you so far. Some second and third tour GMO assignments have significant, real leadership components. Teaching is not leadership. It sounds like you're on a pathway to management and not clinical medicine. Have you considered that? Perhaps you could get out in a few years and use your GI bill to pay for an MBA, MMM, etc.
If you want to continue in medicine in a remotely competitive field, military GME is most likely your only option for success. Don't forget that you started with two strikes against you with a DO and not taking the USMLE. You could roll the dice and take step 2 and 3, but being so far out of medical school with limited clinical experiences, and your history of difficulty with the tests, make the odds of success very low. If you do fail another test, even the military GME programs won't want you.
In the civilian world, you're just too much of a risk and not competitive.
If you do manage to secure a residency, your past issues will be a distant speed bump provided you perform well. You're only as good as the last thing you did. Your medical school and GMO time become largely irrelevant after residency, your residency becomes irrelevant after fellowship, fellowship becomes less relevant after a few years in practice, etc.
Good luck.

 

[bustbones26]

I agree 100%. As noted above, for some people, their GMO time was full of interesting clinical experiences and could fill 10 interviews. Based on what you said, your non clinical GMO time coupled with your test proven marginal baseline clinical ability are the kiss of death for civilian GME. I would seriously question your ability to finish residency, provide safe care, and ultimately pass your specialty boards. You would never be granted an interview. Cashing in on your vet status and possible leadership skills can only get you so far. Some second and third tour GMO assignments have significant, real leadership components. Teaching is not leadership. It sounds like you're on a pathway to management and not clinical medicine. Have you considered that? Perhaps you could get out in a few years and use your GI bill to pay for an MBA, MMM, etc.
If you want to continue in medicine in a remotely competitive field, military GME is most likely your only option for success. Don't forget that you started with two strikes against you with a DO and not taking the USMLE. You could roll the dice and take step 2 and 3, but being so far out of medical school with limited clinical experiences, and your history of difficulty with the tests, make the odds of success very low. If you do fail another test, even the military GME programs won't want you.
In the civilian world, you're just too much of a risk and not competitive.
If you do manage to secure a residency, your past issues will be a distant speed bump provided you perform well. You're only as good as the last thing you did. Your medical school and GMO time become largely irrelevant after residency, your residency becomes irrelevant after fellowship, fellowship becomes less relevant after a few years in practice, etc.
Good luck.

A gentleman in my med school class had some problems as well, he even failed some courses. Now, he got into one of those "crappy" osteopathic EM residencies. However, he did just fine, works in an actuall ER today, passed his EM boards, and is happy.

Look, the board failures will ALWAYS be a black mark on your record, no matter who you attempt to do residency with. In my opinion, your only purpose for staying in the military is because it might earn you a better chance of getting an EM residency. But if the AF denies you this, why would you stay in to do FP and just go back out as a non-clinical GMO again? BTW, you can use your 911 GI bill for civilian GME

 

[ProwlerturnGas]

WOW! Harsh....Man

 

[ProwlerturnGas]

.

 

[bustbones26]

WOW! Harsh....Man

Harsh is correct!!

There are two differences between the EM doctor I know that was a screw up in medical school and did his "crappy" osteopathic EM residency at "St. Elsewhere" and the other doctor I know that scored 90th+ percentile on exams during his military EM residency---------

One is working in an emergency room, seeing emergency room patients, always has, and always will, while the other is a BDE surgeon reporting to an infantry commander the vaccination status of the unit and maybe gets to moonlight in the ER on occasion. Guess which one is which

The second difference? One if getting paid a lot more money than the other, guess which one?

Your board failures will always be a stain on your record, but please do not give up on yourself. You owe it to yourself to attempt an EM residency and if you cannot get in, then opt for an alternate specialty. Don't waste your time!! Study now!! Read up now!! This way, if you get into an EM residency, you can hit the ground running!! Even if you don't get into EM and opt for an alternative such as FP, you can STILL be ready.

 

[cerebral edema]

First of all thank you for you advice (even if it is harsh)! I guess I should briefly describe what it is that I do. I am not a traditional AF flight doc but am operationally focused (line-side). Most of what we do is train to provide point of injury care i.e., CASEVAC. Our focus is not clinical (although we see clinic when we are in garrison); rather it is training - mostly operational emergency medicine - and deployments.
At the moment I plan on continuing my current job for 3 more years but in Japan. I think the experience has been good overall (including training minus AMP) even with the bureaucracy. I have learned valuable EM skills and have had awesome hands-on training (again very atypical for most med group flight docs).
I have considered an AF EM program but they are pretty limited in terms of geography and if I do go through with it I will owe them more time afterwards. I do not see myself as a career military physician.
With the experience of this job I was hoping to negate some the issues I had when I was "younger". Interestingly I didn't have trouble with medical school. No, I wasn't stellar by any means but I wasn't at the bottom of my class. For some reason I struggled with the standardized tests. Unfortunately for me I understand that that will haunt me but will my experiences help negate those past failures? What can I do to help make myself a better EM candidate at this time? Any feedback is appreciated.

Are you working with PJ's?