Any advice from people who did their second or third choice specialty??

[kgamon8]

Hi everyone, previously in my M3 year I was considering dropping out, with motivation from my family I’ve decided to keep going and am doing better emotionally. But I still have my low step 1 (205) and will have one HP and rest Ps in clinicals.

Really tried to like the rest of my peds rotation bc I love kids but I really disliked both clinic and inpatient, the general medicine of peds didnt interest me. FM was fun in a rural setting but liked it much less in my city (300k), living rural (after residency..would do rural residency) is not an option as a POC with disabled family members

Anyone in my situation did you just go for either of these? Or did you try for dream specialty (mine would be obgyn or anesthesia). I have spent a lot of time telling myself that maybe pursuing a peds specialty would give some fulfillment. Maybe that’s right but it is a three year fellowship. But I have no bargaining chips. No mentors or research in either obgyn/gas (some third author pubs in basic science). I don’t think I can take the risk of not matching.

So I feel it’s too risky to spend fourth year time doing a subi in anything else besides peds to secure some letters. So I filled my schedule with peds stuff but feel myself kind of dreading it. It’s hitting me that this will be my life. Seeking advice about accepting my circumstances and being positive. I’ve spent too long wishing I took a gap year for P/F or pushing my admin for more study time… have to move on…

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[Captain_Falcon]

What did you not like about FM in a 300k person city? I am no expert on OB or Anesthesia for competitiveness but a 205 surely limits your problems for both whereas Family it doesn't matter much

 

[stickgirl390]

Im applying to OB right now. 205 is pretty risky for OB, but it’s technically not impossible if the rest of your app compensates. The OB average is 230-235. If I’m not mistaken, there are FM programs that are OB heavy, and I think there is an OB fellowship after FM residency that’s out there? Not 100% sure

 

[M&L]

Well why not dual apply and see how it turns out ? Please don’t go into peds if you are dreading it . It would make your life hell . I would explode subspecialties of FM instead . How about substance abuse ? Sounds interesting !
But yeah, why not dual apply ???

 

[GoSpursGo]

Do you have anything in your app that would compensate for the step score? It is possible to match obgyn or anesthesia with that score, but only if there is something else in your app that compensates.

Also, the most important thing when applying for a reach specialty is knowing how your home program views you. If you seriously want to consider applying, you need to start making connections now, and get some honest feedback about whether they would consider keeping you. If it’s a no from your home program, then I can’t recommend taking the risk.

 

[Mass Effect]

Hi everyone, previously in my M3 year I was considering dropping out, with motivation from my family I’ve decided to keep going and am doing better emotionally. But I still have my low step 1 (205) and will have one HP and rest Ps in clinicals.

Really tried to like the rest of my peds rotation bc I love kids but I really disliked both clinic and inpatient, the general medicine of peds didnt interest me. FM was fun in a rural setting but liked it much less in my city (300k), living rural (after residency..would do rural residency) is not an option as a POC with disabled family members

Anyone in my situation did you just go for either of these? Or did you try for dream specialty (mine would be obgyn or anesthesia). I have spent a lot of time telling myself that maybe pursuing a peds specialty would give some fulfillment. Maybe that’s right but it is a three year fellowship. But I have no bargaining chips. No mentors or research in either obgyn/gas (some third author pubs in basic science). I don’t think I can take the risk of not matching.

So I feel it’s too risky to spend fourth year time doing a subi in anything else besides peds to secure some letters. So I filled my schedule with peds stuff but feel myself kind of dreading it. It’s hitting me that this will be my life. Seeking advice about accepting my circumstances and being positive. I’ve spent too long wishing I took a gap year for P/F or pushing my admin for more study time… have to move on…

Lots to consider here.

You say you're doing better emotionally. What was happening before? Were you depressed about medicine in general or were there external factors? It sounds like it was bad enough that your family was also encouraging you to drop out so I'm curious if you were just hating medicine?

What parts of the rural FM did you enjoy? Why would rural FM not be a possibility? You said you have a disabled relative so is it because you want to be in a big city to access medical care for that person? There are some places that are "rural" but not too far from a big city. I guess that depends on the disability of your relative.

Never apply to a specialty you hate. Write off peds if you don't like it. I would probably apply to one of your dream specialties with FM as the back up (at different places). With FM, you will do a lot of Ob/Gyn. You can even do a fellowship from FM so here is flexibility and ability to do the stuff that attracts you to OB. Once you're out of residency, you can try to meld the things you like about rural FM wherever you are and/or try to live in a rural area of a more metro suburb/city.

 

[kgamon8]

Lots to consider here.

You say you're doing better emotionally. What was happening before? Were you depressed about medicine in general or were there external factors? It sounds like it was bad enough that your family was also encouraging you to drop out so I'm curious if you were just hating medicine?

What parts of the rural FM did you enjoy? Why would rural FM not be a possibility? You said you have a disabled relative so is it because you want to be in a big city to access medical care for that person? There are some places that are "rural" but not too far from a big city. I guess that depends on the disability of your relative.

Never apply to a specialty you hate. Write off peds if you don't like it. I would probably apply to one of your dream specialties with FM as the back up (at different places). With FM, you will do a lot of Ob/Gyn. You can even do a fellowship from FM so here is flexibility and ability to do the stuff that attracts you to OB. Once you're out of residency, you can try to meld the things you like about rural FM wherever you are and/or try to live in a rural area of a more metro suburb/city.

I had undiagnosed hypothyroidism.

Yes, i will have full care of brother with CP/autism.

 

[kgamon8]

Do you have anything in your app that would compensate for the step score? It is possible to match obgyn or anesthesia with that score, but only if there is something else in your app that compensates.

Also, the most important thing when applying for a reach specialty is knowing how your home program views you. If you seriously want to consider applying, you need to start making connections now, and get some honest feedback about whether they would consider keeping you. If it’s a no from your home program, then I can’t recommend taking the risk.

What would compensate?

 

[kgamon8]

Well why not dual apply and see how it turns out ? Please don’t go into peds if you are dreading it . It would make your life hell . I would explode subspecialties of FM instead . How about substance abuse ? Sounds interesting !
But yeah, why not dual apply ???

Thank you I appreciate this. I like kids I think enough to make me not dread going to clinic. Will try again 4th year and look for the spark then consider family

 

[Ho0v-man]

With your scores and not so great clinical grades, I would just do my best to match FM tbh. There are OB fellowships. But these can get competitive so you need to go to an OB heavy FM residency as they want higher than bare minimum numbers of deliveries, etc.

Addiction is a good fellowship choice for someone wanting to be in a bigger city.

An often overlooked and extremely not competitive fellowship is palliative.

 

[Dr G Oogle]

What about a peds fellowship or IM fellowship, if you like anesthesia maybe you’ll like ICU or NICU or even pulm? You’re story is compelling enough to compensate for the low board score. If you’ve overcome a lot in med school that’s more of a marker of success than a one day test. We’ve matched people into urology with 210s because of similar circumstances and they turned out to be great.

Just like everyone else said, check out the OB dept at your school and see what they say.

 

[NITRAS]

Why OB or gas? If you hate Peds clinic, why did you like rural FM but not “big city” FM?

You won’t have time to take care of family in either gas or OB residency.

I have a very low step 1 score (Lower than yours btw). I was interested in anesthesia. I applied to both. I should have not wasted my money and just applied to IM. I did get one anesthesia interview, btw. It was a program that was in suspension that I didn’t rank.

Honestly, I feel that you are running from something as opposed to running to something. Figure out why you like or don’t like about a rotation. Remembrer that once you are An attending, you have a lot more control about how you set yourself up. You don’t have hardly any control in residency, but it is only a season. Try and have the 5 and 10 year picture in mind. You will figure it out.

 

[Taddy Mason]

Addiction is a good fellowship choice for someone wanting to be in a bigger city work with patients with substance use disorders.

FTFY.

 

[Ho0v-man]

FTFY.

Obviously they’d have to like the job. Just trying to explain that there are more fellowships after FM than just sports med and OB since everyone seems to think that’s all there is. For instance, I thought obesity would be pretty interesting stuff and kinda satisfying work.

 

[kgamon8]

Why OB or gas? If you hate Peds clinic, why did you like rural FM but not “big city” FM?

You won’t have time to take care of family in either gas or OB residency.

I have a very low step 1 score (Lower than yours btw). I was interested in anesthesia. I applied to both. I should have not wasted my money and just applied to IM. I did get one anesthesia interview, btw. It was a program that was in suspension that I didn’t rank.

Honestly, I feel that you are running from something as opposed to running to something. Figure out why you like or don’t like about a rotation. Remembrer that once you are An attending, you have a lot more control about how you set yourself up. You don’t have hardly any control in residency, but it is only a season. Try and have the 5 and 10 year picture in mind. You will figure it

Why OB or gas? If you hate Peds clinic, why did you like rural FM but not “big city” FM?

You won’t have time to take care of family in either gas or OB residency.

I have a very low step 1 score (Lower than yours btw). I was interested in anesthesia. I applied to both. I should have not wasted my money and just applied to IM. I did get one anesthesia interview, btw. It was a program that was in suspension that I didn’t rank.

Honestly, I feel that you are running from something as opposed to running to something. Figure out why you like or don’t like about a rotation. Remembrer that once you are An attending, you have a lot more control about how you set yourself up. You don’t have hardly any control in residency, but it is only a season. Try and have the 5 and 10 year picture in mind. You will figure it out.

I have seen that while rural fm sees some kids suburban sees none and is basically like outpatient IM. I like kids enough and I think they would keep me going as opposed to strictly adults. But general peds was pretty boring to me and most specialties are tied to academic centers. I’ve considered med peds but that appears competitive.

I have shadowed pediatric anesthesia and that was my end goal in gas. Like I prefer working in specialty and catering to kids vs antibiotics and asthma.

OB was something I tried to hate but fell in love with. I liked the variety of clinic and l&d and surgery and especially the patient population.

 

[TelemarketingEnigma]

Med Peds is a great specialty but it’s gonna have all the boring parts of both IM and Peds (in addition to the fun parts of each). Is peds clinic boring to you because of the flow of outpatient work or the types of cases you see?

If you were to look into MP the step score isn’t going to help, it’s definitely below the average for the specialty. but I will say that there are many MP PDs who really emphasize the fact that they don’t look closely at scores and care more about other things. It is hard to know if they really walk the walk though, you can talk all you want about holistic review but still end up with a class of only high scores.

 

[kgamon8]

Med Peds is a great specialty but it’s gonna have all the boring parts of both IM and Peds (in addition to the fun parts of each). Is peds clinic boring to you because of the flow of outpatient work or the types of cases you see?

If you were to look into MP the step score isn’t going to help, it’s definitely below the average for the specialty. but I will say that there are many MP PDs who really emphasize the fact that they don’t look closely at scores and care more about other things. It is hard to know if they really walk the walk though, you can talk all you want about holistic review but still end up with a class of only high scores.

 

[Taddy Mason]

I’m a little confused by some of the aspects of your situation. You mention living restrictions due to caring for family as being a downside to FM - why would this only impact where you live as an attending and not as a resident/fellow? I’m also confused as to what about rural FM made it appealing enough to compensate for your dislike of general outpatient IM/Peds, as the latter is still going to be your bread and butter even in a rural setting. As per below, is it because of the greater perceived “respect” of FM in rural locations v. more urban? In your initial post, you also don’t seem thrilled about the length of training for peds + fellowship but this is essentially the same length of training as gas + peds gas fellowship. As others have suggested, it seems like there’s something else you dislike about about peds and FM (e.g., medicine altogether, the perceived “prestige” of these specialties, etc.) and that these are merely surface level excuses that probably warrants some more introspection/self-reflection on your part.

That said, and taking the rest of your posts in this thread as is, I don’t think applying to OB/Gyn or gas is completely unreasonable so long as you don’t put all your eggs in one basket and apply broadly (both in geography and quantity) and also apply to a back-up specialty (e.g., either FM or peds). I realize it’s anecdotal, but I had classmates and knew people in the class above me at a “low tier” MD school with similar Step 1 scores and academic performance, little to no research/nothing outstanding as far as ECs to compensate for academic performance, and no home program in either specialty who managed to match both OB/Gyn and gas - though they all managed to do much better on Step 2…

As far as FM, practicing in an urban setting v. rural is basically going to limit doing things like colonoscopies and EM/hospitalist work, though urgent care would still be doable and depending on the hospital and your training working as a hospitalist may still be a possibility. Minor procedures like vasectomies and uncomplicated joint injections are very much possible to make part of your practice even in an urban setting. I live in one of the major cities in the NE and the physician who delivered my son and is the PCP for my spouse and son is FM who did an OB fellowship. She works for a hospital system, the bulk of her practice is uncomplicated OB and peds, and she routinely does uncomplicated c-sections as well. She’s also not an exception as there were plenty of similarly trained FM docs with similar practices in the area that my wife considered. So I think you have some misconceptions as how different rural v. suburban/urban FM is (at least as far as limitations in practice as an attending) and/or this is a superficial excuse to write off FM.

 

[calivianya]

I will throw in a disclaimer that I don't know much about OB specifically as a field.

People don't seem to be mentioning it, but since you had a legit medical condition likely contributing to your step 1 performance, I bet a baller step 2 might open some doors. I also think it's possible to dramatically raise your step 2 score if you can successfully argue that your step 1 and clinical rotation scores were in fact due to untreated hypothyroidism that affected your studying.

It sounds like you really like OB so I would at least dual apply OB/FM and try to knock step 2 out of the park, then I would reach out to all OB faculty at your school to see what connections they have and who they can email to get someone to review your app. You might be auto-filtered out because of that step 1, but someone asking a PD/selection committee to take a look, and then that person seeing a 240+ or 250+ step 2, the rest of your rotations being HP or honors, and then reading your story, might get you an interview or two.

I'm a little confused by your timeline - like how you'd know your clinical grades for all of third year already considering that it's only December, and how you're scheduling fourth year rotations already as a c/o 2023. Do you not have any third-year rotations in the spring that you could possibly do better on? And VSAS didn't even open up until April 15th last year for away apps, so you have months before you could even submit apps for fourth year away rotations anyway, so you have plenty of time to think about it if you want to do aways for letters.

 

[Matthew9Thirtyfive]

I'm a little confused by your timeline - like how you'd know your clinical grades for all of third year already considering that it's only December, and how you're scheduling fourth year rotations already as a c/o 2023. Do you not have any third-year rotations in the spring that you could possibly do better on? And VSAS didn't even open up until April 15th last year for away apps, so you have months before you could even submit apps for fourth year away rotations anyway, so you have plenty of time to think about it if you want to do aways for letters.

Different schools have different curricula. We started our third year rotations halfway through second year. I finished my third year rotations about three weeks ago and have all my fourth year rotations (which start in March) scheduled except one.

 

[calivianya]

Different schools have different curricula. We started our third year rotations halfway through second year. I finished my third year rotations about three weeks ago and have all my fourth year rotations (which start in March) scheduled except one.

Just curious - does your school let you cancel your rotations you have planned if you do get an away later, or do they make that difficult? We just have to have our rotations scheduled 60 days before the start date of the rotation, so we can wait to hear back before scheduling anything, which is nice since they make us do extra paperwork to cancel a rotation.

 

[Matthew9Thirtyfive]

Just curious - does your school let you cancel your rotations you have planned if you do get an away later, or do they make that difficult? We just have to have our rotations scheduled 60 days before the start date of the rotation, so we can wait to hear back before scheduling anything, which is nice since they make us do extra paperwork to cancel a rotation.

No, you can literally just email them and cancel. I’ve known people who canceled 2 weeks before a rotation and rescheduled something else.

 

[kgamon8]

I will throw in a disclaimer that I don't know much about OB specifically as a field.

People don't seem to be mentioning it, but since you had a legit medical condition likely contributing to your step 1 performance, I bet a baller step 2 might open some doors. I also think it's possible to dramatically raise your step 2 score if you can successfully argue that your step 1 and clinical rotation scores were in fact due to untreated hypothyroidism that affected your studying.

It sounds like you really like OB so I would at least dual apply OB/FM and try to knock step 2 out of the park, then I would reach out to all OB faculty at your school to see what connections they have and who they can email to get someone to review your app. You might be auto-filtered out because of that step 1, but someone asking a PD/selection committee to take a look, and then that person seeing a 240+ or 250+ step 2, the rest of your rotations being HP or honors, and then reading your story, might get you an interview or two.

I'm a little confused by your timeline - like how you'd know your clinical grades for all of third year already considering that it's only December, and how you're scheduling fourth year rotations already as a c/o 2023. Do you not have any third-year rotations in the spring that you could possibly do better on? And VSAS didn't even open up until April 15th last year for away apps, so you have months before you could even submit apps for fourth year away rotations anyway, so you have plenty of time to think about it if you want to do aways for letters.

Rotation schedule due today !!

 

[TelemarketingEnigma]

Med-peds is not competitive. I know several DOs with no USMLE and <500 COMLEX who successfully matched in the last 3 cycles.

It's not competitive compared to like derm, but it is slightly more competitive than both peds and IM individually. Fit seems to be very important. Given that there's just fewer programs overall, if I were in OPs shoes and did pick the Med Peds route (because it's the best route, duh) I think that I would dual apply (probably with peds, if they can sort out their feelings about it). It's definitely not off the table at all, but programs are also very geographically limited so unless OP is willing to go literally anywhere, I don't know if going all in on Med Peds sounds right for them.

 

[Mass Effect]

It's not competitive compared to like derm, but it is slightly more competitive than both peds and IM individually. Fit seems to be very important. Given that there's just fewer programs overall, if I were in OPs shoes and did pick the Med Peds route (because it's the best route, duh) I think that I would dual apply (probably with peds, if they can sort out their feelings about it). It's definitely not off the table at all, but programs are also very geographically limited so unless OP is willing to go literally anywhere, I don't know if going all in on Med Peds sounds right for them.

The question why would anyone do Med/Peds when you can just do FM?

 

[Matthew9Thirtyfive]

The question why would anyone do Med/Peds when you can just do FM?

Fellowship. CHD pts from cards, etc. I don’t see the point if you don’t plan on doing fellowship.

 

[TelemarketingEnigma]

The question why would anyone do Med/Peds when you can just do FM?

Tbh FM makes way more sense for OP since they want ob gyn. That’s one of the differentiating factors. Otherwise amount of peds exposure, inpatient time, fellowship opportunities, culture, specific interest in transitional care are main reasons

 

[Chelsea FC]

Hi everyone, previously in my M3 year I was considering dropping out, with motivation from my family I’ve decided to keep going and am doing better emotionally. But I still have my low step 1 (205) and will have one HP and rest Ps in clinicals.

Really tried to like the rest of my peds rotation bc I love kids but I really disliked both clinic and inpatient, the general medicine of peds didnt interest me. FM was fun in a rural setting but liked it much less in my city (300k), living rural (after residency..would do rural residency) is not an option as a POC with disabled family members

Anyone in my situation did you just go for either of these? Or did you try for dream specialty (mine would be obgyn or anesthesia). I have spent a lot of time telling myself that maybe pursuing a peds specialty would give some fulfillment. Maybe that’s right but it is a three year fellowship. But I have no bargaining chips. No mentors or research in either obgyn/gas (some third author pubs in basic science). I don’t think I can take the risk of not matching.

So I feel it’s too risky to spend fourth year time doing a subi in anything else besides peds to secure some letters. So I filled my schedule with peds stuff but feel myself kind of dreading it. It’s hitting me that this will be my life. Seeking advice about accepting my circumstances and being positive. I’ve spent too long wishing I took a gap year for P/F or pushing my admin for more study time… have to move on…

DO PM&R if you end up hating general rehab you can do a peds fellowship to work with kids.