Any reasonable path to psych?

[starbuck2]

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Well gang I’ve dug myself into a situation and am wondering if you have thoughts on whether I have any sort of reasonable/feasible path into psych or if I should just move on.

Current 4th year US MD. I have some red flags so a couple psych advisors talked me out of psych near the end of 3rd year. I applied into pediatrics (my second love). Red flags are a failed step 1 (passed 2nd), low step 2 (23x), and a pass on psych rotation. I understand why my advisors had significant concerns but now I regret not giving it a shot at least then SOAPing into peds. Not my best decision but I guess I figured I’d rather have the stability of matching into a better peds program vs the risk of not matching psych and soaping.

Anyways I now have regrets gnawing away at me and I haven’t even started intern year (heck, I haven’t even matched yet). Are there any pathways that would give me a shot at psych? Or should I give it up? Time is of the essence as I have two kids of my own to support and can’t take a year off to reapply, etc. I’ve hear of the post pediatric portal program into child and adolescent psych (which has been the psych specialty I’ve always wanted to do) but six years feels like a long road and I have absolutely no idea how competitive those few spots are. If they’re even remotely competitive I feel like my app would get tossed in the bin right away because of my academic red flags from med school.

Thanks in advance.

 

[Bartelby]

Some programs allow PGY2 transfer. The three problems you listed with your application do not seem like enough on their own to guarantee you would not match. I think doing your intern year and trying to transfer PGY2 year sounds like your best bet.

 

[splik]

Post-peds portal is your best bet. It would have been better to double apply to psych and peds to see what happens, but with a step 1 failure, poor performance on psych clerkship and and no compensating factors (at least you didn't mention anything like going to a top med school, having a PhD, having multiple psych publications, URM applicant etc) it would have been tough and you may not have SOAPed. even if you did get a SOAP position, you'd have far less choice over where you ended up.

By the time you're done with peds and have passed step 3, no one will care about your step 1 score. You could either do PPP or apply to PGY-2 spots in psych AFTER peds residency. you would not be competitive for PGY-2 spots applying as a PGY-1 based on the information provided.

 

[Bartelby]

Post-peds portal is your best bet. It would have been better to double apply to psych and peds to see what happens, but with a step 1 failure, poor performance on psych clerkship and and no compensating factors (at least you didn't mention anything like going to a top med school, having a PhD, having multiple psych publications, URM applicant etc) it would have been tough and you may not have SOAPed. even if you did get a SOAP position, you'd have far less choice over where you ended up.

Interesting, I may be out of touch with current psychiatry competitiveness. I would have thought these were negatives but not application killers.

Thinking more about it on a practical level if you would need to declare your intent to match in PGY2 and potentially give up the peds spot if you don't match then that might be too risky. I believe you would need your program director's support for that PGY2 transfer application, if that means they would seek to fill your spot then post-peds portal might be the way to go. Ending up without either the peds or psych residency would be much worse than just doing peds.

 

[Stagg737]

and a pass on psych rotation

poor performance on psych clerkship

Interesting, I may be out of touch with current psychiatry competitiveness. I would have thought these were negatives but not application killers.

So going to disagree a bit here, but a Pass on psych clerkship is not a red flag where I’m at (mid-tier academic). It’s definitely not ideal, but extremely unlikely to be something we even consider unless there’s some MSPE or preceptor comments included that are concerning.

A failed Step 1 with a lower Step 2 would likely be DOA though. We’ve got to find a way to cut down ii numbers, and that’s probably the easiest and legitimate if there’s concerns an applicant won’t pass Step 3. I was actually directly asked about this where I did residency as my board scores were poor, and had a strong study plan outlined as a response. Anyone with a failure or low scores should be ready to answer that question.

By the time you're done with peds and have passed step 3, no one will care about your step 1 score. You could either do PPP or apply to PGY-2 spots in psych AFTER peds residency. you would not be competitive for PGY-2 spots applying as a PGY-1 based on the information provided.

I’m also going to partially disagree here. If OP becomes aware of a PGY-2 spot to transfer into, they should go for it if they still want psych. To be clear for OP, I’m not talking about trying to match as a PGY-2, in which case the only way you’d have any chance is to pass Step 3 before September. I mean to try to find out what programs will have PGY-2 slots available to transfer to. That will require a supportive PD during your intern year and some legwork on your end to find those positions, but it’s certainly possible. Where I did residency it happened twice when I was there, and neither of those who joined as PGY-2s were superstars. We just had openings due to PGY-4s leaving early for CAP.

All that said, I agree that the best option is most likely the PPP, as failing Step 3 would kill any chance of psych before then and would be another huge red flag.

 

[comp1]

Concur that pass on psych is not a red or even yellow flag. Many, if not most, medical schools have moved away from offering honors. I'm also not sure a 230 on Step 2 is a red flag unless psychiatry has changed dramatically since I applied. Any failure is, of course, because the residency needs to be confident you'll pass Step 3, not necessarily that the Steps prognosticate any other particular success in psychiatry residency.

 

[calvinhobbes]

I know people in the peds portal program. Your best option at this point is hope to match into peds, and apply for the post pediatric portal program, show interest early and often! Build up your resume. I hear the spots are competitive as there aren’t many, but it’s really applicant dependent and what they may be looking for that year changes yearly. They will care more about your peds training and experience and interest in psych during those years. Traditional Psych to child psych is 5 or 6 years, so you’re really not losing any time if you peds portal. Or try to transfer to psych in your institution if you match peds but it may be harder.

 

[Merovinge]

As a sideways consideration, there would always be the option for more typical peds fellowships like Adolescent Medicine and Developmental Peds, which are certainly not the same as CAP, but do have quite a bit of crossover. If you like eating disorders, you will get far more training in it with adolescent medicine than in psychiatry (which is odd, but that's another talk show), and you can certainly be doing 1st and 2nd line psychopharmacology with your teens. If you like kids with serious issues and being their go-to in wading through the serpentine medical system, developmental peds can be great.

Beyond anything else, just see what you think about peds. The pay sucks, but it remains an amazing field with lots of great fellowships off it. I think the pediatrician driving their Honda is often a lot happier than the specialty surgeon in their Ferrari if you can walk back a bit from our primate desire for social comparison.

 

[Osminog]

I am involved in advising for medical students who are currently applying to psychiatry, and I can confidently tell you that 23x Step 2 and a "pass" on psychiatry clerkship are not red flags. The Step 1 failure, on the other hand, is a red flag — but it's far from insurmountable.

If you match into a pediatrics program at a hospital that also has a psychiatry program, reach out to the psychiatry PD and discuss the possibility of an "internal" transfer outside of the match. If you're told that this would not be a possibility, ask for help with the process of landing a psych spot at a different program; the program leadership may have connections who would be able to help you. Networking can be invaluable in your situation.

If the above option isn't available or doesn't work out, pass Step 3 during early PGY-1 and apply broadly through the match. And if you're fully committed to psychiatry, don't opt for the post-pediatric portal; it would be an unnecessary time sink.

 

[calvinhobbes]

I am involved in advising for medical students who are currently applying to psychiatry, and I can confidently tell you that 23x Step 2 and a "pass" on psychiatry clerkship are not red flags. The Step 1 failure, on the other hand, is a red flag — but it's far from insurmountable.

If you match into a pediatrics program at a hospital that also has a psychiatry program, reach out to the psychiatry PD and discuss the possibility of an "internal" transfer outside of the match. If you're told that this would not be a possibility, ask for help with the process of landing a psych spot at a different program; the program leadership may have connections who would be able to help you. Networking can be invaluable in your situation.

If the above option isn't available or doesn't work out, pass Step 3 during early PGY-1 and apply broadly through the match. And if you're fully committed to psychiatry, don't opt for the post-pediatric portal; it would be an unnecessary time sink.

Agree with the above but just wanted to comment that the post peds portal is not an unnecessary time sink if OP does peds as his only option, and then becomes accepted to post peds portal, he’s only spending an extra year (6 total rather than 5 from the psych —> cap route). Also keep in mind some people do 4 years of gen psych then 2 years of CAP if they dont fast-track, so in reality it all works out anyway.

 

[Osminog]

Agree with the above but just wanted to comment that the post peds portal is not an unnecessary time sink if OP does peds as his only option, and then becomes accepted to post peds portal, he’s only spending an extra year (6 total rather than 5 from the psych —> cap route). Also keep in mind some people do 4 years of gen psych then 2 years of CAP if they dont fast-track, so in reality it all works out anyway.

Fair enough. I would think that landing a post-pediatrics portal spot wouldn't be a guarantee, though. There are only 5 programs (~10 spots nationwide). Given how psychiatry is becoming more popular — and pediatrics compensation isn't getting any higher, I imagine this pathway is becoming at least mildly competitive.

 

[starbuck2]

Thanks everyone for your very helpful input. I have some thoughts and individual replies but will post again tomorrow. Traveling tonight.

 

[J ROD]

I do not see the Psych rotation pass as a problem, nor the the Step 2 score. Failing Step 1 is a concern for sure but you did pass Step 2. If you really want psych and there is a few months left in the match, can you apply to a few lower tier psych programs and give it a shot? Try to get letters of recommendation from two psych folks and call some programs. I had about half my interviews after Jan. Might can get a couple interviews in if you have no geographic issues.