Applying psych with red flags..advice?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

psychguy5

Full Member
Joined
Aug 20, 2020
Messages
17
Reaction score
1
Hello all,

Many apologies if this is the wrong place to post this.

I am a 4th US DO medical student that will be applying psych in the upcoming cycle.

Under extenuating circumstances, I have several red flags on my application (multiple class remediations, Comlex 1 level fail, second attempt sub 450, Comlex 2 sub 500 first attempt), and I am really trying to figure out what my best plan of action is for applying psych.

I am very passionate about the field, as I have overcome my own mental health road blocks and have received treatment for my recently diagnosed ADD. I am also painfully aware that I am not competitive whatsoever for the upcoming season.

Due to my low board scores, I have been virtually unable to be accepted to any audition rotation and I have had a lot of difficulty finding electives in general. I will have the letter requires due to 3rd year rotations and working with my school's chair on research.

I have several job experiences (psych related) as well as having contributed to 2 published articles, and 1 psych abstract so far. I plan on taking 1-2 psych research months to expand upon this aspect of my application, since I will most likely continue to struggle to find rotation experience (citing COVID and scores).

Regarding step 1, that is really a mixed bag for me. I'm very aware that I do not do well on standardized tests, and that every practice exam I have ever taken has over-predicted my score significantly. I also understand the importance of the exam for applications. Prior to receiving my Comlex 2 score, I had scheduled Step 1 for end of September, but now believe I should postpone (at the very least) if I decide to take it at all.

I have also read posts here regarding applying to a transition year or something, but the research I have done on that shows very limited PGY2 spots for psych. I could be very incorrect on this, so please correct me if I am.

If anyone has been in a situation similar to this, taken time off, or has been accepted etc, please reach out. If you did not take step 1, or can recommend specific programs, that would awesome, as well.

I understand that I have a lot going against me, so any advice would be greatly appreciated.

Thank you :)

Members don't see this ad.
 
Yeah, I have been told that prior. Would probably rather apply transition year or whatever before family med. Thank you for the input.
 
Members don't see this ad :)
Don't apply everywhere everywhere. There are many places that will not take red flags, or even DOs, let alone both so save their time and your money. It will not change the results. I think you should apply to a lot of places, don't get me wrong. Transitional internships are easier to leave and openly interview during at possible PGY-II slots. I agree with you on that. As far as Step I, if you don't fail it you are better off with it. We can't tell you the odds so it has to be your choice.
 
  • Like
Reactions: 2 users
Don't apply everywhere everywhere. There are many places that will not take red flags, or even DOs, let alone both so save their time and your money. It will not change the results. I think you should apply to a lot of places, don't get me wrong. Transitional internships are easier to leave and openly interview during at possible PGY-II slots. I agree with you on that. As far as Step I, if you don't fail it you are better off with it. We can't tell you the odds so it has to be your choice.

Thank you for your input! I need to look more into transitional years then.. I did not know I could leave them easily.

I'm aware that there are lots of programs that don't take d.o.s and red flags. I'm currently doing research on which programs these are, and making a list. I will be apply to as many less competitive programs as I can.

Regarding step 1, I understand that I would be MUCH better off with a passing step 1 score. The issue is that even if i am doing well on the practice exams, there is a good chance that I could still do poorly/fail on the real thing. If that happened, I would basically not be applying this cycle. The other option would be to take it late and update my programs late, but I'm not sure if that would be any better.

Thank you for responding :)
 
Taking step I in Sept. is also late in that I'm not sure when you will get results. Decisions about who gets interviewed is generally early and as interview positions saturate early and the bar goes up on who gets invited. I don't suggest that you purposely miss a cycle for any reason or any result in an USMLE. I didn't want to suggest that it is easy to leave a transitional program mid year. I wanted to communicate that it is easier to go to PGY-II interviews while doing a TY year. It is true that there are not many PGY-II positions in the match in psychiatry and many are research tracks, but a lot of PGY-II openings are spontaneous. TY directors may hate me, but leaving mid year from TY will make less angry fellow residents than leaving family medicine, a 3 year program. Be persistent and follow your dreams, but cover your tail with plan Bs and plan Cs.
 
  • Like
Reactions: 1 user
Taking step I in Sept. is also late in that I'm not sure when you will get results. Decisions about who gets interviewed is generally early and as interview positions saturate early and the bar goes up on who gets invited. I don't suggest that you purposely miss a cycle for any reason or any result in an USMLE. I didn't want to suggest that it is easy to leave a transitional program mid year. I wanted to communicate that it is easier to go to PGY-II interviews while doing a TY year. It is true that there are not many PGY-II positions in the match in psychiatry and many are research tracks, but a lot of PGY-II openings are spontaneous. TY directors may hate me, but leaving mid year from TY will make less angry fellow residents than leaving family medicine, a 3 year program. Be persistent and follow your dreams, but cover your tail with plan Bs and plan Cs.

I greatly appreciate your input, thank you!

The score release is before the deadline of oct 15 for application. But just to clarify, is your advice that if I don't take step 1 before the deadline not to take it at all? It makes sense, since it was my initial impression it wouldn't be too important later on. But.. I hadn't had that confirmed.
 
Have you applied to away rotations at bottom of the barrel programs?

Thank you for your reply!

I have tried to apply to many program, especially all throughout my state. The issue is that my board score prevents me to apply to hca programs, and most other programs aren't even accepting students. I've been emailing/reaching out etc without much luck yet. But I'm keeping my head up.
 
Maybe this is not an option for you, but if you end up matching into FM or IM consider completing the residency and then doing psych as a second residency. Being dual boarded and having the medicine experience along with psych will be invaluable for the rest of your career.
 
  • Like
Reactions: 1 user
I would suggest sending letters of interest to lower level programs you would like to interview at. If written well, these will help get you on their radar and may lead to interviews
 
  • Like
Reactions: 1 user
Maybe this is not an option for you, but if you end up matching into FM or IM consider completing the residency and then doing psych as a second residency. Being dual boarded and having the medicine experience along with psych will be invaluable for the rest of your career.

Thank you for your reply. I wouldn't be able to apply internal, as I wouldn't have the letter or required audition (or whatever it is called). I don't think it would make sense for me to go through family med and then psych, but I understand why you made the recommendation. If I were to do something similar, I would probably have to go transition year..as someone recommended previously. I don't know much about doing that, so I am looking into it.

Thanks!
 
I would suggest sending letters of interest to lower level programs you would like to interview at. If written well, these will help get you on their radar and may lead to interviews

Thank you for your reply! Do you have any advice on navigating which programs to send letters (I assume you mean emails) to? I've tried to get this information from my school's advisors, but they continue to tell me to not apply psych. I'm hoping I can find a template, as well.
 
Members don't see this ad :)
Thank you for your reply. I wouldn't be able to apply internal, as I wouldn't have the letter or required audition (or whatever it is called). I don't think it would make sense for me to go through family med and then psych, but I understand why you made the recommendation. If I were to do something similar, I would probably have to go transition year..as someone recommended previously. I don't know much about doing that, so I am looking into it.

Thanks!

I will caution you against going for a transitional year and relying on getting a PGY2 psych spot. They are competitive and very far from a sure thing, and you don't want to finish your transitional year and not have a spot. If there are other backup specialties you will apply to during the TY then OK (maybe), otherwise I would rank non-psych categorical over prelim and transitional positions.
 
  • Like
Reactions: 1 user
Thank you for your reply.

I didn't mean to sound like that would be a definite plan. I know I'm in a bad spot for applying to transition year. It just seemed like the better option to applying family med and trying to leave that, as well.

I'm really just trying to consider all of my options at this point.

:)
 
I greatly appreciate your input, thank you!

The score release is before the deadline of oct 15 for application. But just to clarify, is your advice that if I don't take step 1 before the deadline not to take it at all? It makes sense, since it was my initial impression it wouldn't be too important later on. But.. I hadn't had that confirmed.
If you match somewhere without USMLE, there would be no point in taking it. Getting matched contractually obligates both sides and adding USMLE after you have been granted all the interviews you will get isn't going to change a thing. Getting a USMLE score in while programs are reading applications is useful. Assuming you don't fail of course.
 
  • Like
Reactions: 1 user
If you match somewhere without USMLE, there would be no point in taking it. Getting matched contractually obligates both sides and adding USMLE after you have been granted all the interviews you will get isn't going to change a thing. Getting a USMLE score in while programs are reading applications is useful. Assuming you don't fail of course.

Right, this is what I was trying to address. I was trying to question whether or not it would be worth taking after the application cycle had started. I had heard mixed reviews.. as in, maybe schools would reconsider the app if the Step score was better/passing. But I understand that you are saying that it wouldn't be overtly helpful.

I'm thinking at this time, it would be naive of me to try and take the exam in the month. In additional, it does not seem fruitful to take the exam after the application cycle as started; when I would be more likely to be better prepared. I will continue to ask around and take input on this, but will most likely only consider taking it if I take a gap year.
 
OP, I don't have experience with your situation, so take my advice with a grain of salt:

As others have said, definitely apply broadly in psych, but not to ALL programs as some will filter you out based on your scores/etc. I think it makes sense to also apply to transitional year, but not necessarily with the expectation that you would be able to gain a PGY2 spot after. If you decide to go the TY route, consider you will likely have to apply for PGY-1 psych spots (which would mean an extra year of residency, but if passionate about psych, I think is a good trade-off). A TY could be good if you shine more clinically than on exams because you can get a letter after 2 months from an attending that speaks to your ability as an intern on medicine (which as you know, we do 4 months of medicine in psych). Good luck!
 
  • Like
Reactions: 1 user
OP, I don't have experience with your situation, so take my advice with a grain of salt:

As others have said, definitely apply broadly in psych, but not to ALL programs as some will filter you out based on your scores/etc. I think it makes sense to also apply to transitional year, but not necessarily with the expectation that you would be able to gain a PGY2 spot after. If you decide to go the TY route, consider you will likely have to apply for PGY-1 psych spots (which would mean an extra year of residency, but if passionate about psych, I think is a good trade-off). A TY could be good if you shine more clinically than on exams because you can get a letter after 2 months from an attending that speaks to your ability as an intern on medicine (which as you know, we do 4 months of medicine in psych). Good luck!

Thank you for your reply.

I plan to apply VERY broadly, as in, any program that I believe is attainable (do/img friendly etc). I'm not going to bother applying to programs that don't meet that criteria or seem even moderately competitive to begin with.

I really want to find a better resource on how to navigate transition year, as I'm not sure it would be any better than taking a gap year (other than being paid and the letter). I also recognize that it will not be particularly easy to get transition year, and that there would be other opportunities if unable to continue with psych (such as applying for family med then or whatever).

At this point I am also contemplating taking a "gap year" or a year extension with school, as I have been told that that has been helpful to others in my situation.

But as always, really considering all of my options.

Thanks!
 
Gap years are considered a red flag by some. It depends on the reasons of course, but "it was because I couldn't match" isn't a good reason. I suggest you keep your hat in the ring and do a gap year if you have to. I don't see how taking one voluntarily will help your chances unless you take a lot of steps and kill them. Step I will be pass fail soon so that is even slipping away from helping you. If you use a gap year to do work with a particular program and impress them to the point they take you, then a gap could make sense. Otherwise I don't see how it will help.
 
  • Like
Reactions: 1 user
Gap years are considered a red flag by some. It depends on the reasons of course, but "it was because I couldn't match" isn't a good reason. I suggest you keep your hat in the ring and do a gap year if you have to. I don't see how taking one voluntarily will help your chances unless you take a lot of steps and kill them. Step I will be pass fail soon so that is even slipping away from helping you. If you use a gap year to do work with a particular program and impress them to the point they take you, then a gap could make sense. Otherwise I don't see how it will help.

I can totally see that. I'm just curious what I would do if I don't match. Would it still be considered a gap year if I just don't match and have to apply next cycle? Maybe I'm just being naive and don't know exactly how that works.

I understand what you are saying about Step. I just think with my record, it wouldn't be advisable at this point. I've been told again and again that if I could pass step 1 that it would help my application significantly.. I will continue to study and take practice exams at this point. Maybe if I manage to do well on practice exams I could aim for January or February so it would be available in case of soap? Even then, I'm not sure. Unless my situation changes drastically in the next month, I don't think I will go through with my current exam date in September.

If I were to just barely pass step 1, I assume that wouldn't really help my application much.

Thanks again!
 
Most schools will keep you enrolled if you don't match and you can continue to do rotations and or research within their hospital and research institutions. That can give you explained time and let you take steps with time to study. It will be clear that you didn't match and I don't recommend this as plan A, it is really plan B. Of course, this is my opinion and others may feel differently.
 
  • Like
Reactions: 1 user
Most schools will keep you enrolled if you don't match and you can continue to do rotations and or research within their hospital and research institutions. That can give you explained time and let you take steps with time to study. It will be clear that you didn't match and I don't recommend this as plan A, it is really plan B. Of course, this is my opinion and others may feel differently.

OP, I agree with this, and would talk to your school to see if this is a possibility. I've heard that "US Seniors" (i.e. MS4s) have a better chance at matching, even if it's their second go-around than those that have already graduated. I also have an n=2 example of the above working out, though they are MD not DO, but I think that matters less these days. I matched in 2018 but one of my really good friends didn't. (She may not be the best example as she didn't have an red flags; she just didn't apply to enough programs because she had a geographic constraint.) She remained enrolled and matched the next year. Another friend of mine was a year behind me in school. He DID have a couple red flags (including failing a Step and then passing it with a low score). So he stuck around, then entered the match again the following year w/success.
 
  • Like
Reactions: 1 users
OP, I agree with this, and would talk to your school to see if this is a possibility. I've heard that "US Seniors" (i.e. MS4s) have a better chance at matching, even if it's their second go-around than those that have already graduated. I also have an n=2 example of the above working out, though they are MD not DO, but I think that matters less these days. I matched in 2018 but one of my really good friends didn't. (She may not be the best example as she didn't have an red flags; she just didn't apply to enough programs because she had a geographic constraint.) She remained enrolled and matched the next year. Another friend of mine was a year behind me in school. He DID have a couple red flags (including failing a Step and then passing it with a low score). So he stuck around, then entered the match again the following year w/success.

I have heard similar things in the past. Seems like a tough decision between transition year/additional year of school.

Thanks
 
I have heard similar things in the past. Seems like a tough decision between transition year/additional year of school.

Thanks

Belaboring this question makes me concerned you don't appreciate how dire your situation is:

You don't have a "red flag," which is to say a warning sign. You have a significant, enduring pattern of marginal at best academic performance which predicts continued academic struggles and raises concerns whether you can pass your level 3 licensing exam, much less achieve board certification. I don't think you have an opportunity anymore to materially break this pattern for application. Nothing you do in an additional year can really address this deficiency, and arguably a 5th year would only be a further data point for academic struggles.

If there is an opportunity to become a doctor, you need to grasp it. A transitional year allows you to wing up a practicing physician in many states.
 
Belaboring this question makes me concerned you don't appreciate how dire your situation is:

You don't have a "red flag," which is to say a warning sign. You have a significant, enduring pattern of marginal at best academic performance which predicts continued academic struggles and raises concerns whether you can pass your level 3 licensing exam, much less achieve board certification. I don't think you have an opportunity anymore to materially break this pattern for application. Nothing you do in an additional year can really address this deficiency, and arguably a 5th year would only be a further data point for academic struggles.

If there is an opportunity to become a doctor, you need to grasp it. A transitional year allows you to wing up a practicing physician in many states.

Would it be okay to direct message you?
 
Don't apply everywhere everywhere. There are many places that will not take red flags, or even DOs, let alone both so save their time and your money. It will not change the results. I think you should apply to a lot of places, don't get me wrong. Transitional internships are easier to leave and openly interview during at possible PGY-II slots. I agree with you on that. As far as Step I, if you don't fail it you are better off with it. We can't tell you the odds so it has to be your choice.

I have to disagree with this advice. From what I've seen, you want to apply broadly. It makes no sense to me that after being already in debt for over $100k, you think that saving a couple thousand dollars for one the most important processes in your life is a good idea. I know for a fact that we interviewed candidates with low boards but great EC.
 
I have to disagree with this advice. From what I've seen, you want to apply broadly. It makes no sense to me that after being already in debt for over $100k, you think that saving a couple thousand dollars for one the most important processes in your life is a good idea. I know for a fact that we interviewed candidates with low boards but great EC.
I respect your opinion, but these are not low board scores. These are failed COMLEX. It just seems beyond unlikely for some programs if you were determined to apply everywhere.
 
Top