Are my dreams of EM over?

[thrownaway123]

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Background

- US MD student at Mid-Lower Tier US School
- No issues throughout academic history prior to Step1
- I have no idea what happened, I was projecting 230+ on all my practice tests and just found out that I scored a 193 (failed by one lousy point).

All I ever wanted to do was EM at a trauma center and according to what I've read so far it seems like that's over with regardless of how well I do on a retake. My campus dean told me that if I do well on my retake and Step2 that I could shoot for a lower tier FM program and try to work in rural ERs but honestly, what got me out of bed in the morning these last few years to wade through medical school was the thought that at least I'd have a job that I would love going to work to do every day and that I would be proud of accomplishing it. And after all this time, money, and stress that I'd at least have a say in what specialty I wound up in. But instead now I just feel like I have to accept complacency and take the leftovers that no one else wanted let alone myself. I love everything about being an ER doc and have quite a bit of experience and research in that field and it's severely degrading knowing where I stand now. It's honestly hard to wake up in the morning and keep going at this point and don't really know what to do now. I was looking forward to the last two years of med school but now, feel like its just wasting time to eventually match/soap into a program that I never wanted to work in. I'm sure that at least one of you is going to say "don't disparage other specialties until you rotate in it" or "FM can do a EM fellowship" but honestly, I have only wanted to do ER since all this started and I feel like I've ripped away any chance I may have had at becoming a ER trained physician. Any feedback is appreciated, do I have any shot at EM after a retake?

Sorry for the long post, really working through a lot of emotions at the moment and tried to make this as coherent and short as possible.

 

[LebronManning]

I think if you killed your Step 1 retake you would have a shot at the lowest tier EM programs given your dedication to the field.

 

[theseeker4]

Background

- US MD student at Mid-Lower Tier US School
- No issues throughout academic history prior to Step1
- I have no idea what happened, I was projecting 230+ on all my practice tests and just found out that I scored a 193 (failed by one lousy point).

All I ever wanted to do was EM at a trauma center and according to what I've read so far it seems like that's over with regardless of how well I do on a retake. My campus dean told me that if I do well on my retake and Step2 that I could shoot for a lower tier FM program and try to work in rural ERs but honestly, what got me out of bed in the morning these last few years to wade through medical school was the thought that at least I'd have a job that I would love going to work to do every day and that I would be proud of accomplishing it. And after all this time, money, and stress that I'd at least have a say in what specialty I wound up in. But instead now I just feel like I have to accept complacency and take the leftovers that no one else wanted let alone myself. I love everything about being an ER doc and have quite a bit of experience and research in that field and it's severely degrading knowing where I stand now. It's honestly hard to wake up in the morning and keep going at this point and don't really know what to do now. I was looking forward to the last two years of med school but now, feel like its just wasting time to eventually match/soap into a program that I never wanted to work in. I'm sure that at least one of you is going to say "don't disparage other specialties until you rotate in it" or "FM can do a EM fellowship" but honestly, I have only wanted to do ER since all this started and I feel like I've ripped away any chance I may have had at becoming a ER trained physician. Any feedback is appreciated, do I have any shot at EM after a retake?

Sorry for the long post, really working through a lot of emotions at the moment and tried to make this as coherent and short as possible.

Re-take the step 1 and score in the 230's, take step 2 and do better than that on the first try, and do plenty of rotations at EM sites that are not considered super competitive and you would have a shot. You will not be able to match at a super "big name" EM program, but that doesn't really mean that much. You might be able to become an EM physician, but it will take a lack of future screw ups, and even then nothing is certain. good luck!.

 

[Pigg-O-Stat]

Dude, don't ever give up. If you want EM bad enough you'll find a way. Personally I would have gone to Puerto Rico for residency if it was my only choice. Re-take the test, kill it and keep moving forward toward EM.

 

[carbonizedeyesockets]

Will it be tough to get into a program? Yeah. But, it is not impossible. Don't give up.

 

[Cryc_to_the_point]

I'm a know-nothing 1st year, but would you consider doing FM and then an EM fellowship?

 

[shoal007]

It can be done but your path will not be easy nor without risk.

Score well on your retake, step 2, be personable, responsive and a rockstar during your rotations - you may have a chance. Please have a backup, as if you do not match the first year, things get harder and even more miserable. I know one doc who is facility at a well known EM program who did just as you did (graduated in 2010 from medschool though). He had to take a gap year and take step 3 prior to reapplication though.

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[Moose A Moose]

I’m sorry, OP. Keep pushing like the ‘fail’ never happened. It’s all you can do.

 

[Gomertose]

Background

- US MD student at Mid-Lower Tier US School
- No issues throughout academic history prior to Step1
- I have no idea what happened, I was projecting 230+ on all my practice tests and just found out that I scored a 193 (failed by one lousy point).

All I ever wanted to do was EM at a trauma center and according to what I've read so far it seems like that's over with regardless of how well I do on a retake. My campus dean told me that if I do well on my retake and Step2 that I could shoot for a lower tier FM program and try to work in rural ERs but honestly, what got me out of bed in the morning these last few years to wade through medical school was the thought that at least I'd have a job that I would love going to work to do every day and that I would be proud of accomplishing it. And after all this time, money, and stress that I'd at least have a say in what specialty I wound up in. But instead now I just feel like I have to accept complacency and take the leftovers that no one else wanted let alone myself. I love everything about being an ER doc and have quite a bit of experience and research in that field and it's severely degrading knowing where I stand now. It's honestly hard to wake up in the morning and keep going at this point and don't really know what to do now. I was looking forward to the last two years of med school but now, feel like its just wasting time to eventually match/soap into a program that I never wanted to work in. I'm sure that at least one of you is going to say "don't disparage other specialties until you rotate in it" or "FM can do a EM fellowship" but honestly, I have only wanted to do ER since all this started and I feel like I've ripped away any chance I may have had at becoming a ER trained physician. Any feedback is appreciated, do I have any shot at EM after a retake?

Sorry for the long post, really working through a lot of emotions at the moment and tried to make this as coherent and short as possible.

Your post sums up why it is such a hard time for me soaping IM. "Get through the years of BS med school but practice what you want for the rest of your life" is what I felt.

I app'd em this past year. US MD senior 210/240 no repeats, no fails, no leave of absence, no red flags, etc. Tried my hardest on aways, turns out 2 middle third sloes. App'd 100 programs, pretty much all middle America and only a couple bigger names. "You'll have no problem matching." "Great clinical skills, hope to have this student as a future resident in our program." 6 interviews, 3 waitlists, unmatch Monday came and gave me the bad news.

"Kill retake step 1. Kill step 2. Kill clinical grades. Kill aways. Kill interviews."

Anyone can give this advice. I received it, I tried to do it, still didn't match em with a passing step 1. Try your hardest for steps, SLOEs are incredibly important and can get you matched with bad scores. Apply every program. Consider applying a second specialty because there are almost no good programs left in the SOAP. SOAP prelim surg at a place with an em residency if it comes to that. Good luck, I'm rooting for you.

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[thrownaway123]

I'm a know-nothing 1st year, but would you consider doing FM and then an EM fellowship?

I have and that's was one of my Dean's suggestions along with:

1) match low tier nonacademic FM and try to work EM. He said I wouldn't be able to work in a trauma center (nor be a "top EM doc" that handles high acuity patients) like I had planned but more so rural EM. My thoughts on this are that I feel like I would always consider this an act of complacency on my part (I know beggars can't be choosers, but damn that's a tough thing to come to terms with). To me it sounded more like urgent care based on his description and that doesn't really fit into what I wanted to get out of medicine either nor is it what drives me. Plus my spouse is an IM-PGY1 looking to fellow in Pulm/CC so I obviously want to give her that opportunity and not weigh her down by dragging her to the middle of nowhere.

2) match lower tier nonacademic IM and try to do a fellowship in Pulm/CC as it may offer similar aspects as EM. I'm open to this but still feel like I'd miss the ED and not feel as if I accomplished what I set out to do.

3) if I feel that so strongly about EM apply and see what happens but know that I'll most likely be screened out of most programs.

 

[thrownaway123]

Your post sums up why it is such a hard time for me soaping IM. "Get through the years of BS med school but practice what you want for the rest of your life" is what I felt.

I app'd em this past year. US MD senior 210/240 no repeats, no fails, no leave of absence, no red flags, etc. Tried my hardest on aways, turns out 2 middle third sloes. App'd 100 programs, pretty much all middle America and only a couple bigger names. "You'll have no problem matching." "Great clinical skills, hope to have this student as a future resident in our program." 6 interviews, 3 waitlists, unmatch Monday came and gave me the bad news.

"Kill retake step 1. Kill step 2. Kill clinical grades. Kill aways. Kill interviews."

Anyone can give this advice. I received it, I tried to do it, still didn't match em with a passing step 1. Try your hardest for steps, SLOEs are incredibly important and can get you matched with bad scores. Apply every program. Consider applying a second specialty because there are almost no good programs left in the SOAP. SOAP prelim surg at a place with an em residency if it comes to that. Good luck, I'm rooting for you.

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How often do folks make the transition from things like Prelim spots to EM? I haven't ever looked into the whole prelim thing just because I honestly never thought I'd be in this situation.

 

[thrownaway123]

Thanks for you all for the advice and encouragement. I was in a pretty bad place mentally before your replies and I really appreciate it. Everywhere else I turned was kind of doom and gloom so its good to hear that I might actually have a fighting (albeit uphill battle) chance.

 

[deuist]

I'm a know-nothing 1st year, but would you consider doing FM and then an EM fellowship?

No, don't do that

 

[EMincognito]

Thanks for you all for the advice and encouragement. I was in a pretty bad place mentally before your replies and I really appreciate it. Everywhere else I turned was kind of doom and gloom so its good to hear that I might actually have a fighting (albeit uphill battle) chance.

I personally know at least two people that matched into solid EM residencies at level I trauma centers who failed step 1 on their first take -- so not impossible!

 

[gutonc]

As mentioned above (and in many other similar threads/posts) this will not be impossible, but it will be difficult. If EM is your dream, go for it. But go in with a backup specialty as well (something you actually can imagine doing - IM, FM, Anesthesia, whatever floats your boat) and be sure to get at least 1 solid LOR for that as well (keep in mind that you can have as many LORs in your ERAS as you like, the only limit is how many you can assign to a program).

 

[Elevencents]

Don’t ever give up. Auditions/SLOE’s can save almost anyone. Do the best you absolutely can on your retake and Step 2 (duh) and then do as many auditions as you can at places you have a shot at matching. Be interested, be ready to learn, and don’t be a douche and make the residents want to go to bat for you.

 

[GonnaBeADoc2222]

Nothing's impossible but will definitely be very difficult. Whether or not it's valid, PDs will view you as an abem boards failure risk. If I were you, in addition to the above, I would do 3 away rotations at less competitive locations and target those strongly as your best chance at this point will be to match at a place you rotated at.

 

[GonnaBeADoc2222]

Would also caution junior medical students and especially premeds from having such a closed mind about what specialty you want to do before having any medical school clinical experience. You may have preconceived notions about field this or that which may be completely ubtruebonce you actually start working in the field

 

[The White Coat Investor]

I tell lots of people to give up, but not after just one bad thing happened to them. However, you're going to want to address this red flag in your essay and interviews and make sure there aren't any more.

I suppose, however, that most in your situation also get middle of the road MS3 grades, middle of the road SLOEs, middle of the road grades on EM rotations, aren't particularly inspiring in their writing or at their interviews etc. When I say, don't give up this isn't over yet, that assumes this is the only bad thing in your package and that you'll be applying to less competitive EM programs.

Unfortunately, this was the first thing you encountered in medical school that actually matters to your chances to match and you bombed it. There are a few more things, but none of us, including you have any idea how you will do on those. Hopefully awesome, but if not, then yes, you may not be doing EM the rest of your life. The good news is there's a decent chance that isn't even what you'll want by the end of MS3.

 

[DO2016EM]

Lots of new programs opening up. Focus on those. Rotate at reasonable places with your stats. Study hard for step 2. Be ok with FM or prelim as back up.

 

[gamerEMdoc]

I tell lots of people to give up, but not after just one bad thing happened to them. However, you're going to want to address this red flag in your essay and interviews and make sure there aren't any more.

I suppose, however, that most in your situation also get middle of the road MS3 grades, middle of the road SLOEs, middle of the road grades on EM rotations, aren't particularly inspiring in their writing or at their interviews etc. When I say, don't give up this isn't over yet, that assumes this is the only bad thing in your package and that you'll be applying to less competitive EM programs.

Unfortunately, this was the first thing you encountered in medical school that actually matters to your chances to match and you bombed it. There are a few more things, but none of us, including you have any idea how you will do on those. Hopefully awesome, but if not, then yes, you may not be doing EM the rest of your life. The good news is there's a decent chance that isn't even what you'll want by the end of MS3.

You hit the nail on the head. People can match with a board failure, or a low board score. But what happens more often when they don't match is, they are an average to below average student, with below average grades, and middle to low 1/3 sloes. Then they don't match, and they blame the board performance for not matching. In reality, it wasn't the boards but rather the total underwhelming package along with the board red flag. If a candidate otherwise excels clinically, its easy to overlook a single failed board exam.