Can I match to Gen Surg with these scores?

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Hembrick

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I'm a US grad MS3 (Michigan), extremely interested in general surgery but my grades are sub-par. I wanted to lay out my scores/numbers such that people can comment on my likelihood of matching to a gen surg residency. Since my time to apply to ERAS is near, any input will be appreciated.

I do not wish to apply to a top tier program. Instead, I would be ecstatic to match into a smaller community program situated in a suburban neighborhood.

USMLE Step I: 192
USMLE Step II: pending July 2011
Clinical: 4 passes, 2 NP (had to retake family and medicine)
Preclinical: all pass
Research/presentations: 6+ projects all in surgery
Publication: 3 first authorships in surgery. 3 more pending this summer.

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I'm not a program director, so don't take my word as final by any means, but I don't think you will match in surgery with that record. The ~50% pass rate in M3 year alone is going to close a lot of doors (what is conditional pass?). The research is nice but I doubt it will overcome the other stuff. Same for a good Step 2 score. Have you met with your Dean and/or Surgery PD? Might want to save your money and wait to scramble into something less competitive.
 
I'm not a program director, so don't take my word as final by any means, but I don't think you will match in surgery with that record. The ~50% pass rate in M3 year alone is going to close a lot of doors (what is conditional pass?). The research is nice but I doubt it will overcome the other stuff. Same for a good Step 2 score. Have you met with your Dean and/or Surgery PD? Might want to save your money and wait to scramble into something less competitive.

Thanks for your post. I really appreciate it. I did speak to my dean and Surgery PD. Both of them were realistic in saying that I should have a plan B (thinking about an alternative residency choice) but also thought that with great letters and step 2 score, I might have a chance in small community programs. Overall, they were very respectful of my situation. I've heard of applicants doing 2+years of prelim surgery and finally landing a PGY1 or PGY2 spot. Do you think that's even an option for me? Do my scores fall short of even pursuing that route instead of a categorical?
 
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The problem with taking on a prelim spot is that you will still face the same problem one or two years down the road. The prelim group is not necessarily less competitive than the categorical group. The prelim group has a lot of people that didn't match into surg subspecialties or other fields, and they will have good grades and Step scores. Some of them give up on ortho or ENT or neurosurg and end up doing general surgery when a spot opens up. Those applicants will be the first ones to get open spots...

At my program, most of the undesignated prelims were those who failed to match into ENT, Ortho, Plastics, Neurosurg... they usually eventually went into Radiology, although some ended up in GS. Among the ones who originally failed to match in GS, about half of the undesignated prelims actually interested in GS found spots in GS. The other half spent extra years doing a 2nd year prelim, unaccredited fellowships, and eventually ended up doing something like FM.
 
Clinical: 4 passes, 2 NP (had to retake family and medicine)
Preclinical: all pass
Research/presentations: 6+ projects all in surgery
Publication: 3 first authorships in surgery. 3 more pending this summer.

I don't mean to be rude so please don't take this the wrong way but how did you end up with those grades and board scores and nearly 12 research publications/projects? I know our school stresses academics, academics, academics and then research so I am just curious.

In all honesty, I think shoot for the stars but keep your feet on the ground and have plan B ready.

Best of luck.
 
What happened during those two failed rotations? Did you have extenuating circumstances or just didn't study hard enough for the shelf?

Those failures, plus the low Step 1 score, will make matching a tough prospect without a stellar Step 2 and great letters of recommendation. You might want to consider away rotations as well.

Definitely apply broadly.
 
Not a ton to add except more doom and gloom.

Based on the last edition of "charting outcomes" - your step 1 score alone gives you a 1 in 4 shot of matching; and things have only become more competitive since then.

Throw in multiple failed clerkships, including a fail in a major core rotation like medicine, and you are in big trouble.

Honestly I'm not sure how much great LORs or research will help, because the vast majority of programs aren't going to look past the above factors.

You need to seriously consider alternative options.
 
Not a ton to add except more doom and gloom.

Based on the last edition of "charting outcomes" - your step 1 score alone gives you a 1 in 4 shot of matching; and things have only become more competitive since then.

Throw in multiple failed clerkships, including a fail in a major core rotation like medicine, and you are in big trouble.

Honestly I'm not sure how much great LORs or research will help, because the vast majority of programs aren't going to look past the above factors.

You need to seriously consider alternative options.

I think that is the crux of the matter. Programs that use filters often use Step 1 and IMG/FMG status. And for those programs that use the former, they are unlikely to set the filter at USMLE Step 1 < 200, so those programs aren't even going to see Step 2, the publications, etc.

The OP needs to pull out all the stops which includes having faculty who support you call programs and ask them to look at you beyond the obvious red flags.
 
In "Charting Outcomes in the Match" for 2009, for American seniors with a Step 1 score range of 191-200, 66 matched and 22 didn't. This gives him a 75% chance based on that score alone, not 25% as previously stated. However, since 192 is on the low end of that scale, you would expect that that score would give you a lower chance than those at the upper end.

The problem is that most people with that score don't improve very much on Step 2. I recognize that you have already taken Step 2, so your fate is sealed, in a way. And despite this, the clerkship issues are red flags.

I think your path should really depend on a the results of a no-holds-barred self-appraisal, where you truly break yourself down and analyze whether or not you could be happy doing something else. My feeling is that the road will likely be quite long and potentially personally destructive, all without any sure end in sight. If all of this is worth it to you, then press on and don't look back. If I were in your shoes, I would probably look for another career, as brutal as that sounds.
 
Cuple of sticky points here though...

Another way to look at that data is that of the 760+ applicants who matched, only 78 had a score lower than 200. So you could say that only one in ten of matched applicants have a score similar to the OP's. We need a statistician to tell us which interpretation of this data is most representative.

Also, the OP's step II is pending for this coming July, so it is not set in stone yet.

But yeah, either way, doesn't look good based on what I have been reading from other threads on competitiveness. I know that from the interview trail this year, there were ALOT of stellar applicants, and just a higher number than in previous years. A rough straw poll on the trail had about 25-75% higher number of Gen Surg applicants from each interviewees school, compared to previous year averages.

Just a thought...
 
I'm a US grad MS3 (Michigan)
Are you at the University of Michigan? If not, MD or DO? This will make a very big difference, especially if you're in the former category.
 
I'd say your chances don't look good. If you really love surgery, then I would apply, but I'd keep a plan B open. I wouldn't try to do multiple prelim years (or even one) to try to get into surgery.
 
Since you haven't taken Step 2 yet, as opposed to what I said earlier, I would focus all your energy on dominating that exam. That and quality away rotations are your best shot at getting interviews, and, if anything will, letters of recommendation and great interview performance are what's going to get you ranked in this situation.
 
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Thanks everyone for the overwhelming response! At the time I did the OP, I did not expect to get so many different perspectives. I'll answer some questions first and put down my thoughts thereafter.

"I don't mean to be rude so please don't take this the wrong way but how did you end up with those grades and board scores and nearly 12 research publications/projects? I know our school stresses academics, academics, academics and then research so I am just curious."

Thanks for your input Chirurgia magna. I'm sure some of the residency programs' directors would be asking the same question. I'm not certain if the following explanation will do justice but I contribute the inconsistency of my scores on some personal matters. Extenuating circumstances led to postponing my Step I exam by 2 months. Then, I started my family and internal medicine rotations without quite having resolved the issue in the first place. Obviously, the results of the 2 core clerkships were poor and reflective of the poor state-of-mind I was in.

As for the research, I enjoy doing research in general. Unlike creative writing, journal writing comes natural to me. Prior to medical school, I got my masters in public health and held a research job for a couple years. Although I would like to incorporate elements of research to my career down the line, I focused intensely on it with the intention to make up for my poor grades during the 1st semester of my 3rd year. I figured I could not redo Step I or erase NP on my transcripts so the next best thing was to re-channel my strengths to become a more prolific med student in the realm of investigative work.

"What happened during those two failed rotations? Did you have extenuating circumstances or just didn't study hard enough for the shelf?"

Thanks Buzz me for your question. Without going to specific details, I did have some extenuating circumstances during that phase of my 3rd year which negatively affected my academic performance. I'll definitely explicate the situation on my personal statement when it's time to apply ERAS. Luckily, I have a physician mentor who saw me through this entire process. I'm hoping his LOR will depict my positive work ethic and perseverance as opposed to a poor grades alone. However, I'm not sure how much leeway room I'll have. At the end of the day, it seems like it all comes down to the numbers...

"Are you at the University of Michigan? If not, MD or DO? This will make a very big difference, especially if you're in the former category."

Thanks Guile for your comment. I'm at Michigan state MD program. Other than campus notoriety, I'm not sure if this will positively or negatively affect my chances. I'd appreciate it if you can further comment on this.
 
Thanks everyone for the overwhelming response! At the time I did the OP, I did not expect to get so many different perspectives. I'll answer some questions first and put down my thoughts thereafter.

"I don't mean to be rude so please don't take this the wrong way but how did you end up with those grades and board scores and nearly 12 research publications/projects? I know our school stresses academics, academics, academics and then research so I am just curious."

Thanks for your input Chirurgia magna. I'm sure some of the residency programs' directors would be asking the same question. I'm not certain if the following explanation will do justice but I contribute the inconsistency of my scores on some personal matters. Extenuating circumstances led to postponing my Step I exam by 2 months. Then, I started my family and internal medicine rotations without quite having resolved the issue in the first place. Obviously, the results of the 2 core clerkships were poor and reflective of the poor state-of-mind I was in.

As for the research, I enjoy doing research in general. Unlike creative writing, journal writing comes natural to me. Prior to medical school, I got my masters in public health and held a research job for a couple years. Although I would like to incorporate elements of research to my career down the line, I focused intensely on it with the intention to make up for my poor grades during the 1st semester of my 3rd year. I figured I could not redo Step I or erase NP on my transcripts so the next best thing was to re-channel my strengths to become a more prolific med student in the realm of investigative work.

"What happened during those two failed rotations? Did you have extenuating circumstances or just didn't study hard enough for the shelf?"
Thanks Buzz me for your question. Without going to specific details, I did have some extenuating circumstances during that phase of my 3rd year which negatively affected my academic performance. I'll definitely explicate the situation on my personal statement when it's time to apply ERAS. Luckily, I have a physician mentor who saw me through this entire process. I'm hoping his LOR will depict my positive work ethic and perseverance as opposed to a poor grades alone. However, I'm not sure how much leeway room I'll have. At the end of the day, it seems like it all comes down to the numbers...

"Are you at the University of Michigan? If not, MD or DO? This will make a very big difference, especially if you're in the former category."

Thanks Guile for your comment. I'm at Michigan state MD program. Other than campus notoriety, I'm not sure if this will positively or negatively affect my chances. I'd appreciate it if you can further comment on this.

As for my thoughts:
Things couldn't be any more puzzling. Unlike the med school application process where I easily resorted to and compared my credentials to a single source like USNews or Princeton Review of Medical schools, the application process for residency is a completely different animal! Frieda yields some info but I realized that things are discovered mostly through word-of-mouth. It's important to weigh in networking/obtaining a strong LOR from a prominent, well-connected doc. But even this might not compensate for my shortcomings.
Surgery was the initial reason I came to medical school. Loved the surgery rotation. Still envision myself doing it for the rest of my life. But it's not easy finding a way to get to the interview door, let alone go through the door with my numbers. On one side, I don't want to go down without even swinging the bat which helps me think, "maybe I should apply just to see what happens." But on the flip side, applying/interviewing is a hefty investment of both money and time (without any guarantees at the end of the day) so I need to be wise about the entire process.
What a predicament! Any other thoughts/comments/suggestions?
 
But on the flip side, applying/interviewing is a hefty investment of both money and time (without any guarantees at the end of the day) so I need to be wise about the entire process.
What a predicament! Any other thoughts/comments/suggestions?

Forget about the couple thousand dollars and relatively little time you'll have to invest in the process and consider the price of not at least attempting.

choice 1) Risk losing a couple thousand dollars and wasting a year or two now, and spent the next 30 years doing something you enjoy and living out a dream.

Choice 2) succumb to the fear of failure and spend the rest of your life waking up to go to a job you despise.

This may a bit melodramatic, but I believe it gets the point across.
 
In "Charting Outcomes in the Match" for 2009, for American seniors with a Step 1 score range of 191-200, 66 matched and 22 didn't. This gives him a 75% chance based on that score alone, not 25% as previously stated. However, since 192 is on the low end of that scale, you would expect that that score would give you a lower chance than those at the upper end.

whoops, you are correct. I was looking at the IMG numbers...
 
Forget about the couple thousand dollars and relatively little time you'll have to invest in the process and consider the price of not at least attempting.

choice 1) Risk losing a couple thousand dollars and wasting a year or two now, and spent the next 30 years doing something you enjoy and living out a dream.

Choice 2) succumb to the fear of failure and spend the rest of your life waking up to go to a job you despise.

This may a bit melodramatic, but I believe it gets the point across.

IMHO, it's a much harder decision than you make it out to be.

I've seen friends fail to match, and I've seen friends go through the hell of a prelim year with no certainty of a good outcome at the end of it. I wouldn't wish it on anyone.

The reality is that your fourth year application represents your BEST shot of landing a residency; the odds only go down after that, not up. Wasting it in a fruitless effort at a specialty you aren't competitive for is not a good decision. You may not just be risking "wasting a year or two" - you may be risking your chances of ever succeeding in finding a solid residency position.

Failing to match, being forced to scramble, doing a prelim year...these all have a very real potential of permanently altering your career trajectory.

I am far from an expert and don't know all the specifics of the OP's application or chances for success. But if the choice is between failing to match in general surgery and scrambling for an undesirable prelim year, or having a chance at a solid if unspectacular FM, IM, or peds residency; then that choice is much harder than you make it out to be.
 
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IMHO, it's a much harder decision than you make it out to be.

I've seen friends fail to match, and I've seen friends go through the hell of a prelim year with no certainty of a good outcome at the end of it. I wouldn't wish it on anyone.

The reality is that your fourth year application represents your BEST shot of landing a residency; the odds only go down after that, not up. Wasting it in a fruitless effort at a specialty you aren't competitive for is not a good decision. You may not just be risking "wasting a year or two" - you may be risking your chances of ever succeeding in finding a solid residency position. The odds are not good of just falling backwards into a medicine or FM residency spot after failing to match in general surgery and spending 1-2 years as a prelim.

I am far from an expert and don't know all the specifics of the OP's application or chances for success. But if the choice is between failing to match in general surgery and scrambling for an undesirable prelim year, or having a chance at a solid if unspectacular FM, IM, or peds residency; then that choice is much harder than you make it out to be.

Good point, but I guess it comes down to an individualistic point of view or preference. If The OP can see himself doing "FM, IM or peds" than yes, the decision becomes more difficult.

My statement was made with the assumption (with admitted over exaggeration hence the use of the term: MELODRAMATIC) that the OP cannot see himself finding any sense of enjoyment in the aforementioned (non-surgical) specialties. For those that fall in this category, the choice becomes a little more allowing and the risk, a little less daunting.

I personally would rather take the risk 10 times out of 10.
 
Forget about the couple thousand dollars and relatively little time you'll have to invest in the process and consider the price of not at least attempting.

choice 1) Risk losing a couple thousand dollars and wasting a year or two now, and spent the next 30 years doing something you enjoy and living out a dream.

Choice 2) succumb to the fear of failure and spend the rest of your life waking up to go to a job you despise.

This may a bit melodramatic, but I believe it gets the point across.
It's not just the "fear of failure," it's the "very real possibility that you will never match into a given specialty, and you will sabotage your chances at getting into any other specialty you were interested in during that process."

If it's just about a few thousand dollars and some sacrificed time, that's one thing. I'll pick a specialty that's more competitive to make the point more clear - you could really really want to be a neurosurgeon, and you apply for residency and fail to get a spot. You then scramble into a prelim surgery spot, and try again the next year for neurosurgery. A little wiser, you also now try applying to general surgery spots. You're at high risk for not getting into neurosurgery again, and you may also not get any general surgery spots because they know you're not really interested primarily in general surgery, and you may leave their program for greener pastures at some point.
 
If it's just about a few thousand dollars and some sacrificed time, that's one thing. I'll pick a specialty that's more competitive to make the point more clear - you could really really want to be a neurosurgeon, and you apply for residency and fail to get a spot. You then scramble into a prelim surgery spot, and try again the next year for neurosurgery. A little wiser, you also now try applying to general surgery spots. You're at high risk for not getting into neurosurgery again, and you may also not get any general surgery spots because they know you're not really interested primarily in general surgery, and you may leave their program for greener pastures at some point.

This example also points out another factor. If you are a general surgery prelim - these are the people you are competing against for categorical slots a year or two down the line - the folks who tried to match plastics, neuro, urology, etc and who are now fighting against you for the table scraps. They may not have matched into their competitive subspecialty, but their numbers are still above average for general surgery. All issues of questionable motivaiton aside, it makes for a competitive pool of applicants who are all targeting the small number of available positions.
 
It's not just the "fear of failure," it's the "very real possibility that you will never match into a given specialty, and you will sabotage your chances at getting into any other specialty you were interested in during that process."

If it's just about a few thousand dollars and some sacrificed time, that's one thing. I'll pick a specialty that's more competitive to make the point more clear - you could really really want to be a neurosurgeon, and you apply for residency and fail to get a spot. You then scramble into a prelim surgery spot, and try again the next year for neurosurgery. A little wiser, you also now try applying to general surgery spots. You're at high risk for not getting into neurosurgery again, and you may also not get any general surgery spots because they know you're not really interested primarily in general surgery, and you may leave their program for greener pastures at some point.

Picking a specialty that is "more competitive" for comparison doesn't exactly "make the point" anymore than does comparing apples and oranges.

General surgery is competitive. Yes, I agree, but it's no Rad Onc in terms of competitiveness.

In "Charting Outcomes in the Match" for 2009, for American seniors with a Step 1 score range of 191-200, 66 matched and 22 didn't. This gives him a 75% chance based on that score alone, not 25% as previously stated.

Given these stats, it's safe to say that the benefits outweigh the risks for someone who cannot see himself/herself doing anything other than surgery. I would apply 10 times out of 10 (as previously stated).
 
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Given these stats, it's safe to say that the benefits outweigh the risks for someone who cannot see himself/herself doing anything other than surgery. I would apply 10 times out of 10 (as previously stated).
The idea that someone can't do anything other than surgery is BS to begin with.

Also, the USMLE/match stats don't take into account the fact that the original poster had two failures in clinical rotations and a marginal pass on another.
 
The idea that someone can't do anything other than surgery is BS to begin with.

To each his own. Besides, I have no interest in entertaining a discussion about whether or not someone I've never met can envision himself/herself doing something other than surgery.

Also, the USMLE/match stats don't take into account the fact that the original poster had two failures in clinical rotations and a marginal pass on another.

OP, do not apply! You have no shot in heaven. In fact, undo your medical school education and move to Mismaloya beach in Mexico to sip on Pina Coladas and make pom poms with the villagers indefinitely.
 
OP, please listen to the idealistic medical student over the cautionary advice of the residents and attendings!
 
OP, please listen to the idealistic medical student over the cautionary advice of the residents and attendings!

Actually, a sandy mexican beach and pina colada sound pretty good right now.....I just have to learn how to make pom poms.....maybe the villagers will teach me.

To the OP:

If you want to be a general surgeon, I say go for it. Because of your sub-par scores and previous failures, you will have to cast a very large net, and you will have to have a plan B....but that doesn't mean surgery is off limits.

The only thing I would mention is that 99% of med students with bad scores or failed clerkships will cite "extenuating circumstances" as the major cause of their missteps...so I wouldn't focus heavily on that in your personal statement and interviews.

Also, since you are a Mich State person, I would mention that Mich State Kalamazoo (and Lansing to some extent) are considered less competitive programs, and you may be able to get your foot in the door with a strong Sub-I.

Good luck.
 
You can still match, but you will need to rock Step 2, get good letters of recommendation, apply broadly to many programs, interview at as many programs as you can, and have some luck.
 
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OP, please listen to the idealistic medical student over the cautionary advice of the residents and attendings!
quix·ot·ic/kwik&#712;sätik/
Adjective: Exceedingly idealistic; unrealistic and impractical: "a vast and quixotic project".

radical
&#8211;noun 9. a person who holds or follows strong convictions or extreme principles; extremist.
 
I think that is the crux of the matter. Programs that use filters often use Step 1 and IMG/FMG status. And for those programs that use the former, they are unlikely to set the filter at USMLE Step 1 < 200, so those programs aren't even going to see Step 2, the publications, etc.

The OP needs to pull out all the stops which includes having faculty who support you call programs and ask them to look at you beyond the obvious red flags.

Hembrick,

Take the above advice very seriously. The reality is that with a STEP 1 score of 192 even applying broadly may not help get sufficient number of interviews, because of the way filters are set up. Your best bet is your home program: hope they love you and will be willing to take you. Communicate closely with your home program during the application/interview cycle and make sure to have someone (a faculty) call on your behalf - it might help to get more interviews (although, of course, there are no guarantees).
 
quix·ot·ic/kwik&#712;sätik/
Adjective: Exceedingly idealistic; unrealistic and impractical: "a vast and quixotic project".

radical
&#8211;noun 9. a person who holds or follows strong convictions or extreme principles; extremist.

Haha, the right words in the wrong hands can very easily make room for oblivious misinterpretation. :laugh:

Nevertheless, I am flattered by the effort you've exerted by researching those two very poignant words.
 
Thanks for all your input everyone. It looks like there is a wide variety of opinions:
1. Don't apply - think plan B;
2. Apply broadly but focus more on plan B;
3. Rock the step II, LOR, away electives and reassess at that time;
3. Shoot for the stars - even if that means prelim x2 years as persistence pays off if surgery is truly what I want to do

They are all good options. Damn, lot to think about.

On the bright side: I'm single and have no pets so I'm not bound by any means =)
 
Thanks for all your input everyone. It looks like there is a wide variety of opinions:
1. Don't apply - think plan B;
2. Apply broadly but focus more on plan B;
3. Rock the step II, LOR, away electives and reassess at that time;
3. Shoot for the stars - even if that means prelim x2 years as persistence pays off if surgery is truly what I want to do

They are all good options. Damn, lot to think about.

On the bright side: I'm single and have no pets so I'm not bound by any means =)

Of all those options, I think the "safest" option that still allows you to try to reach your goal would be #2 above. Except, I would recommend you focus more on Plan A. For example, apply broadly, do an away rotation or two, but still do a sub-I at your school in something less competitive (psych, peds, FM, etc). You can include prelim programs in your "applying broadly" part, but understand the difficulties that come along with that.

The fact that you're single and flexible reduces a great deal of problems that I would have faced if I was in your shoes. I am ready to move somewhere for 5-7 years and not even change apartments in that time period.

With that said, do speak to a faculty mentor and come up with a solid plan. You still have 6 months before applying, but you have to use them wisely.
 
I'm a DO and want to do an MD general surgery residency. I heard it is impossible but I am not sure why... my scores are USMLE 236/99 and COMLEX 687/95. I'm in the top ten students... do I still not have a prayer in getting in? Also, everyone has said dont do subI's because they will hurt me in the long run... is that true?
 
I'm a DO and want to do an MD general surgery residency. I heard it is impossible but I am not sure why... my scores are USMLE 236/99 and COMLEX 687/95. I'm in the top ten students... do I still not have a prayer in getting in? Also, everyone has said dont do subI's because they will hurt me in the long run... is that true?

I think for those with low scores, they have nothing to lose so they'll help. If you have good scores, they can potentially hurt you. There are allopathic programs that take DO students, so it's not impossible. If your USMLE 236 for step 1? That's the most important selection criterion.
 
I'm a DO and want to do an MD general surgery residency. I heard it is impossible but I am not sure why... my scores are USMLE 236/99 and COMLEX 687/95. I'm in the top ten students... do I still not have a prayer in getting in? Also, everyone has said dont do subI's because they will hurt me in the long run... is that true?


Not going into GS, but we had 3 from our class land allo GS categorical spots. The places were Loma Linda, West Virginia University and University of Maryland. All 3 were good students, with probably similar scores as to yours. So no, it isn't impossible.
 
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just apply.
there are many ways to get in.
 
I'm a DO and want to do an MD general surgery residency. I heard it is impossible but I am not sure why... my scores are USMLE 236/99 and COMLEX 687/95. I'm in the top ten students... do I still not have a prayer in getting in? Also, everyone has said dont do subI's because they will hurt me in the long run... is that true?

From my own interview experience this year, I got that perception that programs don't really care about COMLEX. Many times I was asked what COMLEX means, so USMLE is your ticket to get interviews. Apply broadly I mean very broadly. You competing with many excellent MD students for MD surgical spots...but it is not impossible as a DO to get it. Be ready to answer why you want allopatic surgery spot coming from DO school.

I think subi will not hurt you because during subis you can showcase and get excellent LORs 🙂 Anyway, thats what I did...

Good Luck :luck:
 
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