Carib student with low step 1 score pathology residency

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jokes of life

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Hi
I'm a carib student with a low step 1 score.I just took the test and got a 194.I didn't expect the score as I was score above 200 in all my practice tests.But now I cannot change what has already happened.I'm worried about my chances in applying to a pathology residency. I'm moving onto my third year and would like to know what I can do to offset that and I worry that my application will not even meet the cut off for programs to open my application file.How do I work around this.Any advice is appreciated.

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If you can do significantly better on the Step 2 CK and Step 3 exams you will have a shot at some of the lower tier programs. Also, doing away rotations might help open some doors. Good Luck.
 
Yeah, you can probably still get interviews at low tier programs, but you'll need to apply very broadly and do everything you can to buff up the rest of your CV. As mentioned away rotations are a great option. People are more willing to overlook academic struggles if they know you personally and you've demonstrated a good work ethic and a personality that fits in. Be sure to schedule aways at places that you would be more competitive at though. Look for programs that already have one or more Caribbean residents there, especially if there's someone from your school.
 
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i would stay away from pathology now. your board score is bad and your carib, so the only programs that would want to take you would be low-tier community programs with poor teaching and low surgical volume. finding a decent job after that would be difficult, even after doing two fellowships, and the possibility of being unemployed would be real. pursue family medicine instead since you would always be able to find work.
 
i would stay away from pathology now. your board score is bad and your carib, so the only programs that would want to take you would be low-tier community programs with poor teaching and low surgical volume. finding a decent job after that would be difficult, even after doing two fellowships, and the possibility of being unemployed would be real. pursue family medicine instead since you would always be able to find work.

Sadly, I would have to agree. The program I trained at, which admittedly was upper mid-tier, wouldn't look at anyone with a STEP score of less than 200. And the market just got tighter actually with the latest reimbursement cuts going through in addition to every hospital in sight cutting part A payments as well. My group isn't going to hire for years to come it seems unless either business really really picks up or payments go up.
 
Not to beat the dead horse, but I also wonder if this person can succeed in pathology. Your best chance is to do an away rotation at a mid to lower tier program and impress them so that you bypass the normal application processes that would likely get your application discarded based on your Step 1 score alone. Some programs automatically interview anyone who does a rotation in their department.

Are you sure you wouldn't be happy doing primary care? Those fields remain less competitive and can provide a nice income and satisfying work.
 
Jokes, Pathology is not a very competitive specialty, and there are many great programs that will consider your application even with a lower step 1 score. I know people who got invited to top-tier schools like U of Michigan, Cleveland Clinic, Yale, UPMC with a step 1 score that was not much higher than yours (Some of those top schools state on their website that they require a step 1 score of 200, others say just passing scores are enough, and you are in that range so don't despair). It will help if you have strong letters of recommendation from pathologists. Research experience also helps. Getting a better Step 2 CK score would also help greatly. It will help even more if you do away rotations in places you will be more likely to match (think mid-upper schools like Duke, University of Rochester, etc. - in the last few years those excellent schools didn't fill all of their slots and had to use SOAP to fill the remaining positions. They frequently take IMGs). The places that see you and get to know you in away rotations will very likely invite you to interview and probably rank you highly if they liked you, even with a low step 1 score. I talked to some program directors that are even willing to overlook first time fails if the candidate has strengths in other areas. Don't lose hope, and apply broadly when the time comes. Send personalized emails to programs that you don't hear from after 3-4 weeks have passed from submitting ERAS to express your interest in their program. Ask your letter-writers to personally contact schools that they trained in or have connections to so that they can put in a good word for you - that can also go a long way. Finally, write a strong personal statement and have good reasons for wanting to be a pathologist that you can talk about during the interviews. I hope that helps. Good luck to you.
 
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I know people who got invited to top-tier schools like U of Michigan, Cleveland Clinic, Yale, UPMC with a step 1 score that was not much higher than yours

Were those people who got invites AMG's or IMG's? It makes a huge difference for the OP's case. An invitation is one thing. Getting a spot is another. I'd be willing to bet there are zero Caribbean grads at any of those programs with <200 on their Steps. For that matter, there's hardly any Carib grads at any of the top programs. To say pathology is not very competitive regarding the OP's case is misleading. It is competitive for a Carib IMG, particularly with a sub-200 score. The rest of the advice is good as far as things one can do to boost their application though.

I would also echo the sentiment about primary care. Be aware of the opportunity cost you will be sacrificing if you go into Path vs primary care i.e. 2-3 more years of training, slimmer job prospects, and as a consequence less geographic flexibility. If you like Path that much, and it's worth that cost, then go for it. But, apply to primary care as a backup.
 
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Were those people who got invites AMG's or IMG's?

The people I know were AMG's, from good US schools. I agree that the applicant's med school does make a big difference. However, if you look at the composition of most top-tier schools, there are anywhere from 5 to 25% IMGs in their current residents lists (Washington U in St. Luis has 27% IMGs). My bet is that not all IMGs who match into pathology programs have great scores. And I guess the point I was trying to make with the AMGs who got invited to even top tier schools with ~200 Step 1 is that even the best programs are willing to overlook low Step 1 scores, so what about the mid to low tier schools?

Keep in mind, the market right now is in favor of Pathology residency applicants. See the attached match data from 2016. USC - a mid-upper program - only filled 2/6 residency spots in the match last year. Rush filled 3/4 spots. U of Kansas 2/4. U of Louisville 1/3. Mayo, a top-tier program, didn't fill it's one CP only track. Duke, another mid-upper, filled only 1/5 spots. Case Western/Metro Health filled 1/2 spots. Oregon Health and Sci Univ filled 2/3. UPMC (top-tier) filled 5/6. U of S Dakota 2/3. U of Tennessee COP-Memphis 3/4. Baylor in Dallas TX (mid upper) filled 3/5. Virginia Commonwealth U filled 4/5.

I met a resident at one of the mid-upper programs that I mentioned earlier who was an IMG who applied to IM and FM but did not match to any of the programs he applied to. He SOAPed into that mid-upper program in pathology without even having originally applied to pathology. I didn't ask about his Step scores because I didn't think it was my business, but my hunch is that of the 167 IMGs that matched into the 549 pathology spots in 2016, not all of them had great Step 1 scores (especially if other aspects of their application were strong). And a decent amount of the applicants who SOAPed into programs probably also had low scores.

I guess the take home message I want to send any prospective Path applicants is that if they have a genuine interest in the field, a low step 1 score + IMG status are certainly hurdles that will likely make the application process much more challenging, but I highly doubt that they will preclude them from entering the field at the present time. Efforts should certainly be made to make up for those weaknesses. Particularly, you should try to do as good as possible on Step 2, do multiple away rotations, get strong Letters of Rec, apply to a wide range of programs (especially any who didn't fill the previous year), and be assertive in trying to secure as many interviews as possible.

Wishing the best for all who read this,
doctor313
 

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  1. would it help to apply to a position that has both the research side ( i.e.. a post doc) as well as the clinical service side? the theory would be to get "your foot in the door" by doing the post doc for say about 2 years and then enter the clinical service side. I am familiar with the U Wash outfit in Seattle, WA and somewhat with the UNC-Chapel Hill outfit that have large departments where such activity go on. also at leapt years ago the outfit at Peter Bent Brigham ( now called Womens Brigham ) when Ramzy Cotran was Chief had some pathology residents that really just did post doc type work with minimal service commitments most went on into academic work but seem to have decent careers. the latter I recommend since my view is that the service role of pathologist shall be more and more reduced as automation, digital pathology, and insurance cut backs start to kick in. so considering more research and just getting Anatomic boards with say a post residency fellowship in Heme path might be a viable alternative to traditional AP-CP the days of going to a group at a community hospital and making $400K are really over with. Most Mills ( e.g. Quest and Lab corp) pay about $135K plus benefits so consider an academic post with research I am familiar with academic outfits like MD Anderson which pays about $120K plus benefits which is not all that different from the Mills. the atmosphere is more intellectually stimulating. Knowing what I know now--and I do not want to give my name_ I think I would have had a better career by going to "The Brigham" getting AP boards and doing Heme path rather than getting triple board certified and having to deal with politics. it is up to you. others will give their own viewpoint but I would rather see you as a part of a large academic department with TIAA_CREF and not have to worry about a retirement. so look at the research side of the field and those departments that cater to that rather than the service work they seem to be a little easier to 'get the foot in the door" best wishes to you
 
Jokes, Pathology is not a very competitive specialty, and there are many great programs that will consider your application even with a lower step 1 score. I know people who got invited to top-tier schools like U of Michigan, Cleveland Clinic, Yale, UPMC with a step 1 score that was not much higher than yours (Some of those top schools state on their website that they require a step 1 score of 200, others say just passing scores are enough, and you are in that range so don't despair). It will help if you have strong letters of recommendation from pathologists. Research experience also helps. Getting a better Step 2 CK score would also help greatly. It will help even more if you do away rotations in places you will be more likely to match (think mid-upper schools like Duke, University of Rochester, etc. - in the last few years those excellent schools didn't fill all of their slots and had to use SOAP to fill the remaining positions. They frequently take IMGs). The places that see you and get to know you in away rotations will very likely invite you to interview and probably rank you highly if they liked you, even with a low step 1 score. I talked to some program directors that are even willing to overlook first time fails if the candidate has strengths in other areas. Don't lose hope, and apply broadly when the time comes. Send personalized emails to programs that you don't hear from after 3-4 weeks have passed from submitting ERAS to express your interest in their program. Ask your letter-writers to personally contact schools that they trained in or have connections to so that they can put in a good word for you - that can also go a long way. Finally, write a strong personal statement and have good reasons for wanting to be a pathologist that you can talk about during the interviews. I hope that helps. Good luck to you.


Thanks a lot, my situation is similar, and this gave me a lot of hope. Kudos!
 
I need a full picture to comment. Do you have some stand out feature? Like are you a model, or elite athlete or well connected somehow? Independently wealthy? Heir to an industrial tycoon?

Or just Joe Blow grinding away in Grenada hoping you dont need to rescued by Marines again?

No right or wrong answer here, Im not judging but want to tailor my advice.

I can say with 100% certainty you can work around this with ease if you take a deep breath and move forward with a plan of action. If you panic and freak, start huffing paint to ease the mental anguish I cant help you.
 
If you have good scores, its easy to secure a pathology residency. If you have not so good scores, you need to shadow someone in a small program. Most of the times that does it. Move on and try to get better scores in step 2.
 
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