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[lmnprtymn]

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[Merely]

I apologize in advance for creating yet another of these threads, but I could really appreciate the advice.

I am a non-american DO MS4, and as such, will require either an H1B (obviously preferred, and understandably hard to obtain) or J1 visa for residency.

For some background: I was in the top quartile of my class in preclinical years, scored average on step 1 (~225) and relatively well on COMLEX I (~640). I have long been interested in psychiatry (essentially since high school), and have received high grades in all of my 3rd year clerkships, where I was largely told that I was an eager and effective student. I will be taking step 2/level 2 at the end of the month, and am primarily hoping to improve my step score.

However, and most importantly, I recently learned that I failed the COMLEX PE (DO version of CS, if anyone is unfamiliar). This was a... rather humbling experience, to put it mildly. I am fairly confident that I know where my issues were, and I will be retaking it later this year - unfortunately, the result of the retake will not be out until early november. The failure took me entirely by surprise and has forced me to reconsider my entire application strategy. I was not initially going to apply to the AOA match, and do not know if I will be able to now do so in time as I am still currently preparing my application and waiting for most of my LORs to be written/uploaded. This was something I was planning on working on after finishing step/comlex 2. Having no geographical ties, I was already willing to go essentially anywhere in the country, so longer as the program would sponsor a visa for me. I was planning on applying to ~50 programs, but am now considering applying to ~100. I am also considering applying to backup FM residencies, though I know that I would be far happier in the most "malignant" of psych programs than in the average FM program, simply because of where my interests lie.

When NRMP applications go out in September, I take it that many programs will see the PE failure and will auto-screen my application out. Is there any value to holding off on releasing my COMLEX scores, only releasing step, until the (hopefully) passing PE grade comes in in November? Or would it be better to put the failure up front and release everything as it comes? I take it that the PE failure is something that I must mention in my personal statement, as any red flag typically needs to be, in which case there would be little use in postponing the score release.

All feedback, advice, comment is welcome. If anyone is familiar with some lower-tier programs that I might still have a reasonable shot at, I would be glad to hear of them.

Why did you fail the step 2?

 

[lmnprtymn]

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[Mad Jack]

Why did you fail the step 2?

COMLEX PE is a bit nightmarishly unpredictable, it's hard to fault anyone for failing it. It isn't like the USMLE Step 2 where you just have to speak English to pass. You need to meet very specific but unstated objectives, and no one is quite sure how a failure happens, as the scoring standards aren't published in anything but a generalized, vague form. Many great students fail it every year, it's a pity.

 

[Mad Jack]

Have a backup specialty- you're below the mean for USMLE in psych these days, and you've got a PE failure to boot. Your chances of matching aren't zero, but they aren't good, probably 50/50.

 

[Central_SOULcus]

COMLEX PE is a bit nightmarishly unpredictable, it's hard to fault anyone for failing it. It isn't like the USMLE Step 2 where you just have to speak English to pass. You need to meet very specific but unstated objectives, and no one is quite sure how a failure happens, as the scoring standards aren't published in anything but a generalized, vague form. Many great students fail it every year, it's a pity.

With all due respect, I have to disagree with your assessment of Step 2. If you go back and read many of the CS threads last application cycle, it's no longer enough "just to speak English," and many people felt CS also required "very specific but unstated objectives." I myself have never taken COMLEX, so I can't comment on that exam. I can say that while I comfortably passed CS, it wasn't a total breeze, and scoring standards are also not published except in a vague form.

 

[Central_SOULcus]

I apologize in advance for creating yet another of these threads, but I could really appreciate the advice.

I am a non-american DO MS4, and as such, will require either an H1B (obviously preferred, and understandably hard to obtain) or J1 visa for residency.

For some background: I was in the top quartile of my class in preclinical years, scored average on step 1 (~225) and relatively well on COMLEX I (~640). I have long been interested in psychiatry (essentially since high school), and have received high grades in all of my 3rd year clerkships, where I was largely told that I was an eager and effective student. I will be taking step 2/level 2 at the end of the month, and am primarily hoping to improve my step score.

However, and most importantly, I recently learned that I failed the COMLEX PE (DO version of CS, if anyone is unfamiliar). This was a... rather humbling experience, to put it mildly. I am fairly confident that I know where my issues were, and I will be retaking it later this year - unfortunately, the result of the retake will not be out until early november. The failure took me entirely by surprise and has forced me to reconsider my entire application strategy. I was not initially going to apply to the AOA match, and do not know if I will be able to now do so in time as I am still currently preparing my application and waiting for most of my LORs to be written/uploaded. This was something I was planning on working on after finishing step/comlex 2. Having no geographical ties, I was already willing to go essentially anywhere in the country, so longer as the program would sponsor a visa for me. I was planning on applying to ~50 programs, but am now considering applying to ~100. I am also considering applying to backup FM residencies, though I know that I would be far happier in the most "malignant" of psych programs than in the average FM program, simply because of where my interests lie.

When NRMP applications go out in September, I take it that many programs will see the PE failure and will auto-screen my application out. Is there any value to holding off on releasing my COMLEX scores, only releasing step, until the (hopefully) passing PE grade comes in in November? Or would it be better to put the failure up front and release everything as it comes? I take it that the PE failure is something that I must mention in my personal statement, as any red flag typically needs to be, in which case there would be little use in postponing the score release.

All feedback, advice, comment is welcome. If anyone is familiar with some lower-tier programs that I might still have a reasonable shot at, I would be glad to hear of them.

Given how competitive Psych was last year, I don't think anyone can comfortably predict the Match this year. I'm sorry I don't know much about your chances of matching, particularly because I'm not familiar with DO requirements. (I'm MD. Also, I know people with higher Step scores and people with lower scores than mine who didn't match this past cycle so it's hard to know what scores programs really want). In reading your post, however, I think it's clear how much you love psychiatry. Before making a decision, consider the "worst case" scenario--you apply to psych and FM, and end up matching into FM. Do you think in that case you'll be relieved just to have matched, or do you think, you will end up wishing you didn't match so you could try again for psych the following year? (I know people tend to paint re-applying as the kiss of death, but I know several people who matched on their second try last cycle (1 psych, 1 PM&R, 1 gen surgery, 1 OBGYN, 1 EM). If I were in your situation (I too love psych more than any other specialty), I would probably apply just Psych (but apply VERY broadly/to MANY programs) and release only your Step scores for now (which means only apply to allopathic programs for now since I assume AOA programs require COMLEX). Then study hard for your PE retake and rock it!

Regarding your Step 1 score of 225, the newest match data shows 226 as the average score for matched psych applicants in 2018 (here's the link, though it only lists the average stats of US MD students: http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdf).

 

[lmnprtymn]

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[Taddy Mason]

You need to meet very specific but unstated objectives, and no one is quite sure how a failure happens, as the scoring standards aren't published in anything but a generalized, vague form.

And this is different from CS how?

 

[Mad Jack]

And this is different from CS how?

H u m a n i s t i c D o m a i n

There are a bunch of weird artificial and specific things you have to do to be "humanistic" that go above and beyond the regular "be normal" level of things. Because you can fail on each domain independently, it's kind of a pain.

The there's the whole failing for OMM thing... Which is an extra pain because we have one less minute in each case and one less minute to chart but you're still expected to do osteopathic structural exams quickly and efficiently in addition to regular exams while remaining "humanistic." We've basically just got extra ways to fail, extra expectations, and less time in which to do things, which all coupes together to create an exam that has historically had a failure rate five times higher than the CS.

 

[yanks26dmb]

H u m a n i s t i c D o m a i n

There are a bunch of weird artificial and specific things you have to do to be "humanistic" that go above and beyond the regular "be normal" level of things. Because you can fail on each domain independently, it's kind of a pain.

The there's the whole failing for OMM thing... Which is an extra pain because we have one less minute in each case and one less minute to chart but you're still expected to do osteopathic structural exams quickly and efficiently in addition to regular exams while remaining "humanistic." We've basically just got extra ways to fail, extra expectations, and less time in which to do things, which all coupes together to create an exam that has historically had a failure rate five times higher than the CS.

I have been told some people never did structural exams and still passed. I don't know if this is an absolute requirement

 

[Amygdarya]

Given the options of matching FM vs. taking an additional year to match into psych, I would definitely prefer the latter. Realistically, however, if I were to apply only psych this year and fail to match then, I don't imagine my chances would be any better the following year. I do think I would ultimately rather match into FM than going unmatched, which is a terrifying but ever-present possibility (though I would still rather go unmatched than matching into, say, surgery). I am already planning on applying essentially as broadly as I can afford, and the field just gets more and more competitive every year, it seems. What would be considered applying to many programs, 100? 150?

 

[Amygdarya]

Given the options of matching FM vs. taking an additional year to match into psych, I would definitely prefer the latter. Realistically, however, if I were to apply only psych this year and fail to match then, I don't imagine my chances would be any better the following year. I do think I would ultimately rather match into FM than going unmatched, which is a terrifying but ever-present possibility (though I would still rather go unmatched than matching into, say, surgery). I am already planning on applying essentially as broadly as I can afford, and the field just gets more and more competitive every year, it seems. What would be considered applying to many programs, 100? 150?

I'm sure the person you're replying to meant well, but it is absolutely better to match into a backup specialty than not to match at all if you're interested in a clinical career. For one, you have the safety of having at least your backup specialty to continue with, and you may even like it and stick with it (there's plenty of psych in primary care). Two, if you decide to reapply to psychiatry the following year, it's better to have more clinical experience under your belt than spend the reapplication year twiddling your thumbs. Also, parts of family medicine year may count toward the medicine requirement in psychiatry residency. So there is really nothing to lose and quite a lot to gain from matching into a backup specialty rather than not matching at all.

 

[Mad Jack]

I have been told some people never did structural exams and still passed. I don't know if this is an absolute requirement

If you're doing OMM, you should have an OSE. If they passed I'm surprised

 

[Central_SOULcus]

I'm sure the person you're replying to meant well, but it is absolutely better to match into a backup specialty than not to match at all if you're interested in a clinical career. For one, you have the safety of having at least your backup specialty to continue with, and you may even like it and stick with it (there's plenty of psych in primary care). Two, if you decide to reapply to psychiatry the following year, it's better to have more clinical experience under your belt than spend the reapplication year twiddling your thumbs. Also, parts of family medicine year may count toward the medicine requirement in psychiatry residency. So there is really nothing to lose and quite a lot to gain from matching into a backup specialty rather than not matching at all.

I did mean well. I prefaced everything with: "Given how competitive Psych was last year, I don't think anyone can comfortably predict the Match this year. I'm sorry I don't know much about your chances of matching, particularly because I'm not familiar with DO requirements."

While I matched on the first try and thus don't have personal experience, I only said what I would likely do if I were in OP's situation. For me personally, I absolutely love psychiatry and would not be happy doing anything else. I would rather risk not matching than potentially matching to another specialty because we have all heard how difficult transferring is (especially transferring to a completely different specialty). Granted, the people I listed who matched on their second try were MD applicants, but they also didn't, as you say, "spend the reapplication year twiddling [their] thumbs." One of them was an IMG who spent the year getting an MS while doing full time research at an academic institution where he also made networking connections.

I know you also mean well in the advice you gave OP, but I think it's important to give OP info about different options so then OP can make the decision he/she thinks is best. I don't think it's helpful to have absolutes like "it is absolutely better to match into a backup specialty than to not match at all." I think we all know people (or have heard of people) who failed to match at all on their second try, and conversely, know of others who not only matched on their second try, but even matched into a program they were happy with. I'm not saying one option is better than the others. I'm saying OP should know as much info as we can provide, and then OP can make as informed a decision as possible.

 

[Central_SOULcus]

Given the options of matching FM vs. taking an additional year to match into psych, I would definitely prefer the latter. Realistically, however, if I were to apply only psych this year and fail to match then, I don't imagine my chances would be any better the following year. I do think I would ultimately rather match into FM than going unmatched, which is a terrifying but ever-present possibility (though I would still rather go unmatched than matching into, say, surgery). I am already planning on applying essentially as broadly as I can afford, and the field just gets more and more competitive every year, it seems. What would be considered applying to many programs, 100? 150?

To address the first part, please see my reply to @Amygdarya. As for how many psych programs, that's also hard to say. I would probably apply to as many as you can afford as long as you apply to a broad range of competitiveness and do your research on each one first. For instance, despite your failed PE, you'll only be submitting Step scores for now, so you can apply to "reaches" and "maybes." (Even for the best applicant, I don't really believe in "likelies" and "safeties" because it's all become so unpredictable.) If cost is a consideration, I would probably only apply to a few "reaches" and focus more on mid-tier programs. Make sure to look at each program's current residents and apply only to those who have a mix of MD and DO residents.

If in the end you think also applying to FM as a "backup" is the way you're going to go, that's fine too. As I've said many times now, the Match was so unpredictable last year that there doesn't seem to be a right or wrong answer anymore.

 

[splik]

When NRMP applications go out in September, I take it that many programs will see the PE failure and will auto-screen my application out. Is there any value to holding off on releasing my COMLEX scores, only releasing step, until the (hopefully) passing PE grade comes in in November? Or would it be better to put the failure up front and release everything as it comes? I take it that the PE failure is something that I must mention in my personal statement, as any red flag typically needs to be, in which case there would be little use in postponing the score release.

you are required to disclose the results of any exams you have taken so this is not an option. even if it were, it would be obvious once you released your scores that you deliberately withheld information to deceive programs, which would be even worse.

I hope you are doing some away rotations right about now and programs you have a reasonable shot at matching into, and from which you can get some LoRs. failure of PE/CS is looked upon more negatively than failure of the written exams. you need to show people based on rotations at places with a residency program that you can cut it. no one is going to be interested in your clerkship grades.

It is better to be "smart" about which programs you apply to rather than applying to 100 programs and hoping for the best. There are a lot of programs that you have no hope in hell of ever matching into, so it is better not to apply to them, apply to lower tier programs in a region you are interested in, or close to where you go to school. also look at the programs people from your school matched into, as they may be more favorably disposed to consider other applicants from your school (assuming they like said residents).

historically, I would always recommend the H1 visa for applicants, but at the current time this has caused so many problems and there have been so many delays, that you are probably better off with a J1 if you are unable to apply for a green card, even though that comes with its own problems. regardless, you would do the first yr of training on OPT.

 

[Amygdarya]

I did mean well. I prefaced everything with: "Given how competitive Psych was last year, I don't think anyone can comfortably predict the Match this year. I'm sorry I don't know much about your chances of matching, particularly because I'm not familiar with DO requirements."

While I matched on the first try and thus don't have personal experience, I only said what I would likely do if I were in OP's situation. For me personally, I absolutely love psychiatry and would not be happy doing anything else. I would rather risk not matching than potentially matching to another specialty because we have all heard how difficult transferring is (especially transferring to a completely different specialty). Granted, the people I listed who matched on their second try were MD applicants, but they also didn't, as you say, "spend the reapplication year twiddling [their] thumbs." One of them was an IMG who spent the year getting an MS while doing full time research at an academic institution where he also made networking connections.

I know you also mean well in the advice you gave OP, but I think it's important to give OP info about different options so then OP can make the decision he/she thinks is best. I don't think it's helpful to have absolutes like "it is absolutely better to match into a backup specialty than to not match at all." I think we all know people (or have heard of people) who failed to match at all on their second try, and conversely, know of others who not only matched on their second try, but even matched into a program they were happy with. I'm not saying one option is better than the others. I'm saying OP should know as much info as we can provide, and then OP can make as informed a decision as possible.

Well, here's the thing: if you don't match, you find something to do in the iterim and reapply next year.
If you match into a backup specialty, you can still reapply next cycle, ie participate in the general match (not transfer) (this is the same option as if you don't match). *In addition to this*:
1) given that you're going to have an intern year under your belt, you're eligible to apply for PGY-2 psych positions, which are typically less competitive than PGY-1 positions;
2) you can transfer from your backup resudency to a psych residency - you're right, this is not the easiest or most common option, but it's by no means the only option for someone who matched into a backup specialty! - see the other 2 options anove;
3) meanwhile, you're already in residency training in a specialty/program you may even like; and
4) spending your reapplication year in residency is much better than doing anything else because you get general clinical medicine experience, part of which may count toward psych residency requirement. Getting a graduate degree, research experience etc, with some exceptions, is generally not as valuable as getting clinical experience - just ask @OldPsychDoc @MacDonaldTriad @psychattending

You seem to base your conclusion on 2 mistaken assumptions:
1) that transferring residencies is the only optinon for someone who matched into a backup specialty and wants to go into psych - it's not;
2) that doing something other than clinical training during the application year is somehow better - in most cases, it's not because clinical experience is valued by resudency programs, while graduate degrees and research can be of questionable value, especially if they don't fit into your narrative/career goal (eg. if you don't have a strong interest and *track record* in research, public health etc) and you're not productive during that year. Re networking: you can network within your residency institution just as well as within your place of research. Solid evaluations/recommendations from your attendings and PD can go a long way.

Bottom line is, there are more options to get into psych, you're getting a valuable clinical experience and have a backup clinical career if you match into a backup specialty. I don't see how this could possibly be worse than not matching at all, with very rare exceptions like a research star (and I'm talking someone with multiple publications and likely MD/PhD) not matching for whatever crazy reason (and I know that this happens - last year 6 MD/PhDs didn't match into psychiatry) and continuing to do research during their reapplication year. But these are rare special cases that don't apply to most people.

Oh, and something interesting I noticed in Charting Outcomes: unlike having AOA or PhD or coming from a top 40 school, all of which are helpful with getting into psychiatry residency, having *other graduate degrees* is not: there is a significantly higher % of people with "other graduate degrees" among those who didn't match than among those who matched, which means that by and large having these degrees doesn't really improve your chance of matching into psychiatry. Just check out last year's Charting Outcomes.

 

[lmnprtymn]

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[shaosoldier]

When applying to a backup specialty, is it generally frowned upon to apply to more than one specialty at the same hospital?

That's a tough question cause PDs do talk to each other. I would say, if psychiatry is your number one choice, just be real with them during the interview process and say that you are applying FM as well but it's a clear back up, these days they should understand since psychiatry is now a rough field to match into. Something to consider, this may backfire as well but I feel most psychiatrist should understand, especially PDs.

 

[shaosoldier]

When applying to a backup specialty, is it generally frowned upon to apply to more than one specialty at the same hospital?

Also, I skimmed the previous posts and would agree with having a back up. Scrambling or Soaping is no fun.

 

[J ROD]

I would target lesser name programs and newer programs. Psych is more competitive for sure but there still is more consideration for the person that just numbers like other specialties. Several away rotations and finishing strong would help. You have to let folks know you are clinically able to do your job.

 

[OldPsychDoc]

That's a tough question cause PDs do talk to each other. I would say, if psychiatry is your number one choice, just be real with them during the interview process and say that you are applying FM as well but it's a clear back up, these days they should understand since psychiatry is now a rough field to match into. Something to consider, this may backfire as well but I feel most psychiatrist should understand, especially PDs.

I agree--if you're going to do it, be transparent about it. Be ready to talk about your thinking in both interviews. Good PDs will be interested in giving you good advice, because that's why we chose this job (some vestigial high school guidance counselor gene we still express at low levels). Had a couples matching applicant lately who made it clear that her priority was matching with her spouse, even if it had to be in her backup specialty. I'm cool with that...