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Hey, all. I'm new to SDN, but I had a question pertaining to my chances of matching in psychiatry? I ended up scoring a 199 on Step1 on first attempt and haven't taken Step2 yet. No psychiatry-specific research and only a neurology project that's been dragging its feet; no poster or presentation, yet. Couple of research projects with presentations from undergrad. I do have a few leadership positions and I anticipate strong LORs. No red flags from the first two years of med school. US MD. I'm just curious what my chances are for matching and how many programs would be a reasonable number to apply to? I really don't have any preference on a particular region of the country. Thanks for your time-I really appreciate it!
 
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I'm only a lowly M2, but the odds don't look terrible to me. According to this chart, 59/77 US senior psychiatry applicants matched with a Step 1 from 191-200.
Screen Shot 2017-08-12 at 10.09.46 PM.png
 
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grapefruit17

im a psychiatry intern, DO student at a MD program. you almost certainly will match.Especially since you aren't super picky region wise, I would think you'll be fine.

I know some say "apply 30" others say 50, some say 20 etc. Honestly I say apply to as many as you can afford, you can always cancel interviews but you can't cancel interviews you don't have.
 
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Stagg737

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Hey, all. I'm new to SDN, but I had a question pertaining to my chances of matching in psychiatry? I ended up scoring a 199 on Step1 on first attempt and haven't taken Step2 yet. No psychiatry-specific research and only a neurology project that's been dragging its feet; no poster or presentation, yet. Couple of research projects with presentations from undergrad. I do have a few leadership positions and I anticipate strong LORs. No red flags from the first two years of med school. US MD. I'm just curious what my chances are for matching and how many programs would be a reasonable number to apply to? I really don't have any preference on a particular region of the country. Thanks for your time-I really appreciate it!
I'm in a somewhat similar boat in terms of having a mediocre app, OP. I'll be applying to a lot of programs and if I don't get X number of interviews by X date, I'll be sending more out. As long as you're applying to reasonable programs and not just reaches, you'll probably be alright. That being said, apply to enough programs that you'll be confident you'll match somewhere. It's better to spend too much on residency apps and match than to be frugal now and risk not getting a position.
 
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12glaucoma34

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Hey, all. I'm new to SDN, but I had a question pertaining to my chances of matching in psychiatry? I ended up scoring a 199 on Step1 on first attempt and haven't taken Step2 yet. No psychiatry-specific research and only a neurology project that's been dragging its feet; no poster or presentation, yet. Couple of research projects with presentations from undergrad. I do have a few leadership positions and I anticipate strong LORs. No red flags from the first two years of med school. US MD. I'm just curious what my chances are for matching and how many programs would be a reasonable number to apply to? I really don't have any preference on a particular region of the country. Thanks for your time-I really appreciate it!
Approaching 100% match rate
 
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Hey, all. I'm new to SDN, but I had a question pertaining to my chances of matching in psychiatry? I ended up scoring a 199 on Step1 on first attempt and haven't taken Step2 yet. No psychiatry-specific research and only a neurology project that's been dragging its feet; no poster or presentation, yet. Couple of research projects with presentations from undergrad. I do have a few leadership positions and I anticipate strong LORs. No red flags from the first two years of med school. US MD. I'm just curious what my chances are for matching and how many programs would be a reasonable number to apply to? I really don't have any preference on a particular region of the country. Thanks for your time-I really appreciate it!
Many UFAP evangelical medical students at my university wont reveal their Step 1 Score. When asked what area of medicine they will be practicing, pyschiatry is the most oft heard field.

I think the field deserves better than to be seen as a dumping ground of low board scores, never mind UFAP evangelists.

OP, choose a field that you think you will love and apply to over 100+ programs including in BFE. A residency on an Indian Reservation in Montana for a field you will be passionate benefits you and the patients you will be serving. Don't let your Step 1 score choose your future for pete's sake
 

Stagg737

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May be true, but psych was more competitive than ever last year for some reason. There were only 4 positions in the country that were available for people to SOAP into and several attendings in the psych subforum said they weren't even interviewing people they would have ranked at the top of their lists 2-3 years ago. Psych may very well be going the way of EM and be much more competitive in the next 5 years (or maybe last year was an anomaly, too early to know).

Many UFAP evangelical medical students at my university wont reveal their Step 1 Score. When asked what area of medicine they will be practicing, pyschiatry is the most oft heard field.

I think the field deserves better than to be seen as a dumping ground of low board scores, never mind UFAP evangelists.

OP, choose a field that you think you will love and apply to over 100+ programs including in BFE. A residency on an Indian Reservation in Montana for a field you will be passionate benefits you and the patients you will be serving. Don't let your Step 1 score choose your future for pete's sake
I wouldn't assume that OP isn't serious about psych just because his Step 1 sucks and he hasn't done research in the field. Even if I had a 250 Step 1 (which I don't), I'd still be applying for psych. No field "deserves" to be the dumping ground for low scores, but the reality is some fields are just more desirable than others (largely because $$$ due to the way reimbursement is set up).
 
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12glaucoma34

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May be true, but psych was more competitive than ever last year for some reason. There were only 4 positions in the country that were available for people to SOAP into and several attendings in the psych subforum said they weren't even interviewing people they would have ranked at the top of their lists 2-3 years ago. Psych may very well be going the way of EM and be much more competitive in the next 5 years (or maybe last year was an anomaly, too early to know).
That wouldn't surprise me. I'm surprised it isn't more competitive. The job market is idea and the hours are great. All psychiatrists I have worked with have short days (8-9ish until 3 PM and no weekends) that aren't often that difficult and they still make over $225,000. If they wanted to work a little harder, faster, and/or longer they could probably increase their salary dramatically.

My insight into this is limited, but I would be interested to read why I'm right or wrong?
 
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Mad Jack

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I'm only a lowly M2, but the odds don't look terrible to me. According to this chart, 59/77 US senior psychiatry applicants matched with a Step 1 from 191-200.
View attachment 222503
That's still a pretty solid chance of not matching, ouch.

I'm on the DO side of things, you don't even want to see how bad they are here.

Hell, it's hard to even get a decent sub-I or rotation in psych this year.
 
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grapefruit17

I actually didn't do any SUBis for psych. But I would recommend doing them in places you are dead set on. One place that interested me exclusively only took people who did a subi there.

yea its competitive. Not what people think it is. I talked to some top 4 carib students last year on the interview trail with average-slightly higher than average usmles and they only had 1-2 interviews. One DO on the interview trail I met only had 2 interviews for MD by late dec..but her personality was..interesting...to say the least
 
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Stagg737

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That wouldn't surprise me. I'm surprised it isn't more competitive. The job market is idea and the hours are great. All psychiatrists I have worked with have short days (8-9ish until 3 PM and no weekends) that aren't often that difficult and they still make over $225,000. If they wanted to work a little harder, faster, and/or longer they could probably increase their salary dramatically.

My insight into this is limited, but I would be interested to read why I'm right or wrong?
For the most part you're right. Psychiatry is one of the lowest paying specialties because psychiatrists commonly work fewer hours than everyone else, not because reimbursement sucks. I've worked with a few guys that clear 500k easy because they put in the hours. If you're willing to work 12 hour days in psychiatry, you can definitely make bank.

Additionally, I think more people are starting to realize that Psych is actually closer to a ROAD specialty (especially in terms of lifestyle) than most people realized with a solid job market, which is why it's becoming more competitive imo. The trade-off is that it's a very different field from everything else in medicine as there's almost no physical aspect to it, which turns a lot of people off. I think in the next few years we're going to see more people that are chasing the $$$ going into psych as lifestyle is becoming more and more of a draw for our generation.
 

Crayola227

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seems to me a lot of people underestimate the number of programs they need to apply to for psych, as the main issue

as for why more people don't do psych? well why don't more people do peds or surgery?

it's not very "general" medicine - it's a particular type of work and it takes a particular type of person to want to do it and be good at it

it's not for everyone
 

PreMedMissteps

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A med student contacted me with his Step 1 score. He is a citizen but he went Abroad for med. Score is 210. Low, I know.

I’ve seen the chart for domestic seniors wanting Psychiatry, but where is the chart for American IMGs?

He is one of their strong students, but made the poor decision of going Abroad. So far I’ve advised him to do better on step 2 and, during M4, apply to a very large number of community residency programs that would be more likely to interview and possibly rank him.

What other or different advice would you give?
 

PreMedMissteps

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2012: Do you have a pulse, no more than two Step 1 fails, and a medical degree?

2018: Better off applying Derm or Ortho, you’re not good enough.

/s
Are you replying to my post? If so, I don't understand.

If you were replying to another, can you please comment on my post? I feel very badly for this young man. He was given terrible advice when pushed to go abroad. Now his score reinforces my belief that caribbs don’t teach well, even if they are known to “teach to the test.” BTW, this student did have US med school stats....just was poorly advised.
 
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Candidate2017

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seems to me a lot of people underestimate the number of programs they need to apply to for psych, as the main issue

as for why more people don't do psych? well why don't more people do peds or surgery?

it's not very "general" medicine - it's a particular type of work and it takes a particular type of person to want to do it and be good at it

it's not for everyone
Psych involves quite a bit of “general medicine”. I review/order labs, EKGs, XRs, CT head etc and treat medical conditions on the inpatient unit and recommend medication changes on consults. Psych patients are veritable magnets for pneumonia, UTIs, rashes, electrolyte derangements, neutropenia, cellulitis, hypertension, prolonged QT, chest pain, withdrawal, boxer’s fx, lacerations, falls. I also make sure the ED or IM docs have adequately managed or ruled out medical issues before I admit a patient to psych.

I enjoy the general medicine stuff for now but I will eventually reach green pastures and become as dumb as an orthopod and punt anything remotely mediciney.
 

Candidate2017

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For the most part you're right. Psychiatry is one of the lowest paying specialties because psychiatrists commonly work fewer hours than everyone else, not because reimbursement sucks. I've worked with a few guys that clear 500k easy because they put in the hours. If you're willing to work 12 hour days in psychiatry, you can definitely make bank.

Additionally, I think more people are starting to realize that Psych is actually closer to a ROAD specialty (especially in terms of lifestyle) than most people realized with a solid job market, which is why it's becoming more competitive imo. The trade-off is that it's a very different field from everything else in medicine as there's almost no physical aspect to it, which turns a lot of people off. I think in the next few years we're going to see more people that are chasing the $$$ going into psych as lifestyle is becoming more and more of a draw for our generation.
ROAD specialties don't have to spend 30 minutes listening while a patient lacrimates. It's probably easier and less taxing for a IM doc to make $500k by rounding on a hospital in the morning and then a second hospital in the afternoon.
 

Crayola227

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ROAD specialties don't have to spend 30 minutes listening while a patient lacrimates. It's probably easier and less taxing for a IM doc to make $500k by rounding on a hospital in the morning and then a second hospital in the afternoon.
these sorts of comparisons are a bit silly.... IM is still VERY taxing, there are a lot of social issues, in fact, I think a lot of people go into IM underestimating that, and it contributes to burn out. Because they find themselves dealing a lot more with lacrimation than they expected. There are a hundred other reasons I could put out there for why it's more taxing physically, mentally, and emotionally than many realize.

Anyone that makes any claim that IM is easier than anything but some surgical specialties, really doesn't understand it. It's generally regarded as one of the least desirable specialties for many, many reasons.

IM is extremely emotionally taxing. Chronic issues that tend to lead to nasty deaths, a lot of wasting deaths on vents, by the 4 Ws (wind, water, wound, walk, ie PNA/respiratory failure, urosepsis, bed sores, immobility, etc)

(and here I'll say walk usually means VTE/PE, here I use "walk" to mean how mobility issues leads to nasty deaths. Mostly this acronym is used in surgery to discuss the most common causes of fever and post-op complications, wound is taken for wound, but this is easily adapted as an IM acronym for a lot of the serious issues to consider in your chronically ill)

A lot of it is medical handholding people and families to these wasting deaths.

Derm spends a lot more time dealing with patients' emotional problems too, than people think. It was put to me this way by derms: of all the body organs, skin is the one you see the most of, and it's exquisitely sensitive, and a huge part of our identities.

You don't really feel your liver failure until it's pretty far along, and in the meantime you don't have the self esteem issues and social problems that severe acne makes people suffer. Frankly a lot of people care more about what they can see and feel, than what they can't, when it comes to health. Acne vs atherosclerosis.

A lot of what derm does is managing painful chronic conditions like eczema, psoriasis, acne. Not to mention, if it's beyond what a PCP can manage on their own, it's quite likely so severe it might even be to the point of disability. They just don't see as much acute passing rashes. They deal a lot with the elderly, because they develop all sorts of skin problems. If they're mainly doing more cosmetic stuff, guess what, not a cakewalk. I've heard over and over again that those patients can be pretty crazy. But you don't have the tools to deal with that crazy at its source, you palliate with procedures, and in the end it can make you feel pretty rotten to give in to that at times.

Rads is not at all what it used to be. Path neither. The job market is going into the shytter, and they are being pushed to read so fast, so much volume, that there creeps a big fear of what you might be missing, it actually keeps some of them up at night.

Anesthesia is having its own job market issues.

Opthalmology is still what it's cracked up to be.

ROAD is not as sweet as it once was. Although I agree, besides derm, that patient social and emotional issues are less of the stress in those fields.

The reality I think, is that whether or not you find psych or IM more stressful, has more to do with what subset of patient suckiness you'd rather deal with, what you enjoy, what you find fulfilling, what skills you possess. They're just too different for a blanket statement when I think it's a great deal of subjective.
 
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Crayola227

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Psych involves quite a bit of “general medicine”. I review/order labs, EKGs, XRs, CT head etc and treat medical conditions on the inpatient unit and recommend medication changes on consults. Psych patients are veritable magnets for pneumonia, UTIs, rashes, electrolyte derangements, neutropenia, cellulitis, hypertension, prolonged QT, chest pain, withdrawal, boxer’s fx, lacerations, falls. I also make sure the ED or IM docs have adequately managed or ruled out medical issues before I admit a patient to psych.

I enjoy the general medicine stuff for now but I will eventually reach green pastures and become as dumb as an orthopod and punt anything remotely mediciney.
Um, OK, no, psychiatrists are not "generalist" practitioners of medicine. You do not provide primary care outside of primary mental health care. I respect psych and totally acknowledge that your medical degrees are essential learning for the care of your patients, and that a lot of that is applied in providing the best psychiatric care.

EM, IM, FM, peds, even ob/gyn (many of whom end up acting almost like PCPs for a lot of their patients), might all be considered "generalist" practitioners of medicine. They do a lot of PCP work (yes, even EM, in fact, a lot more than they would like... they just don't have follow up, so it's not terribly good primary care) and the knowledge base for addressing a number of organ systems is quite broad.

More than most fields, IM is responsible for the broadest swath of medical knowledge. They specialize in adult care so they can specialize in diagnosis and treatment of complex and often chronic medical conditions. Of all the zebras you learned in medical school, (besides the peds ones), they are the specialty expected to know, recognize, and treat all of those conditions. They are responsible for the most of that knowledge from medical school going forth in training and practice.

I'm not going to act like diagnosing and treating uncomplicated MDD makes me a general practitioner of psychiatry. Neither should a psychiatrist interpreting a lipid panel in someone on Seroquel, think that makes them a general practitioner of medicine.

If your point was that psychiatrists consider and evaluate the whole patient, including aspects beyond mental health, more than most people realize, I wholeheartedly agree. As I said, much respect, and I do think the MD/DO is important in a psychiatrist's training. The idea that people can provide psychiatric care without it, I find insulting to the entire field of medicine and mental health.
 

PreMedMissteps

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A med student contacted me with his Step 1 score. He is a citizen but he went Abroad for med. Score is 210. Low, I know.

I’ve seen the chart for domestic seniors wanting Psychiatry, but where is the chart for American IMGs?

He is one of their strong students, but made the poor decision of going Abroad. So far I’ve advised him to do better on step 2 and, during M4, apply to a very large number of community residency programs that would be more likely to interview and possibly rank him.

What other or different advice would you give?

Can some of you knowledgeable people please comment on the above?

And is there a link/chart that shows match results for IMGs, particularly US citizens, wanting psychiatry?

And if chances are low, particularly for a 210 Step 1 score, would you advise the Student dual apply....to many psych Community residencies and to trans/prelim year as backup?
 
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