Devil's Advocate Thread: What if you barely pass?

Discussion in 'Step I' started by Messerschmitts, Jun 17, 2008.

  1. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    Okay, I'm sick of all the "poor me, I started a 240 on NBME and I only improved 20 points to 260! Woe is me!" kind of threads. I started below passing and clawed my last NBME to a 226. However, I just took the real thing today and I think I ran out of fuel and completely bombed the last block. Maybe I underestimate myself. Maybe not. There is a wide range of scores that I would not be surprised at.

    So my question is, if playing Devil's Advocate I end up barely passing, scoring a feeble 195 or 206 or something, what are my realistic options, career-wise? Obviously I would still get to be a doctor, but really is it just a straight march towards Family Medicine in the Midwest? (I just picked the Midwest as a location with a reputation of being not particularly competitive in terms of geographic desirability...no intended offence to either Family Medicine or the Midwest, but it's definitely not CA or NY in terms of competitiveness)
     
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  3. Knicks

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    QFT.


    overacheivers,,,,,,,,FTL! :p
     
  4. The Angriest Bird

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    Even with a 206, you still have a not-too-bad chance of getting into many specialties. It's safe to say goodbye to the Big Five (Derm, Plasty, ENT, Ortho, Rad-Onc). But hey, that's only 5 out of ~100 specialties.

    If you have FA 2008, just look at the graph on Page 12. The 25% percentile for Internal Medicine is about 208. That for Pediatrics if even lower, about 204. Ob-Gyn is 200. If someone dares to call "Family Medicine" a trash specialty, I doubt anyone has the guts to call Pediatrics a trash specialty.

    The data published by NRMP shows that your chance of getting into a specialty is highly correlated with how many programs you apply contiguously. So, say you apply to 15 Pediatrics specialties with a 205, you chance of matching into one of them is ridiculously high.

    205 isn't the end of the world, even though we say "God forbid let it not happen."
     
  5. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    Thanks for the encouraging words. You truly are a good yeast :laugh: I just hope that last NBME I took was predictive, and that my performance on the earlier blocks (when I was still mostly awake) made up for that disastrous 7th block. There are people on this board who would jump off a bridge if they scored a 226, I would kneel and thank the Lords of Kobol if I got a 226. Damn...maybe I should've studied harder and watched less Battlestar Galactica (inside joke)
     
  6. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow

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    Getting a low Step 1 score isn't the end of the world, or at least, not that I know of. I'm also not some overachiever that plans on getting a 269, but if I were to get around a 210-220, I would be more than content. In the case that I barely pass or that I get a low mark, I'll deal with it; I already have one strike against me as an IMG.

    At the end of the day, it's not what you're practicing, it's about doing what you like. There are plenty of people that get great scores yet still end up doing regular residencies like IM or FP simply because that's the type of medicine they want to practice. Don't underestimate the earning potential of a FP in the Midwest either. I've heard of some FP's that make 300k a year simply because they're the only doctor within an X mile radius. I'm currently in the Midwest (Champaign/Urbana if you were curious), but I'm originally from a suburb of NYC, and to be honest with you, I would prefer practicing out here than by my hometown. I probably won't make as much as I would back by me, but the quality of life here would be infinitely better, from the lower malpractice insurance, to the cheaper housing, to the lower taxes, and to the lower crime/sense of community. It's a simpler, less complicated life, and I really think that the difference in salary would be negligible after you factor everything in.

    For example, by me in Northern NJ, if you were to buy an above average house, you're going to need to spend over $1 million. That same house anywhere else in the country would maybe go for $400-600k depending on location. Paying a $400k premium just to be in the NYC area doesn't seem like a prudent choice, especially when there is already so much competition to begin with in the medical field, high leasing fees, plus the neurotic patients that you'll have. I won't even go into housing if you plan on living in Manhattan or even Brooklyn. Expect to pay around $1 million for 1000-1200 sq. ft.

    I would love to do Obstetrics and Gynecology somewhere in a southern state, ideally Texas, Georgia, or Florida, with a decently sized house, a great wife, and 3-4 kids. That, in my opinion, would be more fulfilling than any residency in the tri-state area, period.
     
  7. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    Very well-written analysis! I too am interested in OB/GYN, but ha ha, I guess it doesn't help that my dream is to live in San Francisco, or at least the Bay Area. I can certainly understand the allure of places like the south and midwest, where as you said life is simpler and the cost of living is exponentially less demanding. However, having grown up in Los Angeles and gone to undergrad in the Bay Area, I prize the cosmopolitan lifestyle coastal locations can offer. Also I was spoiled by good Californian weather.

    Now, if like you said I could have a great wife with 3-4 kids, maybe living in the south or Midwest wouldn't be so bad. However, even on that front, I think I would be disadvantaged in the wrong geographic location. I'm kind of a eccentric person who's not too good with women, and am compatible with very few, so I think I need to be in a place with a huge population to maximise my chances of meeting that one in a million. There's 3 million people in LA, so I'm hoping there's 3 girls somewhere there for me! :-D It amazes me that some people can find their soulmate in a town of 200. I'm one of those "difficult to place" people. :p
     
  8. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow

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    I think that you wouldn't have any issues meeting a girl here in the Midwest or the South for that matter. The girls here are very easy going and laid back, with reasonable expectations when it comes to a mate. I come from the mecca of high maintenance women back in NJ (Bergen County, 2nd most exclusive place to live in the country, 1st being the O.C.). Being a lowly physician and earning only $250k will just not cut it for some women and I won't even go as far as labeling them, as they simply are a product of their environment and have been operantly conditioned as such :)laugh:).

    The girls (albeit few with my hectic study schedule) that I have met here in Champaign have been a pleasure to be around. They are polite, respectful, and not as judgmental as girls from more metropolitan areas. Yes, they lack the uber-chic look of a hipster (i.e. no $350 True Religion jeans, Louis Vuitton bag, or ostentatious sunglasses), but they make up for it with their girl next door looks and fresh faced, no make up way. I saw this girl in my apartment complex that was wearing a pair of cutoff Levi's and a plain white tee-shirt, basically a brunette Jessica Simpson. I said hi and she even stopped to have a conversation with me! I've tried to do that on numerous occasions back in NJ and it just wasn't happening, meanwhile here, the girls are 100000x naturally better looking and they're the ones initiating the conversation. I was like :confused:

    The girls here know that life isn't all about lavish dinners at expensive restaurants or the fact that men will be throwing money in their direction 24/7. Their idea of an extravagant date would be going to the Cheesecake Factory, meanwhile, I doubt the same holds true for the women in SF. If you have some free time, do a little traveling in the U.S. and you'll get to see the difference. I went to a radiology conference in Sarasota, FL and I would highly recommend it. Florida is probably #1 on my list of places where I would relocate. Great weather, nice people, cheap housing, and don't forget Spring Break at Daytona Beach, except this time around, with money, lol.
     
  9. hippocampus

    hippocampus Senior Member

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    i think in the end, it's all up to God, or the higher beings, or whatever you believe in..
    it's really all about luck... you future is based on how lucky you are.. maybe you're destined to go to the midwest and meet some girl there... who knows..
    i say this because i know people who got step1 scores that they shouldn't have gotten... honestly, their nbme practice scores were low/average and they're not the brightest (lower end of the class), yet they manage to get A LOT higher than the national mean.. and now they think their God's gift to the world.. how could anyone say that is not luck..!
    this is so lame.........
     
  10. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow

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    +1

    Who knows what He has in store for all of us. In the whole scheme of things, I think that He knows what he's doing, so I won't question what the reasoning was behind that move.

    It really all does come down to luck. You can be tested only on things that you are strong on and then you're set, knock out a 240+ or you can get stuck with all of your worst subjects and then you barely squeeze through.
     
  11. doc20

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    umm this is not OVER.
    step1 is just the beginning of a long series of exams and interviews.
    you have step 2, possibly step 3 before residency
    ace this 2 with 95'(240) and above, and your step 1 score will not be looked upon critically by PD's
     
  12. Nodelphi

    Nodelphi Member

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    Too true, every time I freak out about the step and tell my wife how all my grades up until this point didn't matter and that this was the one grade that did matter, my wife just rolls her eyes and gently reassures me that I'll be saying the same thing for my medicine rotation, surgery rotation, Step 2, Step 3, interview etc. There will always be a big challenge looming and I'll always be worried about it before I face it.

    That kind of puts it all in perspective, how ridiculous we must all seem to someone not in the medical field. Lets face it we're on a path to a six digit salary that's more or less foolproof, something the vast majority of the nation will never have, and here we are stressing ourselves out at every little mile-marker along the way. We're going to be fine... as long as we don't have a heart attack along the way. (Because I don't know about you but I can't remember cardio drugs to save my life.) :laugh:
     
  13. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    Ha ha oh come now, those Louis-Vuitton sporting spoiled girls make up a small (albeit visible) subset of coastal girls. You're just playing on stereotypes. If we want to talk about stereotypes, I could say that Midwest girls are overly conservative, religious, provincial, married by age 20, and obsessed with alcohol. You could also argue that they're not keen on dating an Asian guy like me cause they've never seen one before. But I wouldn't say those things. I'm just talking pure numeric probability. I need a large number to work from. :p Trust me, it takes a very unique and rare girl to be interested in what I'm offering. I'm equally incompatible with the majority of "cool/popular" girls and the "nerdy/geeky" girls (albeit for very different reasons). While I remain optimistic that the perfect one is out there somewhere in this great country of ours, statistical probability is simply not on my side in a small town. :p

    Although I will say something about the Midwest alcohol culture. I don't drink at all, just because I don't like the taste and never got into it. I don't look down on it, but bars are just not my thing, not my scene. However while this has never been an issue when I lived in California, here in Cincinnati it has caused some alienation from the rest of the class. I mean, ever single social event planned by our class social committee is at a bar, and they wonder why I never show up at any events. Once they finally sponsored a class trip to see a baseball game...with open bar. This very sweet and innocent looking girl in my class was like, "OMG, after this exam I am going to get SO F****** DRUNK!!"

    And I guess I will say something about the being married at age 20 thing. My med school class is less than 40% female, so already there aren't enough. And out of those, probably 60% are married or engaged. Again, this was surprising coming from California, where people are in no such rush. I think by Midwest standards I will have "missed the boat" with girls my age by the time I graduate. The only ones I will have to choose from by then will be divorcees (and there are a shocking number of 25-year old divorcees with one child around here).
     
  14. tcar18

    tcar18 Member

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    are you sure we aren't married to the same person? this sounds eerily familiar.

    its true though I think when people not in our shoes look at how we stress about this stuff we must look utterly ridiculous.
     
  15. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    Dude those cardio drugs are killer, especially the anti-arrythmics! Class IA, IB, IC...I went through my entire pharmacology course never truly understanding what each one is used for, and how. Probably why I didn't do so hot... :p Hopefully I truly "get it" by the time I get that M.D.

    But yes, wise words from your wife. You don't know how lucky you are, I'm so jealous ha ha! You sound like you have a great partner there! ;)
     
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  17. DaveinDallas

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    I know this comment isn't about medicine and is really a detour but I couldn't help myself.....

    I've been married twenty years and have two great kiddos.....

    Trust me, gentlemen, an 'uber-chic' high maintenance woman will leave you just as soon as the party is over. After a while, you'll be asking,"Just how much money do I have to spend to keep you happy and do you really want to be with me or with the party that I provide?". Not worth it. There's a fair share of the surgically enhanced, tanning-bed bronzed set here in Dallas. And yeah, my wife sags a bit and has lines in places that she didn't when we first got married. But she's always been there for me, supported me, loved me through the bad times and has done the heavy lifting in running the household while I chase this career called 'medicine'. No, she's no longer runway model beautiful nor does she make you think 'hot monkey sex' when you see her at the store but she's with me and I wouldn't trade that for all the money or smokin' hot 'uber-chic' blondes who were begging to do the nasty-nasty with me.....no way....

    In the end, you're going to sag and wrinkle and have to look death square in the face, probably wear Depends and try to remember where you left your teeth....find a woman who will laugh with and at you when you do that.......

    Sorry, my $.02 worth....
     
  18. R_C_Hutchinson

    R_C_Hutchinson Senior Member

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    Thanks for the input Dave; any time you want to share more wisdom, we're all ears.
     
  19. Alteran

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    There are some who strive for greatness. For the rest of us, there is the second half of season 4 in 2009.

    And no, a lower than competitive score does not exclude you from a residency. Actually, some residencies have Step I as merely icing on the cake (and I'm not talking about Peds or Fam Med either). If you want more info, look at Iserson's Getting Into A Residency for more info as to what residency directors are looking at given a particular specialty.
     
  20. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow

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    +1

    I aspire some day to have a life like yourself Dave, but with 1 or 2 more kids. :p Even though I am only 24, I would love to have a big family, with a great wife, in a place that would be conducive to raising a family (ideally somewhere warm) in the not so distant future.

    If becoming a physician has taught me anything, it's that family is what is important. I wouldn't have made it this far if it weren't for the support that my parents and sister have provided me through the years. You truly find out whom your friends are through medical school and whom is really looking out for your best interest. I've lost many friends along the way on this path to becoming a physician, but it has taught me that some people may be with you for all the wrong reasons and I will reiterate what Dave so wisely said about the necessity of finding someone that is willing to deal with you through the good times and the bad. The only problem is finding someone like that is easier said than done.
     
  21. LJDHC05

    LJDHC05 Former Chicken Slayer

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    Nice to see someone else finally noticed that everyone seemed to have a 240+ on here too?

    Some specialties don't really care about step 1...they realize that it's not the ultimate measure of your actual skill as a practicing physician. (GASP OF HORROR!!!) It's completely up to the program director; some use them to screen, some don't. I'm pretty sure most programs (outside of the superstar fields) will take a serious look at you if you've done well in your clinicals, improved on step 2 and impressed on your away rotations. You'll be fine as long as you're realistic.

    That said, go get yourself some omeprazole for the ulcer that might form while you wait for your scores to come back, re-watch the last couple episodes to figure out who the 5th cylon is and get ready to work your butt off during third year. That's my plan!
     
  22. DwyaneWade

    DwyaneWade Reiging *** Cynic

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    Shrug my shoulders, work hard the next two years, go into Pediatrics and try to subspecialize down the line.
     
  23. ZonaRidicularis

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    z
     
    #21 ZonaRidicularis, Jun 18, 2008
    Last edited: Dec 26, 2009
  24. Messerschmitts

    Messerschmitts Mythic Dawn acolyte

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    That's my plan too! :-D I just got home to Cali late last night and intend to enjoy my 2 weeks of freedom. I rented the Mini-series and I got my 54-year old Chinese mom into Battlestar Galactica. I'm so proud :-D I think the 5th Cylon is Athena and Helo's daughter. She's obviously very important. I wonder what the frack happened the Earth though.

    And I think the 240+ board scores on SDN must be sampling bias. People who get crappy or even average scores are not as enthusiastic about sharing their underwhelming performance. :p
     
  25. trb25

    trb25 Junior Member

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  26. DaveinDallas

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    I hear you on that one.....yet another side note ---you'll meet 'her' when you least expect it. I had more credit cards than I had discipline to handle them when I was 26 and wound up needing another job (in addition to my full time engineering job) to pay the stupid things off. So I go to the mall to look for a part-timer. Turns out I replaced my (unknown to me at the time) wife. She had been in a similar situation w/credit and had taken a part timer to pay them off also. She was quitting the part-timer and I was taking the jobshe was vacating. We met for one night when she was showing me all the details/responsibilities of the job. 364 days later, we were married....and have been for 20 years.....

    Moral of the story:
    1) Don't do credit cards -they're really dangerous.
    2) Don't go to places/do things you normally wouldn't
    trying to meet potential mates. I was just doing what
    I would normally do -- gotten into debt, working hard to
    pay it off.....
    3) Have a good time while you're young. Not just partying
    and getting trashed, but do and see the stuff you want
    to do and see. Once you have kiddos, it's all about them.
    That's what makes parenthood so much fun. You get to
    watch Tigger and Pooh all over again and really enjoy it
    this time. You get to color in the lines and really think
    you're an artist. Popsicles and splashing in the puddles
    after a good rainstorm are really cool.....
     

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