Did Not Match - Best Next Step

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Shimmmy

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Transitional year vs. prelim (IM, fam med, etc.) vs. categorical (IM, fam med, etc.). Which one will make it easier to enter a psychiatry residency as a PGY-2? All I know thus far from my research is that categorical is not the move as it will be hard to break your contract. Also that transitional is more competitive.

Thanks.

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How do people feel about scrambking into fm/im at a place with a psych residency? Probably easier to transition within the same institution.
 
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I'm hearing about great candidates who didn't match, some of whom were highly ranked at my own program. I hope you're doing ok. I wish it were up to me and I could just create more spots.
I will just add that even if categorical you can still sometimes switch over into psychiatry, I have one friend who did this and is an incredible psychiatrist.
 
Man, I'm so sorry...what a lousy situation. My only thought is that a categorical position gets you a job as a BC/BE doctor at the end of it. Even if you can't get out of your program, you can always do a psych residency afterward (or perhaps a palliative fellowship if that interests you).
 
If you do a prelim medicine year you get 3 years of funding total. If you do a TY year you don’t get locked into the amount of funding an IM resident gets. So TY is preferable.

Are you sure about that? Many people do prelim surgery before a surgical residency. Those are 5+ years, so it would seem odd that it would lock you into anything.
 
I'm hearing about great candidates who didn't match, some of whom were highly ranked at my own program. I hope you're doing ok. I wish it were up to me and I could just create more spots.
I will just add that even if categorical you can still sometimes switch over into psychiatry, I have one friend who did this and is an incredible psychiatrist.
Be careful what you wish for. Go take a look over at the EM forum.
 
Are you sure about that? Many people do prelim surgery before a surgical residency. Those are 5+ years, so it would seem odd that it would lock you into anything.
Yes. It's a stupid system. And it's something that people only tend to learn after they SOAP into prelim spots without an advanced spot. After you run out of funding you get something like 50% funding and then your GME department has to foot the rest of the bill. So if you do a prelim IM year, then re-apply to psych as a PGY1, you have full funding through PGY1 and PGY2. Some GME departments are loaded so it doesn't really matter, but it does make it harder to match as a reapplicant. If you do a TY year, it doesn't matter. I can't remember the original source for where I got this info, but I know it's a thing from personal experience.

This post sums it up to the best of my knowledge:
 
i think the issue is that your funding is decided by where you match. so if you match categorical im/fm, you have 3 years of funding and psych is a 4 year residency.
This. A lot of community and smaller programs won't consider people who don't have full funding, and given that you didn't match, these are probably the programs you're going for in the future
 
now that the important rounds of soap are over, if we couldn't soap either... people's opinion on next steps? try to delay graduation vs graduate and take a clinically relevant job?
 
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I'm very skeptical of these "I'm an american allopathic grad with 220s/230s step scores, no red flags, interviewed at a bunch of places and just
didn't match posts"....

It just doesn't match up with what I'm seeing on the ground.

I have some DO students rotate through(I work in a large community hospital mostly and our group allows DO students to rotate with us as we get like 1000 bucks per student per rotation fromthe school. As you know DO schools generally don't have their own hospitals), and I know one that just matched as we talked about his app and him wanting to do psych and I wrote him a letter.

His app was a train wreck- around the bottom 10% at his DO school, took him 5 years to graduate because he failed the COMLEX initially and had to postpone third year rotations to study and take. After failing COMLEX or whatever the hell it's called he didn't bother taking step1, but failing Comlex is worse than failing step1 I guess. So it took him five years to graduate, his grades are poor, failed Comlex(and told me he barely passed from there) and he got many interviews at allo programs and matched quite comfortably. Oh he also told me he 'Had a few problems on his non-psych rotations' so Im sure his deans letter for each rotation wasnt good either. He went on about 10 interviews and got his #3 place. And no it's not some embarrassing hospital but your typical large state uni program that will do just fine for him and nobody would think it's a bad place to train.

So if he can get that, I just don't see how seemingly allo grads with all passing and even average step scores can fail to match. Just doesn't
add up.....maybe the key was that they came across as weird as hell on the interview. Hell I dunno.....
 
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I'm very skeptical of these "I'm an american allopathic grad with 220s/230s step scores, no red flags, interviewed at a bunch of places and just
didn't match posts"....

It just doesn't match up with what I'm seeing on the ground.

I have some DO students rotate through(I work in a large community hospital mostly and our group allows DO students to rotate with us as we get like 1000 bucks per student per rotation fromthe school. As you know DO schools generally don't have their own hospitals), and I know one that just matched as we talked about his app and him wanting to do psych and I wrote him a letter.

His app was a train wreck- around the bottom 10% at his DO school, took him 5 years to graduate because he failed the COMLEX initially and had to postpone third year rotations to study and take. After failing COMLEX or whatever the hell it's called he didn't bother taking step1, but failing Comlex is worse than failing step1 I guess. So it took him five years to graduate, his grades are poor, failed Comlex(and told me he barely passed from there) and he got many interviews at allo programs and matched quite comfortably. Oh he also told me he 'Had a few problems on his non-psych rotations' so Im sure his deans letter for each rotation wasnt good either. He went on about 10 interviews and got his #3 place. And no it's not some embarrassing hospital but your typical large state uni program that will do just fine for him and nobody would think it's a bad place to train.

So if he can get that, I just don't see how seemingly allo grads with all passing and even average step scores can fail to match. Just doesn't
add up.....maybe the key was that they came across as weird as hell on the interview. Hell I dunno.....
He must have had something else on his apps or serious connections to overcome his COMLEX failure and extended time to graduate. I’m a DO from one of the oldest DO schools, no failures but a low COMLEX Level 1 (which aligns with my preclinical grades), improved significantly on Level 2, received great feedback on all my rotations which was reflected in my dean’s letter. I applied broadly to 65 programs that all had DOs, had seven interviews which I felt I did well in, and did not match. I know people with much better scores, including Step, who also did not match. Even if you get enough interviews to have a 90% chance of matching, 10% still don’t, and it’s not always because there’s something wrong with them, in the interview or otherwise. Sometimes the numbers just don’t work in our favor.
 
I know plenty of people that match with a failed board exam, no connections, they are great at interviewing or had to overcome adversity or the PD just really liked them and felt like they would be a great fit and get along with others, and work hard, and bring unique perspective to the program. Sometimes, it’s more than just board scores, but rather the overall application and the interview. But this year was really brutal with likely more applicants plus the virtual interviewing just doesn’t work for some (brand new way to interview and hard to leave an impression, who could have prepared for that??). I would say to all, don’t give up. Many people do a prelim or TY and transfer out, I even know someone who left their FM program and transferred to a psych program. It can happen, don’t give up, stay vigilant and positive.
 
I want to follow this because I am also getting very mixed advice on delaying vs not delaying graduation. My biggest problem is my school says if I delay I cannot do any clinical rotations... I'm really at a loss.
 
Every training director is going to be able to tell you didn't match this round. This isn't the end of the world, but staying in school vs graduating is a function of a) are they charging you to stay in?, b) can you find other things equally impressive to do between now and 7 months form now vs. medical school rotations. It isn't all algebra, but if it were mathematically modeled, this would be the equation. Do you want a year with the peace corps, or a few sub-Is to try and get your foot into some doors?
 
I want to follow this because I am also getting very mixed advice on delaying vs not delaying graduation. My biggest problem is my school says if I delay I cannot do any clinical rotations... I'm really at a loss.

I fail to see any benefit to delaying graduation(which I assume means you keep paying tuition lol)......

Graduate, and do whatever you want. If you want to drink beer and watch reality tv at home most of this next year, do it. But just apply to enough programs and go on enough interviews this next cycle to make sure you match. You messed up by not applying to psych programs as well this year, and it's just going to cost you a year.

but what's done is done.....but I wouldn't obsess over trying to do something to 'look impressive'. You have the leverage here....IMGS/FMGS of questionable ability are still flooding the gates, and programs will be happy to have a competent AMG. There is no reason to delay graduation or do crap you don't like if you don't want to.....
 
I respectfully disagree with Vistaril. He makes a good point in a fatalistic perspective, but there is matching, and then there is matching as best you can. My objectivity suffers from the fact that I am a PD, but there are programs that you would not do well to get into and avoiding those is also part of the equation. You can take a year off and play video games and make us wonder how you handled this bump in your road, or you can move forward and make it an advantage as best you can by making use of your time. There were few SOAP positions in psych this year. Being passive and hoping this goes well next year isn't a good strategy. I have no dog in this hunt, just my opinion.
 
I'm very skeptical of these "I'm an american allopathic grad with 220s/230s step scores, no red flags, interviewed at a bunch of places and just
didn't match posts"....

It just doesn't match up with what I'm seeing on the ground.

I have some DO students rotate through(I work in a large community hospital mostly and our group allows DO students to rotate with us as we get like 1000 bucks per student per rotation fromthe school. As you know DO schools generally don't have their own hospitals), and I know one that just matched as we talked about his app and him wanting to do psych and I wrote him a letter.

His app was a train wreck- around the bottom 10% at his DO school, took him 5 years to graduate because he failed the COMLEX initially and had to postpone third year rotations to study and take. After failing COMLEX or whatever the hell it's called he didn't bother taking step1, but failing Comlex is worse than failing step1 I guess. So it took him five years to graduate, his grades are poor, failed Comlex(and told me he barely passed from there) and he got many interviews at allo programs and matched quite comfortably. Oh he also told me he 'Had a few problems on his non-psych rotations' so Im sure his deans letter for each rotation wasnt good either. He went on about 10 interviews and got his #3 place. And no it's not some embarrassing hospital but your typical large state uni program that will do just fine for him and nobody would think it's a bad place to train.

So if he can get that, I just don't see how seemingly allo grads with all passing and even average step scores can fail to match. Just doesn't
add up.....maybe the key was that they came across as weird as hell on the interview. Hell I dunno.....
FWIW, I didn't match this round as US MD with step 1/2 both ~260, told I had great letters by multiple interviewers, and no red flags that I am aware of, never came close to failing anything. Did 11 interviews. Possible I just did not interview well.
 
FWIW, I didn't match this round as US MD with step 1/2 both ~260, told I had great letters by multiple interviewers, and no red flags that I am aware of, never came close to failing anything. Did 11 interviews. Possible I just did not interview well.

Were your 11 interviews all top 30 programs?
 
I respectfully disagree with Vistaril. He makes a good point in a fatalistic perspective, but there is matching, and then there is matching as best you can. My objectivity suffers from the fact that I am a PD, but there are programs that you would not do well to get into and avoiding those is also part of the equation. You can take a year off and play video games and make us wonder how you handled this bump in your road, or you can move forward and make it an advantage as best you can by making use of your time. There were few SOAP positions in psych this year. Being passive and hoping this goes well next year isn't a good strategy. I have no dog in this hunt, just my opinion.
What would you suggest? Struggling to even think of paying jobs other than something in research that would look good and possibly net a new letter. I don’t have any research experience or connections so I’m worried about even getting my foot in the door with a researcher.
 
What would you suggest? Struggling to even think of paying jobs other than something in research that would look good and possibly net a new letter. I don’t have any research experience or connections so I’m worried about even getting my foot in the door with a researcher.
What about a job as a psych tech? It's not glamorous, but would probably actually be a valuable experience later on and would give you a chance to work very closely with psych patients this year. Perhaps you could even develop a relationship with the psychiatrist, maybe get a LOR with input from nursing who can really speak to how you are with patients. Just an idea.
 
What about a job as a psych tech? It's not glamorous, but would probably actually be a valuable experience later on and would give you a chance to work very closely with psych patients this year. Perhaps you could even develop a relationship with the psychiatrist, maybe get a LOR with input from nursing who can really speak to how you are with patients. Just an idea.
I did this for several years before medical school and am thinking about doing it again now too. definitely gives you a perspective on inpatient mental health that you won't have as part of the medical team.
 
For people that are forced to graduate without any connections or help from our schools, I'd also be curious as to what the best plan of action is (outside of taking step 3)
 
no, only 1 was. the rest were a fair spread of what I imagine people would call mid- to maybe some low- tier programs as my preferences were primarily geographic.
Sounds like you did everything right. Scored well on exams, applied to a variety of places. I wonder what went wrong. If you ever find out, please do let us know. Sorry to hear that you didn't match 🙁
 
The main advantage is that loans stay in student status.
This is not so much of an advantage anymore, because with income-based repayment you will only be paying 10% of your discretionary income. In fact, it would be advantageous to take a full time job at a non-profit in order to earn months toward PSLF. And this year, loan payments are all suspended until at least September.
 
This is not so much of an advantage anymore, because with income-based repayment you will only be paying 10% of your discretionary income. In fact, it would be advantageous to take a full time job at a non-profit in order to earn months toward PSLF. And this year, loan payments are all suspended until at least September.
Fair enough, the loan status thing is probably fact specific. With interest capitalizing after you transition from student status it will likely mean more interest accrual (outside of covid situation) than you'll be paying on IBR. Also depends on whether the school will charge tuition. My school did charge an amount during my research year but it was nothing like the usual tuition.
 
no, only 1 was. the rest were a fair spread of what I imagine people would call mid- to maybe some low- tier programs as my preferences were primarily geographic.
It would be worth you and/or your PD reaching out to programs to determine what went wrong. If you interviewed at 11 places with 260’s and no red flags, something went terribly wrong somewhere to not match. It’s worth figuring out what that is and fixing it.
 
no, only 1 was. the rest were a fair spread of what I imagine people would call mid- to maybe some low- tier programs as my preferences were primarily geographic.

It would be worth you and/or your PD reaching out to programs to determine what went wrong. If you interviewed at 11 places with 260’s and no red flags, something went terribly wrong somewhere to not match. It’s worth figuring out what that is and fixing it.

Agree with @TexasPhysician. It would make me wonder if there was something bad in one of my LORs and would want someone who had access to my application to give me their unvarnished opinion.
 
Agree with @TexasPhysician. It would make me wonder if there was something bad in one of my LORs and would want someone who had access to my application to give me their unvarnished opinion.
Thanks for your input. Yeah that makes sense and reaching out is part of the plan that me and my PD have discussed (figured I would wait for the Match to settle first before sending out emails). In argument against it being one of the letters, however, several interviewers told me that my letters appeared to be great (I certainly never asked for such information, it was just volunteered multiple times throughout the season). I would hope that multiple people wouldn't lie to me about this.

If I had to guess by process of elimination, perhaps my interviewing was just not up to par (though I felt like all except one of them went well enough, but perhaps I just don't have the objectivity to make this call).
 
Thanks for your input. Yeah that makes sense and reaching out is part of the plan that me and my PD have discussed (figured I would wait for the Match to settle first before sending out emails). In argument against it being one of the letters, however, several interviewers told me that my letters appeared to be great (I certainly never asked for such information, it was just volunteered multiple times throughout the season). I would hope that multiple people wouldn't lie to me about this.

If I had to guess by process of elimination, perhaps my interviewing was just not up to par (though I felt like all except one of them went well enough, but perhaps I just don't have the objectivity to make this call).

I wouldn’t assume that. My Dean’s Letter had a comment from a non-psych person that was weirdly worded. It could be spun positively or negatively. A couple interviewers caught it and asked. I would spin it positively when asked. Others could have viewed it negatively. I protested it at my school, and those above me said they saw no issue with the wording. They accidentally forwarded me the response of a dean who said it was “just Texasphysician being Texasphysician”.

My point is that some people can see positives where others see negatives and the same in reverse. You never know, but something is up.
 
About 20 years ago, I saw an MS3 Comment from a GYN in Florida;
"This student was very enthusiastic about pelvic examinations". Probably meant to be positive, but memorable in a bad way. 😵 You never know what can end up in a MSPE.
 
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