Did not match, what to do with time off?

[OlReagan]

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So I did not match this year and I'm wondering what I can do during this time to make myself a better applicant.

US-IMG from a "big 4" Caribbean school (whatever that's worth)
step1: 200
step2: 211
honored all but 2 rotations (one being IM)

no failures, CS passed, had all my scores in on time for application.

red flags: low scores, very low class rank which is annoyingly listed on my mspe, no research or publications, and a weird, long write up from IM that described me as "reserved" (IM was my second rotation, after psych, I guess I wasn't as comfortable yet)

I had 10 interviews, 2 were prematch. I applied only to psych, 160 programs. I always felt like my interviews went well, had some really interesting, animated conversations. But obviously, I had 10 interviews and did not match so something has to be off with my interview style, which I've been reflecting on a lot, but that's another thread.​

I'm wondering how I can best utilize this time off. April I went on vacations I had planned (good interview convo fodder, at least?). May and June I am using to take step 3. I figured with my low scores perhaps programs were worried about my ability to pass. Is this wise?

I'm not sure what to do after though. I have possible work lined up in a mental health clinic from a family friend that might lead to some connections, finding out the specifics of that on tuesday. I need research and I would ideally like to match in NYC (obviously, I'll go wherever) so I want to look into finding something there. Observerships are obviously another option. Should I focus myself on research first? Should I just start emailing every NYC residency program?

I guess the real question is what would benefit me the most? Am I wrong about step 3 importance? Would this clinic job be impressive or should I spend my time doing research and observerships instead?

Thank you for any advice

 

[OlReagan]

The other thing I am thinking about is applying for family as a backup this time. I don't have any family letters though so I would have to either dedicate a month to a family observership or ask a doc from my family rotation (who I am sure will barely remember me). I just worry applying to family without a family letter would be futile.

my current letters: 1 peds from someone I really got along with. Both of my attendings from my psych core wrote me letters. 1 from a director of an addiction psych fellowship (one of the prematch programs). I had a great peds behavioral and development rotation with an attending that I really got along with, I might ask her for a generic letter.

I could potentially get an ok peds application out of what I have

I love psych and up until match day it really was what I thought I was going to be doing with the rest of my life but I just don't want to take any chances. A 2nd non-match seems like it would be a big red flag

 

[OldPsychDoc]

I think that getting Step 3 nailed is useful--IF you can pass it. Otherwise the attempt ends up being another red flag. Having it in hand, though does put you a leg up on the other USIMGs coming out of those Big 4 ( and numerous "little others") offshore--who are your real competition for these residency slots. Again, you're in that segment that is going to most acutely feel the relative increase in competitiveness for psychiatry positions--average-ish USIMGs with limited "punch" to their resume. The actual mental health experience will help, especially if you do well with enthusiasm.

 

[OlReagan]

In terms of getting an interview though, would having step 3 done have any effect on the filters programs use to screen potential candidates? I applied to a lot of programs and only heard back from 10 total, I worry I won't get that many again this next time around. Programs also don't re-interview, correct? I can't imagine programs look favorably on re-applicants

 

[Leo Aquarius]

So I did not match this year and I'm wondering what I can do during this time to make myself a better applicant.

US-IMG from a "big 4" Caribbean school (whatever that's worth)
...​

Apparently it's not worth much. Sorry, I can be a little mean sometimes.

 

[OldPsychDoc]

In terms of getting an interview though, would having step 3 done have any effect on the filters programs use to screen potential candidates? I applied to a lot of programs and only heard back from 10 total, I worry I won't get that many again this next time around. Programs also don't re-interview, correct? I can't imagine programs look favorably on re-applicants

We don't use it as a screen, per se, but it's going to be a positive factor relative to someone else with similar numbers and training experience.
Have you reached out to some of the ones that did interview you? We did re-interview a handful of reapplicants--folks we liked well enough to rank in the previous year but had fallen below the point where we filled. We were also looking for a) some improvement from the previous year, and b) a compelling reason to connect to our program. Unfortunately, the field was quite a bit stronger this year and none of them matched with us.

 

[MacDonaldTriad]

My sense is step III >> research >> LOR. LORs seldom make much difference and previous failure evaporate if you are license eligible other than months of training.

 

[whopper]

I didn't know there was a "big 4." SGU has a rep because it's been around awhile, has a high USMLE pass rate and has established rotations in US schools. Last I knew all the other schools had meager board pass rates, some on the order of less than 20%, and I don't even know of 4 of them.

As for SGU (and I'm a grad of it), while I was there it was a hell-hole. I hear it's tremendously better now but when I was there I'm talking about people living in conditions worse than Army barracks, food poisoning quite often, and a business manager that made it quite apparent he just cared about the money (e.g. tells you nothing is wrong with the food despite the food poisoning and he wouldn't touch it with a 10 foot pole). Other crazy things happened during clinic years like they would put you in one hospital for a rotation, then you'd have another rotation in another hospital literally 3 hours a way without much warning and no means to obtain a place to live other than to scout around on your own on your own time while having to tell a potential landlord that you only want to rent the place for 6 weeks. I knew some students that had to commute for a surgery rotation about 4.5 hours a day. This was > 10 years ago.

As mentioned above passing Step III is a big watershed because I've noticed psych residents often times don't focus on making psychiatry their primary focus until it's been passed. Research can help. Other than that just wish you to maintain your mental resilience becuase being in your situation is tough.

OPD mentioned he wouldn't use step III as a screen but I do believe other programs would. I mentioned this in several other threads. PDs and admission committees have the task of having hundreds (or more) applicants and not being able to give each application a good amount of time. They have to filter them to a few dozen where they could then put those applicants under a microscope.

While I was a chief some filters I used were 1-personal statements had no mention of psychiatry 2-multiple failures on USMLE 3-LORs mentioned nothing significant.

 

[OlReagan]

I will reach out to some programs that I interviewed with and see what comes of it. Ultimately it's up to my interview skills, I'm realizing. I harped on a lot about homeless advocacy and a desire to do community work, which I really do care about, but I'm realizing may have come off either as insincere or out of the scope of what a psychiatrist actually does on a day to day basis. I wasn't in the mindset of "this person wants a reliable, hardworking employee", I think I came off as too wishy-washy and laid back, too caught up in being "personable".

OldPsychDoc, do scores play a role in ranking, even after interviews?

Thank you for the input everyone. If you have any more suggestions/advice I would GREATLY appreciate it.

 

[OlReagan]

step 1 pass rates for us aren't a problem, it's always high 90's. The unmatched percentage for us was significant though, 17%; it puts a lot of us in these dire situations.

 

[OldPsychDoc]

I will reach out to some programs that I interviewed with and see what comes of it. Ultimately it's up to my interview skills, I'm realizing. I harped on a lot about homeless advocacy and a desire to do community work*, which I really do care about, but I'm realizing may have come off either as insincere or out of the scope of what a psychiatrist actually does on a day to day basis. I wasn't in the mindset of "this person wants a reliable, hardworking employee", I think I came off as too wishy-washy and laid back, too caught up in being "personable".

OldPsychDoc, do scores play a role in ranking, even after interviews?

Thank you for the input everyone. If you have any more suggestions/advice I would GREATLY appreciate it.

Nope--speaking only for my own program, scores usually only matter before the interview. After that the question is "did they pass?"

*If you really MEAN that, does your CV show it? That would be a good thing to beef up in the next couple of months if you can. And look to target your application to a few more programs that specifically see that as part of their mission. That might help to show that you're more than a nice guy who "went to medical school because he wants to help people".

 

[OldPsychDoc]

I didn't know there was a "big 4." SGU has a rep because it's been around awhile, has a high USMLE pass rate and has established rotations in US schools. Last I knew all the other schools had meager board pass rates, some on the order of less than 20%, and I don't even know of 4 of them.
....

SGU and Ross are probably the "big 2" and I think most would add AUC and Saba to the list of those who do a fairly decent job approximating a US med school--and I've had phenomenal residents come out of each of them, as well as some less well-named ones.

But personally, I'd advise just about any pre-med to avoid them all. The competition for residency placement is getting heavier, and likely to get worse.

 

[MacDonaldTriad]

I know a lot of people are going to say “that’s easy for you to say”, but getting into a domestic medical school is going to become the do or die cut off more and more. In the past, it may have been viable to pay the extra money, move and get an off shore MD, but that necessitates getting into US training. As this becomes more difficulty, the gamble becomes more risky. Medicine keeps a fairly tight clamp on the front end because telling students they are not cutting it down stream can financially ruin people. Now class sizes are getting bigger, the clamp is a bit looser and we will begin to resemble psychologists and lawyers the more this happens. I respect psychologists and lawyers, but there are some that struggle to find jobs and pay back loans. We are a long way from there, but that is the direction this is moving.

 

[whopper]

I've had phenomenal residents come out of each of them, as well as some less well-named ones.

Agree. I've seen some American grads do terrible and FMGs do very well. I've mentioned this several times before but I have a strong lack of faith in judging someone based on scores but as I've said, when you've got hundreds of applicants you can't give each one the time they truly deserve.

I'm also only mentioning this for the sake of the newer members (OPD I'm sure knows I've said thsi many times). There is a science to seeing what parts of the admission process is valid, and unfortunately the best indictor are standardized tests that I'm sure we all would agree do not truly rate how good the person will be as a physician.. Things such as LORs have no validity. I am continually amazed that residency programs don't bother to understand this science (it's heavily published in industrial psychology textbooks and journals).

When the person gets to the interview stage, I want to find something that convinces me that this person really does care about psychiatry and will be a good physician. This is something that perhaps really cannot be validated in studies.