Didn't match, now what? vol. 978

[TN86]

Hey y'all, just resurfaced from a 2 week bender after not matching. Not sure what to do for the next year. I'll be taking step 3 some time this summer, but not sure what else to do.

My options are:
1) Clinical research assistant
2) Pay a schmidt load of money and do a couple of externships and get new LORs
3) Relevant volunteer work
4) MPH
5) Observerships

Background: IMG 250+/260+ CS pass (all first attempt), YOG: 2016, decent ECs, 6 months of US clinical experience (electives), strong (but old?) LoRs. Applied to a competitive specialty, switching to Family Medicine this time.

I know this question has been asked a million times but i'm really lost here. Which of the above options do you think would improve my application the most?

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[hallowmann]

Honestly, I think you'd be fine applying FM broadly without any real change to your app. You'd also probably be fine doing community IM with applying broadly. Just make sure your PS and LORs are appropriate for the field. Apply to a ton of IMG-friendly programs, and I really think you'll be fine. This is all assuming you're a US-IMG.

If it were me, I'd do 1, 3 or 4, but mainly because I wanted to not because you feel you have to. You should do something though.

 

[gutonc]

One thing you don't mention, that might be helpful is, how your interview offers went this year.

Did you apply to every program in your competitive specialty?
Did you get on 2 IVs and not match?
Did you get a good ROI on your applications, rank >10 programs and still not match?

Do you have LORs and other things on your app that an FM (or other specialty) is going to like?
Nobody wants to be your sloppy seconds.

I agree that it's unlikely observships/externships are going to be of any use. Get a job for the year (CRA isn't a bad one) and apply broadly, and intelligently, next year.

 

[NotAProgDirector]

Changing your specialty should fix your problem. You'll still be a relatively fresh grad, your USMLE's are great. University IM isn't out of reach. If you really want a surgical field, applying for prelim surgery in the match would likely be successful but then you have to work/network your way to a real spot.

Basically, you need a plan: if not your chosen specialty, then what?

Next year, you decide whether you apply to only your new field, or try again for both. Some will depend upon the questions @gutonc asked -- your interview offer rate will likely be worse this next year. Step 3 won't make much of a difference -- your scores are already great (and a poor S3 would be a bad outcome, so tread carefully).

As for jobs, research is fine (helps network / build connections), medical scribe, or EMT both keep you clinically active. Some locales will give you EMT training for free if you commit to working enough shifts with them (esp unpopular shifts).

 

[TN86]

Honestly, I think you'd be fine applying FM broadly without any real change to your app. You'd also probably be fine doing community IM with applying broadly. Just make sure your PS and LORs are appropriate for the field. Apply to a ton of IMG-friendly programs, and I really think you'll be fine. This is all assuming you're a US-IMG.

If it were me, I'd do 1, 3 or 4, but mainly because I wanted to not because you feel you have to. You should do something though.

I'm from the great white north so unfortunately i'm a non US IMG. Those seem like the best options but I don't have a family letter so I feel like an externship is a must.

One thing you don't mention, that might be helpful is, how your interview offers went this year.

Did you apply to every program in your competitive specialty?
Did you get on 2 IVs and not match?
Did you get a good ROI on your applications, rank >10 programs and still not match?

Do you have LORs and other things on your app that an FM (or other specialty) is going to like?
Nobody wants to be your sloppy seconds.

I agree that it's unlikely observships/externships are going to be of any use. Get a job for the year (CRA isn't a bad one) and apply broadly, and intelligently, next year.

I applied to every program that I was eligible for. Got 2 interviews.
I don't have any family LoRs, but I have Obstetrics and peds letters. If one were to look at my app now they'd definitely know they're getting sloppy seconds.

Changing your specialty should fix your problem. You'll still be a relatively fresh grad, your USMLE's are great. University IM isn't out of reach. If you really want a surgical field, applying for prelim surgery in the match would likely be successful but then you have to work/network your way to a real spot.

Basically, you need a plan: if not your chosen specialty, then what?

Next year, you decide whether you apply to only your new field, or try again for both. Some will depend upon the questions @gutonc asked -- your interview offer rate will likely be worse this next year. Step 3 won't make much of a difference -- your scores are already great (and a poor S3 would be a bad outcome, so tread carefully).

As for jobs, research is fine (helps network / build connections), medical scribe, or EMT both keep you clinically active. Some locales will give you EMT training for free if you commit to working enough shifts with them (esp unpopular shifts).

I plan on applying only to family medicine this year. I'm not a big fan of IM or Surgery.
Do you think it'd be helpful to do a couple of family externships to get LoRs? That seems like the only way my application would be competitive and not seem like its a backup plan.

 

[NotAProgDirector]

Trying to guess what you applied for that, now that you won't get it, you've decided on FM instead. Derm? OB?

Anyway, it really doesn't matter. Your application is all good, all you need to do is sell yourself as a true FM applicant, not FM-is-a-backup-to-my-real-love-which-is-XYZ.

You only got 2 interviews. Applying again to the same specialty is doomed, unless you go full-out research for several years and build connections, and that's still a risk.

So, I agree that some FM clinical time with LOR's is good. Tell your letter writers that you tried to apply to XYZ, didn't match, and are now excited about FM -- that way they will put that in their letters. You'll also be saying that in your PS. Ideally, you'd want your med school to add that to your MSPE -- since you only get one MSPE, every FM program would know that you were serious (because you couldn't possibly be applying to the other field). More research is unlikely to help, although it's fine if you like it. With all of your US experience already and strong USMLE, observerships alone might be fine (and free). If possible, you'd want to do them with people connected to FM training programs. Although that might seem impossible, if you sell yourself to a program, they might help organize it in an attempt to match you -- remember that you're now going to be "top of the heap" as far as IMG's applying to FM. Once you convince them you're serious, it's a buyer's market.

 

[NotAProgDirector]

Also, an off cycle spot is a real possibility. If there are programs you're interested in (esp if you want to stay local to where you are), get your CV out there. Be clear that you're 100% committed to FM this time. If a spot opens, someone will snap you up.

 

[TN86]

Trying to guess what you applied for that, now that you won't get it, you've decided on FM instead. Derm? OB?

Anyway, it really doesn't matter. Your application is all good, all you need to do is sell yourself as a true FM applicant, not FM-is-a-backup-to-my-real-love-which-is-XYZ.

You only got 2 interviews. Applying again to the same specialty is doomed, unless you go full-out research for several years and build connections, and that's still a risk.

So, I agree that some FM clinical time with LOR's is good. Tell your letter writers that you tried to apply to XYZ, didn't match, and are now excited about FM -- that way they will put that in their letters. You'll also be saying that in your PS. Ideally, you'd want your med school to add that to your MSPE -- since you only get one MSPE, every FM program would know that you were serious (because you couldn't possibly be applying to the other field). More research is unlikely to help, although it's fine if you like it. With all of your US experience already and strong USMLE, observerships alone might be fine (and free). If possible, you'd want to do them with people connected to FM training programs. Although that might seem impossible, if you sell yourself to a program, they might help organize it in an attempt to match you -- remember that you're now going to be "top of the heap" as far as IMG's applying to FM. Once you convince them you're serious, it's a buyer's market.

EM. Family seems like the best "jack of all trades" alternative.

Never thought of mentioning that in my MSPE, thats a great idea. I don't really like research so I think i'll do a couple of family rotations before September, volunteer at a local clinic and hope for the best.

Thanks for the advice!!

 

[NotAProgDirector]

That's an easier sell than "Well, I was thinking about ortho, but now I'm sure I'll be perfectly happy in FM"

I am surprised that you're more interested in FM than IM. I'd think that IM + Critical Care would be a better fit for your interests. But nothing is wrong with FM.

 

[slikric]

I'm in a somewhat similar situation but have a few differences

I'll be applying to internal medicine this year
I have a LOR in the field but I have lower board scores than the op with an attempt on CS
US-IMG
Have publishing credit

I also have an opportunity to be a certified Epic application analyst at a large University based hospital. I was hoping to parlay that job into a few connections (research, observership, LOR). I am also strongly considering preparing for Step 3 due to multiple CS attempts. Do you think this would be an appropriate path leading to the next match cycle? Thanks for any advice