DO and wanting to match Psychiatry...is Step 1 &/or 2 necessary?

[thev3lv3tunderground]

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Hello!

I am a second-year DO student trying to decide if I should take Step 1 & 2, just Step 2, or neither. COMLEX is required (of course), and I am concerned about having to study for and take 2 boards in succession. I am interested in Psychiatry, and would like to attend residency in California/a big West Coast city, or perhaps a large city in the Midwest. I do not care much about being in an academic or research-heavy residency. I am in the middle of the pack in my class and have some leadership positions.

With Step 1 being p/f now, does it really only matter if you take/score well on Step 2? I don't want to close too many doors by not taking it, but I also am trying to be realistic about preparation and studying for both (which makes me anxious). Any advice would be appreciated!

 

[MateoGM416]

For midwest programs, even some academic programs, it's not a dealbreaker not to have taken the Steps. Matching on the west coast as a DO is difficult even with steps, unless you have strong personal connections to the state.

Check ResidencyExplorer to see which programs explicitly require STEP and also which heavily favor applicants who take STEP. A lot of programs will say they only require either but will be heavily biased in who they interview based on whether they take STEP.

But as you alluded to it's better to have passed only COMLEX then fail a board exam. Some people even pass STEP and fail COMLEX. Only you yourself can answer what you think you're capable of. Good luck

 

[Cath Up]

I am a DO PGY4 so take all this with a grain of salt as it has been a while. Also, I recommend sheriff of sodium (just google, he has a site) as he tends to talk about the most recent data. You could also check out the most recent NRMP charting outcomes from 2024 for DOs.

I applied to >90% of all West Coast programs. I had a 72% percentile step 1 when it was scored, COMLEX scores were about average. I did not take step 2. Overall my application was a fair bit above average for DO psych and above average for MD psych - I had a fair bit of research. I was offered a subI at a T10 (but they hadnt had a DO in a while and didn't want to risk a wasted month). I was told I had good letters. I received 2 interview offers to community West Coast programs.

I had no ties to CA. I received no interviews in CA. I saw an MD with a similar profile (I would say slightly worse on paper apart from DO and having step 2) as me receive an absolutely night and day different caliber of interviews, including West Coast. MDs with objectively worse stats across the board received better interview than I did. Overall I applied to about 110 program and received 11 invites, with several from decent mid tier academic programs, the rest community. I avoided a lot of programs that typically take a lot of DOs in the midwest and south which hopefully explains some of my low yield. It looks like signalling has overall been beneficial to the application bloat and getting interview at desired programs. I am glad for that.

As far as I can tell my greatest sin was not taking step 2. I studied hard for step 1 and was kind of burnt out, anticipated a below average or best case scenario average step 2 score, which I felt would hurt me because it would show a downward trend in performance. I think this was poor judgement, and I would have benefited from a below average, but passing step 2 score, because then I could be directly compared to MDs.

I can't advise about step 1 now as it is pass fail, but having a scored exam to directly be compared to your competition makes sense to me, and in my experience is the greatest modifiable factor that seems most likely to explain my different caliber of interview offers when compared to MDs during my cycle. I would strongly recommend taking the step exams if you want West Coast. I would strongly encourage reaching out to programs to develop ties and show interest. I would strongly encourage obtaining the best letters that you can. I would strongly encourage as many subIs as you can manage at programs you might want. I would also advise applying to enough safety programs to ensure you will match - you only get one first try at this and it is the highest yield money you will spend in your life (several thousand dollars to obtain the career you want after 4 years of sunk cost). I would discourage focusing on preclinical grades or extracurriculars.