Does 1-year medical LOA affect psychiatry residency match?

[catdog1234]

Hello,

I am currently an M2 in an MD program that's been recently struggling academically due to some mental health issues. I've had to take about ~6 weeks of time for myself to work through my issues, which I think are being better managed now (i.e. some med changes, weekly therapy, etc). However, this time has cost me a lot in terms of feeling prepared for my clerkships/shelf exams.

My school suggested there's the possibility of taking a Leave of Absence (i.e. medical, research, etc), in which case given my predicament would mean 1 full year LOA. My school is very supportive in this regard. However, I am worried this will negatively impact my competitiveness for residency programs, namely psychiatry, if I were to take a LOA. I know there are some laws that preclude residency directors from asking probing questions pertaining to a medical LOA, but I can't help but feel like they may view this negatively (i.e. they may assume it's related to my mental health, which I've heard is a red flag), especially since I am taking a LOA in the middle of the year.

Can anyone shed insight into whether or not a Leave of Absence (LOA) affects one's application to different psychiatry programs in the US? I'm sure there are programs that wouldn't think much of it, though I wonder if any top programs would hold it against me.

Any insight is much appreciated.

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[Celexa]

In a perfect world it's better to not have a leave of absence (some programs won't care, some probably will). But it's a LOT better to have a leave of absence and an otherwise solid academic record which does not require further explanation of issues than to have a failed clerkship, step, etc.

You should discuss with people close to you (ideally, who understand the challenges of medical school) to evaluate whether you truly are in a place where you can be confident starting clerkships or if a leave of absence would be most prudent in order to reduce the chances of there being more issues later.

 

[comp1]

This is such a complex and ultimately personal question. I can tell you as an MD/PhD, there are some significant downsides to not moving along with your class in terms of emotional support from each other. However, 1 year is not quite the same as 4 years. And the poster above is right that a LOA is much, much less of a red flag than a failed clerkship. If it's truly between the LOA and you not realistically being able to complete 3rd year without failing, then of course do the LOA. I'm not sure it's quite that cut and dry however. For me, this would come down to what exactly would happen during the LOA. How are you going to be more prepared in one year, away from formal school, for clerkships and shelf exams? Are you planning to do some sort of remediation course? You're a bit vague on what the LOA would consist of. A year is both a short time and a long time in various respects. I think we need to know kind of firmly what will happen month by month on that LOA and so do you, before making a decision or recommendations. I can tell you just taking a LOA without a plan in place would not be my recommendation. I actually think that could make you MORE likely to fail clerkships and/or shelf exams.

 

[TexasPhysician]

Some programs will filter out applicants that didn’t finish on time.

Many programs will filter out failures.

If you can catch up and finish without much of a LOA or failure, that is theoretically ideal.

If LOA or a failure, always take a LOA.

 

[Stagg737]

Legally, it shouldn't affect your chances, but chances are pretty good that it could. If you can make it to the end of M2 and take a research year that probably wouldn't cause any issues as long as it's a productive research year. If you have to take a medical LOA or a LOA mid-year that would not be ideal, but would not look as bad as a 2nd year, Step 1, or clerkship failure and needs to be weighed appropriately.

I have some personal experience on both sides of this. I had to take a medical LOA in grad school and failed a course in M2 year. I'm not an academic attending working with med students and residents. Feel free to DM me if you have specific questions.

 

[FlowRate]

Depending on timing and whether you're able to keep up with finishing out your preclinical year, you could always do a medical LOA under cover of a research year?

 

[comp1]

I definitely got the feeling that the OP might be considering a medical leave "under the cover" of something else. However, I think it's important to figure out what a medical leave would consist of as well. The OP isn't describing a cancer diagnosis with chemo and radiation treatments that are quite concrete. If this is primarily a mental health issue, which I assume given the forum, what is the mental health treatment plan? I'm really quite opposed to what I describe as Price is Right therapy where you stay at home watching TV expecting spontaneous recovery. This more often than not makes things worse. Is the OP planning an intensive outpatient program? I'm not sure there are any of those that really last a year. Is the idea somehow research after a 6 week IOP? Again, a year is both a really short amount of time and a very, very long amount of time for different things.

 

[clausewitz2]

I definitely got the feeling that the OP might be considering a medical leave "under the cover" of something else. However, I think it's important to figure out what a medical leave would consist of as well. The OP isn't describing a cancer diagnosis with chemo and radiation treatments that are quite concrete. If this is primarily a mental health issue, which I assume given the forum, what is the mental health treatment plan? I'm really quite opposed to what I describe as Price is Right therapy where you stay at home watching TV expecting spontaneous recovery. This more often than not makes things worse. Is the OP planning an intensive outpatient program? I'm not sure there are any of those that really last a year. Is the idea somehow research after a 6 week IOP? Again, a year is both a really short amount of time and a very, very long amount of time for different things.

If I understand correctly the OP is already back in a place of better functioning and stability but has lost critical Step preparation time. School is suggesting an LOA to get them back on the same schedule as the rest of the class and so they are not playing catch up.

OP, the question is how far behind do you think that you are in terms of academic preparedness because of those six weeks? If you are fairly convinced you're going to wipe out on the USMLE, then yes, maybe take the LOA, but I agree with other posters saying that while this isn't going to kill your chances by any means it is going to make things appreciably harder for you come match time. You don't have the ability to point to a specific discrete curable medical condition that was treated and is highly unlikely to recur as the motivation for your leave.

Also, is this forum just the "MD/PhDs who left academia" club? No offense, @tr , you can be an honorary member.

 

[catdog1234]

Hello,

I really appreciate everyone's replies.

For more context,

1) I have multiple co-morbidities, including recurrent depression, social anxiety, C-PTSD, and ADHD (all on my problem list). I also have an ACES score of 9, lol, if that matters. I was going through a depression in the last few months for personal reasons. The good news is that re-starting therapy again in the last 2 months has helped. I also feel like my medications are finally stable; I've spent the last 1.5 years with a really understanding psychiatrist who's helped me in determining the right medications and dosage. I've also thankfully have about ~3 years of therapy under my belt. I think this winter was just more difficult for me despite my coping skills, a blip if you will.

I'm doing better now thanks to focusing on my mental health. Sleep is good, concentration is also better.

2) Currently, I'm in the phase of my education where I am supposed to take Step 1 and start clerkships. Unfortunately, I am not at a place where I can comfortably pass. I still have 1 month left to take the exam though, so there's room for improvement. This will require me to grind like mad until then, which I think I can do.

3) As mentioned, my school is very understanding of the time I took to address my health, and is working with me to consider different options. My advisor said I could consider two different paths:

Path 1: Try to take Step 1, with at least passing-range on two NBME exams before test date (i.e. 98%+ chance of passing). I'm currently at 50% chance of passing.

Path 2: If more than 1 month is needed for preparedness, take 1 year as a LOA to adequately prepare for Step 1. My advisor explained this would be treated as a medical LOA or research LOA. In my case, I could opt for either and explain it in my residency application.
_____________________________________________________________
4) Since I am doing better and in a time crunch, I am currently on Path 1 (study really hard, see what my practice scores are in May, and then decide then to sit for the exam or not).

5) My question for the forum is if I decide at some point in the next month to choose Path 2, and the repercussions of taking a medical or research LOA. If I had to be completely honest, I would rather not feel so rushed with my Step 1 preparation, and then jump straight into clerkships. My advisor also mentioned that students that have better preparedness for Step 1 typically also have better performance on shelf exams and Step 2, which are the only graded part of my curriculum. I would feel better going into clerkships with better preparedness. Thus, there's a part of me that wouldn't mind the extra year to work on my mental health more, also study more adequately for Step 1, and also do a bit of research so that I'm still building a competitive portfolio.

I just don't know if I'm shooting myself in the foot with choosing Option 2. And specifically, how that appears for psychiatry residencies who are evaluating candidates.

____
I hope this clarifies some of my concerns. Happy to answer additional questions.

 

[TexasPhysician]

Hello,

I really appreciate everyone's replies.

For more context,

1) I have multiple co-morbidities, including recurrent depression, social anxiety, C-PTSD, and ADHD (all on my problem list). I also have an ACES score of 9, lol, if that matters. I was going through a depression in the last few months for personal reasons. The good news is that re-starting therapy again in the last 2 months has helped. I also feel like my medications are finally stable; I've spent the last 1.5 years with a really understanding psychiatrist who's helped me in determining the right medications and dosage. I've also thankfully have about ~3 years of therapy under my belt. I think this winter was just more difficult for me despite my coping skills, a blip if you will.

I'm doing better now thanks to focusing on my mental health. Sleep is good, concentration is also better.

2) Currently, I'm in the phase of my education where I am supposed to take Step 1 and start clerkships. Unfortunately, I am not at a place where I can comfortably pass. I still have 1 month left to take the exam though, so there's room for improvement. This will require me to grind like mad until then, which I think I can do.

3) As mentioned, my school is very understanding of the time I took to address my health, and is working with me to consider different options. My advisor said I could consider two different paths:

Path 1: Try to take Step 1, with at least passing-range on two NBME exams before test date (i.e. 98%+ chance of passing). I'm currently at 50% chance of passing.

Path 2: If more than 1 month is needed for preparedness, take 1 year as a LOA to adequately prepare for Step 1. My advisor explained this would be treated as a medical LOA or research LOA. In my case, I could opt for either and explain it in my residency application.
_____________________________________________________________
4) Since I am doing better and in a time crunch, I am currently on Path 1 (study really hard, see what my practice scores are in May, and then decide then to sit for the exam or not).

5) My question for the forum is if I decide at some point in the next month to choose Path 2, and the repercussions of taking a medical or research LOA. If I had to be completely honest, I would rather not feel so rushed with my Step 1 preparation, and then jump straight into clerkships. My advisor also mentioned that students that have better preparedness for Step 1 typically also have better performance on shelf exams and Step 2, which are the only graded part of my curriculum. I would feel better going into clerkships with better preparedness. Thus, there's a part of me that wouldn't mind the extra year to work on my mental health more, also study more adequately for Step 1, and also do a bit of research so that I'm still building a competitive portfolio.

I just don't know if I'm shooting myself in the foot with choosing Option 2. And specifically, how that appears for psychiatry residencies who are evaluating candidates.

____
I hope this clarifies some of my concerns. Happy to answer additional questions.

Path 1 is the clear winner. If doing fine now, a month of cramming is sufficient time to pass step 1 for most students.

Path 2 comes with research requirements and added anxiety that this will hurt your application. This should be a last resort.

Step 1 is very anxiety inducing in my opinion. I was quite nervous about it and would have preferred to delay it forever. I definitely panicked during the exam and came out fine. At some point, you have to accept that you did your best and let the cards fall.

 

[comp1]

Concur, path 1 seems the way to go. Again, I don't know what you would do for a year to "prepare." I do know very much know what you would do for a month. There are even commercial prep courses.

 

[Stagg737]

I agree path 1 is the better option on paper IF you can succeed with it, meaning passing Step 1 and not failing any clinical rotations. Honoring clinical rotations still isn't really necessary for psych and most places won't care much other than your psych grade. Failing one would hurt as ime it's pretty hard to actually fail a clinical rotation most places. Where I went our clinical grade was 100% based on shelf score/percentile, so we had more failures than other schools and usual and PDs didn't seem to understand (or maybe just didn't care). If that's the case for you it's something to consider, but honestly most of the shelf exams were not particularly difficult (other than IM and surgery which were basically mini board exams).

Otoh, failing Step 1 then having to take an LOA anyway would be major red flags, especially since it seems the LOA would be completely due to MH problems which would be very difficult to spin based on what you've said. If you were to take a full year of LOA it would look far better to take a research year, do solid research (even if just clinical) and gets some presentations and/or pubs, and make sure you pass Step 1.

As mentioned by Comp, a year is a long time to study and there's data that shows that studying past a certain period (I think 8-10 weeks) shows no extra benefit and may worsen scores. So if you can take path 1 do it. If you really think you're going to fail Step 1 after studying for 3-4 weeks and need to take an LOA anyway, take the LOA. Keep in mind you may never confident about Step 1.

 

[comp1]

The point above about it being relatively challenging to fail clinical rotations is accurate. Part of it is the weeding out of the whole process by the time you get to MS3, but it's also that the structure of everything being SO subjective that an attending would really expect you to basically be actively harming or threatening patients to advocate for failure. In 9 years of attendinghood I've only considered it once for a MS3 who was clearly undermining the treatment team. However, even in that case we did a complicated feed forward thing in lieu of failure. There is still the matter of the shelf exams, but I certainly found the clinical ones easier than preclinical even for surgery which was kind of anatomy the sequel.

 

[finalpsychyear]

I literally thought if you apply for the match with a status of US senior your in the same boat if you had no fails on steps, clerkships or courses even if you took a 1 year leave for research, medical etc..

 

[Merovinge]

Hello,

I really appreciate everyone's replies.

For more context,

1) I have multiple co-morbidities, including recurrent depression, social anxiety, C-PTSD, and ADHD (all on my problem list). I also have an ACES score of 9, lol, if that matters. I was going through a depression in the last few months for personal reasons. The good news is that re-starting therapy again in the last 2 months has helped. I also feel like my medications are finally stable; I've spent the last 1.5 years with a really understanding psychiatrist who's helped me in determining the right medications and dosage. I've also thankfully have about ~3 years of therapy under my belt. I think this winter was just more difficult for me despite my coping skills, a blip if you will.

I'm doing better now thanks to focusing on my mental health. Sleep is good, concentration is also better.

2) Currently, I'm in the phase of my education where I am supposed to take Step 1 and start clerkships. Unfortunately, I am not at a place where I can comfortably pass. I still have 1 month left to take the exam though, so there's room for improvement. This will require me to grind like mad until then, which I think I can do.

3) As mentioned, my school is very understanding of the time I took to address my health, and is working with me to consider different options. My advisor said I could consider two different paths:

Path 1: Try to take Step 1, with at least passing-range on two NBME exams before test date (i.e. 98%+ chance of passing). I'm currently at 50% chance of passing.

Path 2: If more than 1 month is needed for preparedness, take 1 year as a LOA to adequately prepare for Step 1. My advisor explained this would be treated as a medical LOA or research LOA. In my case, I could opt for either and explain it in my residency application.
_____________________________________________________________
4) Since I am doing better and in a time crunch, I am currently on Path 1 (study really hard, see what my practice scores are in May, and then decide then to sit for the exam or not).

5) My question for the forum is if I decide at some point in the next month to choose Path 2, and the repercussions of taking a medical or research LOA. If I had to be completely honest, I would rather not feel so rushed with my Step 1 preparation, and then jump straight into clerkships. My advisor also mentioned that students that have better preparedness for Step 1 typically also have better performance on shelf exams and Step 2, which are the only graded part of my curriculum. I would feel better going into clerkships with better preparedness. Thus, there's a part of me that wouldn't mind the extra year to work on my mental health more, also study more adequately for Step 1, and also do a bit of research so that I'm still building a competitive portfolio.

I just don't know if I'm shooting myself in the foot with choosing Option 2. And specifically, how that appears for psychiatry residencies who are evaluating candidates.

____
I hope this clarifies some of my concerns. Happy to answer additional questions.

That correlation is almost assuredly true, however the causality of that is not what you are implying in this post. Students who are better prepared for step 1 are the students who are better at learning/studying/memorizing so of course they will do better on step 2 and shelf exams. Implying that taking extra time to study for step 1 is going to make you better at step 2/shelf is very unlikely to be the case, if anything the year off could make it even harder.

I am not even going to vote for what you should do since there are other members of this forum with more formal understanding of residency application/ranking criteria but I am on a lifetime warpath of making sure correlation is not mistaken for causality.

 

[TexasPhysician]

I literally thought if you apply for the match with a status of US senior your in the same boat if you had no fails on steps, clerkships or courses even if you took a 1 year leave for research, medical etc..

That isn’t always correct. PD’s get many applications and need to cut the numbers down before deciding who to interview. There are tons of filters which include extended time to finish, failures, LOA’s, where you did medical school, etc.

 

[Celexa]

The point above about it being relatively challenging to fail clinical rotations is accurate. Part of it is the weeding out of the whole process by the time you get to MS3, but it's also that the structure of everything being SO subjective that an attending would really expect you to basically be actively harming or threatening patients to advocate for failure. In 9 years of attendinghood I've only considered it once for a MS3 who was clearly undermining the treatment team. However, even in that case we did a complicated feed forward thing in lieu of failure. There is still the matter of the shelf exams, but I certainly found the clinical ones easier than preclinical even for surgery which was kind of anatomy the sequel.

It's challenging to fail rotations but it's not particularly challenging to fail the shelf, particularly if standardized tests are not your forte, and that can snowball quickly in addition to often anchoring the possible clerkship grade to no higher than pass.

OP, you have gotten a lot of good perspectives in this thread but ultimately strangers on the internet are not in a position to weigh in on which option is best for you. Both are viable. Both have different risks and benefits. Sorting out which is right for you is best done with people who are familiar with a much higher level of detail about both you and your medical school than can be conveyed in an internet forum.

 

[catdog1234]

Hi everyone,

thank you for all your input. It seems like everyone is leaning towards not taking an LOA as much as I can depend on it.

I talked to my Dean of student affairs, and told her my interests in psych/im/fm, and she said that LOA had very little impact in those specialties. I guess her opinion is somewhat shared with the prior posts, and also somewhat in disagreement.

She did say that if I took Step 1 in a month, that I would likely only have time for one away rotation in M3 year, vs. two away rotations. She said this is not really an issue for people trying to match into Psychiatry.

I'm not sure if anyone has any insight into that part of residency application (one vs two away rotations, does it matter?), but otherwise I am going to stick to my guns and plan for Step 1 in a month.

 

[comp1]

I'm not sure what exactly a dean of students affairs is. Are they a psychiatrist? Are they a physician? I'm not sure what they are basing their advice on. Clumping psych with primary care specialties indicates perhaps not the most up to date knowledge of relative competitiveness. I don't think away rotations should even be a consideration for you given the other challenges. Just get through the basics. Away rotations are icing and they can add extra layers of difficulty. They are not the cake. They are not required and the minority of people who do away rotations often don't match where they did the away rotation.

 

[Ironspy]

I'm not sure what exactly a dean of students affairs is. Are they a psychiatrist? Are they a physician? I'm not sure what they are basing their advice on. Clumping psych with primary care specialties indicates perhaps not the most up to date knowledge of relative competitiveness. I don't think away rotations should even be a consideration for you given the other challenges. Just get through the basics. Away rotations are icing and they can add extra layers of difficulty. They are not the cake. They are not required and the minority of people who do away rotations often don't match where they did the away rotation.

Agree with this. Away rotations are an additional stressor and are more likely to hurt than help you at this point

 

[Stagg737]

Also agree with the above. There is no reason to worry about doing away rotations during M3 year. Use those electives to explore fields and make sure psych is the right fit. No reason you can't do sub-i's away during M4 year, which imo is much more important because they places you rotate at will actually remember you when it comes time for them to make rank lists.

 

[ObsequiousAplomb]

it's neat that some people get to do away rotations in third year, I guess. I think my school would allow for two aways in 4th year, not that I managed to arrange any. It matters more that you do well on rotations and are a likeable person in general.

 

[TexasPhysician]

Most psychiatrists I know did 0 away rotations. It is an optional event. Focus on passing step 1 and graduating on time if possible. Nothing else matters at the moment.

 

[catdog1234]

Thank you so much for everyone's input. Hopefully, in 3 years I can match and join your field. Back to studying!

 

[Merovinge]

Well done on showing the wisdom and humility of seeking multiple (qualified) opinions on questions you have. I wish I had that skill when I was a M2. It will serve you well in psychiatry.