Fail Step 3 dismissed from prgm, Passed now cant find program.

[Bwilderedsqrd]

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I am a former FM resident. After unsuccessfully completing Step 3 I was required to leave the progrm and not allowd to complete final year training 2009

I have completed Step 3. Applying to progrm after progrm w/o success. I returned to my former PD and requested to reenter the program. She felt that I would not receive the educational experience I deserved by coming back citing “former Attendings and their biases”

I have satisfactory hx with the progrm outlined in LORs. I'm confused and befuddled that even with my extensive medical background (DPM) and glowing LORs from my PD, advisor and chief; I have not been able to even land 1 interview

Any insight on what could possibly be causing my unsuccessful bid for a residency; should I reenter the upcoming match for PGY1 in essence starting all over again; and should I apply for FM or IM or both or neither?

Are there strategies that might help increase my chances in completing my training?

Desperately seeking!

 

[Doctor4Life1769]

how many times did u fail step 3?

do programs dismiss after 1 failure if no previous hx of failed exams?

kinda odd since this is a FM residency, and no other FM residency progs interviewing you?

 

[Buzz Me]

Need a little more info. Did you have conflicts with previous attendings? Had they placed complaints in your residency file? What were the terms of your contract non-renewal (besides failing Step 3)?

 

[Bwilderedsqrd]

The program I attended had a policy that if a second year resident of any progrm in the
univsity, e.g., peds, IM, OB etc… has not passed step 3 by the time they start the 3rd year
would be grounds for dismissal regardless of how many times taken.
Tell me what resident has always gotten along with every attending, especially in FM where
you are in contact with attending from all the specialties. I passed all of my rotations
with one month remediation during inpatient. I never saw my file didn’t know we were privy
to that.
I was given multiple opportunities to pass the exam but I failed. It turns out that during
this entire process I was tested and diagnosed with a reading disability. Step 3 with its
extremely long question stems and time limitation unmasked this condition. The board would
not grant accommodations because they deemed the condition was not extreme enough.
I’ve suffered with this condition all my life and have always compensated by repetition
when it came to exams and by coming in early and leaving late when it came to handling all
other task.

 

[michaelrack]

did you go to a US med school?

 

[Law2Doc]

.. It turns out that during
this entire process I was tested and diagnosed with a reading disability. Step 3 with its
extremely long question stems and time limitation unmasked this condition. The board would
not grant accommodations because they deemed the condition was not extreme enough.
I’ve suffered with this condition all my life and have always compensated by repetition
when it came to exams and by coming in early and leaving late when it came to handling all
other task.

This is a losing argument. If your learning disability didn't prevent you from finishing med school and passing the first two steps, nobody is going to grant you accommodations. You are too "high functioning". Even if you have unmasked some limitation in your abilities, you still have less of a learning disability than 99.9% of those folks who are made to sit through every other standardized test without accommodations.

Also bear in mind that most people would rather write off doing poorly on an exam as an organic issue, rather than take some blame in terms of preparation. I don't know if this is you, but I think a lot of folks shortchanged themselves in some ways in terms of preparation, either by not spending enough time, or obtaining enough resources, or by taking too much comfort in the notion that almost everyone passes, and thus some folks did show up for this test less well prepared than others.

 

[Doctor4Life1769]

The program I attended had a policy that if a second year resident of any progrm in the
univsity, e.g., peds, IM, OB etc… has not passed step 3 by the time they start the 3rd year
would be grounds for dismissal regardless of how many times taken.
Tell me what resident has always gotten along with every attending, especially in FM where
you are in contact with attending from all the specialties. I passed all of my rotations
with one month remediation during inpatient. I never saw my file didn't know we were privy
to that.
I was given multiple opportunities to pass the exam but I failed. It turns out that during
this entire process I was tested and diagnosed with a reading disability. Step 3 with its
extremely long question stems and time limitation unmasked this condition. The board would
not grant accommodations because they deemed the condition was not extreme enough.
I've suffered with this condition all my life and have always compensated by repetition
when it came to exams and by coming in early and leaving late when it came to handling all
other task.

So, I take it you failed numerous times before the start of Year 3. Yikes. I'm not sure what to say. Hopefully aPD can provide some tips. Best of luck..

 

[NotAProgDirector]

So, I take it you failed numerous times before the start of Year 3. Yikes. I'm not sure what to say. Hopefully aPD can provide some tips. Best of luck..

Thanks for the plug, but I'm not certain I have many ideas for the OP.

There could be several reasons why the OP's initial program will not take them back:

1. There was more to the termination than just Step 3, and that simply was an easy excuse to terminate him/her.

2. After multiple fails of step 3, they are worried that he/she will not pass the ABFP boards on the first try.

3. They simply don't have an open slot.

As far as getting a spot elsewhere, this is always difficult at the PGY-3 level. PGY-3's have the maximum amount of responsibility, and get the least amount of supervision. Hence it's rare for me to take someone.

The OP has a much bigger problem, as the ABFM policies state:

The last two years of Family Medicine residency training must be completed in the same accredited program. Transfers after the beginning of the G-2 year are approved only in extraordinary circumstances.

Hence, they should be looking for a PGY-2 year if they are looking at programs other than their original.

 

[Bwilderedsqrd]

{Hence, they should be looking for a PGY-2 year if they are looking at programs other than their original.}

The above info is understood. I am aware of ABFM policy.
Now back to the original question I asked in the beginning.
( should I reenter the upcoming match for PGY1 in essence starting all over again; and should I apply for FM or IM or both or neither?)
Thanks aprodirector for the assessment.

 

[Law2Doc]

{Hence, they should be looking for a PGY-2 year if they are looking at programs other than their original.}

The above info is understood. I am aware of ABFM policy.
Now back to the original question I asked in the beginning.
( should I reenter the upcoming match for PGY1 in essence starting all over again; and should I apply for FM or IM or both or neither?)
Thanks aprodirector for the assessment.

I actually think you probably have a better shot outside of the match, off-cycle. If a program has an unexpected opening, the standards will be lower than if you are competing with others who don't have to explain why they couldn't finish up with their original program. I think you need to figure out why you aren't getting any interest now, rather than waste time with the match.

 

[Bwilderedsqrd]

I actually think you probably have a better shot outside of the match, off-cycle. If a program has an unexpected opening, the standards will be lower than if you are competing with others who don't have to explain why they couldn't finish up with their original program.[ I think you need to figure out why you aren't getting any interest now, rather than waste time with the match.]

To figure this thing out would be the ideal thing to do. But in the mean time while continuing to apply to off-cycle positions shouldn't I consider throwing my hat into the match in hopes that my time isn't wasted. Besides, the match would seem to open up more opporturnity or iam i just hoping for Pie in the Sky.

 

[Law2Doc]

To figure this thing out would be the ideal thing to do. But in the mean time while continuing to apply to off-cycle positions shouldn't I consider throwing my hat into the match in hopes that my time isn't wasted. Besides, the match would seem to open up more opportunity or iam i just hoping for Pie in the Sky.

Like I said, your odds may actually be worse in the match, because you will be competing head to head with folks without the same blemishes. A place with an unexpected opening and nobody to provide the man hours is actually between a rock and a hard place, and would be willing to overlook a lot more. But sure, give it a try. And if that doesn't pan out, the scramble might be worth a shot too. Just know that it may be low yield though, and you might be spending a good chunk of change with nothing to show for it.

 

[NotAProgDirector]

To figure this thing out would be the ideal thing to do. But in the mean time while continuing to apply to off-cycle positions shouldn't I consider throwing my hat into the match in hopes that my time isn't wasted. Besides, the match would seem to open up more opporturnity or iam i just hoping for Pie in the Sky.

I would suggest that you be ready to apply for next year's match, while continuing to look for off cycle spots. It's June, and the match doesn't open until September. If you don't find anything by then, then you apply via the match. A program might see your match application, have an off cycle spot, and consider you for it.

 

[Bwilderedsqrd]

🙂Ok Thanks

 

[Groove]

If worse comes to worse, I don't see how you couldn't find an open FM spot as a PGY2...somewhere. Yes, that would mean having to repeat a year, and ultimately losing 2 years time, but....you'd have the opportunity to finish a FM residency, and that's ultimately what matters most. FM never fills anywhere close to completely, so I just can't imagine you not being able to find someone that would at least take you on. Medicare funding might be an issue, but many programs just need warm bodies to do the work.

In the meantime, if I were you.. I'd get a perm state license ASAP and start moonlighting for some steady income, preparing for every scenario.

 

[lowbudget]

Hmmm... my guess is that you're untouchable for FM programs. For FM, you need to complete 2 consecutive years at a program in order to graduate. The thing is you've completed 2 years already and only need 1 year. You could go for a PGY-2 position, except that you only have 1 year of CMS funding left. So, if you're asking for 2 more years of training with only 1 more year of government funding, no program is going to pick you up unless they're willing to take your last year (PGY-3, but technically your 4th year) of funding onto their own budgets or from some other source.

aProgDirector... is this right?

OP, have you considered Occupational Med/Public Health/Preventive Med?

 

[michaelrack]

Hmmm... my guess is that you're untouchable for FM programs. For FM, you need to complete 2 consecutive years at a program in order to graduate. The thing is you've completed 2 years already and only need 1 year. You could go for a PGY-2 position, except that you only have 1 year of CMS funding left. So, if you're asking for 2 more years of training with only 1 more year of government funding, no program is going to pick you up unless they're willing to take your last year (PGY-3, but technically your 4th year) of funding onto their own budgets or from some other source.

aProgDirector... is this right?

OP, have you considered Occupational Med/Public Health/Preventive Med?

preventative med would present the same funding issues

 

[NotAProgDirector]

Hmmm... my guess is that you're untouchable for FM programs. For FM, you need to complete 2 consecutive years at a program in order to graduate. The thing is you've completed 2 years already and only need 1 year. You could go for a PGY-2 position, except that you only have 1 year of CMS funding left. So, if you're asking for 2 more years of training with only 1 more year of government funding, no program is going to pick you up unless they're willing to take your last year (PGY-3, but technically your 4th year) of funding onto their own budgets or from some other source.

aProgDirector... is this right?

OP, have you considered Occupational Med/Public Health/Preventive Med?

Not exactly.

You are correct that the OP has one more year of full CMS funding. After that, they get partial funding. More specifically, they get 50% of DME and 100% of IME. DME is relatively fixed, is usually around $60K or so. IME is highly variable between programs and depends on a complex formula, is always more than DME, sometimes much more. So, after the OP's next year, funding for each subsequent year will be about $30K less. This is not a "non starter", but is obviously something that programs will consider. Programs that have very high rates of IME reimbursement, it makes much less difference for.

MichaelRack is correct that the funding issue exists no matter what pathway the OP follows now. Changing fields does not restart the clock.

 

[Bwilderedsqrd]

So I have completed two consecutive years of FM R-1-R-2… I don’t quite understand the ABFm policy on certification. Is it the first two or the last two?🙄
I have applied for state licensure but am concern about getting on insurance panels, hospital privileges etc. With so much debt (>500K) not sure if I should be even concern about completing residency. Maybe just rob a bank or start selling body parts.🙁

I would like to finish what I started...it's a matter of principles; but is it worth it?

 

[NotAProgDirector]

Here is the ABFM policy:

The last two years of Family Medicine residency training must be completed in the same accredited program. Transfers after the beginning of the G-2 year are approved only in extraordinary circumstances.

Pretty clear, last two years in same program.