Failed Step 1

[Got Heem]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

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[ERDOC555]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

Pardon, my inexperienced opinion, but you really shouldn't be turning your nose to family medicine or even considering ortho at all.

Study hard, retake it, hopefully try for a decent score, and figure out which non-competitive specialty you can see yourself tolerating.

 

[Brorthopedic]

no ortho for u

 

[deleted480308]

I'm really sorry for you. I would like to recommend no major decisions like quitting right now...it's an emotional time. Does your school have good counseling?

 

[Lord_Vader]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

This is what I hate about most people going into the surgical subspecialties. They think they're above everyone, especially primary care, when the opposite is true since you need to have a large knowledge base if you're going into something like family medicine. The only reason why most people go into the surgical subspecialties is because of lifestyle + compensation which itself is due to the procedure-driven health insurance system we have in this country. This is the reason why these specialties are competitive to get into. I can assure you that if every doctor was paid the same, hardly anyone would want to study penises their entire life. What a sad state of affairs. By the way, with that sort of comment don't expect any sympathy from people here.

 

[neusu]

The data certainly is against you: http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf Only one applicant applied to orthopedics with a score in your range and did not match.

Perhaps this applicant had other marginal parts of the application. If the remainder of your application is superstar (e.g. top of your class, strong ECs, many many publications, exceptional letters from programs you rotate at), it may be seen as an anomaly by a program willing to take the risk.

Common things being common, I would recommend adjusting your aspirations should you want to match directly to a residency from medical school. Alternatively, if you are ortho or nothing, aligning yourself with a strong ortho department and serving as a clinical researcher or house officer (e.g. resident minus the ACGME credit), it may bolster your standing.

 

[Got Heem]

This is what I hate about most people going into the surgical subspecialties. They think they're above everyone, especially primary care, when the opposite is true since you need to have a large knowledge base if you're going into something like family medicine. The only reason why most people go into the surgical subspecialties is because of lifestyle + compensation which itself is due to the procedure-driven health insurance system we have in this country. This is the reason why these specialties are competitive to get into. I can assure you that if every doctor was paid the same, hardly anyone would want to study penises their entire life. What a sad state of affairs. By the way, with that sort of comment don't expect any sympathy from people here.

I never said I was above anyone and I never said there was anything wrong with being in primary care, I just really enjoy surgery and especially orthopedics. The injuries are ones that I've suffered through myself and I love the ability to see a problem and fix it immediately. I understand how difficult FM is and realize I would be lucky to even get a FM residency at this point, but it isn't the kind of doctor I have been working to become and I'm not sure that it's something I would want to do for the rest of my life, especially considering the uphill battle it will require just to get there.

The data certainly is against you: http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf Only one applicant applied to orthopedics with a score in your range and did not match.

Perhaps this applicant had other marginal parts of the application. If the remainder of your application is superstar (e.g. top of your class, strong ECs, many many publications, exceptional letters from programs you rotate at), it may be seen as an anomaly by a program willing to take the risk.

Common things being common, I would recommend adjusting your aspirations should you want to match directly to a residency from medical school. Alternatively, if you are ortho or nothing, aligning yourself with a strong ortho department and serving as a clinical researcher or house officer (e.g. resident minus the ACGME credit), it may bolster your standing.

Thank you for the honest and helpful advice. I'd love some more information about options such as the one in bold; requirements, how to apply to them, etc.

Is the score range only based on my first test? I imagine schools would look more favorably at someone who performed much better on the second try, although I'm sure that would be a statistical anomaly as well.

 

[JustaDO]

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

You are looking like a prime candidate for someone not to match if you continue this route without a strong retest and exceptionally good Step 2 scores.

 

[mcloaf]

This is what I hate about most people going into the surgical subspecialties. They think they're above everyone, especially primary care, when the opposite is true since you need to have a large knowledge base if you're going into something like family medicine. The only reason why most people go into the surgical subspecialties is because of lifestyle + compensation which itself is due to the procedure-driven health insurance system we have in this country. This is the reason why these specialties are competitive to get into. I can assure you that if every doctor was paid the same, hardly anyone would want to study penises their entire life. What a sad state of affairs. By the way, with that sort of comment don't expect any sympathy from people here.

Lol your complex is showing.

 

[futureradres12345]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

Priority number one should be to try and understand why you failed. Poor study habits, personal issues, illness, lack of motivation? Relatively few people fail step 1 and it is a sign of some underlying problem that needs to be corrected. Once you get that figured out, you can worry about retaking step 1, doing well on clinical rotations and step 2, and applying to residency.

Nothing is impossible, but ortho seems like it may be out of reach at this point. Are you truly ortho/surgical subspecialty or bust? If so, might be better to walk away from medicine now rather than waste more years and money. If not, start getting exposure to other fields that might be suitable backups. You could do FM followed by sports medicine, PM&R, or even radiology if you like finding problems that can be fixed. If it has to be surgery, general surgery is probably your best bet.

 

[Warderino92]

I'm not sure how charting the match factors in step retakes or even if it does, but page 179 is pertinent data for your chances at ortho.

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

 

[chipwhitley]

This is what I hate about most people going into the surgical subspecialties. They think they're above everyone, especially primary care, when the opposite is true since you need to have a large knowledge base if you're going into something like family medicine. The only reason why most people go into the surgical subspecialties is because of lifestyle + compensation which itself is due to the procedure-driven health insurance system we have in this country. This is the reason why these specialties are competitive to get into. I can assure you that if every doctor was paid the same, hardly anyone would want to study penises their entire life. What a sad state of affairs. By the way, with that sort of comment don't expect any sympathy from people here.

i mean this is kind of the reason why a lot of people choose to become physicians in the first place, as opposed to any other job in healthcare. I'm not sure why you're surprised.

 

[Lord_Vader]

Primary care isn't competitive yes because they make less, but also because no one wants to go through that much school for that. By no means saying primary care isn't a field we need (it's definitely super important in the field of medicine) but if that's what you wanna go into just be an NP. Less school, better hours, and starting to make the same kind of $ in today's world. To be honest the way things are going right now NP's are going to have the same rights as PCP's soon (Pennsylvania legislation is a great example).

NPs will never completely replace PCPs. The NPs might want that but polls show that the vast majority of people prefer seeing an MD as their family doctor rather than an NP. The only reason we have this problem unfortunately is because nurses have a stronger lobbying arm than us so until the AMA decides to do something it'll get worse. However what'll end up happening is that poor patients with poor insurance will be the ones forced to see an NP while middle-upper class patients will choose to see an MD effectively forming a two tiered healthcare system. As more of these laws are passed we'll also see more lawsuits against NPs who misdiagnose or improperly treat because of the less training they receive. In any case the PCPs will never be completely thrown out of the ball game and in fact their salary has gone up in the past 3 years.

i mean this is kind of the reason why a lot of people choose to become physicians in the first place, as opposed to any other job in healthcare. I'm not sure why you're surprised.

Not all of us are in it for the money and in fact want to genuinely make a difference by helping others. If you go into medicine just for the lifestyle and compensation of some select fields you might not even match into then I'm sorry but you are a foolish person. There are many other careers such as business that allow you to have a better lifestyle than any doctor and also let you make a generous amount of money as well.

 

[chipwhitley]

There are many other careers such as business that allow you to have a better lifestyle than any doctor and also let you make a generous amount of money as well.

Not with as much certainty, and as little risk. Medicine is the only sure shot to a 6 figure income if you finish the training, even if you aren't all that good. That pulls a ton of people in. I don't believe for a second that your only motivation is to "help people".

 

[TBV]

You'd be a fool to think you have any shot at ortho

 

[Med Ed]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

1. Figure out what you did wrong. Did you struggle in M1 and/or M2? Did you not study enough? Did you not do practice questions? Did you simply choke on game day?
2. Apply whatever you determine to your retake strategy. The biggest thing you can do to help yourself is get a respectable score on the second try. Doing so will help frame your 188 as an anomaly.
3. Everyone works hard during M3, but you will have to go above and beyond. Show up early, stay late, and study constantly.
4. Be mindful of Step 2 CK. If you can demonstrate continued improvement on the Steps it will ameliorate PD concerns over your academic capabilities.

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point?

Your only chance at ortho is to have a wealthy relative donate a building. Not kidding. You can also forget urology, plastics, ENT, etc.

It may be possible to find a spot in general surgery or OB/GYN (which has gotten very procedural), although both will be an uphill climb and there are no guarantees.

I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

Regardless of your intentions, singling out a specialty was unnecessary and off putting. And I'm not even an FM doc.

 

[Donald Juan]

Just forget ortho. If by some miracle you make a 260 on a retake, ace your clinical rotations, put in extensive research pubs, ball out on step 2, and overly wow some low tier program during sub-Is, then maybe you have an uphill battle to convince a program director this was a one time fluke. Come back and ask people's advice in a year when you have that 260, all honors, and 5-6 pubs.

Until then, figure out what you did wrong and correct it immediately for the retake. Try to keep an open mind about other specialties. You're still very early on and quite possibly would have changed your mind about what you want to do for the rest of your life during m3 anyways.

 

[TheFutureFatMan]

At this point I would not slam ANY specialty, given that you probably have a large amount of debt in front of you and you need to be a little gracious in defeat. Stop worrying about WHAT you're going to do, and worry about retaking step. Also, really really really consider speaking with counselor's at your school.

 

[deafdealer]

Primary care isn't competitive yes because they make less, but also because no one wants to go through that much school for that. By no means saying primary care isn't a field we need (it's definitely super important in the field of medicine) but if that's what you wanna go into just be an NP. Less school, better hours, and starting to make the same kind of $ in today's world. To be honest the way things are going right now NP's are going to have the same rights as PCP's soon (Pennsylvania legislation is a great example).

If NPs do eventually get equal pay won't they be sending themselves straight into the unemployment line?

 

[Señor S]

Thank you for the honest and helpful advice. I'd love some more information about options such as the one in bold; requirements, how to apply to them, etc.

Is the score range only based on my first test? I imagine schools would look more favorably at someone who performed much better on the second try, although I'm sure that would be a statistical anomaly as well.

Dude. Just stop. You are not going to be an orthopedic surgeon. Look in the mirror and say it hundreds of times until it sinks in. Ditto for any surgical subspecialty. Maybe, just maybe, you can match into General Surgery, but that remains to be seen. Right now, the important decision is whether you still want to be a doctor (ANY kind of doctor) or not. If I were you I'd stick with it and focus your energy (ALL your energy) on passing Step 1. If you can't do that then quit now before you get any deeper in debt.

 

[zeppelinpage4]

Even if ortho, and many of the competitive surgical specialties are out right now, you very likely could still find your niche within another specialty or subspecialty that's more realistic for you. Lots of specialties seem to be getting quite procedural now.

Either way. Wish you the best of luck though, and stay strong.

 

[Stagg737]

Not with as much certainty, and as little risk. Medicine is the only sure shot to a 6 figure income if you finish the training, even if you aren't all that good. That pulls a ton of people in. I don't believe for a second that your only motivation is to "help people".

Is the only motivation to help people? No. Is it the main, or at least one of the biggest reasons? It better be, otherwise the person is setting themselves up for a pretty poor career outlook. It might be the only sure shot to a 6 figure salary, but most people won't make 6 figures until they're in their 30's and have a couple 100k in debt. Trade that with someone that has 30k in debt and starts making 60-70k/year (which is very reasonable in many fields) when they're 22 and the financial trade-off seems much less worth it.


@Got Heem , forget about ortho. In fact, for now you should forget about anything involving medicine other than your current rotation and doing whatever you need to do to pass with a decent score. There's no point in thinking about any fields anymore until you finish Step 1.

 

[W19]

Is the only motivation to help people? No. Is it the main, or at least one of the biggest reasons? It better be, otherwise the person is setting themselves up for a pretty poor career outlook. It might be the only sure shot to a 6 figure salary, but most people won't make 6 figures until they're in their 30's and have a couple 100k in debt. Trade that with someone that has 30k in debt and starts making 60-70k/year (which is very reasonable in many fields) when they're 22 and the financial trade-off seems much less worth it.

One should not expect a starting salary of 60-70k/year in most fields out there with a BA/BS degree... 40-50k/year is a more reasonable figure based on my experience.

 

[235009]

Get off SDN. Focus on passing step 1. This is no time to discuss residency chances. If you fail step 1 again you may not even have the luxury of finishing med school and applying to FM.

(If you're a US MD you'll have plenty more options than just FM.)


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[Stagg737]

One should not expect a starting salary of 60-70k/year is most fields out there with a BA/BS degree... 40-50k/year is a more reasonable figure based on my experience.

Agree, but my point was there are plenty of fields where one can expect to start at 60-70k with just a bachelor's and maybe a certification. There are also plenty of jobs (like landscaping) that can pay that without even going to college. Obviously it's not the norm, but if all one is looking for is financial security, there are far easier ways to achieve that than medicine.

 

[Humble Sloth]

I never said I was above anyone and I never said there was anything wrong with being in primary care, I just really enjoy surgery and especially orthopedics. The injuries are ones that I've suffered through myself and I love the ability to see a problem and fix it immediately. I understand how difficult FM is and realize I would be lucky to even get a FM residency at this point, but it isn't the kind of doctor I have been working to become and I'm not sure that it's something I would want to do for the rest of my life, especially considering the uphill battle it will require just to get there.



Thank you for the honest and helpful advice. I'd love some more information about options such as the one in bold; requirements, how to apply to them, etc.

Is the score range only based on my first test? I imagine schools would look more favorably at someone who performed much better on the second try, although I'm sure that would be a statistical anomaly as well.

If you failed Step 1 clearly you have severe issues with motivation. You can forget about the hard, competitive residencies. At this point you should be looking at Psy, FM, IM, peds or some other soft residency. No schools don't look at how much better you did on your firsts try. They see that you failed. Not many people fail. The fact that you already failed once shows serious issues in your academic integrity and your commitment to the continuous learning process.

 

[W19]

If you failed Step 1 clearly you have severe issues with motivation. You can forget about the hard, competitive residencies. At this point you should be looking at Psy, FM, IM, peds or some other soft residency. No schools don't look at how much better you did on your firsts try. They see that you failed. Not many people fail. The fact that you already failed once shows serious issues in your academic integrity.

Lol... A pharmacy student lecturing a medical student about step1... Only in SDN!

 

[akwho]

My honest advice: quit medical school and become an ortho PA. Less stress, better lifestyle, same patients, same cases, same anatomy, shorter training (even if you quit tomorrow). Also you will never be a surgical subspecialist with a step failure, even with an average step score you are unlikely to match.

 

[deleted274002]

Title pretty much says it all, failed Step 1 with a 188. I know this is obviously not good for my future residency applications, but how much will this hurt me and what steps can I take to limit the damage?

Is there any hope of getting an orthopedic or any surgical/subspecialty residency at this point? I really don't think I can put in the necessary work to pull out of this hole if it's just going to get me into a Family Med residency...

1. As someone who is not doing primary care, I have to say that this is extremely disrespectful to my colleagues in family medicine. Family medicine isn't a specialty for people that couldn't cut it. It's very difficult and vastly needed in this country

2. Not trying to be a jerk or anything, but realistically, you aren't competitive for any specialty with a failure on Step 1. That doesn't mean you can't match SOMEWHERE, but you can forget about ortho, surgery, or even EM (it's getting very competitive). In fact, there are many top quality FM programs that will screen you out based on your failure. Unless you want to be unmatched with hundreds of thousands of dollars in debt, I'd suggest you come up with a backup plan. Think FM, IM, psych, peds, etc. And you can forget top academic programs in those specialties as well. If you can't bear the thought of being in one of those fields (and thankful and gracious to the program that matches you, if you're lucky) cut your losses.

 

[ortnakas]

I never said I was above anyone and I never said there was anything wrong with being in primary care, I just really enjoy surgery and especially orthopedics. The injuries are ones that I've suffered through myself and I love the ability to see a problem and fix it immediately.

Think about PM&R, perhaps? It'll still be an uphill battle at this point, but it might be feasible, unlike ortho.
(Not going to get into the debate about primary care or your disdain for FM-- others are addressing that quite nicely).

 

[gyngyn]

It may be possible to find a spot in general surgery or OB/GYN (which has gotten very procedural), although both will be an uphill climb and there are no guarantees.
.

We are are the original procedural specialty!

 

[WheezyBaby]

We are are the original procedural specialty!

OB/Gyn doesn't get enough credit here. C-sections, TVH, endometrial ablation, D&C, ureteral transection, endometrial ablation, tubal ligation, they got it all! 🙂

 

[gyngyn]

OB/Gyn doesn't get enough credit here. C-sections, TVH, endometrial ablation, D&C, ureteral transection, endometrial ablation, tubal ligation, they got it all! 🙂

Ureteral transection...? What kind of ObGyn Department do you have?
Nevertheless, vaginal surgery is about as elegant as surgical intervention gets.

 

[WheezyBaby]

Except the ureteral transection...

Was just curious how closely you'd read!

 

[giantswing]

1. As someone who is not doing primary care, I have to say that this is extremely disrespectful to my colleagues in family medicine. Family medicine isn't a specialty for people that couldn't cut it. It's very difficult and vastly needed in this country

2. Not trying to be a jerk or anything, but realistically, you aren't competitive for any specialty with a failure on Step 1. That doesn't mean you can't match SOMEWHERE, but you can forget about ortho, surgery, or even EM (it's getting very competitive). In fact, there are many top quality FM programs that will screen you out based on your failure. Unless you want to be unmatched with hundreds of thousands of dollars in debt, I'd suggest you come up with a backup plan. Think FM, IM, psych, peds, etc. And you can forget top academic programs in those specialties as well. If you can't bear the thought of being in one of those fields (and thankful and gracious to the program that matches you, if you're lucky) cut your losses.

I get it, it would be like forcing an internal med person into the or.

 

[TheFutureFatMan]

OB/Gyn doesn't get enough credit here. C-sections, TVH, endometrial ablation, D&C, ureteral transection, endometrial ablation, tubal ligation, they got it all! 🙂

LOVE OBGYN

 

[TheFutureFatMan]

OB/Gyn doesn't get enough credit here. C-sections, TVH, endometrial ablation, D&C, ureteral transection, endometrial ablation, tubal ligation, they got it all! 🙂

really make another surgeons day when you cut that ureter...

 

[Sea Otter]

Think about PM&R, perhaps? It'll still be an uphill battle at this point, but it might be feasible, unlike ortho.
(Not going to get into the debate about primary care or your disdain for FM-- others are addressing that quite nicely).

Many (most?) PM&R programs won't even interview people who failed a Step from what I've been told


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[Merlin007]

Many (most?) PM&R programs won't even interview people who failed a Step from what I've been told


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Also heard the same from my own PM&R PD "very rarely do we give interviews to those who've failed step 1"

 

[ortnakas]

Many (most?) PM&R programs won't even interview people who failed a Step from what I've been told

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Also heard the same from my own PM&R PD "very rarely do we give interviews to those who've failed step 1"

Was not aware of that-- I withdraw that recommendation, then.

Just to clarify, I never meant to imply PM&R wasn't selective or anything like that-- just that numbers-wise they're likely more forgiving than ortho. I'm not very into MSK personally, but you guys do a lot of cool stuff and I have nothing but respect for your field.