future of residency in general

[BolderNewfy]

Im rocked. Intern year in IM has killed my spirit. Im jaded, bitter, and I hate it. This is my fourth month straight of either wards or ICU. only ten days off this entire year. Im done with it. Now to my question.

My PD keeps talking about how lucky we should feel that we got a residency at all. That med school admissions are up so much that in the next year or two there will be more MD graduates than there are spots. I really want to switch from IM to psych. Ive though long and hard about this. I went to one of the better caribbean med schools (I know not something to brag about), but I did well on my boards (99/97). I think Im going to not go on with PGY2 in IM and try and find a PGY2 psych spot. Is the market as bad as my PD sais? Is a bird in the hand worth two in the bush? I just literally want to cry when I think of continuing on in this specialty. I cant take it....please help....

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[DrAwsome]

Im rocked. Intern year in IM has killed my spirit. Im jaded, bitter, and I hate it. This is my fourth month straight of either wards or ICU. only ten days off this entire year. Im done with it. Now to my question.

My PD keeps talking about how lucky we should feel that we got a residency at all. That med school admissions are up so much that in the next year or two there will be more MD graduates than there are spots. I really want to switch from IM to psych. Ive though long and hard about this. I went to one of the better caribbean med schools (I know not something to brag about), but I did well on my boards (99/97). I think Im going to not go on with PGY2 in IM and try and find a PGY2 psych spot. Is the market as bad as my PD sais? Is a bird in the hand worth two in the bush? I just literally want to cry when I think of continuing on in this specialty. I cant take it....please help....

Are you thinking of specializing or straight IM? Primary care IM can be tough. I've always liked heme/onc but have always thought that I could never deal with an ICU month so never went to for it. Psych is still IMG friendly and has a great lifestyle. With that said, yes med school admissions are increasing tremendously and will get more difficult to find spots in future years. Can you search for another spot while still keeping your current one?

 

[Mattchiavelli]

Yep! I'm does suck. Luckily I only have 4 weeks left... best of luck to you. If you hate it now, you probably will in the future, but psych is another beast. At least you will not have play the diuresis game with your 432095211th CHF exacerbation or do an anemia workup on someone who is anemic because you take 3 pints of blood off of a patient per day in labs

 

[peppy]

Hard to predict what will happen any given year in the match, but if the current trends continue I think you'd be able to get a spot in psych. Not necessarily your #1 choice, but if you applied broadly, I think you'd be able to get a spot somewhere as long as your PD gives you a decent LOR. Do you think you'll be able to leave on good terms?

 

[Law2Doc]

Im rocked. Intern year in IM has killed my spirit. Im jaded, bitter, and I hate it. This is my fourth month straight of either wards or ICU. only ten days off this entire year. Im done with it. Now to my question.

My PD keeps talking about how lucky we should feel that we got a residency at all. That med school admissions are up so much that in the next year or two there will be more MD graduates than there are spots. I really want to switch from IM to psych. Ive though long and hard about this. I went to one of the better caribbean med schools (I know not something to brag about), but I did well on my boards (99/97). I think Im going to not go on with PGY2 in IM and try and find a PGY2 psych spot. Is the market as bad as my PD sais? Is a bird in the hand worth two in the bush? I just literally want to cry when I think of continuing on in this specialty. I cant take it....please help....

The market will get tighter, but coming from an IM residency, you probably are in better position than coming from carribbean. Finish out the year at least. FWIW, US folks don't use the two digit board scores, so you should only use the three digits or you stick out as an IMG.

 

[BolderNewfy]

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

 

[turkeyjerky]

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

yeah, 'cept you didn't get a 260. lol, dude, 2 digit scores don't mean anything.

 

[Law2Doc]

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

Your two cents are not relevant. In the US most folks use the three digit scores because otherwise folks get confused that the two digit scores might suggest a percentage. At any rate if you use it you stick out like an outsider. Just stop.

 

[K31]

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

I've never heard anyone but IMGs refer to the two-digit score. It is calculated from the 3-digit score, and the only number that really means anything is being above 75 (ie passing). The NBME only still includes it because some state statutes refer to the passing two-digit score as a criterion for a medical license.

 

[username456789]

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

No.

 

[NotAProgDirector]

Im rocked. Intern year in IM has killed my spirit. Im jaded, bitter, and I hate it. This is my fourth month straight of either wards or ICU. only ten days off this entire year. Im done with it. Now to my question.

My PD keeps talking about how lucky we should feel that we got a residency at all. That med school admissions are up so much that in the next year or two there will be more MD graduates than there are spots. I really want to switch from IM to psych. Ive though long and hard about this. I went to one of the better caribbean med schools (I know not something to brag about), but I did well on my boards (99/97). I think Im going to not go on with PGY2 in IM and try and find a PGY2 psych spot. Is the market as bad as my PD sais? Is a bird in the hand worth two in the bush? I just literally want to cry when I think of continuing on in this specialty. I cant take it....please help....

This makes me sad. I run what I'd like to think is a pretty challenging program, yet we make sure our PGY-1's get much more time off than this. 8 weeks of electives (well, to be fair, you take your vacations during these weeks so it's really 5 weeks of electives), 2 weeks of research time, and at least 6 weeks of outpatient medicine -- all of which have minimal nights and no weekends. And no one does more than 3 months of inpt/call blocks in a row. It's possible you're simply burnt out on work, not on IM.

the problem with the two digit score is it is no indication of how difficult the test I took was. I could have gotten a 260 and on THAT day a 260 was an 85. Using the two digit score is more accurate as to how difficult the test I took was. perhaps in some places US students used the three digit score, but all my rotations were through a university based medical school and the two and digit scores were thrown around all the time. And where I am at now, which attracts a lot of really competitive US grads (all of our prelims are derm, optho and rads) we all throw around two and three digit scores. just my 2 cents.

Two digit scores are no longer reported by the USMLE.

The statement above that the two digit to three digit score conversion could change from one day to another is not correct. The conversion only changes when they change the minimum pass level 3 digit score. Then, the new minimum pass 3 digit score has to = 75, and so the whole score scale needs to be changed. Due to the confusion, the USMLE stopped reporting 3 digit scores unless the scores are sent to a state licensing board.

 

[Mattchiavelli]

This makes me sad. I run what I'd like to think is a pretty challenging program, yet we make sure our PGY-1's get much more time off than this. 8 weeks of electives (well, to be fair, you take your vacations during these weeks so it's really 5 weeks of electives), 2 weeks of research time, and at least 6 weeks of outpatient medicine -- all of which have minimal nights and no weekends. And no one does more than 3 months of inpt/call blocks in a row. It's possible you're simply burnt out on work, not on IM.

Thanks for treating residents like people.

I have a good friend in a program like the OPs where they do some craziness with hours and time off and make it seem like that's the norm. It's effectively gaslighting and they say the same thing, that they're lucky to have matched and that their practices are the norm.

 

[dragonfly99]

U are probably in a crappy IM program that works IM interns very hard. My program worked us very hard but at least we had a shot at pretty good fellowships...
Psych is OK, but make sure you are switching for a good reason and not just because of burnout. Don't quit unless you have another job lined up, such as a PGY2 psych or a research year. I'm sure you can get a psych spot somewhere if that is what you want...safest thing is stay in your current program until you have something better. It would be somewhat risky as a IMG to bail out after 1 year of IM internship (for a research job, etc.). Some people might think you did so because you had fights with hospital staff, attendings, other residents, etc. or that you couldn't cut it. It will probably be hard to find a psych spot right now for next year, but you might get lucky...

 

[BolderNewfy]

I find the advice that I not use my two digit USMLE score because it will "give away" the fact that I went to the caribbean almost offensive. I don't hide behind the fact that I went to the caribbean. Im sort of proud of it. I could care less what American grads or anybody else thinks. With the scores I got on the boards I could have matched into radiology or another ROAD specialty. This distinction is made by people who need to feel superior over someone else for whatever reason. I got to move to another country, and live in the caribbean. I got to live all over the united states for rotations, I got a great education. I rocked the boards, am in a residency in a very desirable part of the country where they can pick whoever they want. And when its all said and done Im a Doctor! Sometimes I think US allopathic medical students/graduates are just bitter.

 

[Droopy Snoopy]

I find the advice that I not use my two digit USMLE score because it will "give away" the fact that I went to the caribbean almost offensive. I don't hide behind the fact that I went to the caribbean. Im sort of proud of it. I could care less what American grads or anybody else thinks. With the scores I got on the boards I could have matched into radiology or another ROAD specialty. This distinction is made by people who need to feel superior over someone else for whatever reason. I got to move to another country, and live in the caribbean. I got to live all over the united states for rotations, I got a great education. I rocked the boards, am in a residency in a very desirable part of the country where they can pick whoever they want. And when its all said and done Im a Doctor! Sometimes I think US allopathic medical students/graduates are just bitter.

Good for you for taking a stand! I did the same thing back in the day. My attending said, "Tic, maybe you should stop bowing to patients and asking them how many fags they blow a day." I said, "Eff you man, I'm almost offended by that" and did the Roger Rabbit all the way out through the side door.

 

[deleted103644]

I find the advice that I not use my two digit USMLE score because it will "give away" the fact that I went to the caribbean almost offensive. I don't hide behind the fact that I went to the caribbean. Im sort of proud of it. I could care less what American grads or anybody else thinks. With the scores I got on the boards I could have matched into radiology or another ROAD specialty. This distinction is made by people who need to feel superior over someone else for whatever reason. I got to move to another country, and live in the caribbean. I got to live all over the united states for rotations, I got a great education. I rocked the boards, am in a residency in a very desirable part of the country where they can pick whoever they want. And when its all said and done Im a Doctor! Sometimes I think US allopathic medical students/graduates are just bitter.

Don't be silly. You shouldn't mention the two digit scores because they are meaningless. The only significance of a two digit score is that it provides a cutoff for passing.

Historically, anything over around a 220 was given a 99, but the NBME changed things in the last couple of years so now the scores are much lower.

Stock with the three digit scores if you're talking to anyone else about the tests, the two digit ones are meaningless.

 

[Law2Doc]

Don't be silly. You shouldn't mention the two digit scores because they are meaningless. The only significance of a two digit score is that it provides a cutoff for passing.

Historically, anything over around a 220 was given a 99, but the NBME changed things in the last couple of years so now the scores are much lower.

Stock with the three digit scores if you're talking to anyone else about the tests, the two digit ones are meaningless.

Agreed. Which is why everyone in US allo uses the three digit. And everyone familiar with the US system uses the lingo. Pretty much the only people not familiar with the lingo are from outside the system. The two digit scores are meaningless and tend to confuse, because folks think of them like percentages and don't realize that each two digit number covers a wide range of 3 digit numbers. Two people with a 95 can have very different scores, so it doesn't convey any information to tell people you have a 95. Drop it OP, you can hoot and holler as much as you want but the US consensus won't change on this, and won't think highly of folks who buck the trend.

For the record, I don't have a problem with folks who did school in the Caribbean, I have a problem with folks that use the two digit scores, even after everyone here tells you they are simply not the appropriate numbers to use. Get with the program.

 

[Law2Doc]

... I rocked the boards, am in a residency in a very desirable part of the country where they can pick whoever they want. And when its all said and done Im a Doctor! Sometimes I think US allopathic medical students/graduates are just bitter.

BTW, it would have been much more compelling to say how desirable geographically your residency is, and how bitter everyone else is, if you hadn't prefaced the discussion with how you are so unhappy you could cry, and looking to make a change.

 

[username456789]

I find the advice that I not use my two digit USMLE score because it will "give away" the fact that I went to the caribbean almost offensive. I don't hide behind the fact that I went to the caribbean. Im sort of proud of it. I could care less what American grads or anybody else thinks. With the scores I got on the boards I could have matched into radiology or another ROAD specialty. This distinction is made by people who need to feel superior over someone else for whatever reason. I got to move to another country, and live in the caribbean. I got to live all over the united states for rotations, I got a great education. I rocked the boards, am in a residency in a very desirable part of the country where they can pick whoever they want. And when its all said and done Im a Doctor! Sometimes I think US allopathic medical students/graduates are just bitter.

Really? A 99 tends to be just a few points above the national average (a 99 is usually around 227-230, if I'm not mistaken). A good score, but not something that would even close to guarantee you matching in ROAD specialties, especially as a Caribbean grad (essentially zero Caribbean grads match in Derm, for example).

We're not trying to put you down, but you have to realize that no one uses the double digit scores . . . in fact, as someone else pointed out the double digit score isn't even reported any longer.

 

[deleted103644]

Really? A 99 tends to be just a few points above the national average (a 99 is usually around 227-230, if I'm not mistaken). A good score, but not something that would even close to guarantee you matching in ROAD specialties, especially as a Caribbean grad (essentially zero Caribbean grads match in Derm, for example).

We're not trying to put you down, but you have to realize that no one uses the double digit scores . . . in fact, as someone else pointed out the double digit score isn't even reported any longer.

It's actually even more confusing than that.

They just rescaled the two digit scores for some weird reason so even 260+ scored are <99 now.

My step 1 was in 99 territory by a good 30 points or so on the three digit scale, but my step 2 (which was higher in the three digit scale) scored low 90's.

Needless to say, 2 digit scores are worthless.

 

[Buzz Me]

This is why no one uses the 2-digit score (NOT a percentile). They used to be scaled so that a 75 was a pass. That's it.

Everyone in the US uses the 3-digit score.

 

[deleted103644]

This is why no one uses the 2-digit score (NOT a percentile). They used to be scaled so that a 75 was a pass. That's it.

Everyone in the US uses the 3-digit score.

75 is still passing, everything else is meaningless.