Guidance on how to match into Psychiatry

[zenlife]

Hi there,

I haven't been here in a while and so I forgot where I previously posted any information about myself asking for some help.

I would like to really match into Psychiatry. I understand it is a competitive specialty.

This was my 4th match. My first 2 matches, I had applied to FM, Psych and Peds. I applied broadly because as an IMG, I was advised to do so.

I had 4 interviews this year - 2 community programs, 2 university programs

Here's a little about me. Please ask as needed.

Year of Grad: 2013
Citizenship: US
School: Low tier off shore Caribbean
Step 1: 193 - 1st attempt
Step 2CK: 202 - 1st attempt
Step 2CS: Pass - 1st attempt
Step 3: 205 - 3rd attempt

Red Flags: transferred from one school + Step 3 attempts + low scores + low tier med school

What I have done to compensate:
1) roughly 2 years of research with 8 publications
2) presented 2 posters at 3 different conferences
3) acquired university-based LORs from my research

What else can I do? I would appreciate the help.

---

Members don't see this ad.

 

[splik]

It's not going to happen. I dread to think how much money, time, and effort your poured into an effectively worthless degree but you need to move on with your life and figure out another way to have the kind of career you want. You are not going to be matching in psychiatry. Research is not going to help. LORs from researchers are not going to help. conference presentations are not going to help. unless you are connected (which evidently you are not) you are not going to buck the system and be the one example of someone who made it.

Were there lots of other students from this "school" that didn't match? If so your best bet is to try and launch some class action lawsuit to recoup your money back. Other than that, you need to move on. I know this is not what you want to hear. It is what you need to hear.

 

[Shikima]

Combine it with a MBA and get into hospital administration.

 

[st2205]

I can't say what you should do or that this is the path I'd recommend, but if I were in this situation I'd scramble to a malignant surgery prelim, if possible, and complete that, be eligible for licensure, then re-evaluate options from there.

 

[zenlife]

Thank you so much actually. I myself was contemplating a career change because I am just fed up. I appreciate the honesty and I will utilize my time towards something else.

 

[Merovinge]

Thank you so much actually. I myself was contemplating a career change because I am just fed up. I appreciate the honesty and I will utilize my time towards something else.

The degree is NOT unless although I think the likelyhood of getting a psychiatry residency is slim. My friend from a Caribbean medical school (admittedly one of the good ones) got a great gig right out of his MD as a consultant for a company employed to help hospitals get paid by insurance companies (basically contracted UR services). He both got to help stick it to insurance companies and make 100k a year for just over 40 hours of work a week with great benefits. There are other options in the business world as well that you wouldnt need an MBA for right away although it might make sense down the road. Best of luck.

 

[zyxab]

In my opinion, if you make the right connections, anything is possible. I think you'll probably have to have one foot in the door at a specific program in order to match. This can be done in a number of ways (for example, externships).

 

[zenlife]

It's not going to happen. I dread to think how much money, time, and effort your poured into an effectively worthless degree but you need to move on with your life and figure out another way to have the kind of career you want. You are not going to be matching in psychiatry. Research is not going to help. LORs from researchers are not going to help. conference presentations are not going to help. unless you are connected (which evidently you are not) you are not going to buck the system and be the one example of someone who made it.

Were there lots of other students from this "school" that didn't match? If so your best bet is to try and launch some class action lawsuit to recoup your money back. Other than that, you need to move on. I know this is not what you want to hear. It is what you need to hear.

I will say one thing. I understand that I don't come from ideal credentials. But I didn't realize this forum has physicians like splik, who are allowed to bully. If I was in front of you, would you say the same thing? Is this how you talk to people in real life? Or is this forum a means of being a bully because the other person is not in front of your face? My research LORs that were "brilliantly" assumed to not be useful came from Psychiatry department physicians with whom I did CLINICAL research, in case that is a foreign concept to you. Asking about that small fact might have been a more intelligent approach than shooting it down entirely. I know of AMGs who can't pass Step 1 or CK or even Step 3 on their first attempt and have other red flags. I know of IMGs with lower credentials than me who match on their efforts if not connections. I worked very hard and my own life has not been easy. My degree is not worthless unlike the baseless bullying that is apparently so "safe" to do using a keyboard. Clearly, you have not talked to enough people who've worked hard and made it. Or people don't tell you their stories since you're so great at demeaning them. I thought this forum was supposed to be resourceful. But I guess if people want to be insulted, I'll make sure to refer them to this site.

 

[clausewitz2]

I will say one thing. I understand that I don't come from ideal credentials. But I didn't realize this forum has physicians like splik, who are allowed to bully. If I was in front of you, would you say the same thing? Is this how you talk to people in real life? Or is this forum a means of being a bully because the other person is not in front of your face? My research LORs that were "brilliantly" assumed to not be useful came from Psychiatry department physicians with whom I did CLINICAL research, in case that is a foreign concept to you. Asking about that small fact might have been a more intelligent approach than shooting it down entirely. I know of AMGs who can't pass Step 1 or CK or even Step 3 on their first attempt and have other red flags. I know of IMGs with lower credentials than me who match on their efforts if not connections. I worked very hard and my own life has not been easy. My degree is not worthless unlike the baseless bullying that is apparently so "safe" to do using a keyboard. Clearly, you have not talked to enough people who've worked hard and made it. Or people don't tell you their stories since you're so great at demeaning them. I thought this forum was supposed to be resourceful. But I guess if people want to be insulted, I'll make sure to refer them to this site.

While he is certainly not being gentle in the comments that you quoted, but he is not being a bully. There are some unfortunate truths there and those truths reflect some deeply unfair things about the world, but I think you need to take what he is saying seriously and consider how you would change your plans if they were true.

 

[zenlife]

While he is certainly not being gentle in the comments that you quoted, but he is not being a bully. There are some unfortunate truths there and those truths reflect some deeply unfair things about the world, but I think you need to take what he is saying seriously and consider how you would change your plans if they were true.

Oh I definitely will change my plans, but saying "not useful" and "worthless" are not gentle terms. Especially considering I had a few more interviews this year compared to the past. I made an effort in the right direction at least. If someone called your degree worthless, I am sure you would not be appreciative. I didnt know splik is superior to ECFMG if my degree is worthless. The truth can be told constructively, not impulsively or ruthlessly. That defeats the purpose of a professional forum.

 

[Amygdarya]

At the risk of being called a bully I'll say this: your research experience is not entirely worthless but is probably less worth than you think, mainly because CLINICAL (sic) research experience does not equal clinical work experience. (And I should know this, as I have years of clinical research experience at several levels before and during medical school.) What have you been doing since you graduated in 2013? You needs to prove you're capable of clinical *work*, not research, especially in the light of low-ranked Caribbean school and Step issues. You may pique some interest with your research, but in the end of the day all that matters is if you're competent enough to be allowed the responsibility of taking care of patients - after all, you're applying to residency, not graduate school (which I would advise at this point given your research involvement).

 

[nexus73]

I'll agree with the above post about an intern year. If you can get in anywhere that has a 1 year traditional intern year/prelim, preferably internal medicine, you can at least get licensed and potentially do urgent care (rural) or disability evaluations. Look into states that allow licensing after 1 year of residency, some require 2 or more (I think California requires 3 years). The optimist in me would hope for an intern year at a site with other residencies. Prove yourself as an intern and maybe you could land a primary care residency spot. You may have to seek out programs in extremely undesirable locations, could be very rural or very urban.

 

[HarryMTieboutMD]

echo going for unfilled medicine/surgery intern year- you need to change your tact, and actually practicing medicine is the best thing you can do for yourself. Also, have you been doing your research at a single university? Have you met with the PD there? He or she might be able to provide face to face advice that might be more worthwhile than what you get on an online forum (btw I agree with Splik's comments but it might be more helpful and prompt fewer rationalizations on your part if you hear it in person from someone whose job description includes evaluating applicants)

 

[zenlife]

At the risk of being called a bully I'll say this: your research experience is not entirely worthless but is probably less worth than you think, mainly because CLINICAL (sic) research experience does not equal clinical work experience. (And I should know this, as I have years of clinical research experience at several levels before and during medical school.) What have you been doing since you graduated in 2013? You needs to prove you're capable of clinical *work*, not research, especially in the light of low-ranked Caribbean school and Step issues. You may pique some interest with your research, but in the end of the day all that matters is if you're competent enough to be allowed the responsibility of taking care of patients - after all, you're applying to residency, not graduate school (which I would advise at this point given your research involvement).

Thank you for your insight and I agree with you. I have done observerships in IM but I limited that to no more than 2 because the term "observership" I have heard doesn't settle well with programs. Even though I saw patients under the supervision of an attending, "observership" could mean anything. I did get feedback from a psych faculty member that it could sometimes just mean you watched someone do an exam, which anyone can do. And I agreed. So, I thought to have something that would stay with me, I thought I'd do research. I wasn't sure what to do to show them I could do something more hands on. But I noticed the suggestions of unfilled med/surg. I will definitely keep that in mind should I decide to apply next year.

 

[zenlife]

I'll agree with the above post about an intern year. If you can get in anywhere that has a 1 year traditional intern year/prelim, preferably internal medicine, you can at least get licensed and potentially do urgent care (rural) or disability evaluations. Look into states that allow licensing after 1 year of residency, some require 2 or more (I think California requires 3 years). The optimist in me would hope for an intern year at a site with other residencies. Prove yourself as an intern and maybe you could land a primary care residency spot. You may have to seek out programs in extremely undesirable locations, could be very rural or very urban.

Thank you for the suggestion! I will look into doing that.

 

[zenlife]

echo going for unfilled medicine/surgery intern year- you need to change your tact, and actually practicing medicine is the best thing you can do for yourself. Also, have you been doing your research at a single university? Have you met with the PD there? He or she might be able to provide face to face advice that might be more worthwhile than what you get on an online forum (btw I agree with Splik's comments but it might be more helpful and prompt fewer rationalizations on your part if you hear it in person from someone whose job description includes evaluating applicants)

Thank you so much. Yeah I guess that is the drawback. I was only at one institution and it did not take international graduates. It was difficult to approach the PD but the faculty were very helpful in that sense. In the event I decide to apply next year, I will keep the med/surg intern year in mind.

 

[st2205]

But I noticed the suggestions of unfilled med/surg. I will definitely keep that in mind should I decide to apply next year.

I don't think it's something you keep in mind. It's something you do. Now. Are there any available?

 

[Mad Jack]

I will say one thing. I understand that I don't come from ideal credentials. But I didn't realize this forum has physicians like splik, who are allowed to bully. If I was in front of you, would you say the same thing? Is this how you talk to people in real life? Or is this forum a means of being a bully because the other person is not in front of your face? My research LORs that were "brilliantly" assumed to not be useful came from Psychiatry department physicians with whom I did CLINICAL research, in case that is a foreign concept to you. Asking about that small fact might have been a more intelligent approach than shooting it down entirely. I know of AMGs who can't pass Step 1 or CK or even Step 3 on their first attempt and have other red flags. I know of IMGs with lower credentials than me who match on their efforts if not connections. I worked very hard and my own life has not been easy. My degree is not worthless unlike the baseless bullying that is apparently so "safe" to do using a keyboard. Clearly, you have not talked to enough people who've worked hard and made it. Or people don't tell you their stories since you're so great at demeaning them. I thought this forum was supposed to be resourceful. But I guess if people want to be insulted, I'll make sure to refer them to this site.

You're confusing honesty with bullying. Your situation, overall, makes your degree useless for the practice of medicine, or at least for getting a categorical residency. You might land a preliminary surgical position in BFE, but that's about it. Your best shot would be pathology or FM, psychiatry just isn't realistic. And this many years out, even those are very long shots.

 

[Mad Jack]

Thank you for your insight and I agree with you. I have done observerships in IM but I limited that to no more than 2 because the term "observership" I have heard doesn't settle well with programs. Even though I saw patients under the supervision of an attending, "observership" could mean anything. I did get feedback from a psych faculty member that it could sometimes just mean you watched someone do an exam, which anyone can do. And I agreed. So, I thought to have something that would stay with me, I thought I'd do research. I wasn't sure what to do to show them I could do something more hands on. But I noticed the suggestions of unfilled med/surg. I will definitely keep that in mind should I decide to apply next year.

You shouldn't try next year, you should try right now. Every year severely decreases your ability to land even these programs. See if you can find any available that went unfilled in the match.

 

[TexasPhysician]

4 years out of school is a big red flag. I agree with other posters that you need to find a 1 year position anywhere now. Do not wait any longer. Your school should have advised this year's ago.

 

[Salpingo]

You're confusing honesty with bullying. Your situation, overall, makes your degree useless for the practice of medicine, or at least for getting a categorical residency. You might land a preliminary surgical position in BFE, but that's about it. Your best shot would be pathology or FM, psychiatry just isn't realistic. And this many years out, even those are very long shots.

Yeah, I agree that splik is not a bully, but I always read his posts in the voice of the genius savant/mildly autistic kid in the class who bluntly tells the teacher off. Is telling someone they wasted money on their degree honest? I guess... is it necessary? Probably not. But on the internet, you kind of take the good with the bad, and I think we all enjoy spliks posts (when we're not on the receiving end).

Anyway, another option for OP is to get an NP degree. More money and time, and if you're a bad test-taker, you should figure that out before embarking on more school.

 

[MacDonaldTriad]

“I’m a bad test taker”

Most likely Translation:

“I’m deluded into believing that I have a unique and mysterious form of intelligence that somehow evades any effort to quantitate it and I’m trying to manipulate you into validating my desperate and unlikely belief system.”

Ok, I would agree that test taking can be a skill, but being unable to apply learned knowledge and logic to answer test questions has to imply some deficits that are going to be a disadvantage in the practice of medicine. Professional test taker would be a fair description of an MS-4 don’t you think?

 

[Merovinge]

“I’m a bad test taker”

Most likely Translation:

“I’m deluded into believing that I have a unique and mysterious form of intelligence that somehow evades any effort to quantitate it and I’m trying to manipulate you into validating my desperate and unlikely belief system.”

Ok, I would agree that test taking can be a skill, but being unable to apply learned knowledge and logic to answer test questions has to imply some deficits that are going to be a disadvantage in the practice of medicine. Professional test taker would be a fair description of an MS-4 don’t you think?

100% agree that is the most likely translation. There is something to be said about test anxiety that can potentially get worked out and improve a person's performance, but people who are "bad" at tests are not going to enjoy a career in medicine.

 

[Shikima]

I'm genuinely bad at taking tests. I often do not know or understand what the other person is attempting to ask despite having the knowledge.

 

[Salpingo]

“I’m a bad test taker”

Most likely Translation:

“I’m deluded into believing that I have a unique and mysterious form of intelligence that somehow evades any effort to quantitate it and I’m trying to manipulate you into validating my desperate and unlikely belief system.”

Ok, I would agree that test taking can be a skill, but being unable to apply learned knowledge and logic to answer test questions has to imply some deficits that are going to be a disadvantage in the practice of medicine. Professional test taker would be a fair description of an MS-4 don’t you think?

Fair enough. Maybe the better question is "why have I done so badly on these tests?" Bored with material? Performance anxiety? Reading comprehension?

The Steps aren't rocket science, particularly as you progress further. With enough time and resources, most people should be able to get close to an average score. So yeah, I'd say the OP has to identify the reason for poor performance before moving on (which could include the fact that they'd rather be doing something else).

 

[FlowRate]

Thank you so much. Yeah I guess that is the drawback. I was only at one institution and it did not take international graduates. It was difficult to approach the PD but the faculty were very helpful in that sense. In the event I decide to apply next year, I will keep the med/surg intern year in mind.

Did you fail to obtain a position in SOAP the past four years, or did you not try? Your best bet would have been SOAPing after your first match--most people have significant school support during those few hours.

 

[zenlife]

Did you fail to obtain a position in SOAP the past four years, or did you not try? Your best bet would have been SOAPing after your first match--most people have significant school support during those few hours.

The way you're surprised - I'm curious to know if you are even a part of a residency committee and know anything about SOAP. Do you not know that SOAP runs in favor of american medical graduates? For someone who wants to talk, how did you fail to know that?