I Need advice from pros

First of all, start by taking a deep breath. you sound really stressed out and that's not going to help the situation.

Secondly, it's hard to tell you anything with that little piece of information. yes, the step 1 failure is a factor against you. if you kick butt on step 2 that can help. Need more info to specifically help since I don't know what medical school you are attending, how your grades are, if you have any research projects, if you are planning on doing any away electives in PM&R, etc

USMLE scores are only part of the big picture. If you do a lot better on step 2, then your family stress reason will be more believable. If your grades and letters are stellar, that will also help. I wouldn't give up PM&R but definitely need to cast your net wide. Apply to all the programs you would consider going to - even if it's not the best geographic location. If your family situation has not resolved, you need to concentrate on that.

pm me if you want to privately discuss your situation.

 

I think an elective rotation somewhere you would like to go can either make or break your application. It could mean the difference between a strong LOR to advocate for you or a mediocre one which can work against you (try to avoid at all costs). You really have to demonstrate a strong desire to learn, volunteer to present topics, read about your patients. And remember no one expects you to be a master of the subject (that's what residency is for). One of the places I interviewed at this year and ranked very highly told me they consider applications of people who have failed multiple times (and subsequently passed), as long as they showed potential to do well from an audition rotation. PM me for more info.

 

I have to agree that you have to rely on contacts more than scores at this point. You should of course try to get the highest scores you can on your step 2, but the best thing you can do for yourself is show your face at some programs.

If you are stuck in one place geographically, you should study the local PMR residency positions and target ones that are mid to lower tier. This is just to be practical, so you can devote your time wisely.

If you can move around, apply the same technique on a national level. Do a search on this forum to see which places have had openings after the match, unexpected vacancies, and even places that people have made "negative" comments about on the interview trail. These are distressed programs in some way, and you are a distressed candidate. (I don't mean to hurt your feelings).

You should plan to secure a prelim spot as well, which will buy you more time even if you don't match on the first try. Openings pop up unexpectedly, and some are not even advertised (larger programs will just work around a missing resident, but if a replacement comes knocking, they might take a look).

You can also look into Family Med or even some IM programs to get your foot in the door, and if time is not an option transfer later (switching residencies is looked favorably sometimes, especially when it is motivated by interest in PMR and not just hating the current job).

If you want to just practice in a rehab hospital after finishing IM, you could easily do that as well. Or tack on a sportsmed fellowship to either of those and do outpatient. Practically, the knowledge base is the same either way unless you want to practice at an academic or elite level.

I hope this helps.