I need help please

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If your Step 1 was low, you need to take Step 2 ASAP and rock it. Not a good idea to apply to derm with a low Step 1 and a pending Step 2.
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Medstudentquest said:
Again, I am not shocked about the derm issue at all. Derm's tough. The prelim issue was surprising since I did get many interviews, but the list was never counted. Time off was is not a problem, as I'm also doing an MPH and it was a very short time off, not like a year or anything. As far as the lab experience, I started at the end of last year. I have done extremely well clinically otherwise.

I am not sure why you say that I am aiming too high. Thanks for your wishes.
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Understood.

The Aiming too High part is regarding applying for Derm in the first place without a backup. You already know that it is "not surprising" that you didn't get it. Why then did you not apply for a categorical medicine position? Nevermind, what matters now is what your next step will be and I think placing all your energy in Derm will yield the same results.
 
Quick question... what about a surgery prelim makes it physically more demanding than a medicine prelim such that you cannot even consider a surgery prelim?
 
Medstudentquest said:
I have a chronic medical condition and I have permanent muscular weakness among other things. A surgical prelim is brutally demanding physically. If you've gone through your surgical rotation vs. your medicine rotation, I'm sure you'll agree. Medicine i think is alot more mentally taxing, but not nearly as much physically demanding as surgery. Also like I mentioned, a surgical prelim wouldn't really help me in any way.
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A surgical prelim would help if a PGY-2 position opened up. Taking time off to pursue a MPH or pursue research would also help you should you decide to reapply, but you wouldn't qualify for that PGY-2 position then.
 
Doing research for another 1 year isn't a terrible idea, but next year you need to apply to another specialty as a backup to derm. You might never get a derm spot, despite being a generally strong residency applicant. If you don't like IM, then apply to something else as a backup. You could do preventive medicine, physical med/rehab, neurology, peds, etc. You could do pathology as a backup...good specialty with cush hours that med students often overlook. Regardless, you need to have a backup plan that is viable.

It also concerns me that you didn't understand how to do the rank list (i.e. didn't list any categorical or prelim IM programs at the end of your rank list).

The letters of interest you get from PD's or faculty in the match don't mean anything. They don't mean you will match. Take those with a grain of salt.

I agree that not having Step 2 might have been a red flag, if the Step 1 was lowish for a derm applicant. You need to take it and do well.

Finally, having done an IM residency, I don't think a medicine intern year is >> on the easiness scale than surgery. It's not AS physically demanding as surgery, but it's not a cakewalk either. We regularly worked 80 hours, and stayed up x 30 hours with no sleep. TY's are easier (usually) in terms of hours and call, but also the hardest to get.
 
dragonfly99 said:
TY's are easier (usually) in terms of hours and call, but also the hardest to get.
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True but for an unmatched applicant, I think a prelim medicine year is probably a better way to go.

On the trail, I actually interviewed at quite a few prelim programs that were close to a transitional year in terms of elective time offered. There are a few more floor months in those programs but I would still gladly be doing general medicine over some TYs mandated surgery/obgyn/pediatrics/SICU/MICU rotations.
 
Medstudentquest said:
It wouldn't qualify me for another specialty, but it would give me time to reapply to derm, and then do internship. I don't think a ton of PGY2 derm spots will open up.
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That is true. Although I did hear a rumor a couple years ago that someone enjoyed their prelim year so much they voluntarily gave up their derm spot to continue in IM.

Now that is dedication. I'd also order a UDS. :laugh:
 
Medstudentquest-- sorry to hear about your troubles.

Let me ask you a question: are you in a position to be choosy? If so-- i.e. you're not worried about loan repayment, supporting a family/relatives, have other job options besides clinical medicine, whatever-- then you could hold out for derm at all costs.

I read through some of your past posts. You got a few interviews in dermatology, which is an awesome accomplishment, but you didn't seem particularly... proactive in the whole Match process. Even now, you're sort of sitting back asking to be told what to do. Most successful reapplicants to a competitive specialty are really grabbing life by the cojones during their 'gap year' to make up for whatever it was they felt led to their first unsuccessful match. You need to do the same.

Secondly, if you *can't* afford to be choosy, then you're going to have to think about applying to a specialty that seems less palatable to you right now as a backup. I understand that chronic muscle weakness would not lead to happiness in a surgery internship-- which would also rule out specialties like ob/gyn, anesthesia and EM. You say you "don't like IM." Perhaps you could consider something like PM&R, which has a very good lifestyle, doesn't make too many physical demands, and could allow you to safely geographically constrain the programs to which you apply. (Because as a reapplicant to derm, you will have to apply to every single program in the country to have a shot). At any rate, you definitely need a contingency plan next year, unless you don't really want to do a residency and have other options.

Finally, you shouldn't count on any PGY-2 derm spots opening up. As you said, that's extremely, extremely rare. I think you need to do some good self-inventory, think long and hard about what makes you happy and what you *could* do in medicine... after all, the universe isn't maximally fair, and sometimes we don't get what we want the most. Come up with a solid plan B and make your peace with it, while working hard to improve your derm apps for 2010.
 
Medstudentquest said:
Hi,

I think i am doing everything I can. I talked to my dean, have emailed all the PD's where I interviewed asking if they could possibly open up a spot, I am searching for open spots, etc. etc. Please don't forget that I got news about all this disaster just very recently. Please also realize that it's very emotionally depressing/draining to have something like this happen.

I am weighing my options but it's a difficult choice you know? I will also go talk to my derm PD to see if I could potentially do a fellowship in the dept. and get a spot for the next cycle.


As far as what you asked, I am married and don't have kids so no, I don't have a family to support. I can potentially delay loan repayment, that's something to be determined. I am not planning on continuing to apply to derm forever of course, but at the same time, with all the work and effort that I have put into this, I don't want to do something I hate for the rest of my life.

If I can never do derm, I may just simply get a residency, pay off loans, and just sort of become a stay at home wife perhaps. Not sure. Like I said, I feel frustrated and anguished about the whole situation.
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I would definitely urge you to consider re-applying for a derm residency in the next cycle. 12 months go by a lot quicker than you would think. It seems you have a real interest in dermatology and this is what you want to do above everything else. A year is not a long time, but doing internal medicine for 40+ years if you don't like it is a long time. It takes a long time to pay off loans, and you may need to do internal medicine for a long time. Even if you don't get derm next year, you have figured out the complexities of entering prelim positions so you will likely get a prelim position next year AND at least you will know that you did everything you could to try for your dream a second time. You don't want to be thinking to yourself "what if . . . ".

I would talk to the derm PD and ask how to improve your application for derm next year. Likely you could do derm research at your school and perhaps do a derm rotation or observership or something. I would also study hard for Step 2 CK and blow it away. Your are right that there are people with average Step 1s i.e. 210's or 220's in dermatology.

If you don't make derm next year, then you could have a prelim medicine year. The biggest problem I think is that you don't like medicine and you may not do well as a medicine resident if you simply want to "get a residency", your medicine colleagues are as gung-ho on medicine as you are on derm! If you don't do well in prelim medicine then your career in medicine is in danger and you can forget about derm.

If you do get a prelim medicine spot you should have passion to do well as the best dermatologists are also great internists as you need to have broad knowledge/skill in internal medicine to do well in dermatology so this is part of dermatology training. Most derm candidates ate their internal medicine rotation for breakfast (and most of their other rotations as well), really studying for Step 2 CK will help reassure PDs that you have the knowledge to be a well trained dermatologist.

How did third year go? Having honors in most rotations helps alot.

I would say in summary, make a recomitment to dermatology and view yourself as a 2010 dermatology match participant and act like it, i.e. network with derm attendings, do research (maybe finish MPH and do derm research) and apply broadly next year.
 
Medstudentquest said:
I have a chronic medical condition and I have permanent muscular weakness among other things. A surgical prelim is brutally demanding physically. If you've gone through your surgical rotation vs. your medicine rotation, I'm sure you'll agree. Medicine i think is alot more mentally taxing, but not nearly as much physically demanding as surgery. Also like I mentioned, a surgical prelim wouldn't really help me in any way.
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From what I gathered, surgery internship was a lot of scutmonkey floor work and practically no time in the OR. The interns at my hospital couldn't decide which one was worse (between medicine and surgery internship).

I'd probably agree with you about the surgery prelim not helping in any way...
 
Medstudentquest said:
If I can never do derm, I may just simply get a residency, pay off loans, and just sort of become a stay at home wife perhaps. Not sure. Like I said, I feel frustrated and anguished about the whole situation.
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I think your disappointment/anguish/frustration might be clouding the picture.

There's certainly nothing wrong with being a stay-at-home-wife. But I'd consider at least exploring other fields in medicine before throwing away your medical school education. It doesn't seem like it right now but there are other great fields out there beyond derm.
 
Whatever you decide to do, make sure you listen to your gut. If your gut is telling you that surgery prelim will not work out, then by all means do not do a surgery prelim year. I personally would have wanted to kill myself as a surgery intern. Medicine was pretty bad too (even though I thought I liked medicine as a med student). Both are physically taxing, but I believe medicine would be more understanding of your condition. Certainly do not apply to categorical medicine as a backup if you don't like medicine. Even though I love differentials, managing complex problems, etc... I think IM sucks big time in so many ways. Never have a seen a nicer, more bitter group of residents :(.

Really take a step back and think about how a medicine prelim year is going to help you. If you are unable to ever match derm (not sure how long you are willing to hold out), is a medicine prelim year the best bet? I have done mine now and realized that I am not that interested in other specialties that require a prelim year so basically am in a position that I will have to repeat my intern year if I don't match into derm this time around. Do you want to do something like ER, anesthesia, ophtho, radiology, internal medicine, family medicine, psych, preventive medicine if derm doesn't work out? If not, a prelim medicine year won't help you (and will be pretty painful/make you bitter if you don't ejoy medicine).

You need to do what is best for you, but think hard about what you would do if you decide to apply again next year (assuming you don't do a prelim year this year). Perhaps ranking a prelim med at the end by itself is not the best option. Derm is really competitive -- not saying you aren't qualified, but no matter how qualified you are it can be difficult to get a spot. Unless you are willing to sit out for years waiting for a spot and kissing ass (the latter is not in my nature, I don't know about your's), it might be better to rank another specialty as a backup. Of course, if derm is really what is best for you, then that may be easier said than done. Even though I want derm and am more interested in it than other specialties, I can't hold out forever and will be ranking another specialty as a backup (which unfortunately won't be one that requires a prelim med year so will have to repeat my intern year). It is possible to be just as happy in another specialty.

Good luck to you. I am glad you spoke to the people at your school. Hopefully they will be able to help you. Sorry if they are pressuring you. I guess it is important to figure out if they are pressuring you just to make their match numbers look good or if they are pressuring you b/c they have your best interests in mind.
 
It's hard when you genuinely love a very competitive field. So, so hard.

I think you should consider what you can do to improve your application. An extremely solid Step 2 score should be first. Having as many derm-specific publications is second. It's great that you're in your department's PD's lab-- but how prolific is it? Will you get to present at a national conference? Will you get a first-author publication out of it? Even if it's a wonderful lab, you can still network and publish with other academic dermatologists. Ask other faculty members if they have a chart review or other clinical project you could help with part-time. Be aggressive and proactive. I think a random prelim year in anything would not help nearly as much as some serious, high-level research-- you should almost consider yourself blessed that you didn't match for prelim medicine.

If your home school's PD cannot offer you significant research experience, then work hard to find a place at another school. Apply for the advertised derm research fellowships. And come up with an acceptable backup plan for next year's cycle.

Edit: unfortunately, from a PD's perspective, wanting it isn't enough. The PD wants two things: to brag to the department chair about how they "filled at 5" and the average stats of matched applicants was blah blah blah, and to choose residents who will both excel clinically whilst in the program, and who will go on to glory afterwards and reflect very well on where they trained. Keep in mind *their* filters for candidates and what they're looking for.
 
I love derm too. And I am not saying you won't get a spot, and am certainly not saying you won't get a spot EVER. But, the wait and the process of reapplying can be agonizing. If you are qualified, dedicated, have the financial means, etc... then waiting for a spot may be what's best for you. You are right that there are spots that open up and that doing research will help but so much of it is who you know, being in the right spot at the right time, etc...

There are people from my class who have matched after not initially matching. Are they more academically qualified than I am? ha! definitely not. Are they going to be better dermatologists than I am? no. Are they better ass kissers? definitely. I heard of this one girl from a nearby school who worked her butt off in a lab for 3 years after completing her prelim year, was highly qualified and well liked, ended up not matching despite being told by the program she did research for that they loved her, so finished up 2 years of categorical medicine. Bad stuff like that happens. On the other hand, I know of someone who was academically not very strong, clinically was lazy and weak, was not well liked by most residents and students, only wanted to do cosmetics, and matched the second time around.

Is your husband able to relocate if you need to do a research fellowship after prelim year? That has been my problem. Or are you willing to spend time apart from your husband? I am doing research at a nearby university, not my home institution, but there is no funding b/c it is not a formal fellowship. There are not too many formal paid derm fellowships, and you would likely have to relocate to get one unless you happen to live in an area with lots of fellowships. It is possible to get funding if you plan in advance and are working with a PI who has funding, but otherwise it is very difficult unless you are doing an official fellowship.

Don't count on getting a spot at your home program. Have hope, but don't put all your eggs into one basket. That's all I will say about that.

I am not trying to be negative, just want you to know the realities of what it is like as an unmatched applicant. It is good you are dedicated and have hope -- those things will get you far.
 
Medstudentquest said:
In part, yes. That's why I decided it's not the wisest choice to simply go and take any random spot out there that may not be in my best interest.

I love derm though. :( You don't think that at least your own school's PD would eventually let you in if you show them how much you want derm?
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If you two are related, possibly.

If not, there's really no need to take the person who's lingering behind year after year because there will always be a fresh new batch of talent. (Read: rising 4th years)
 
I think what we're all saying is that you can't pull your eggs in one basket.

Trust no one-- no one is your friend. The Match is a self-interested process on both sides. *Of course* everyone is telling you how awesome you are-- they want you to think of the program well, talk about it well to others, rank it highly, etc.

Don't misinterpret me-- I am NOT saying that you're NOT awesome. But you need to take everything you hear in this process with a heaping tablespoon of salt.

Absolutely sit down with your PD, but remember-- he doesn't owe you anything. If you say something to the effect of "I thought if I did research with you I was guaranteed a spot" or "you told me I would match" that will come across as accusatory, whiny and lazy. *If* there is such an arrangement in place at your school, it is certainly unspoken, and to verbalize it would be very bad form.
 
Medstudentquest said:
Hey, be nice! I didn't cry at school. I cried at home.

Congrats on matching in derm. You should be proud of yourself. Can I ask what your stats were and how many interviews you went on?
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I'm sorry, I was just joking around. (I know I know, horrible thing to joke about)

I've posted all that on the dermatology board. In all seriousness, I think you should speak with your PD (tears or not) as he/she will probably have the most experience on how to handle the path from here on out. My experience has shown that the deans (while well-intentioned) usually try to shunt unmatched students towards a different specialty.
 
I'm not sure what you mean by completing your project. In a lab, projects require daily work for several months until they are "completed" (ready to submit for publication). If he's your PI, you're having weekly lab meetings, right?

Unless you've been slacking on something and your conscience is bothering you (we've all been there), I think time is of the essence. Give yourself till next week (because tomorrow will be hard for you) to clear your mind, and set up a Monday meeting if possible.

PDs will tell candidates that they have absolutely no shot-- on some occasions. Most will think "a bird in the hand is worth two in the bush" regarding having a potential candidate, and won't flat out reject you. You better believe they will drop you like a hot potato if someone better comes along. Most will also be happy for free labor in the lab. Is this unfair? Perhaps-- but you would most likely do the same if a higher-ranked or more desirable program suddenly started salivating over you. That's what I meant when I said the process is very self-interested, on both sides. It doesn't make people evil or bad, and it doesn't mean your PD-PI doesn't care if you match or not, but it means you should view the process very objectively.
 
How about dermatopathology fellowship? Path residencies are a lot easier to get than derm... not sure how competitive the fellowship is, though.
 
t33sg1rl said:
How about dermatopathology fellowship? Path residencies are a lot easier to get than derm... not sure how competitive the fellowship is, though.
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Ehhh, the fellowship is quite competitive to get. I don't envy those having to go for a prestigious fellowship after their residencies. And of course, you'll want to be a in top-notch path residency if you're applying for dermpath. Which is not something that's easily scrambled into. Or even easily applied for.

Also, from what I've seen so far, you can certainly read slides as a path-trained dermatopathologist but I've yet to see one actually run a clinic/see patients on a regular basis. Which I'm assuming is a large appeal to those applying for dermatology.
 
I'm surprised nobody has mentioned this yet...what about being a "5th year medical student?" That is, delaying graduation, and taking this year to get all your ducks in a row, and applying as a medical student instead of an intern.

What you can do this year:

RESEARCH:
- Find an unpaid fellowship (emphasis on free indentured servitude) with a top-grade PD at a top-grade derm program and a prolific publishing history. Since your husband is unemployed, I see a silver lining: you can work ANYWHERE. Research some famous programs' projects and see what piques your interest. Email and call derm PD's around the country after thoroughly doing your homework and say you are willing to work in their lab. You cannot do clinical research because you haven't completed internship.
- Present your research to AAD and/or SID. Make sure you can at least present posters. Much better to PUBLISH something in a peer-reviewed journal, but anything counts!
- Finish your work. Do not leave any loose threads.

CLINICAL:
- At the same program, work as a student doctor. This means following the PD or a Very Important Attending in clinic at least twice a month or more.
- Keep an eye out for case reports during these shadowing opportunities and write them up.
- Work with a private practitioner on WEEKENDS...yes, they do exist!
- Working with both academic and private practitioners for one year shows dedication and a beginner's appreciation for longitudinal care!

CONNECTIONS:
- Attend the Boston AAD (it's FREE for med students!!!) -- this is a popular city and all the bigwigs will come out to play
- Plan ahead of time which lectures you will attend. Pick lectures given by PD's and have a list of questions to ask them.
- Schmooze
- Do not be seen with swag (free stuff). Ever.

Letters:
- If you get new letters, ask in September, after you've been working for free for at least 3 months.

--

I hope this brings a fresh perspective to other options. Bonus points if you pursue this for two years -- you will certainly be a top choice in derm with tons of lab and clinical experience.

It will look better if you apply as a medical student instead of an intern. Plus you will have an easier time finding time to interview than those in their prelim year.
 
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Medstudentquest said:
I will speak with the PD. I just want to be in a slightly better morale to do so. Also, do you think I should attempt to complete my project before speaking with him? Also why do you think he would bother letting me do research in his lab if he never intended on admitting me or while even bother interviewing me if I'll never get in?
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I think the point of doing research in a desired specialty is to broaden your horizons i.e. learn more about the specialty, and it is good background for going into a residency. From surveys of residency selection factors it might not be as big a factor as board scores and clinical grades. Research does help I think more at the fellowship level. Excellent medical students with great board scores and excellent clinical grades, but no research, match all the time into prestigious residencies.

Point being, research is not a "time out box" where you sit and collect points which will help you get a competitive residency. IF you do excellently, and are a star researcher i.e. several first publications, a PhD or a masters degree then yes this will help you, but if you just sort of punch your card for a year at a lab doing work that an undergraduate can do, and without a lot of passion, then this won't help and could hurt you.

If you love dermatology research then do it, but don't go for it with half a heart and hoping it alone will increase your derm chances . . . if it demonstrates your passion for derm then do it.

Your PD may have interviewed you as a "courtesy interview", or perhaps there was some real interest going on there in your application, probably both. However, just doing some research part time in a PD/PIs lab in fourth year won't sway him/her enough to give you a guaranteed position. Being allowed to work on research projects is not a big deal as the PD/PI can find an undergraduate to work full time and is more of a favor for you so that you get some research experience.

PDs want residents who are interested in research if they have a record, i.e. multiple publications then they might take an applicant, but if you did just some research in fourth year then you wouldn't be an investment as a star researcher.

Remember, when the PD and committee sits down to rank applicants, if you do not have third year honors and don't have say 230+ on Step 1 or higher then yes, with the competitive nature of dermatology this is a negative. Also, consider that there are many derm applicants who matched who had stellar board scores and clinical grades AND research . . . although the PD knows you, he/she would likely rank other such candidates higher as they sort of did more work. It isn't a slight to you.

I think some schools take their own applicants as the students rank their own program first and want to stay in said city, but they might also be and quite likely are quite stellar candidates.
 
you knew derm was a tough match.
I suggest you regroup meet with the dean again and talk with the PDs of FP IM ETC and work something out immediately.
You must be in a PGY1 year on July 1. Period. No ifs ands buts or whines.
A TY is probably out of the question at this late date.
 
Medstudentquest said:
I will speak with the PD. I just want to be in a slightly better morale to do so. Also, do you think I should attempt to complete my project before speaking with him? Also why do you think he would bother letting me do research in his lab if he never intended on admitting me or while even bother interviewing me if I'll never get in?
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I would suggest doing this as soon as possible. Your PD will wonder why it took so long for you to see him. I don't think it matters at all whether or not you finish your project. If I had to scramble, I would've been in my PD's office by 1:00PM on Monday (and that's counting the 45 min commute I would have to make back to campus)

As for his intentions, I'm not sure if this is the case or not, but who would turn down someone offering to do free work? Or someone willing to "kiss butt" or at least "play nice" while doing the free work? Research gets your foot in the door, but by no means does it guarantee anything.
 
Medstudentquest said:
I called NRMP and all they did was give me attitude, even though I explained the situation and they basically told me the wrong thing intially.
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To be fair, the instructions are pretty explicit. And I'm pretty sure all medical schools are required to have deans' offices available to help students in these situations. I don't think you can blame NRMP for this as they'll say you should have followed up with your student adviser even if they initially gave you incorrect advice. (Perhaps you phrased the question awkwardly? I doubt people who work at the NRMP would mess up something this basic)
 
Medstudentquest said:
Just out of curiosity, did you list your prelims under your derm programs and then under the supplemental list? Maybe I'm just an idiot who should drop out of medicine. :(
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I did list the prelims under the derm programs as well as under the supplemental list. I agree it seems counterintuitive to have to list them twice.

I think you're being a tad hard on yourself. The instructions are clear but the process of listing out the prelims twice does seem odd.
 
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