IMG who did not match - Please HELP!!!

[ThetisAntithesis]

Hi all,
I'm asking for a family friend who is trying to match.
I'm not sure of all that is needed so forgive me if I say something wrong or miss out some information.

She graduated medical school in West Africa in 2012.
Completed 1 year of what is called 'house job' over there - basically a residency from what she describes.
Arrived in the US in 2015.
She is on a student visa which I know is a huge hindrance.
Completed a masters in psychology in 2016.
Currently getting an associates degree in substance abuse counseling (she needs to be in school to maintain her F1 visa).

Match Attempts: 2 (2018, 2019/2020 cycle). She is interested in psych and applied to 60 or 70 programs with no interviews.
Her clinical experiences are all in psych, including her work in home country

USMLE:
Step 1 (3 attempts), most recent score 206 (2017) - It seems like this is a red flag.
Step 2 (2 attempts), most recent score 217 (2018)
Step 3 (1 attempt) 199 (2019).

Currently, shadowing and observerships cancelled due to COVID.

Clinical experience:
Currently working as a psychology/ substance abuse counselor which is a paid position (volunteer since 2018, paid starting 1 year ago).
Hospital volunteer last year - She says she was mostly working with the nurses.

Letters of rec: 4 letters
All from experiences in home country.
(I told her these were old and she needed more recent ones).

Can you please advise on what she should do in order to match for this upcoming cycle.
Where should she apply? Specific programs? (I'm an incoming MS1 so I'm not sure how people find places to apply to, I'm sure she does).
Any particular states?
I have told her she absolutely needs to apply to a ton of family medicine (As I've seen said on here) and limited psych (is this correct info?)

I have told her to also try to connect with physicians in some capacity to establish relationships and give advice. Limited right now due to COVID.

Thank you so much!!

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[GoSpursGo]

I'm sorry, there's really no other way to put this--she is absolutely not going to match this year no matter what she does, and it seems unlikely that she ever will.

Those letters from her home country are unfortunately worthless. She needs US clinical experience to get a letter from someone in the US, and as you mentioned there's no real way for her to get that at the moment. It's very clear from the fact that she didn't get any interviews these last 2 years that she is not competitive for psych. With apps opening in under 2 months, that means that even if she tried to change plans and apply to FM there's no way for her to get appropriate letters or experience that would show that she knows what she's getting herself into. I feel reasonably sure that it would be a waste of money.

With year of graduation 2012 and 3 step failures, I honestly don't see how she becomes competitive for any residency. If she is committed to giving it another go, I would spend a year trying to gain US clinical experience (assuming it ever becomes possible in the next 12 months with COVID) and pivot to FM. If she applies and then still gets no interviews, I think at that point she would really need to see the writing on the wall and find some other way to be happy doing something medicine-related other than a physician.

 

[ThetisAntithesis]

I'm sorry, there's really no other way to put this--she is absolutely not going to match this year no matter what she does, and it seems unlikely that she ever will.

Those letters from her home country are unfortunately worthless. She needs US clinical experience to get a letter from someone in the US, and as you mentioned there's no real way for her to get that at the moment. It's very clear from the fact that she didn't get any interviews these last 2 years that she is not competitive for psych. With apps opening in under 2 months, that means that even if she tried to change plans and apply to FM there's no way for her to get appropriate letters or experience that would show that she knows what she's getting herself into. I feel reasonably sure that it would be a waste of money.

With year of graduation 2012 and 3 step failures, I honestly don't see how she becomes competitive for any residency. If she is committed to giving it another go, I would spend a year trying to gain US clinical experience (assuming it ever becomes possible in the next 12 months with COVID) and pivot to FM. If she applies and then still gets no interviews, I think at that point she would really need to see the writing on the wall and find some other way to be happy doing something medicine-related other than a physician.

Thank you @GoSpursGo
Would a letter from a supervisor from her current work as a counselor help.
So she should skip this year? So she can improve her chances with shadowing/clinical experiences.
Thanks again.

 

[GoSpursGo]

Thank you @GoSpursGo
Would a letter from a supervisor from her current work as a counselor help.
So she should skip this year? So she can improve her chances with shadowing/clinical experiences.
Thanks again.

I would guess her immediate supervisor isn’t a physician, so the answer is no I don’t think that such a letter would help. Keep in mind, this isn’t pre-Med where you’re applying for Med school and literally any patient contact counts because they'll have 4 years to teach you how to be a physician—she’s applying for residency, which is an actual job and where on day one she needs to be able to manage patients. She needs letters which can speak to her ability to fulfill that role. As of now, she hasn't filled that role in over 5 years, and as far as I can tell she never has filled that role in the US healthcare system.

Again, I’m not sure that anything can help at this point. I'm afraid the reality is that there are just too many red flags at this point to overcome. But if she’s committed to giving it at least one more shot, she needs more direct clinical experience in a field that she may actually have a chance in (ie FM).

 

[ThetisAntithesis]

@GoSpursGo Got it.
Thanks so much!

 

[Dral]

Oof, those step failures are rough. That is the main issue that she may not be able to overcome. I would agree with gospursgo that family medicine could be a last ditch effort.

The opioid crisis is such a hot topic right now. If with her background she could get some experience with that and then spin it to a family med residency about how she wants to work in a rural area as a family med doc who also treats patients with opioid addiction...that may help.

For a lot of imgs, there is a fine line between optimism and realism. I wish her the best, but it's going to be a tough one.

 

[Animalcules]

I have to agree with the others here. One Step failure can be hard to overcome. Being an IMG, having three Step failures, having low Step scores, and having graduated now 8 years ago will make it impossible for her to match to any specialty in the US. I'm sorry, but I just don't see this worth pursuing in the US. If moving is not an option, she may still find fulfillment working as a psychologist or counselor. The visa seems like another bad situation given the current political environment.

 

[ThetisAntithesis]

Thanks so much @Dral @Animalcules . I appreciate your input.