IMG with low step 1 score. Any chance in this field?

[Actinium24]

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So I’m currently approaching the end my third year and am feeling very anxious approaching my 4th year and the upcoming match cycle. I’m an USIMG at one of the big 4 Caribbean schools and have a low (201) step 1 score. I also repeated my last semester on the island after failing my last term pushing my graduation back a year. Clinicals haven’t been going too well either and I need to retake an NMBE shelf ironically in the specialty I was initially most interested in (OBGYN). Even though my evaluations have been decent, sometimes I honestly wonder if it’s even worth continuing. I've gotten B's in most of my rotations to this point with the exception of psych which I honored. Are there even any programs in pathology that would consider taking someone with such a poor academic history on top of being an IMG? I have yet to take step 2 CS/CK but plan to within the next 6 months. I feel like I can really use some advice on how to structure the approach to my remaining clinical rotations/board exams to give myself the best chance possible moving forward and hopefully securing a path residency. Any input from the community would be greatly appreciated.

 

[Unty]

Sadly you stand a chance. You just need path experience that is key. I mean as many rotations in pathology as possible. Programs want to know that you know what youre getting into. Get rotations at university hospitals which may be hard to get especially as a Carribean grad.

The bar is set low in Pathology and it’s hurting our field. Low tier programs will take anyone who shows an interest in Pathology and has done rotations and says “I like pathology.”

You will never see a post like this in the Derm forum. Why? Because they protect their field from degradation.

 

[Actinium24]

Sadly you stand a chance. You just need path experience that is key. I mean as many rotations in pathology as possible. Programs want to know that you know what youre getting into. Get rotations at university hospitals which may be hard to get especially as a Carribean grad.

The bar is set low in Pathology and it’s hurting our field. Low tier programs will take anyone who shows an interest in Pathology and has done rotations and says “I like pathology.”

You will never see a post like this in the Derm forum. Why? Because they protect their field from degradation.

My father is a pathologist and can likely help me secure an elective rotation at the hospital where he did his training (though it is a top tier university program where I don't think i'll stand much of a chance). Also, my school offers an elective at a site that has a residency program where I will try to schedule as soon as my last third year ends in May.

Does being born/raised in the US and having citizenship make a big difference? I ask because I read that 60% of all spots are filled by non American citizens

 

[Unty]

At this point, just do as many pathology rotations as you can. You are at a huge advantage for IMGs as you have access to a department residency program where you can sit in signout and learn as much as you can in all aspects of surgical pathology, Cytopathology and hematopathology.

hopefully your dad can get you to do several months of rotations. Get a letter of rec from any well known pathologists in the program if you can. Ask to spend time with one or two well known pathologists so you can get a letter. if your dad knows them then you are golden. Do rotations in surgical pathology, hematopathology and Cytopathology if you can. You should have no problems getting a spot if you spend several months in rotations and you can get letters of recommendation.

 

[Unty]

Being a US citizen may help somewhat as you can speak good English. Other than that, that’s the only slight advantage. Your low board scores will close doors on most residency programs so that’s why you have to make up for it by doing as many pathology rotations as you can.

if you get interviews and can speak about pathology based on what you learned in your rotations (in an enthusiastic way) that will help you a lot. Your dad can also teach you.

 

[Unty]

Improve on Step 2 and get Step 3 passed before residency then you should be fine. You must pass step 3 before residency because that exam is hard especially if you don’t have clinical experience.

 

[Actinium24]

Being a US citizen may help somewhat as you can speak good English. Other than that, that’s the only slight advantage. Your low board scores will close doors on most residency programs so that’s why you have to make up for it by doing as many pathology rotations as you can.

if you get interviews and can speak about pathology based on what you learned in your rotations (in an enthusiastic way) that will help you a lot. Your dad can also teach you.

One thing that does concern me a little is how many programs have university affiliations. Assuming these programs will be off limits to me based on my step 1 score and lackluster academic record, I am worried that there won't be many programs that will read my application. Is this a valid concern or are there many community programs that are not popular. I'm willing to train anywhere and am aware of the disadvantages (job placement, etc) that come with training at a low-tier program. Are connections really the only way I will stand a chance?

 

[Unty]

Just apply to as many lower to mid tier programs as you can and take whatever comes your way. Don’t worry about what programs will look at your application or not. If you enjoy pathology and truly want to become a pathologist you will find a way. If they won’t offer an interview then so be it.

you have to definitely show you’ve been exposed to pathology via rotations. I mean do three to four months if you can. You also have to improve on step 2 and 3. If you don’t pass step 3 before residency, then programs may not offer you an interview because they don’t want people struggling to pass the exam in residency.

 

[mark-ER]

Ok, this may come across as a bit harsh, but may be needed. You have a father who is a doctor (regardless if he is a pathologist)... that is a huge leg-up. And you were already behind the 8-ball by being enrolled at a Caribbean medical school. You knew you had to absolutely crush step 1 -- lock yourself in a room for 3-4 months do 12-hour days, whatever it takes. Be honest with yourself, did that happen? If you are that bad of a test-taker, then you might have trouble with passing the boards, which in turn might mean you might not be able to land a job post-training, regardless of specialty. As others have said, time to really buckle down, ace Step 2 (at a minimum 240), do rotations and shine. I do not post doom & gloom here ever, but the pathology world is small and the job market may not be abysmal but it is challenging. Unless you would really, really hate it, consider family medicine, peds, psych something bigger where the residents are highly recruited, almost regardless of their training/pedigree.

 

[Unty]

Ok, this may come across as a bit harsh, but may be needed. You have a father who is a doctor (regardless if he is a pathologist)... that is a huge leg-up. And you were already behind the 8-ball by being enrolled at a Caribbean medical school. You knew you had to absolutely crush step 1 -- lock yourself in a room for 3-4 months do 12-hour days, whatever it takes. Be honest with yourself, did that happen? If you are that bad of a test-taker, then you might have trouble with passing the boards, which in turn might mean you might not be able to land a job post-training, regardless of specialty. As others have said, time to really buckle down, ace Step 2 (at a minimum 240), do rotations and shine. I do not post doom & gloom here ever, but the pathology world is small and the job market may not be abysmal but it is challenging. Unless you would really, really hate it, consider family medicine, peds, psych something bigger where the residents are highly recruited, almost regardless of their training/pedigree.

lol that’s bull. You don’t need a 240 on step 2 to get a residency position in path sadly. This guy is trying to match anywhere. I’ve seen ppl get in with scores in the 200-210 range. They’ve done ok to well in path.

But yeah the original poster needs to think about his future hard and whether he or she really wants to be a pathologist. I hope your just not doing it because your dad is a pathologist.

 

[ScubaV]

Going from OB-GYN to pathology is a big change. Getting into a low-tier pathology residency is pretty easy, but you need to ask yourself if you're doing it because you think you might like it vs. being desperate for any residency at all. Do you want to be trapped in a specialty you don't particularly care about, coming from a low-tier program with low-tier education, and trying to fight for a job in a job market that is mediocre at best? If you truly want pathology, then yeah take those risks and do what you can to mitigate them. Otherwise, I'd explore other less competitive fields.

 

[mark-ER]

You can do a lot of what OB-GYN does in family practice, if you tailor your practice in that angle (not so much in GYN-onc, but on the OB side). On average, family docs are probably overworked/overburdened with needless paperwork administration and underpaid for what they do, but again that is the average. The distribution curve hides successful family docs, in solo or in a partnership model practice, with mid-levels and lean operations who make good money, live well and write their own ticket.

I am not so much trying to tell the OP you can't get in somewhere with passing Step 1, 2 and 3 score, but to aim higher, at least a mid-tier program, which would require something solid. You already have your father to speak to your interest in path, the possibility to rotate thru a US pathology department and get positive letters, perhaps even consider contributing to a manuscript -- a first author paper can be churned out in 9 months, if you get lucky and it shows initiative, followthru and writing skills.

 

[Actinium24]

Going from OB-GYN to pathology is a big change. Getting into a low-tier pathology residency is pretty easy, but you need to ask yourself if you're doing it because you think you might like it vs. being desperate for any residency at all. Do you want to be trapped in a specialty you don't particularly care about, coming from a low-tier program with low-tier education, and trying to fight for a job in a job market that is mediocre at best? If you truly want pathology, then yeah take those risks and do what you can to mitigate them. Otherwise, I'd explore other less competitive fields.

OBGYN was my preferred specialty since before I started medical school. But I’ve come to terms with the fact that I am simply not competitive and that the most likely outcome for me going for it is not matching and being completely screwed. While it would be a huge lie for me to say that I grew up always wanting to be a pathologist, of the specialities that seem to be realistically obtainable to me, it is by far the one that interests me most mainly due to its academic nature, lack of patient interaction and reasonable hours. I’m not only interested in this field because of my father and I don’t want programs to think that is the only reason I’m interested. That being said, my father is very happy in this profession and I don’t think his lifestyle is too bad at least compared to other attendings I’ve worked with in other fields (no call, weekends/holidays free, etc).

**one more thing I didn’t mention before. I do have some research experience. It was from when I was an undergrad, but was surgical related and did result in several publications. Is this something that would be looked upon favorably? “Charting outcomes in the match” does not show it making much of a difference in outcomes which is surprising to me

 

[Med Director New England]

Publications are good even if in a different field. It shows a program you are capable of writing up data and taking a project across the finish line. So many path trainees present poster after poster here and there but never actually publish the work...

dad being a pathologist also good. You will have a much better understanding of what a pathologist does than the majority of applicants. I would recommend you emphasize this in your personal statement - it will be a good talking point during in person interviews too.

as others have mentioned path is currently not competitive- I bet you’ll be More competitive than you think & able to get interest / interviews from all but the upper tier programs.


go to the best program you are able to get into. Pedigree is important in job seeking post training - see the many, many threads on the job market.

GL

 

[Unty]

OBGYN was my preferred specialty since before I started medical school. But I’ve come to terms with the fact that I am simply not competitive and that the most likely outcome for me going for it is not matching and being completely screwed. While it would be a huge lie for me to say that I grew up always wanting to be a pathologist, of the specialities that seem to be realistically obtainable to me, it is by far the one that interests me most mainly due to its academic nature, lack of patient interaction and reasonable hours. I’m not only interested in this field because of my father and I don’t want programs to think that is the only reason I’m interested. That being said, my father is very happy in this profession and I don’t think his lifestyle is too bad at least compared to other attendings I’ve worked with in other fields (no call, weekends/holidays free, etc).

**one more thing I didn’t mention before. I do have some research experience. It was from when I was an undergrad, but was surgical related and did result in several publications. Is this something that would be looked upon favorably? “Charting outcomes in the match” does not show it making much of a difference in outcomes which is surprising to me

you wanted to do obgyn but you don’t like patient interaction, and like good hours? That doesn’t make sense. obgyn is the complete opposite.

If you like obgyn I would go for it. Life is too short for you to be doing something your heart isn’t into 150%. Seriously, if you really want to do obgyn you can but you may have to take a year or two off doing research.

I’ve met people who wanted derm so bad they took a year or two off to do research. You could do obgyn research with a well known person andall it takes is for them to make a call on your behalf and your in despite low scores.

research doesn’t help at all for lower to mid tier programs in my opinion. Sure it helps but the main things they look atare your board scores and if you have any path experience andcan speak about it while showing enthusiasm.

have you done any path rotations. You may not even enjoy it once you do it.

do not go into path because “you can’t get into obgyn” abd it’s the only field that interests youbased on hours and lack of patient interaction.

 

[Actinium24]

you wanted to do obgyn but you don’t like patient interaction, and like good hours? That doesn’t make sense. obgyn is the complete opposite.

If you like obgyn I would go for it. Life is too short for you to be doing something your heart isn’t into 150%. Seriously, if you really want to do obgyn you can but you may have to take a year or two off doing research.

I’ve met people who wanted derm so bad they took a year or two off to do research. You could do obgyn research with a well known person andall it takes is for them to make a call on your behalf and your in despite low scores.

research doesn’t help at all for lower to mid tier programs in my opinion. Sure it helps but the main things they look atare your board scores and if you have any path experience andcan speak about it while showing enthusiasm.

have you done any path rotations. You may not even enjoy it once you do it.

do not go into path because “you can’t get into obgyn” abd it’s the only field that interests youbased on hours and lack of patient interaction.

I haven’t done any path rotations yet. I’ve really wanted to. But as I’m sure you know, your exposure is limited aside from the class we all take in our second year unless you actively seek it out in your fourth year. I did enjoy the class second year, but I agree that aside from testimony from my father’s experiences, my exposure to what a pathologist does in the real world is very limited. I still have a few months to decide on pursuing this specialty and have by no means fully made up my mind. All I am saying at this point is that it is something I would be interested in even though it is quite different from my earlier interests (obgyn). I just wanted to be sure that before I schedule my electives in this field over doing a sub-I or other elective in obgyn, I am not wasting my time pursuing a specialty that I am all but disqualified from due to my academic performance thus far. I know that the position I am in is not a good one to be in, and I pragmatically don’t think I can afford to be picky with my specialty options. Based on what this forum and others are telling me, my opinion are essentially limited to family, path, and peds. Of these-I am most interested in path and would at least like to explore it further.

 

[Unty]

I haven’t done any path rotations yet. I’ve really wanted to. But as I’m sure you know, your exposure is limited aside from the class we all take in our second year unless you actively seek it out in your fourth year. I did enjoy the class second year, but I agree that aside from testimony from my father’s experiences, my exposure to what a pathologist does in the real world is very limited. I still have a few months to decide on pursuing this specialty and have by no means fully made up my mind. All I am saying at this point is that it is something I would be interested in even though it is quite different from my earlier interests (obgyn). I just wanted to be sure that before I schedule my electives in this field over doing a sub-I or other elective in obgyn, I am not wasting my time pursuing a specialty that I am all but disqualified from due to my academic performance thus far. I know that the position I am in is not a good one to be in, and I pragmatically don’t think I can afford to be picky with my specialty options. Based on what this forum and others are telling me, my opinion are essentially limited to family, path, and peds. Of these-I am most interested in path and would at least like to explore it further.

well good luck but if your heart and passion is set on obgyn I would pursue it and do whatever it takes to get it. Connections and research can trump low scores (you mentioned you like the academic side of things). If you have strong publications in your name and publish with a big name in the field that can help your cause a lot. I wouldn’t let low scores stop you.

you know you have to have that Mamba mentality.

 

[Actinium24]

I took the advice from this forum and scheduled a 4 week audition rotation at a hospital with a residency program. However, this particular program does not participate in the match. Does this mean that is possible to get a job offer after finishing the rotation? And if so, it is advisable then to have step 2 completed earlier? I had no idea there were any pathology programs that you could prematch into and would definitely like to do whatever I can to give myself a chance at this program since its location is very preferable to me and they have taken a lot of students from my school in recent years.

 

[Torsed]

So I’m currently approaching the end my third year and am feeling very anxious approaching my 4th year and the upcoming match cycle. I’m an USIMG at one of the big 4 Caribbean schools and have a low (201) step 1 score. I also repeated my last semester on the island after failing my last term pushing my graduation back a year. Clinicals haven’t been going too well either and I need to retake an NMBE shelf ironically in the specialty I was initially most interested in (OBGYN). Even though my evaluations have been decent, sometimes I honestly wonder if it’s even worth continuing. I've gotten B's in most of my rotations to this point with the exception of psych which I honored. Are there even any programs in pathology that would consider taking someone with such a poor academic history on top of being an IMG? I have yet to take step 2 CS/CK but plan to within the next 6 months. I feel like I can really use some advice on how to structure the approach to my remaining clinical rotations/board exams to give myself the best chance possible moving forward and hopefully securing a path residency. Any input from the community would be greatly appreciated.

I would do psychiatry since you mentioned that. There is a growing demand 500k jobs out there for this field.

I would not do path. I doesn't matter if you are AOA in pathology it is a screwy field, reimbursement is in the gutter and will not rise, competition from bigger labs is mafioso. You would do a severe career fatality to do pathology. At best you will go to a VA and be insulated. At worst you will struggle and have zilch job satisfaction. I cannot emphasize enough, read this again, the competition is crushing. Your colleagues will turn on you to make 1 penny more. You will have very little dedication / loyalty no matter how good you are at pathology.

Pick a clinical job such as psych that you mentioned, you will have control of where to go and a good income in a high demand field. The long term goal is your happiness and your family (or future family's) stability.

If you choose pathology, you will have to be self motivated, unless you happen to go to a magical program you can pretty much expect to be forgotten in training. I used to train and help younger pathologists and flood them with career advice, but I can't say I have had anyone do exceptional career wise despite some very bright and motivated people.

At the end of the day in path: medicare reimburses 37 bucks for an 88305 basic biopsy (i.e. skin / breast / etc)., which you may be sued for the terms of your insurance policy. Its total b.s. The best part, probably another smarter pathologist than me said, that even as a medical director in a big hospital, we are only as guaranteed as far as our 90 day contract termination clause.

I don't know if LADoc00 has chimed in, but his and other's advice are pretty good if you look through similar previous posts like yours. I don't really want to crush your pathology dreams, but from what you say and what I've seen, there are much better areas for you, that will likely be more rewarding and lucrative.

 

[Med Director New England]

To add to above ^^^- where I live many psychiatrists no longer take insurance, all self pay. Psychiatrists who treat peds have a 4 month or longer back log.