i've fallen through the cracks and i can't get up

Discussion in 'General Residency Issues' started by tbone14, Jun 3, 2008.

  1. tbone14

    tbone14 New Member

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    i had some lofty goals of specializing for residency after graduating medical school. however, pds and the nrmp had different ideas, and i have accepted this realization. i know i was not a perfect medical student (translation: 1 failure step 1, 2 failures step 2). however, i did work hard to pass the exams. i am also an american medical school graduate, with average grades and great letters of recommendation. now, i am completing an internship in medicine. i have been trying to find an advanced spot to continue in medicine. no matter how many programs contact with me initial interest; i am never offered a position, as presumably, it has been filled with another more qualified candidate. it seems like i have fallen through the cracks in the medical community, as no one wants to give me a chance, no matter how hard i have worked to overcome my past failures.

    this sucks. maybe a career in healthcare is not for me after all.

    "it's always darkest before the dawn". i am just wondering if dawn will ever come? :(
     
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  3. medicienne

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    Thats very strange esp since you are an american medical school graduate too. I never thought USMLEs are taken so seriously as if life is static and people are static! I am sorry and hope things work out for you.
     
  4. Top Gun

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    I tell you what. Maybe you can try doing Step 3 and getting a great score on that. And apply for something like family medicine. Its pretty noncompetitive, so I think you'd have a better shot at that than internal medicine. You'll have to start as a PGY 1 again, but if you can't land an advanced position, sometimes you have to take what you can get. Also, do more externships and get more great letters of recommendation.
    Incidentally, I would say the problem appears to be your ability to do well on standardized tests. Have you ever been tested for a learning disability or any other problem with your test-taking skills? I would consider getting tested for those things and finding a study-skills program which well help you score better on any future exams you might choose to take. This will come in handy if you decide to take Step 3 and you really want to get an awesome score on it. Just something to think about.
    But do all of the stuff mentioned above only if you are really, really sure you still want to be a physician. If you don't feel its worth it, that's okay too. There are plenty of rewarding careers outside of medicine. Choose whatever you would most like to do.
     
  5. buckley

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    I am sorry to hear you are going through dark times. Whether it is a case of being the darkest before dawn, or getting darker-lighter-darker-darker-lighter-lighter...your dawn will come. They say when you yearn for something, that's because it's coming... When and in what form--only time will tell.

    Maybe you could speak with your present PD. Someone finishing IM internship ought to have quite a number of options. If you want to break from the clinics, maybe you can do research with a faculty? I agree with Step 3. As an american grad, I understand you can be licensed in certain states already with just 1 year of postgraduate training. Someone mentioned here that famous alternative medicine guy actually just finished internship...But I think with the way the US system is, a residency is almost "mandatory". So if you think you still prefer the traditional route, PGY 2 spots do spring out. I know for Neurology, I've heard a couple. And neuro always loses slots to people who matched in the advanced and then opted to finish IM as a categorical instead. Ok, I'm not selling the field to you, but just so you have an idea that people do shift.

    Good luck to you :luck:
     
  6. DarthNeurology

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    Yikes!, failing Step 2 two times says more than anything you can say about "studying hard", i.e. failing once should have been a wake up call. I would think that if you did a good job in what I assume is a pre-liminary medicine internship then the PD would have offered you a position categorical based for the next year.

    Frankly, it is good for IMGs/FMGs that PDs realize that there are many students educated outside the US who can do a better job than many US grads who failed the step multiple times but thought they could get a "specialty" like radiology or anesthesiology.

    Realize that you have to prove yourself in medicine, i.e. get outstanding letters during internship in your case. I assume that your third year med school grades were not so hot as well. Remember you were already given a big chance just going to an American medical school.
     
  7. RTrain

    RTrain National Merit Finalist

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    Jeez, way to kick someone when they're down, man.

    I'm quite certain that the OP feels plenty bad about the imperfections in his/her record - S/he is asking for help and guidance, not to have his/her nose rubbed in ****. As Jackson Browne sang, "Don't confront me with my failures, I have not forgotten them."

    To the OP, I would echo what Top Gun suggests - a stellar score on Step 3, and consideration of why you have done poorly on exams, even with adequate preparation. If you have an underlying learning disability, identifying it will have two advantages - you will have taken the first step toward overcoming it, and programs will likely be more sympathetic to your difficulties.
     
  8. DarthNeurology

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    Sometimes you have to give people "tough love", i.e. it seems a little whinny that the OP complains that "no one wants to give me a chance" despite "hard work", many many many students have achieved the goal of passing step 1 and step 2 without failing these examinations and failed to secure a residency, . . . it is magical thinking to think this person could get a residency if he/she hasn't done anything especially worthy of one as yet. . . . I think a lot of PDs would be concerned about someone who failed step 2 twice and step 1 once, . . . and who also did not want to initially do primary care. I would have major reservations about seeing someone who failed step 2 twice as a doctor and who really just wanted to specialize . . . he/she needs to know the problems they will face. There is always research and non-clinical work as well.
     
  9. efex101

    efex101 attending
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    I truly wish you the best of luck and hate to see anyone fall through the cracks despite NOW having passed both Step I and II...but I do have a question for you. Are you applying all over the country for IM and to "lower tiered community" programs or are you focusing on a geographical preferance? also have you thought about also applying for FM? or some other specialty like psychiatry which seem more forgiving of standardized BS.
     
  10. DarthNeurology

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  11. DrDre311

    DrDre311 Makaveli

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    Your call on this one is good. Extremely good. Almost as good as the time that you said plastic surgeons only do it for the cash. Not quite as good (but close!) as the time you said residents were your enemies and students should set out to make them look bad in front of attendings in the name of some "power game."

    I can only hope that your medical knowledge rises to the level of your interpersonal skills/ability to read people/empathy. :thumbup:
     
  12. DarthNeurology

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    . . . . . . . .
     
    #11 DarthNeurology, Jun 3, 2008
    Last edited: Jun 4, 2008
  13. tbone14

    tbone14 New Member

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    by posting this, i am completely aware that i will get both good and bad responses. i will respond to all questions and inquiries in kind.

    yes, my usmle failures are a red flag. i will explain further. take what you will from it, but they are not excuses. everything falls upon my shoulders, and if anyone is to blame, it is me. i was clearly not ready for step 1, and studied for it in the wrong way. after studying on my own, my score improved by 30 points, and i passed the examination successfully on my second attempt. on the eve before usmle step 2, i could not sleep. i was awake all night, and on the drive to the test center, called my dean, along with school educators, and asked for advice as to whether or not i should take the test or miss it and suffer the ramifications. i was told to do the best i could, and see what happens. after the first failure, i met with many specialists. not to determine if i had a test taking deficiency, but rather, to develop new test taking strategies and skills at the way i answered questions. i also enrolled in two supplemental enrichment programs. the second go around for step 2 was a failure. on the third attempt, i passed, with much help from the second educational program. i passed step 2 cs on my first attempt.

    top gun - i graduated from an american medical school. thus, externships would not apply to me. as for family medicine, that career choice does not interest me. concerning test taking skills, that avenue has also been exhausted. after my step 1 failures, i began working with educational specialists at my school. i even met with a psychologist regularly to work on coping with stress, easing state of mind, relaxation exercises, etc. etc. in the end, all of the assistance i received did help in passing the tests.

    buckley - i have spoken with my current pd many times. we have looked at all options, and both agreed my current plan (to seek out open pgy-2 positions and send my application materials) was the best. research? that is on the very backburner as something that i would be interested in. as i stated in the original post, i have come to grips with reality, and a subspecialty is not in my future, not right now, at least. concerning step 3, i am aware of all state rules concerning licensure. (http://www.fsmb.org/usmle_eliinitial.html) if i am not able to secure a pgy-2 spot in the near future, i will be preparing for step 3, with hopes of obtaining state and national licenses (dea) to practice medicine. after all, i do have bills to pay back. as for open spots, i have subscribed to many resources, both free and paid.

    darthneurology - i welcome your skepticism and incredulousness, yet, it is disheartening at the same time. yes, my pd and other attendings have hinted that i could stay at my current program. however, i am choosing a change of scenery for a variety of reasons. i am never one to burn bridges, and i may end up staying where i am currently at. this topic was initially a rant. i will not get into an argument concerning AMG vs IMG vs FMG, or MD vs DO for that matter. there are good and bad physicians in each of those categories, and it is what you learn, how motivated you are, how well you relate to patients that determines the type of person and physician you end up becoming. i cannot fault you for judging me based on my usmle step examinations. however, to judge me solely on that in comparison with other medical graduates around the world without other considerations, is, well, extremely short sighted and of narrow view. i hope the rest of your thought processes are not as limited. i doubt that, though, as you assume my credentials are poor based upon just my usmle test scores. i did well in my third and fourth year clerkships, with the majority of them being high satisfactory interspersed with a few superiors. and, i have received many excellent letters of recommendation, from my attendings during my school education to my attendings at my current program. the chairmen of the program, the program director, one cardiologist, and two prominent attendings have written letters on my behalf this year. in the end, i would hope you do not assume that all people with test failures and difficulties are deficient in other aspects of medicine.

    rtrain - thank you for the words of encouragement. see above as needed, concerning your post.

    darthneurology part 2 - yes, i am aware of "tough love". if i could not take the fire, i would not be in the kitchen. my complete application is strong, with the exception of usmle failures. again, take from that what you will. i understand the problem i will and have faced. i have started at the bottom of the hill, and have constantly been working my way back up. that was the point of my original post. as for subspecializing versus primary care, i do enjoy aspects of primary care. these last few months i have made it a point to remember the good patients and the good people that i have helped, and to dwell less on the rigors of internship. if medicine did not interest me ever slightly, i would not be trying to find a pgy-2 position. as for non-clinical positions, i have already looked into that. however, my first priority is to continue and finish residency. should that not work out is when i will exhaust other possibilities.

    efex101- i have contacted many programs throughout the country. i have cast a net far and wide. i mainly focused on larger programs, or smaller programs with an academic affiliation, but have also contacted a few smaller community programs in desirable geographic locales. i have not contacted small programs in undesirable areas (to me, at least). as stated earlier, FM does not interest me. along with all the above thoughts, i am also considering other fields - neurology, pathology, and even possibly surgery. what do i want? i am not completely sure. hence, my dilemma(s).

    drdre311 - strangely enough, the lyric below in relation to your handle is quite fitting. it seems you agree with rtrain in your assessment (or so i hope). if so, thanks.

    "The last straw can land in your mix
    Your best day could be apocalypse
    Nobody paid attention to the first straw
    It seems the last one is all we ever saw"

    feel free to discuss among yourselves....
     
    #12 tbone14, Jun 4, 2008
    Last edited: Jun 4, 2008
  14. Apollyon

    Apollyon Screw the GST
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    Although oblique, Burnett's Law is invoked!
     
  15. Winged Scapula

    Winged Scapula Cougariffic!
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    While I may disagree with Darth's manner in which he addressed you, his point is simple and accurate: PDs look at USMLE scores as a measure of whether or not you will pass the boards. If you cannot get past the initial screening because of your failures, they will never see your evaluations, your LORs, etc. This is a sad fact of life.

    At this point, you seem to be limiting yourself. You have to decide whether or not it is worth it to you to be a physician, even if that means going into an "undesirable" area or perhaps doing a specialty you hadn't thought about before. FM may not interest you, but its not far off from IM and you may be able to parlay an FM residency into an IM one or a practice more IM like. In regards to surgery, you may not be aware that the specialty has become much more competitive with only a couple of spots left open after the match (which have long been filled). It is true that there will be drop outs, but it is not the easy match you might be thinking it is.

    I'd encourage you to think about how much you will do to practice as a physician and whether or not that means going ANYWHERE for residency, even low level community programs in undesirable areas.
     
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  17. tbone14

    tbone14 New Member

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    i agree completely with the above statement. that was the reason behind my post and my frustration with this process. i cannot make it through an initial screen, no matter what i have done since, step 3 notwithstanding.

    as for the surgery comment, well, that was more in line with completing research. concerning a switch of fields, well, that would be a last resort. i would rather choose a career path to make me happy and be rewarding and fulfilling, as opposed to settling for something less. i would rather not be someone in a field that dislikes it day in and day out. and yes, i have been debating whether or not to continue as a physician or to break away, so to speak. i am quite sure that i want to continue, but in doing so, i am back at square one and the initial reason for starting this thread. it seems i am walking in circles.
     
  18. efex101

    efex101 attending
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    Tbone, I think that the comments from wingedscapula are right on and you really have to decide IF practicing medicine in *any* area is your top priority versus possibly not practicing medicine at all. It seems that yes, you have applied somewhat broadly but if you are mostly focusing on programs affiliated with academic centers and only applying to "desirable" areas for you, this may be indeed the wrong approach for someone with your test taking history. Smaller community programs that are non-academic centered and are located in "undesirable" areas may be much more receptive of an applicant like yourself and often have superb training for IM.

    I also have to agree with her that maybe pursuing family medicine for *now* should also be included in your approach. FM residency may not be your cup of tea but afterwards you can certainly focus on a specific population and make it more IM like. Anyways, I wish you the best and hope to hear good news from you in the near future :)
     
  19. DrDre311

    DrDre311 Makaveli

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    Me too.

    "Ya gotta find a way to survive
    Cause they win when your soul dies"--Pac
     
  20. DarthNeurology

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    I am sorry if my wording was too harsh which it probably was. Obviously if you have done decently in your clinical rotations and in PGY-1 preliminary year then you would have a reasonable chance of getting an IM or FM residency position, I would have no idea about other fields but obviously we are not talking IM at MGH or Hopkins, . . . so you may have to swallow your pride and go to a community program somewhere. As your PD has offered you apparently a position at your current program you haven't "falling through the cracks" and should consider this position seriously (and should be happy that you were able to please them). I would think surgery would be hard to get, unless you did maybe a preliminary surgery position and blew them away and then applied for surgery categorical after this . . . it is sad as many med students don't realize how important the steps are, . . . I would think surgery, anesthesiology, radiology, ob/gyn i.e. middle to high-middle competitive programs would be out of your reach but the only way to find out is too apply I guess.
     
  21. Top Gun

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    Tbone, while I understand that you want to do a specialty that you really enjoy and in a location that makes you happy, you need to understand that your options are really limited with your USMLE scores. As someone else said, would you rather at least practice some field of medicine, even if its not your desired specialty, or not practice medicine at all?
    Your best bet is to either continue at your current program (from your posts, it sounds like your attendings and PD are willing to offer you that option) or to apply to a very noncompetitive specialty that doesn't care so much about USMLE scores. Right now those specialties include family medicine, psych, and possibly path. You mentioned that you were interested in path, so if you decide not to continue at your current program, you might try looking into a few of those programs as well. As for surgery, I hate to say it, but I think that would be pretty much out of your league. Even students who have passed Step 1 and Step 2 on the first attempt find competition for a general surgery spot pretty tight. And many of those applicants have done research as well.
    As others have said, if you decide to apply to FP, but you really like IM, later on when you've graduated from residency, you can have a practice consisting mostly of adult patients if you want. Then it becomes more like IM. That's the good part of FP. You are trained in a variety of areas, so you can tailor your practice the way you see fit. And try for path as well, since you mentioned some interest in it. And you might also think about just staying at your current program. And apply to a wide variety of locations throughout the country. Some may not be as desirable as others, but understand that when your options are limited, sometimes you have to take what you can get. Anyway, good luck with your decision.
     
  22. barcalounger

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    I agree with Top Gun. You really have to be aware of how competitive you are relative to the position you want. When I was applying to neurosurgery, I realized I was probably not the most outstanding candidate in a very competitive pool, so I had to ask myself, "Would I rather not match than go somewhere "undesirable" location-wise?" The answer was absolutely not - I would be happy to be trained anywhere. I fortunately ended up somewhere I really wanted to be, but had I not, I am sure I would have been very happy to go and be trained. That is the question you need to ask, and include the question, "Would I rather not do medicine than be in a specialty that is not your first choice?"
     
  23. buckley

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    From what I gather from your post, it seems you've made a "decision" to go for that PGY 2 post. I really hope you find one. Your dean (from your step 2 ck story) , seems very accessible to you, may I suggest you look him up as well? Good luck!:luck:
     
  24. Just out of curiosity, is your goal to finish a 3-year IM residency, or are you currently looking for an advanced position (e.g. Anesthesia)?

    If it's the former, have you been applying widely in multiple areas around the country? (By widely, I mean to all tiers of programs - not just top-tier academic ones.)
     
  25. pencilfloor

    pencilfloor Junior Member

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    Okay, I've got some simple questions about this post, just some things I don't understand since I'm only a second year student. Why do an internship rather than go directly into a program of your choice. Does it become more difficult to match into a specialty after completing an internship. Basically what is an internship and how is it different from a traditional residency program and what benefit is there in completing one. :O)
    Thank you!!! I know, some of you are thinking what planet is this person from. I just don't get the lingo. :confused:
     
  26. pencilfloor

    pencilfloor Junior Member

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    Couldn't this person just continue the internship in IM and do general work like an FP as an IM doc? Once again just trying to familiarize myself with everything. Thanks Guys.
     
  27. efex101

    efex101 attending
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    I will try to explain and others will chime in as well.....Some residencies such as anesthesia, opthalmology, dermatology, physical medicine and rehab, and more will require to do the first year which is called your *intern year* in either IM or surgery. So those folks have to apply for BOTH the residency they want to start as second year residents (PGY2) *and* for the first year (PGY1) spot they want in either IM or surgery. Hence some folks end up going to TWO different places for their total time in residency. All first year residents regardless if you are doing one of the above specialities or not are called interns. Many folks end up "changing specialties" after their intern year and hence look at applying again for whatever specialty they now like better.

    Clear as mud?
     
  28. nattygann01

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    I agree with the posts above. You're not falling thru the cracks, you're simply not getting EXACTLY what you want. A lot of people experience this. Perhaps you should consider doing the undesirable if you want to stay in the field of medicine. I wish you the best!
     
  29. Faebinder

    Faebinder Slow Wave Smurf

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    Mmm... frankly... tbone. You aren't unique and your attitude disgusts me. People would kill to be graduates from a US medical school... and to have a year of internship in IM under their belt... yet you toss that away because you aren't competitive enough to get the location "you" want...

    Cry me a river... some people went out of the country for years to get the privilage of practicing in the US. And it's not like after residency they will hold your hands and tell you.. practice here or else.

    Best of luck making your mind.. let me know privately if you need tips, but it seems you have enough volunteers.
     
  30. shipalert

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    I agree with FAEBINDER'S POST. Be happy for this opportunity, and work on being the best doctor you can be. It's a selfless profession. Always look at the positive, be humble, be thankful. For GOD sake you pretty much freaked up on your steps, be happy that you got the IM internship. I think it's great that you want to aim for something bigger and in your mind better, but if it doesn't happen don't whine to the world about it. Really your life won't be over, I promise. Also a little bit of ass kissing can go a long way towards getting a good letter of recommendation but it does not make up for poor work ethic. Grow up, get on your knees and be thankful you made it this far. I think you started this post because you needed someone to tell you or maybe remind you to get your head out of your ass and just be grateful for a change. :)
     
  31. shipalert

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    Oh and what might that undesirable things be, oh could it be taking care of people, or just being happy that you made it through 4 years of med school and got a residency and will never have to worry about work. Oh yeah and the respect that you get even when you probably don't deserve it. If it's so undesirable to be just a regular ol doc then do me a favor and take a detour away from the cracks, make your detour away from the practice of medicine .
     
    #29 shipalert, Jun 5, 2008
    Last edited: Jun 6, 2008
  32. DarthNeurology

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    Also, not to beat a dead horse or gang up, but it takes a lot of work to be a good primary care or internal medicine hospitalist, i.e. there are a lot of things that you need to read up on to be current in medicine. If for some reason you don't like reading a lot of scientific papers and going to meetings to stay up to date, then you won't even be able to excel as a general internist. You really have to have the passion to take care of people.

    Ironically, in the "old days" the braniacs went into internal medicine, as it was more highly regarded than say dermatology--where the losers went who couldn't study hard enough to get into internal medicine and were left to just try to master the skin . . . nowadays med students want high income and lifestyle and being the old country doc who takes care of everyone, which really is a hard field, is seen as less desirable. So, ironically your poor score may have pushed you into a field which requires a lot of academic interest to do well as well as very very hard work.

    Obviously you have time to change and become an excellent IM doc if you have the motivation, but realize you may have a huge knowledge deficit.
     
  33. LADoc00

    LADoc00 There is no substitute for victory.

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    the ironic thing is you will look back on this in say 10 years and laugh. Pick yourself and look at your options. Do something adventurous, join the Green Berets or something.

    There is always a path to redemption.
     
  34. buckley

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    True! :love:
     

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