Looking For Guidance, Gas, and Psych

[clement]

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Hi All,

Hoping for some input...

I took the USMLE and got a score in the 201-205 range.

Interested in both gas and psych. Would honestly be equally happy in both fields, but wanted to find out:

1) Is my score range really doom-n-gloom for good teaching gas and psych programs? CA and the West Coast in general would be a tremendous uphill battle- I'm just going to assume that for now.

2) The '09 Charting Outcomes place DO's in the independent category with people generally having to match with higher scores than allopathic grads (for gas, at least?). I acknowledge that not all programs will evaluate us on the same scale, but allopathic grads are getting in with the 201-205 range (for gas). Would it be safe to assume that at least some programs won't require me to have a 230 for the same position?

3) Is the "get at least 200 for a decent shot at a residency" (usually excluding ROADS) a giant myth? I'm not promoting the idea that people should "barely pass Step 1" but well, some encouragement helps, and I hear 200 is often used as a cut-off for screening purposes.

4) Should I take Step 2 in June and if all goes well (meaning I get 220+), apply by Sept 1 regardless of whether all letters of rec are ready? Any quality gas or psych programs that won't completely screen me out based on both my Step 1 score and being a DO student? (feel free to PM me). By "good programs" I don't mean elite or big-name, just good teaching and solid reputation. I suspect 220+ on Step 2 will help my chances at good programs, but not completely...

Of course I am giving 150% to my rotations and trying to keep my chin up. My practice exam scores and free 150 were all in the 219-223 range 4-7 days before the exam. I'm still scratching my head...But so be it.

 

[SukaNeNauka]

I am also an Osteopathic med student applying for anesthesia programs for 2010/2011. In my opinion, your USMLE score is too low for anesthesia, especially now that anesthesia is considerably more competitive. Of course scores are not everything, and there are other factors that will come into play, but you do need to get interviews in order to rank/match, and getting those largely depends on board scores. Step 1 is much more important than Step 2, and so I am not sure how much it will help. Also, you never know how well you will do on step 2; saying that you will get 220or higher is different than actually obtaining this score; of course I anticipate a fair effort on your part.

I imagine that psyche is much less competitive and you should have a good shot at matching somewhere. If you would truly be equally happy in either fields, concentrate on psyche; your odds are much better there. Not really relevant to your questions, but how do you picture yourself equally happy in either of two fields that are so different?

 

[okayplayer]

I think you should aim to do well on shelf exams this year (hopefully your school uses NBME shelves) and then take USMLE Step 2 early. As a fourth year DO student who is also currently going for MD anesthesia, I would say applying with your Step 1 score puts you at a tremendous disadvantage. You will need a huge improvement on your Step 2, great letters, and excellent evals. Not trying to be a di*k, just trying to be very realistic with you, because if your school is like mine, they don't even tell the people with 200/200 that applying for MD dermatology is out of the question.

Since you are aware of the Charting the Outcomes pdf, you can see that anesthesia is getting more competitive. Mean Step 1 of matched independent applicants is 226. Independent applicants with a Step 1 between 201-210 had a 23% chance (11/52) to match successfully. Not great odds.

If you can knock out all of your shelves and then get a massive improvement on Step 2, you will really help yourself.

 

[clement]

I think you should aim to do well on shelf exams this year (hopefully your school uses NBME shelves) and then take USMLE Step 2 early. As a fourth year DO student who is also currently going for MD anesthesia, I would say applying with your Step 1 score puts you at a tremendous disadvantage. You will need a huge improvement on your Step 2, great letters, and excellent evals. Not trying to be a di*k, just trying to be very realistic with you, because if your school is like mine, they don't even tell the people with 200/200 that applying for MD dermatology is out of the question.

Since you are aware of the Charting the Outcomes pdf, you can see that anesthesia is getting more competitive. Mean Step 1 of matched independent applicants is 226. Independent applicants with a Step 1 between 201-210 had a 23% chance (11/52) to match successfully. Not great odds.

If you can knock out all of your shelves and then get a massive improvement on Step 2, you will really help yourself.

It's my understanding that anesthesiology is getting more competitive (although there are attendings and residents on SDN that refute that understanding, for reasons I am not entirely clear on). People say the same thing about psychiatry.

I've come across threads with applicants eventually getting into mid-tier gas programs with 20-30 point improvements on Step 2, from the Step 1 range I fall into. The overall consensus is that Step 2 did matter then, and especially in light of a specialty becoming MORE competitive now, I'd imagine.

What I wonder about, however, with regard to the charting outcomes, is how much of an "independent applicant" is a DO applicant really when you are comparing groups above a certain numeric threshold? It would seem to me there is a lot of geographic (i.e. Michigan vs CA), program-specific (i.e. some programs may consider a DO a "US-grad?") type of "wiggle-room" for the allo 201-210 vs the DO 201-210 matching people, and the fact that there are less DO students overall applying in the independent outcome numbers...But I guess the charting outcomes are good for the purpose of assuming the worse case scenario (in which every single program would choose not to equate your 201-210 range with that of the allo applicant)?

 

[SukaNeNauka]

I have a friend who had about the same score as you on Step 1 and applied to 40+ allopathic anesthesia programs last year. He did not get a single interview. Nowadays there is no shortage of stellar applicants going for anesthesia, applicants who scored 230+, research, excellent LORs...so what makes you think that any PD will overlook your low step 1 score and even consider your step 2? They do not need to do this. Some programs receive 100s of applications per spot.

People who matched any competitive specialty with low board scores were likely special in other important areas. Having connections and knowing people could be considered being special.

 

[clement]

I have a friend who had about the same score as you on Step 1 and applied to 40+ allopathic anesthesia programs last year. He did not get a single interview. Nowadays there is no shortage of stellar applicants going for anesthesia, applicants who scored 230+, research, excellent LORs...so what makes you think that any PD will overlook your low step 1 score and even consider your step 2? They do not need to do this. Some programs receive 100s of applications per spot.

People who matched any competitive specialty with low board scores were likely special in other important areas. Having connections and knowing people could be considered being special.

What was your friend's Step 2 score? What kind of programs did he apply to?
What was his class rank? Good LORs? Did he do all his electives in programs he applied to? When did he submit applications? Was he personable? I don't doubt some programs receive barrels and barrels of applications per spot, but would anyone that's already been through the process care to comment on whether a person's Step 2 score is considered garbage given a low 200s Step 1? I'm no shoe-in by a long shot, but I also find it hard to believe that >90% of PD's wouldn't even bother to look at Step 2 in this case, especially if you've rotated with them, done well there, and have quality LORs.
I'm also told anesthesiology is typically not a field where research is considered a major application asset.

Anyone care to comment on the psychiatry end of this? What kinds of programs are open to the above stats?

 

[Suedehead]

I'm a DO, matched in psych in SoCal with a similar USMLE step I score. And I didn't take USMLE or COMLEX step II in time for my apps.

Yes, psych is getting a little more competitive, and yes, your step 1 score matters.

But I got plenty of interviews at good programs like Vanderbilt, Emory, Loma Linda, UCI, not 'top-tier' but really good programs. May have had lots to do with good letters and a good personal statement. Psych tends to be more interested in who you are.

So key is to do your best, apply early, and be a good person.

 

[Suedehead]

After thinking about it, another VERY IMPORTANT notion is the away rotation.

Basically, do it. Get them to KNOW you. They'll look past all kinds of things if you're an awesome person.

 

[SukaNeNauka]

You find it hard to believe that >90% of PDs would not bother looking at your step 2 scores? Why is that ? This is an objective reality of how anesthesiology is nowadays; competitive. Your step 1 score is about 1 SD below the average and you are a DO student; not a great combo. I do not mean to sound discouraging, and I hope you interview at many places and match in the end, but be realistic. Research is not a major application asset? You will be surprised.

 

[clement]

You find it hard to believe that >90% of PDs would not bother looking at your step 2 scores? Why is that ? This is an objective reality of how anesthesiology is nowadays; competitive. Your step 1 score is about 1 SD below the average and you are a DO student; not a great combo. I do not mean to sound discouraging, and I hope you interview at many places and match in the end, but be realistic. Research is not a major application asset? You will be surprised.

Re research: Not a big "wow factor" nor a "must" for gas, according to people in their own forum. Elite academic programs in any specialty, yes...Derm and friends, yes. Mid-tier gas, not so much.

Regardless, I appreciate your input and I DO agree that what you have to say is very realistic, both numbers-wise and DO-wise...I don't think however Step 2 is likely to be completely overlooked IF it shows a significant improvement in addition to all else.

 

[okayplayer]

Re research: Not a big "wow factor" nor a "must" for gas, according to people in their own forum. Elite academic programs in any specialty, yes...Derm and friends, yes. Mid-tier gas, not so much.

Regardless, I appreciate your input and I DO agree that what you have to say is very realistic, both numbers-wise and DO-wise...I don't think however Step 2 is likely to be completely overlooked IF it shows a significant improvement in addition to all else.

I think we just want you to know what you're up against because sometimes it's hard to get honest advice.

Do I think you can do it with just the low Step 1? Maybe. But I think if you work really hard third year and then blast Step 2 out of the park (definitely possible, I jumped 40+ points on mine) it will very likely help you. So keep working hard, get some solid letters, destroy your shelves, and then rock Step 2. That's the formula for success.

Good luck.

*I'm only a fourth year. I just applied a few days ago and have an early interview, but that's all so far. So take what I'm saying with a grain of salt too.

 

[wmc24]

what is your comlex score? obviously usmle carries a ton of weight, but maybe if u have a solid comlex score, u can open some doors for yourself at MD gas programs with DO higher-ups.

 

[clement]

what is your comlex score? obviously usmle carries a ton of weight, but maybe if u have a solid comlex score, u can open some doors for yourself at MD gas programs with DO higher-ups.

My COMLEX is right along the lines of average joe/jane "meh." No 600+ to flaunt. Took it three weeks before the USMLE and honestly walked out feeling much, much worse. I guess the bottom line question here is given the USMLE Step 1 + DO status, is there a shot in hell they will even look at a Step 2 improvement? The majority seem to vote "yay," but I appreciate the tough-love responses as well...A kick in the rear is definitely in order here.

Not to make myself feel way better or make anyone else feel worse, but any consensus on whether there is in fact a "200 cut-off" mark or if that's just a myth (as far as mid-tiers go)?

 

[wmc24]

not really sure of the 200 score myth or whatever. all i know is a friend of mine scored 505, 570 on comlex 1 and 2 and got some pretty decent interviews. not sure where in the 500s u are and how u will do with usmle step 2, cant see it hurting u though if u improve a good bit over your weaker step 1

 

[mamitch4]

One really great thing about the ERAS application/ Match process is that you don't have to commit to one specialty. Apply to 40 (or 60 or 80) gas programs if you really want to be an anesthesiologist-- and apply to psych programs as well, if psychiatry is a satisfactory back-up plan for you. Then see what you get for interviews. You can interview at and rank as many as you can afford.
Being realistic about what your chances are is important, but that doesn't mean you shouldn't try really hard for what you want.

 

[clement]

One really great thing about the ERAS application/ Match process is that you don't have to commit to one specialty. Apply to 40 (or 60 or 80) gas programs if you really want to be an anesthesiologist-- and apply to psych programs as well, if psychiatry is a satisfactory back-up plan for you. Then see what you get for interviews. You can interview at and rank as many as you can afford.
Being realistic about what your chances are is important, but that doesn't mean you shouldn't try really hard for what you want.

Thank you. I can always count on SDN to give me the low-down on how the match process works (as in my school makes zero effort, but I hear that's the case at many places). Think I'll hold off on the First Aid book about matching.

As for charting outcomes: I'm not 100% convinced that greater than 90% of PD's will trash a DO application in the 201-210 range if the match rate is decent in that range for allo applicants. Not saying it helps to be a DO in that range, but when comparing independent candidates to non-independents in terms of the mean Step 1 score for gas, it's not tremendously different, so why the discrepancy in the low 200s? Does the "DO-disadvantage" only crop up below the mean? Maybe less people apply in the 201-210 range as well? Plus what are all those unknown scores, wonder how those skew things.