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Hi all. Long-time lurker, 1st time poster.

Got my level 1 score today of 422. Is FM the only available specialty to me?

Thanks for any advice
 
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Leggomyeggo128

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What specialty do you want to do?
 

Mad Jack

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Well, these programs will also be open to IMG with 240+ in step1...
Many places are willing to take someone that is a US grad over an IMG despite the score difference, as it builds up their resident list and makes them more competitive in future matches, amongst other reasons.
 

AlbinoHawk DO

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Do you have a step score? Might be too late to take it if you haven't, but i could see a scenario where a decent step 1 would open doors despite the COMLEX
 
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Many places are willing to take someone that is a US grad over an IMG despite the score difference, as it builds up their resident list and makes them more competitive in future matches, amongst other reasons.
Isn't this all conjecture still? I don't see why low-tier struggling programs wouldn't take IMGs with 240s over DOs with barely passing 400 level-I scores. If they're crappy struggling programs, it make more sense to take applicants that can increase their board pass rates.
 
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Staphylococcus Aureus

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I'm not sure what a 240 is worth from an IMG when some Caribbean schools have +6 months to study for it.

Is psych still a bottom 3 competitive specialty? If not, which are?
 

Mad Jack

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Isn't this all conjecture still? I don't see why low-tier struggling programs wouldn't take IMGs with 240s over DOs with barely passing 400 level-I scores. If they're crappy struggling programs, it make more sense to take applicants that can increase their board pass rates.
Really depends on the program. Some are willing to take a short loss on candidates with better domestic credentials to attract better candidates in the future, some aren't. If you've got a reputation as a IMG program, US MDs and DOs largely just don't apply and even if they do they rarely will jump at your program. Of course, there are some PDs who like having their residents by the balls and actually prefer high-scoring IMGs that they can work like dogs with high scores that will definitely pass the boards. But there's been a general uptick in programs upping their general tier of students (IMG programs having PGY-1 and PGY-2 classes that are now partly or mostly DO/US MD, formerly IMG/DO programs that are mostly US MD), likely due to the increased competitiveness of the match in general.
 

AlbinoHawk DO

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Isn't this all conjecture still? I don't see why low-tier struggling programs wouldn't take IMGs with 240s over DOs with barely passing 400 level-I scores. If they're crappy struggling programs, it make more sense to take applicants that can increase their board pass rates.
The number of IMGs with 240s is not as large as you make it out to be. Being able to understand American culture and communicate effectively is important. Not all in medicine is a score, especially if its community IM
 

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take the dawn Step 1 and ace it, then no one will care about your Level I anymore
 

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btw, I scored 585 on Level I, still gonna take Step I in a month. With the merger coming, w/o Step I you gonna end up in FM anyway. No one gonna care about Level I anymore
 

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take the dawn Step 1 and ace it, then no one will care about your Level I anymore
That's true, failing step 1 of USMLE will look even worse. Come on, if your scraping by in the bottom quarter of Comlex the USMLE is prob not for you. I mean a NBME or two will tell the tale better, but I don't think that's a realistic option, and its certainly not gonna be easy.
 

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That's true, failing step 1 of USMLE will look even worse. Come on, if your scraping by in the bottom quarter of Comlex the USMLE is prob not for you. I mean a NBME or two will tell the tale better, but I don't think that's a realistic option, and its certainly not gonna be easy.
Pretty much this.
 
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Staphylococcus Aureus

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I agree that telling someone with a 422 COMLEX to, a year after studying step 1 material, take USMLE and "ace it" is unrealistic.

The mean COMLEX is what, 500? Do you really think those 50% under 500 will ace step 1? Will this persons chances really be that much better with a 422 and a potentially sub 200 on step 1 rather than just the COMLEX?
 
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darklabel

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Yeah, but there are so many low-tier community programs out there that there are plenty that will be happy to take a US grad that passed boards on first try. They just have to apply strategically.
Just to add on to this, there are new programs that will take people passing a second time domestically over international grads to build up prestige. Having gone to conferences and talking candidly with people, the sad reality is that while boards do matter a lot, the schools that the students attended can sometimes matter more. I've had conversations where people will not bother applying for programs with too many IMGs even if they all scored 240+. Whenever you see a program's list of residents, they never list the step 1 scores and most people wouldn't really care. Most of the time they care about the fellowship match and prestige of the schools that the residents attended. Hell even for me if I see more IMGs than MDs and DOs, I think that program is malignant and has some serious problems.
 
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Just to add on to this, there are new programs that will take people passing a second time domestically over international grads to build up prestige. Having gone to conferences and talking candidly with people, the sad reality is that while boards do matter a lot, the schools that the students attended can sometimes matter more. I've had conversations where people will not bother applying for programs with too many IMGs even if they all scored 240+. Whenever you see a program's list of residents, they never list the step 1 scores and most people wouldn't really care. Most of the time they care about the fellowship match and prestige of the schools that the residents attended. Hell even for me if I see more IMGs than MDs and DOs, I think that program is malignant and has some serious problems.
Its worth adding, many foreign medical schools aren't equivalent in terms of depth of education that US medical schools provide. I worked with FMG completing an externship hoping to match this cycle, he told me how difficult it was for him to pass the USMLEs because much of the stuff preclinical stuff wasn't taught, particularly biochemistry, microbiology, and pathology. Some foreign countries just don't go into the same depth we do in the US.
 

GUH

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I did enjoy my psych rotation but I have heard it has gotten very competitive recently?
More competitive, yes. "Very" competitive - not really. Even if there is a larger applicant pool, board scores aren't the sole deciding factor at a lot of psychiatry programs.
Our PD likes to see candidates who passed on the first attempt and who have a genuine, demonstrated interest in psychiatry. The residents here don't really care about a candidate's board scores; our input is largely based on a candidate's work (if they auditioned), social skills (we tend to veto annoying/negative/lazy/apathetic people), and personal compatibility with the residents.
 
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That's true, failing step 1 of USMLE will look even worse. Come on, if your scraping by in the bottom quarter of Comlex the USMLE is prob not for you. I mean a NBME or two will tell the tale better, but I don't think that's a realistic option, and its certainly not gonna be easy.
I did exactly what these people are saying. I scored horribly on level 1, though not as low as OP. I took step 1 at the end of 3rd year with my back against the wall and pulled 230's. It was one of the hardest things I've ever had to do, but honestly it saved my career as far as I'm concerned. My score (and OP's score) wouldn't even meet the cutoff for an away rotation for most programs. I had no idea how limited you truly are with a low comlex score.
 

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Its worth adding, many foreign medical schools aren't equivalent in terms of depth of education that US medical schools provide. I worked with FMG completing an externship hoping to match this cycle, he told me how difficult it was for him to pass the USMLEs because much of the stuff preclinical stuff wasn't taught, particularly biochemistry, microbiology, and pathology. Some foreign countries just don't go into the same depth we do in the US.
While this may be true in some cases, its important not to rely or put too much stock into something like this. For one thing, its not like medical school preclinical material is particularly difficult for someone with mild/moderately above average intelligence. So in other words, even if they don't have the same knowledge base, a few months of board prep and studying USMLE material might be enough for them to catch up.

There are also tons of IMGs that have very strong training (arguably better with regards to knowledge base than many US schools), but that's not really what we're talking about. I also want to make it clear that if IMGs match, it usually means they did well. So if any of you in the future are working alongside them, I'd be careful to recognize that (not saying this is what you meant, but I don't want someone on here reading your post and assuming that IMGs all had a sub-par education, because that's just not true).

More competitive, yes. "Very" competitive - not really. Even if there is a larger applicant pool, board scores aren't the sole deciding factor at a lot of psychiatry programs.
Our PD likes to see candidates who passed on the first attempt and who have a genuine, demonstrated interest in psychiatry. The residents here don't really care about a candidate's board scores; our input is largely based on a candidate's work (if they auditioned), social skills (we tend to veto annoying/negative/lazy/apathetic people), and personal compatibility with the residents.
Fit and interest matters a lot for most residency programs. I know we harp on the importance of board scores constantly (and they are important), but unless we're talking the very competitive surgical subspecialties, a low score doesn't necessarily block you out of most fields.

I did exactly what these people are saying. I scored horribly on level 1, though not as low as OP. I took step 1 at the end of 3rd year with my back against the wall and pulled 230's. It was one of the hardest things I've ever had to do, but honestly it saved my career as far as I'm concerned. My score (and OP's score) wouldn't even meet the cutoff for an away rotation for most programs. I had no idea how limited you truly are with a low comlex score.
Congratulations on the Step 1, especially taking it after 3rd year. That's not an easy thing to do. That said, don't overemphasize how limited you are with lower board scores. There are plenty of places that have cutoffs for auditioning, but actually interview a lot of people below their auditioning cutoffs. There were a couple places I interviewed at that just did not take any DOs for auditions (pretty much a university policy) that had no problem interviewing and ranking DOs.

In other words, you'd be surprised by the application cycle. Its unpredictable. Don't limit your applications just because you think a place won't interview you. If you want to interview there just apply and let the invites fall where they may.
 

GUH

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Congratulations on the Step 1, especially taking it after 3rd year. That's not an easy thing to do. That said, don't overemphasize how limited you are with lower board scores. There are plenty of places that have cutoffs for auditioning, but actually interview a lot of people below their auditioning cutoffs. There were a couple places I interviewed at that just did not take any DOs for auditions (pretty much a university policy) that had no problem interviewing and ranking DOs...
Was one of them in Nebraska?
 
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So out of curiosity I have to ask. Why wouldn't a program just take an IMG with a 240 over a DO student who only has a low COMLEX LEVEL 1. ESPECIALLY if the Program Director is an IMG as well. I'm from the Northeast (NY), and this is the pattern that I've noticed. If a program director is a IMG/FMG and there is no rule stopping them from FLOODING the program with IMG/FMGs, they'll hire as many IMGs/FMGs as humanly possible.
I also think this entire process is becoming far too competitive and frankly stupid. If all these programs care about is STEP 1 scores and STEP 2 scores. Then give us 6+ months off to take these board exams.
 
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I did exactly what these people are saying. I scored horribly on level 1, though not as low as OP. I took step 1 at the end of 3rd year with my back against the wall and pulled 230's. It was one of the hardest things I've ever had to do, but honestly it saved my career as far as I'm concerned. My score (and OP's score) wouldn't even meet the cutoff for an away rotation for most programs. I had no idea how limited you truly are with a low comlex score.
I am interested in hearing more about this, as I plan to take Step at the end of year 3. Care to share your timeline and Step 1 plan?
 

zero0

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So out of curiosity I have to ask. Why wouldn't a program just take an IMG with a 240 over a DO student who only has a low COMLEX LEVEL 1. ESPECIALLY if the Program Director is an IMG as well. I'm from the Northeast (NY), and this is the pattern that I've noticed. If a program director is a IMG/FMG and there is no rule stopping them from FLOODING the program with IMG/FMGs, they'll hire as many IMGs/FMGs as humanly possible.
I also think this entire process is becoming far too competitive and frankly stupid. If all these programs care about is STEP 1 scores and STEP 2 scores. Then give us 6+ months off to take these board exams.
New York is the exception where IMG>DO, and possibly also New Jersey. Also, SGU directly pays several of those programs in NY, so there's that.

As for psych, I was under the impression that it was on the upswing. My cohort seems to be all about dat lifestyle.

Maybe pathology can take it's place in the bottom 3.
 
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This generation of medical students is all about the lifestyle. So yes, Psychiatry has become exponentially competitive. But don't worry if you're an IMG in NY or NJ. I can already name a few hospitals off the top of my head where the Program Director is an IMG and PREFERS IMGs and even FMGs.
 
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Here are the "new" Lifestyle Specialities: PROADE

PMR: Over glorified PT. Ask an PMR resident what they do, they'll say, "Hey, I can get a pain management fellowship"
Radiology: Technician. Never sees patients.
Optho: 9-5
Anesthia: Technician that needs to know how to deal with codes. 8-4
Derm: Do I have to say it? The KING of Lifestyle Specialities
ER: 3 days of work/ 4 days off OR 4 days of work/ 3 days off. Some days you just see simple family med type cases and get $300k yearly.

But yeah you get the idea lol.
 

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Hi all. Long-time lurker, 1st time poster.

Got my level 1 score today of 422. Is FM the only available specialty to me?

Thanks for any advice
PM&R!
 

Mr Kenobi

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PMR is no longer the fallback speciality for non matchers and low scores...the competiton has really ramped up to my understanding .
^This. If you try to match ACGME PM&R with a 422 COMLEX now a days, you're likely going to have a bad time.
 
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ThreeCheers

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Peds, community IM, and path.

Also PMR and psych if you show improvement in your clinical grades and step 2. Yes, they’re becoming more competitive but that’s true for literally every field.

Well, these programs will also be open to IMG with 240+ in step1...
Why are you under the impression that formerly AOA programs with DO PDs are clamoring at the idea of matching IMGs? One of 2 things would have to be true for these applicants:
a) Their grades/GPA didn’t cut it for DO admissions, which is a frequently cited rationalization for favoring US MD applicants over DOs in the ACGME match.
b) They turned their nose up on the DO degree so much that they actively chose to move overseas to a developing nation because the MD initials were just that important to them. Even DOs that don’t particularly care about osteopathy will see this as a slap in the face.
 
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Peds, community IM, and path.

Also PMR and psych if you show improvement in your clinical grades and step 2. Yes, they’re becoming more competitive but that’s true for literally every field.



Why are you under the impression that formerly AOA programs with DO PDs are clamoring at the idea of matching IMGs? One of 2 things would have to be true for these applicants:
a) Their grades/GPA didn’t cut it for DO admissions, which is a frequently cited rationalization for favoring US MD applicants over DOs in the ACGME match.
b) They turned their nose up on the DO degree so much that they actively chose to move overseas to a developing nation because the MD initials were just that important to them. Even DOs that don’t particularly care about osteopathy will see this as a slap in the face.
PDs want residents who can pass the board...
 

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And people with <240 step are capable of passing the board so...
I was not talking about an average DO applicant; I was talking about a DO applicant who had class and/or board failure(s) etc... What I meant was is the safety net will no longer be there. For instance, I had a DO IM preceptor who passed COMLEX1 on second attempt and CE on third attempt. People like her will have a tough time post merger.
 
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ThreeCheers

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I was not talking about an average DO applicant; I was talking about a DO applicant who had class and/or board failure(s) etc... What I meant was is the safety net will no longer be there. For instance, I had a DO IM preceptor who passed COMLEX1 on second attempt and CE on third attempt. People like her will have a tough time post merger.
Sure, but I was talking more about OP’s situation. I know people with sub-500 COMLEX that matched ACGME (not even formerly AOA) FM/peds/community IM just fine.
 
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Believe it or not, in the Northeast (NY/NJ) there ARE AOA PROGRAM DIRECTORS THAT ARE NOT DOs. They are American MDs or FMGs. These guys are just trying to run a company. That's it. That's all a hospital really is at the end of the day, a business. So yeah, if they can place some arbitrary cut off score for applicants, that makes the screening process easier for them. They'll do it. So a 240 IMG will get through faster than a 500 COMLEX.

I'll give you a personal example. In my hospital, DO candidates had an easier time getting audition rotations set up. This is IM community. Now the SAME PROGRAM wants a 600 COMLEX LEVEL 1. A 600 just to audition for community IM! Why? Because they are taking FMGs now, due to the merger. Let's say there are 10 IM residency spots at that hospital. It used to be that those 10 spots were filled by DOs. Now 5 of those spots HAVE TO GO TO MDs, because of the Merger. So those are 5 EMPLOYMENT OPPORTUNITIES DOs just lost.
 
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PMR is getting pretty competitive (kinda like psych). The recent matches show very little or no unfilled spots.
Students realized PMR is a lifestyle specialty. No emergencies, no "on-call", good pay. It's naturally going to get more and more competitive. Anything Lifestyle = More Competition
 

ThreeCheers

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Believe it or not, in the Northeast (NY/NJ) there ARE AOA PROGRAM DIRECTORS THAT ARE NOT DOs. They are American MDs or FMGs. These guys are just trying to run a company. That's it. That's all a hospital really is at the end of the day, a business. So yeah, if they can place some arbitrary cut off score for applicants, that makes the screening process easier for them. They'll do it. So a 240 IMG will get through faster than a 500 COMLEX.

I'll give you a personal example. In my hospital, DO candidates had an easier time getting audition rotations set up. This is IM community. Now the SAME PROGRAM wants a 600 COMLEX LEVEL 1. A 600 just to audition for community IM! Why? Because they are taking FMGs now, due to the merger. Let's say there are 10 IM residency spots at that hospital. It used to be that those 10 spots were filled by DOs. Now 5 of those spots HAVE TO GO TO MDs, because of the Merger. So those are 5 EMPLOYMENT OPPORTUNITIES DOs just lost.
Many of the AOA/formerly AOA PDs (especially in primary care) are DOs. Not all, many. Please show me where I claimed that all AOA PDs are DOs.

Also, it’s just as easy to filter out IMGs in the screening process.

Finally, where did you hear that 50% of the AOA residency slots “have” to go to MDs?

I find that hard to believe dude.
You find it hard to believe that DO students with no red flags matched primary care? Uh, ok. Can’t help you there.
 
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