Low Step 1 - what are my reaches?

[deleted573103]

hi! I am reaching out for advice because it has been impossible to get any from my assigned advisor. I am someone with a proven strong commitment to psychiatry but have a low Step 1 (205). I did have mitigating circumstances that my deans are well aware of and have been very supportive. During rotations I've done average to above average. Allopathic school. Lots of extracurriculars. Applying to Health service corp.

My issue is thus: I want to go on aways and get into the best programs I can. But, I don't want to 'waste' the opportunity on a program that is just not a possibility for me. I am hoping to eventually go into psychosomatic. What would be some appropriate "reach" schools for me? I am looking at UW, U Colorado, U Penn, Thomas Jefferson, as well as Cambridge Health Alliance. I would just love for someone to tell me if this is appropriate or if I'm being crazy. A school like johns hopkins for example I would not be competitive for I think.

Thank you!

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[splik]

While step 1 is important it's only a small part of the application. I know for a fact that there are residents who scored worse than 205 or even failed step 1 at some of the programs you mentioned. Im more concerned about your "mitigating circumstances" sounds ominous tbh. I hate it when people draw attention to weaknesses in their application or try to make excuses (even if valid). You should highlight your strengths. If you do well during an away that could give you a significant bump up. Don't waste aways on randomrototations that are not with core faculty though. Needs to be inpatient or consults.

 

[TexasPhysician]

Most you listed are a reach but worth trying if u really want that program, except Cambridge. You have better odds at Hopkins than Cambridge.

 

[TexasPhysician]

We dont know enough about the applicant to say that. I know for a fact CHA has at least one resident who failed step 1.

I didn't say it was impossible, but at the same time realistic advice is valuable. There are a limited number of away rotations and that step score is a major reach at Cambridge. I'd also argue that other programs in the same city have better C/L fellowships.

My thoughts would be to consider Mayo, UNC, and Johns Hopkins. All 3 are well known medical centers that will draw C/L cases from a large geographic area. Except for the last 1-2 years, Hopkins hasn't been known to be as competitive as the name implies due to its workhorse reputation in psychiatry.

 

[Candidate2017]

205 is the average 2014 score for unmatched psychiatry applicants. Realistically you should be auditioning at lower tier places to maximize your chances.

 

[grapefruit17]

205 is the average 2014 score for unmatched psychiatry applicants. Realistically you should be auditioning at lower tier places to maximize your chances.

most American MDs who apply to psych are successful in matching. If this person was a DO it would be a different story.

 

[Drrrrrr. Celty]

most American MDs who apply to psych are successful in matching. If this person was a DO it would be a different story.

Pretty much the baseline match rate for DOs with just a passing COMLEX score and no usmle is around 70%. So most DOs are matching too. Probably not in the same places however.

 

[FlowRate]

While step 1 is important it's only a small part of the application. I know for a fact that there are residents who scored worse than 205 or even failed step 1 at some of the programs you mentioned. Im more concerned about your "mitigating circumstances" sounds ominous tbh. I hate it when people draw attention to weaknesses in their application or try to make excuses (even if valid). You should highlight your strengths. If you do well during an away that could give you a significant bump up. Don't waste aways on randomrototations that are not with core faculty though. Needs to be inpatient or consults.

I think there's something to be said for explaining why performance at a given time was poor. I think it's key to not dwell on it and to also say that it's now managed/not an issue.

 

[grapefruit17]

Pretty much the baseline match rate for DOs with just a passing COMLEX score and no usmle is around 70%. So most DOs are matching too. Probably not in the same places however.

yeah, i saw the charting the match. But based on my experience, I'm not sure what I think about those numbers. Also i personally know 2 people in my class with low comlex scores, (that still passed) and did not match in psychiatry. And one guy who barely passed ended up in a random DO program. Plus, i feel like when ranking comes along being a DO has some influence on that as well.

Psych is no ortho of course, but def far from a slam dunk easy match.

 

[thomasina]

I think the tier of your med school and/or any established relationships your med school has with programs matters in getting interviews as well. My steps were mediocre and honestly I feel like I got some invites because of my school. It's not ophtho but ivies like ivies, inbreeding happens, connections sometimes matter, etc.

 

[Blitz2006]

Most you listed are a reach but worth trying if u really want that program, except Cambridge. You have better odds at Hopkins than Cambridge.

Isn't UPenn a powerhouse?

 

[Drrrrrr. Celty]

yeah, i saw the charting the match. But based on my experience, I'm not sure what I think about those numbers. Also i personally know 2 people in my class with low comlex scores, (that still passed) and did not match in psychiatry. And one guy who barely passed ended up in a random DO program. Plus, i feel like when ranking comes along being a DO has some influence on that as well.

Psych is no ortho of course, but def far from a slam dunk easy match.

Well, not anymore for sure. But honestly even university FM isn't a small dunk easy match anymore. In either case I think for the foreseeable future even low tier applicants will have a shot in psych. Most DO psych seems to be merging too tbh.

 

[SmallBird]

Most you listed are a reach but worth trying if u really want that program, except Cambridge. You have better odds at Hopkins than Cambridge.

And better odds at Hopkins then Penn I would think.

 

[Candidate2017]

most American MDs who apply to psych are successful in matching. If this person was a DO it would be a different story.

Ok yeah. 90% of US MDs with a 205 match psychiatry (224 USMLE is avg matched, 214 avg unmatched). My hypothesis is low scorers likely match at their home institution or low tier place, not somewhere like UPenn.

A 70% match rate for DOs with a low Comlex (no USMLE) is very good considering most of us don't have a psych program at our home institution to fall back on as a safety.

 

[FlowRate]

I think the tier of your med school and/or any established relationships your med school has with programs matters in getting interviews as well. My steps were mediocre and honestly I feel like I got some invites because of my school. It's not ophtho but ivies like ivies, inbreeding happens, connections sometimes matter, etc.

Agreed, I think my med school made a huge difference.

Ok yeah. 90% of US MDs with a 205 match psychiatry (224 USMLE is avg matched, 214 avg unmatched). My hypothesis is low scorers likely match at their home institution or low tier place, not somewhere like UPenn.

A 70% match rate for DOs with a low Comlex (no USMLE) is very good considering most of us don't have a psych program at our home institution to fall back on as a safety.

I'd say you're overreaching. Low competitiveness applicants do likely match home or low tier, but you don't know if someone is low competitiveness based solely off of their step 1 score.

 

[MacDonaldTriad]

Everyone is talking about how competitive psych has become, but this is relative. Almost anyone can have "reaches" no matter how strong they are. Conversely, unless you interview very poorly, almost everyone who is an AMG with a non-failing USMLE can match if they play it right. Of course this assumes no red flags, but "low USMLE" isn't failing and there is a difference.

 

[thomasina]

I think Colorado and Thomas Jefferson would be within your reach. Hopkins as well. Not sure about UW, Penn, Cambridge. But if you like C/L I think Longwood might be a good program to look into.

 

[Blitz2006]

Well, not anymore for sure. But honestly even university FM isn't a small dunk easy match anymore. In either case I think for the foreseeable future even low tier applicants will have a shot in psych. Most DO psych seems to be merging too tbh.

Like MacDonalad Triad said above, its all relative.

A US MD with a 205 is a slam dunk for a community, midwest program. However 3 years ago, this same applicant would have been a slam dunk for a university, midwest program. Today, 2018, perhaps not so much a 'slam dunk' for academic midwest program.

 

[Drrrrrr. Celty]

Like MacDonalad Triad said above, its all relative.

A US MD with a 205 is a slam dunk for a community, midwest program. However 3 years ago, this same applicant would have been a slam dunk for a university, midwest program. Today, 2018, perhaps not so much a 'slam dunk' for academic midwest program.

I think a DO with a 205 is a good shot for a community midwest program. Hell I don't think a DO even needs to take the USMLE for Psych in the midwest or southeast. A MD with a 205 probably will still not struggle to match a university program in the midwest pending they're not a complete tool.

 

[Blitz2006]

I think a DO with a 205 is a good shot for a community midwest program. Hell I don't think a DO even needs to take the USMLE for Psych in the midwest or southeast. A MD with a 205 probably will still not struggle to match a university program in the midwest pending they're not a complete tool.

"probably" will still not struggle is not a slam dunk. Of course, US MD with 205 will most likely match into a midwest university program, but I don't believe it is a guarantee anymore.

 

[melonballer]

I am certainly no expert as I just matched in March but I had a lower Step 1 score than the OP (mine was sub-200) and I interviewed at all of the top 10 programs to which I applied (I was restricted to programs in NE). I matched into a top program as well. While it is important to ultimately apply to a range of programs for residency, applying for aways at the schools you listed seems reasonable to me. Just a warning though, I had applied for aways at a few of the schools that later interviewed me for residency and was rejected from all of them. I wound up not doing any away rotations. I am not sure what this means (clerkship directors caring about Step 1 more than PDs??) but I think it is worth keeping in mind that acceptance for aways is not necessarily the same as acceptance for residency. Good luck with aways!

 

[grapefruit17]

I am certainly no expert as I just matched in March but I had a lower Step 1 score than the OP (mine was sub-200) and I interviewed at all of the top 10 programs to which I applied (I was restricted to programs in NE). I matched into a top program as well. While it is important to ultimately apply to a range of programs for residency, applying for aways at the schools you listed seems reasonable to me. Just a warning though, I had applied for aways at a few of the schools that later interviewed me for residency and was rejected from all of them. I wound up not doing any away rotations. I am not sure what this means (clerkship directors caring about Step 1 more than PDs??) but I think it is worth keeping in mind that acceptance for aways is not necessarily the same as acceptance for residency. Good luck with aways!

really awesome. Are you an american MD?

 

[sazerac]

I am certainly no expert as I just matched in March but I had a lower Step 1 score than the OP (mine was sub-200) and I interviewed at all of the top 10 programs to which I applied (I was restricted to programs in NE). I matched into a top program as well. While it is important to ultimately apply to a range of programs for residency, applying for aways at the schools you listed seems reasonable to me. Just a warning though, I had applied for aways at a few of the schools that later interviewed me for residency and was rejected from all of them. I wound up not doing any away rotations. I am not sure what this means (clerkship directors caring about Step 1 more than PDs??) but I think it is worth keeping in mind that acceptance for aways is not necessarily the same as acceptance for residency. Good luck with aways!

You really put the "Baller" in melonballer. Congrats!

 

[Mad Jack]

yeah, i saw the charting the match. But based on my experience, I'm not sure what I think about those numbers. Also i personally know 2 people in my class with low comlex scores, (that still passed) and did not match in psychiatry. And one guy who barely passed ended up in a random DO program. Plus, i feel like when ranking comes along being a DO has some influence on that as well.

Psych is no ortho of course, but def far from a slam dunk easy match.

If you're a DO with USMLE scores, it's a different animal than a DO with COMLEX scores as well. There's a difference between a DO with a 460 COMLEX and a DO with a 220 USMLE come match time, despite them both being in the same ballpark percentile-wise. Most of the unmatched DOs I know of applied to few places, had no USMLE score, and had low COMLEX scores. If you've got a USMLE and you apply broadly, it shouldn't be impossible to match unless you've got red flags.

 

[MacDonaldTriad]

If you're a DO with USMLE scores, it's a different animal than a DO with COMLEX scores as well. There's a difference between a DO with a 460 COMLEX and a DO with a 220 USMLE come match time, despite them both being in the same ballpark percentile-wise. Most of the unmatched DOs I know of applied to few places, had no USMLE score, and had low COMLEX scores. If you've got a USMLE and you apply broadly, it shouldn't be impossible to match unless you've got red flags.

"Let us see, we have 8 slots, 80 interviews. We have these 100 DOs with USMLE and these 100 without. What to do....?"

 

[Candidate2017]

If you're a DO with USMLE scores, it's a different animal than a DO with COMLEX scores as well. There's a difference between a DO with a 460 COMLEX and a DO with a 220 USMLE come match time, despite them both being in the same ballpark percentile-wise. Most of the unmatched DOs I know of applied to few places, had no USMLE score, and had low COMLEX scores. If you've got a USMLE and you apply broadly, it shouldn't be impossible to match unless you've got red flags.

Applying to a few places is the biggest factor. DOs who don't match either have personality issues or are oblivious to what it takes to match psych which demonstrates a lack of commitment. Every DO who is serious about matching psych knows you backup with the AOA match if you don't get at least 10 Acgme invites. Maybe the very top places will ding you for not having Usmle but I had Comlex only (below avg for matched applicants) and still got nearly double the minimum amount of invites needed to go Acgme. Places that regularly take DOs know the difference between a 400 and 600 Comlex. I'm not saying don't take Usmle, just that it depends on your goals.

 

[MacDonaldTriad]

I would agree. It does depend on your goals and there is still a lot of room for AMG expansion in general, but as the hyper applying grows, these concrete small differences in applications become magnified. We aren't looking for reasons to cull you out of the heard, but this becomes the job more and more.

 

[Lunzio]

Applying to a few places is the biggest factor. DOs who don't match either have personality issues or are oblivious to what it takes to match psych which demonstrates a lack of commitment. Every DO who is serious about matching psych knows you backup with the AOA match if you don't get at least 10 Acgme invites. Maybe the very top places will ding you for not having Usmle but I had Comlex only (below avg for matched applicants) and still got nearly double the minimum amount of invites needed to go Acgme. Places that regularly take DOs know the difference between a 400 and 600 Comlex. I'm not saying don't take Usmle, just that it depends on your goals.

Curious as to your take on still applying AOA even if one has above avg psych stats with both exams? Basically, if one wants an ACGME residency and willing to apply strategically (30+ programs) within ACGME, should AOA residencies still even be pursued/applied to?

 

[hallowmann]

Well, not anymore for sure. But honestly even university FM isn't a small dunk easy match anymore. In either case I think for the foreseeable future even low tier applicants will have a shot in psych. Most DO psych seems to be merging too tbh.

Depends on the university.

Applying to a few places is the biggest factor. DOs who don't match either have personality issues or are oblivious to what it takes to match psych which demonstrates a lack of commitment. Every DO who is serious about matching psych knows you backup with the AOA match if you don't get at least 10 Acgme invites. Maybe the very top places will ding you for not having Usmle but I had Comlex only (below avg for matched applicants) and still got nearly double the minimum amount of invites needed to go Acgme. Places that regularly take DOs know the difference between a 400 and 600 Comlex. I'm not saying don't take Usmle, just that it depends on your goals.

To be fair, most DOs I know that didn't match psych either had a redflag (e.g. board failure) or didn't understand what it took to match/didn't apply to enough places. They were convinced that since they're applying to Psych they don't need to apply broadly, or they don't need to apply to places in the midwest, etc. A lot of DOs get close to no counseling/advising with regards to the match, and that's especially true for applying ACGME with NRMP match.

Curious as to your take on still applying AOA even if one has above avg psych stats with both exams? Basically, if one wants an ACGME residency and willing to apply strategically (30+ programs) within ACGME, should AOA residencies still even be pursued/applied to?

Well, so here's the thing. I would apply to more ACGME programs than that (maybe more like 40, but this really depends on your app as a whole). Make sure you have a good mix of programs in there in terms of competitiveness/desirability. If you really want to be cautious, you can drop another $100 and apply to 10 of the 19 AOA psych programs and see what happens. If in the end you get more ACGME invites than you can handle, forget the AOA programs.

 

[Lunzio]

Well, so here's the thing. I would apply to more ACGME programs than that (maybe more like 40, but this really depends on your app as a whole). Make sure you have a good mix of programs in there in terms of competitiveness/desirability. If you really want to be cautious, you can drop another $100 and apply to 10 of the 19 AOA psych programs and see what happens. If in the end you get more ACGME invites than you can handle, forget the AOA programs.

Is it possible to schedule "tentative" AOA interviews later into the fall, giving some time for ACGME invites to hopefully accrue? I'm certainly willing to make sure I am covered.

I will likely post in the WAMC thread within the next few weeks for more specific advice!

 

[hallowmann]

Is it possible to schedule "tentative" AOA interviews later into the fall, giving some time for ACGME invites to hopefully accrue? I'm certainly willing to make sure I am covered.

I will likely post in the WAMC thread within the next few weeks for more specific advice!

That's exactly what you should do, and its something I did. There's no point spending the money on interviews for programs you're not even going to try for. Just be sure to contact them and cancel ahead of time.

I think the magic number right now is around 12, but I unfortunately know a guy with OK stats that didn't match with 11, so I would aim for 15 interviews to be safe. To be clear, I tend to be overly cautious, so you might be fine with less than this.

 

[grapefruit17]

Is it possible to schedule "tentative" AOA interviews later into the fall, giving some time for ACGME invites to hopefully accrue? I'm certainly willing to make sure I am covered.

I will likely post in the WAMC thread within the next few weeks for more specific advice!

yes

 

[grapefruit17]

That's exactly what you should do, and its something I did. There's no point spending the money on interviews for programs you're not even going to try for. Just be sure to contact them and cancel ahead of time.

I think the magic number right now is around 12, but I unfortunately know a guy with OK stats that didn't match with 11, so I would aim for 15 interviews to be safe. To be clear, I tend to be overly cautious, so you might be fine with less than this.

i ranked 9 programs in psych. 15 seems a bit overkill, but if you have the money/time sure go for it. I dunno how people get time off for that many interviews tho? my DO school gives zero time off for interviews.

 

[Candidate2017]

Curious as to your take on still applying AOA even if one has above avg psych stats with both exams? Basically, if one wants an ACGME residency and willing to apply strategically (30+ programs) within ACGME, should AOA residencies still even be pursued/applied to?

Concur 100% with Hallowmann. Registering for AOA/NMS is a great, cheap insurance policy (you can scramble AOA only if you registered) that includes 10 applications. There is no obligation to rank AOA programs. I cancelled all AOA interviews when the Acgme invites rolled in.

Congrats on the good Usmle but don't put too much stock in it at places that don't usually take DOs. Auditions, personality, fit, geographic connections, applying to programs that historically take DOs (or have DOs on staff), and number of interviews are probably better predictors of DO matching. The data shows MDs need 10 interviews for a 95% chance of matching but DOs need 15-16. I applied to 55 Acgme places which may or may not have been overkill since I matched my #1.

 

[Candidate2017]

i ranked 9 programs in psych. 15 seems a bit overkill, but if you have the money/time sure go for it. I dunno how people get time off for that many interviews tho? my DO school gives zero time off for interviews.

*cough* radiology

 

[hallowmann]

i ranked 9 programs in psych. 15 seems a bit overkill, but if you have the money/time sure go for it. I dunno how people get time off for that many interviews tho? my DO school gives zero time off for interviews.

We got 10 days total including travel time. The only way we got more was by working it out with attendings/rotation sites.

 

[melonballer]

really awesome. Are you an american MD?

American MD from a mid-tier school.

 

[Twomonty17]

That's exactly what you should do, and its something I did. There's no point spending the money on interviews for programs you're not even going to try for. Just be sure to contact them and cancel ahead of time.

I think the magic number right now is around 12, but I unfortunately know a guy with OK stats that didn't match with 11, so I would aim for 15 interviews to be safe. To be clear, I tend to be overly cautious, so you might be fine with less than this.

What were his stats? I notice a lot of people throw out average or ok when in fact they might not be.

 

[hallowmann]

What were his stats? I notice a lot of people throw out average or ok when in fact they might not be.

He's a DO, high 220s Step 1, I don't think he took Step 2. He did well in pre-clinicals, not sure about rotations, but knowing him I would be very surprised if he didn't do fine. He successfully SOAPed, but not into Psych.

I honestly don't know what it was. I doubt it was an issue with interviews, but it's possible he applied to a narrow range of programs or strictly to one limited region.

 

[reca]

I didn't say it was impossible, but at the same time realistic advice is valuable. There are a limited number of away rotations and that step score is a major reach at Cambridge. I'd also argue that other programs in the same city have better C/L fellowships.

My thoughts would be to consider Mayo, UNC, and Johns Hopkins. All 3 are well known medical centers that will draw C/L cases from a large geographic area. Except for the last 1-2 years, Hopkins hasn't been known to be as competitive as the name implies due to its workhorse reputation in psychiatry.

Interesting. I had a 238 Step 1 and was rejected by all three of those programs. I did fail a preclinical block but successfully remediated. Don't believe I had any other red flags on my application.

 

[TexasPhysician]

Interesting. I had a 238 Step 1 and was rejected by all three of those programs. I did fail a preclinical block but successfully remediated. Don't believe I had any other red flags on my application.

A single failed class is a bigger red flag at many programs. My residency program automatically discarded any application with a failure.

We are talking reach programs in which an away rotation would open up a fair possibility. By no means will it result in a match.

 

[Twomonty17]

A single failed class is a bigger red flag at many programs. My residency program automatically discarded any application with a failure.

We are talking reach programs in which an away rotation would open up a fair possibility. By no means will it result in a match.

7

Which reach programs are you thinking of when you mention that?

Edit: disregard my post my reading comprehension was off and I confused reach with safety for some reason.