Low Usmle Score...and I can't stand Primary Care

[Esteban24]

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Recently received my USMLE score and it looks like I'll have to change some of my plans for residency. I got a 198/81 and and am a AMG MSIII so needless to say that after reading SDN for the past few years I'm a little freaked.

My interests are in EM and Anesthesiology but at this point I'm not sure if either one is an option. I'm more than willing to take Step II early my fourth year but honestly, I don't know if I'd do that much better considering that I studied my butt off for Step 1. I guess tests just aren't my thing (...yeah I know that's a cop out but I've definitely learned more in the first few weeks of my rotation than I would in a couple of months of the first two years of med school).

I'm interested in hearing if you guys know of people who matched into specialities other than primary care with a sub-200 Step 1 score.
Granted Step 1 is just a test but it's definitely used to open doors as well as close them and I'm trying to figure out which doors are now open to me. I also want to avoid any chance of a transitional year or a scramble so I'm open to looking at "low-tier" programs, preferably near large cities...not really sure where to find which programs are low-tier so if you guys know of any I"d appreciate the input. Anyways, what's the negative consequence of doing your residency at a low-tier institution, does it affect your chance of finding a position after?
I've been reading on SDN that doing away rotations at certain places might make you attractive as a candidate so I'm hoping to identify a few places that I can rotate at and prove that I'd be a good pick.
thanks,

 

[synapse lapse]

Check out the NRMP match data report from 2007 and 2009 (new). I don't remember off the top of my head, but I think both of those specialties are possible for you if you apply to a ton of programs and aren't too picky where you end up. Also, there are some less competitive specialties that aren't primary care (path, neurology, psych [kind of]) so I think you have some options. I can't speak to how training at a "low-tier" place would affect your future career, but would imagine it wouldn't have too much impact if wanting to do private practice.

 

[gman33]

While that score doesn't help, there are people who match into those fields with scores in that range every year.

The test is in the past, so I'd just try to forget about it. Focus on doing as well as possible the next 2 years. Try to make some connections at your school, as maybe that would give you a better chance of matching.

I'd also come up with a backup plan just in case things don't work out. You could apply to more than one field and rank your backup lower in the list.

 

[Esteban24]

Thanks for the replies so far. I took a look at the NRMP data for 2009 and that definitely was a little bit of a wake up call (http://www.nrmp.org/data/index.html). Despite some of the talk on SDN apparently it is possible to match in Anesthesiology and EM with a low score on Step 1. Not saying it's easy or that I'll end up in the places I really want but its good know that people with low Step 1 scores still get admitted to those programs.
Again, if anyone knows of places with these programs that have accepted people with less than stellar Step 1 scores let me know. Never too early to start thinking of possible places.

 

[synapse lapse]

Thanks for the replies so far. I took a look at the NRMP data for 2009 and that definitely was a little bit of a wake up call (http://www.nrmp.org/data/index.html). Despite some of the talk on SDN apparently it is possible to match in Anesthesiology and EM with a low score on Step 1. Not saying it's easy or that I'll end up in the places I really want but its good know that people with low Step 1 scores still get admitted to those programs.
Again, if anyone knows of places with these programs that have accepted people with less than stellar Step 1 scores let me know. Never too early to start thinking of possible places.

Glad to help 🙂 Don't believe everything you hear or read on SDN, or anywhere else for that matter.

 

[Pinkertinkle]

u can do pm and r.

 

[njbmd]

Don't put the cart in front of the horse just yet. Your future isn't etched in stone. You still have year 3 ahead of you (honor everything) and you still have Step II ahead of you (make sure this one is high). Take Step II early and do well.You can do an audition rotation at the programs that interest you most and do extremely well. It's not a good idea to make a specialty choice based on your USMLE Step I score alone.

After you have done some clinical clerkships, then revisit the specialty choices. People change their minds all of the time so keep an open mind and be prepared to do some long and hard prep for Step II. You can't afford to take prisoners here. Good luck!

 

[The Angriest Bird]

You mentioned EM. If you goal for the future is to work in the ER, you should know that you can go through the Family Medicine residency and become an ER doctor. And as far as I know, Step I score plays a minor role in matching into a Family Medicine program; it is the least-competitive specialty known to mankind.

 

[SplenoMegastar]

Although 198 is pretty low there are still things that you can do in order to build your file back up. To tell you the truth you really have to focus pretty hard right now to try and overcome your step 1 score. You have to make the rest of your file strong so on interviews people may actually believe you when you tell them you had a bad day. I would focus on nailing the rest of your clinical rotations and try to get as many honors as you can. I would also try and do as well as you can on step 2. You really have to improve that score a decent amount on your step 2 exam if you want to go into a more competitive field.

If I were you I would try and honor as many clinical rotations as possible, nail step 2, pick a specialty and do research and publish within that specialty, and get rock solid letters of rec. That is about all you can do at this point, and hopefully schools will see that you are a solid student that has some goals.

That site was set up so that the guy could get a few pennies thrown his way every time someone decides to buy a book linked from his site at Amazon. And you are probably that guy. It preys on people freaking out about the exam and I hate crap like that.

 

[synapse lapse]

Dude, why are you spamming what is obviously your site on all these message boards, and trying to act like it's not you. Seriously, you just went and posted it in the step 2 section, and even on my NRMP charting outcomes post when it is totally unrelated. Don't be a DB, trying to make a buck on an amazon reference link instead of offering meaningful advice.

 

[twilightdoc]

My advice would be to take an objective look at yourself and how a program might evaluate you. I suspect that there are very good ER and anesthesia residencies that are a bit undervalued and that don't require their applicants to all be AOA, etc. That doesn't mean you shouldn't apply to a few "top shelf" programs, but you should realistically look at a range of programs, and perhaps have a back up plan such as a transitional residency year that would allow you to try again. You need to find an advisor at your home institution to help you navigate through the process. Don't be caught in the "snob appeal" trap of rejecting less well-known residencies- remember that all programs that are accredited have similar educational programs and duty expectations for their residents.

 

[danzman]

Slightly off topic, but as was suggested PMnR is an interesting field if you are interested in gas. I have been hanging out with a guy who did a PMnR residency and then a pain fellowship and this guy is making cash hand over fist! He has a really neat practice and almost never gives out any real narco's. Straight procedures, all day long. Also fellowships like sleep are a neat little corner of the market also.

In the end, I have found that people who think outside the box a little can do great in any specialty and have an interesting job too.

 

[shiftingmirage]

Remember, there is some technique to the match. If you look at page 60 on that file posted, for EM, people that rank 15 programs have almost 100% placement. Gas, was not as nice (15 seems like ~92%). So rank every program you interview at.

 

[BigRedBeta]

Keep in mind that "primary care" residencies lead to fellowships in all sorts of specialties. Obviously, you have work through the residency requirements, but trust me, life in the ER is way closer to your typical "primary care" stereotype than spending a month doing Allergy and Immunology clinic, months in the ICU, or working on an Infectious Disease consult service.

You're probably drawn to procedures if anesthesia and ER are your top choices, so perhaps fields like GI (scopes), critical care (central lines, ventilator management, swan-ganz caths and plenty of intubations), or cardiology (caths), are things you might be interested in.

Fellowships don't care about Step 1 scores.

 

[Tiger26]

You mentioned EM. If you goal for the future is to work in the ER, you should know that you can go through the Family Medicine residency and become an ER doctor. And as far as I know, Step I score plays a minor role in matching into a Family Medicine program; it is the least-competitive specialty known to mankind.

Not true at all--even though there's a couple fellowships in EM for FP residents, they do NOT lead to board certification in EM and FPs are increasingly being pushed out of hospital ED for not being board certified

 

[NRAI2001]

Would a research year help a person like this?? Low step 1 and a low projected step 2?

 

[kevster2001]

If he can run the table w/ honors during 3rd year and maybe supplement with a year a research, he's probably not locked of anesth or EM. Can also try to do well on Step II and send those in w/ your app

 

[FractureFixer]

Stay strong OP. I too am interested in anesthesiology and I too received a crappy score (228/95). I am just going to keep trying hard in third year and let the cards fall where they fall.

 

[synapse lapse]

Stay strong OP. I too am interested in anesthesiology and I too received a crappy score (228/95). I am just going to keep trying hard in third year and let the cards fall where they fall.

That's not a crappy score, way to make the OP feel even worse. It is above the average step 1 score and is above the average Anesthesiology matched step 1 of 224.

 

[Pinkertinkle]

Stay strong OP. I too am interested in anesthesiology and I too received a crappy score (228/95). I am just going to keep trying hard in third year and let the cards fall where they fall.

lol what an inappropriate comment

 

[ninjapenguin]

Stay strong OP. I too am interested in anesthesiology and I too received a crappy score (228/95). I am just going to keep trying hard in third year and let the cards fall where they fall.

Empathy fail. 👎

 

[beanbean]

EM is a possibilty despite your low score. Most important in your application to EM residency is your LORs and your EM rotations. So do well in MS3, study hard for Step 2 and kick butt on your EM rotation. If you still feel EM is the specialty for you then apply broadly and early. There will be programs who don't interview you based on numbers, but plenty of others will interview you if the rest of your application is solid.

 

[Isoprop]

Not true at all--even though there's a couple fellowships in EM for FP residents, they do NOT lead to board certification in EM and FPs are increasingly being pushed out of hospital ED for not being board certified

Also, I think you only see FPs in EDs in rural areas. So if OP really wants to live in the boonies...

 

[Esteban24]

Thanks for the constructive comments guys, much appreciated.
I think its pretty much a given that some places wont interview me based on Step 1 and I can't really fault them for that since it is their only objective measure of all applications.
I have meetings coming up with the people at my school who are in EM so hopefully they can to help me focus on those spots that will look at my application despite my score. I think my best bet is to try to ace my rotations, especially surgery and emergency medicine and then just focus on away electives in my area. I don't really have any other red flags on my application, mostly passes with some high honors, so hopefully I can get my foot in the door with an interview and then impress them with my away rotation. I've been told by graduating seniors going into EM that my school has a strong reputation for clinical experience among EM residencies in the area so hopefully I can use that to my advantage.
I'd rather do EM than Anes. and I've heard that some EM programs tend to focus more on your performance on your last 2 years (clinical) than your first 2 so hopefully I still got a shot
Worst comes to worst, I'll probably rank IM (maybe a low-tier spot) as a backup with the hope of eventually working my way up to a fellowship. Definitely want to avoid a year of research (which I doubt would really help me that much for EM) and a transitional year.