MD grad at the bottom end of the class - what residencies are realistic?

[TheMantaRay]

Can someone give me an idea of what the typical residency choices for someone in the lowest 25% of a state school MD class are?

Psych?
Peds?
IM?
FP?

What about EM?
Gas?
Anything involving surgery?

Cheers.

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[Iquitos]

Need more info.... class rank can be meaningless to some PD's. Board scores are a more standardized way of judging potential residents. Letter's or Rec and who you know can also give you a considerable upper hand at some programs.

 

[TheMantaRay]

My bad. Assume this student is in the bottom quarter of all the stuff that matters, like board scores. Not that the student is lazy - he's just not gunning for a career as the king of neurosurgery.

Is there a list of residencies in order of competitiveness?

 

[FenderHM]

this website http://www.nrmp.org/ has documents that you can read to see how competitive every specialty is for the match

 

[silas2642]

Can someone give me an idea of what the typical residency choices for someone in the lowest 25% of a state school MD class are?

Psych?
Peds?
IM?
FP?

What about EM?
Gas?
Anything involving surgery?

Cheers.

What exactly are your board scores? How have you done on your clinical rotations, and how are your lors? These all count? I mean, you make it sound as if you're alone, but this is sdn, and 1/4 of the US allopathic world is in the exact same boat you are in. A lot of what is available seems like it depends on if you passed your boards the first time, how well you did in them, if there are any red flags in your application, if you failed any courses/had to stay back a year due to academic reasons, etc.

 

[TheMantaRay]

No board scores yet. I'm just trying to realistically plan for what is likely to be a non-stellar performance in medical school.

The nrmp.org site was good - thanks for that link.

Any anecdotal evidence of where the low end of the class typically ends up? (Ignoring the girl in the bottom 5% who ends up getting the ortho position, of course.)

 

[Ashers]

No board scores yet. I'm just trying to realistically plan for what is likely to be a non-stellar performance in medical school.

The nrmp.org site was good - thanks for that link.

Any anecdotal evidence of where the low end of the class typically ends up? (Ignoring the girl in the bottom 5% who ends up getting the ortho position, of course.)

Wait, are you a premed? Are you planning on not doing well? What's this world coming to?

Don't worry about this now. Come back and ask the same thing if you're in the same situation during third year after taking the boards and getting past the typically not so heavily weighted M1 and M2 classes.

No one talks in percentages. Like others have said some PDs don't care about ranks, not all med schools have official ranks, and USMLE does not give percentiles.

 

[lilnoelle]

Another thing to think about - Although some fields aren't competitive to get into (IM for instance) there is a value in getting into the residency location that you want to. For instance.... if you want to get into a relatively nonmalignant program with higher pay, fewer hours, more average days off a week, more benefits, in a desirable location - then you probably want to be an appealing candidate. Is it really worth spending your first few years of med school working - not knowing your stuff when you get into clinicals/residency, and then having a MISERABLE 3 years of residency because the only location that wanted you was the location that NO ONE ELSE WANTED.

So, I realize it might be a bit of an exaggeration, but it is worth thinking about.

 

[Pinkertinkle]

Just pick the guys on the right:

 

[TheMantaRay]

Wait, are you a premed? Are you planning on not doing well? What's this world coming to?

Kids make it hard to devote copious amounts of time to medical school. I'm planning to do well, but not oblivious to the fact that family obligations will take a huge chunk out of my study time. (but too).

I like the chart above - very useful.

Thanks.

 

[lilnoelle]

Kids make it hard to devote copious amounts of time to medical school. I'm planning to do well, but not oblivious to the fact that family obligations will take a huge chunk out of my study time. (but too).

I like the chart above - very useful.

Thanks.

Hey, I have two kids by the way. It is possible to do well in school when you have kids, but you do have to maximize the time you have available to study... meaning its not very realistic to plan on working 10-15 hours a week as well.

 

[AmoryBlaine]

Kids make it hard to devote copious amounts of time to medical school. I'm planning to do well, but not oblivious to the fact that family obligations will take a huge chunk out of my study time. (but too).

I like the chart above - very useful.

Thanks.

Pretty hard original question -- there are a million variables including how likeable a person you are!

I would look at it instead as "fields that are most likely closed to you." These would include the typical Derm, Ophtho, Plastics, Ortho, Rad Onc, Radiology group of competitive specialties. There may be a few anecdotes about the underperforming student who matched in such a field but these would be just those - anecdotes.

I can speak fairly knowledgebly about EM since you mentioned it. While it is heresy punishable by stoning to suggest that any EM program is not stellar, there are a whole bunch of them in small cities with no university affiliation that would probably be happy to take a "lower fourth" candidate assuming they were a cool person.

 

[Hoya11]

depends on how good your board scores are and how good your med school is...

boardscore above 210 in an allopathic school, you should match in reasonable em, gas, gen surg residencies.

for any passing boardscore, at least for gas, from an allo school you will match SOMEWHERE

 

[Blesbok]

All aboard the failboat

 

[docscience]

I am not sure how much class rank plays a factor into residency selection. Not even sure if it is reflected in our dean's letters.

I do know that PDs like to look at USMLE scores and 3rd year clinical grades.

Anyone else have something to say about that?

 

[Blesbok]

I am not sure how much class rank plays a factor into residency selection. Not even sure if it is reflected in our dean's letters.

I do know that PDs like to look at USMLE scores and 3rd year clinical grades.

Anyone else have something to say about that?

Class rank generally has a direct correlation to board scores though.

The harder you work the first two years, the higher your board scores are going to be. And generally the people that work hard the first two years are more likely to work hard the second two years and do well on clinical shelfs as well as impress the attendings by going the extra mile.

 

[Law2Doc]

Class rank generally has a direct correlation to board scores though.

The harder you work the first two years, the higher your board scores are going to be. And generally the people that work hard the first two years are more likely to work hard the second two years and do well on clinical shelfs as well as impress the attendings by going the extra mile.

Hard work is part of the equation, but not the total equation. Boards test not just knowledge, but application of it. So there will always be someone who works impressively hard but doesn't do well on that test. And folks who can study more effectively, so with less effort. There is also some standardized test aptitude necessary. So I would suggest that there is a strong correlation between how well you do in med school and on the boards, but not that the person who does best worked the hardest.

 

[Law2Doc]

Wait, are you a premed?

Bear in mind that specialties fall into and out of favor. For instance, not too long ago, anesthesia was much further to the left on charts like the above. So if you are a premed, some of these specialties may move into and out of reach, no point deciding now. Realistically, if you end up on the bottom of your class, the primary care fields will tend to be most attainable, because there are many more residency slots. But certainly don't go into it hoping to squeak by. Med students who try to just pass sometimes misjudge that hurdle and end up having to retake things. Med school is expensive enough without adding another year.

 

[Blesbok]

Hard work is part of the equation, but not the total equation. Boards test not just knowledge, but application of it. So there will always be someone who works impressively hard but doesn't do well on that test. And folks who can study more effectively, so with less effort. There is also some standardized test aptitude necessary. So I would suggest that there is a strong correlation between how well you do in med school and on the boards, but not that the person who does best worked the hardest.

Well, ya, but that is what I mainly meant. He said class rank, which means the people that are able to apply the knowledge and do well on the test. I was just stating that the people that have good class ranks are generally the ones that do best on the boards. I don't see too many lower end students getting 260s on the boards.

 

[Blesbok]

Bear in mind that specialties fall into and out of favor. For instance, not too long ago, anesthesia was much further to the left on charts like the above. So if you are a premed, some of these specialties may move into and out of reach, no point deciding now. Realistically, if you end up on the bottom of your class, the primary care fields will tend to be most attainable, because there are many more residency slots. But certainly don't go into it hoping to squeak by. Med students who try to just pass sometimes misjudge that hurdle and end up having to retake things. Med school is expensive enough without adding another year.

I have never understood why anyone would want to go to med school to watch a little machine beep all day long while everyone else has all the fun. It is a lifestyle residency, but at the cost of spending 40+ hours a week staring at a bunch of machines for the rest of your life.

 

[SomeDoc]

I have never understood why anyone would want to go to med school to watch a little machine beep all day long while everyone else has all the fun. It is a lifestyle residency, but at the cost of spending 40+ hours a week staring at a bunch of machines for the rest of your life.

To each their own. Different strokes for different folks.

 

[Blesbok]

To each their own. Different strokes for different folks.

I know, I was just hoping someone would help me figure out why they would want to do it other than because it is a lifestyle residency.

 

[ninjapenguin]

Wait, are you a premed? Are you planning on not doing well? What's this world coming to?

Aim low, avoid disappointment. I like the OP's philosophy.

 

[Law2Doc]

Aim low, avoid disappointment. I like the OP's philosophy.

Aim a bit lower and OP can skip med school and residency altogether.

 

[Blesbok]

Aim a bit lower and OP can skip med school and residency altogether.

What do you want to be when you grow up?

A hobo.

 

[45408]

Class rank generally has a direct correlation to board scores though.

Keep telling yourself that. Lulz.

The harder you work the first two years, the higher your board scores are going to be. And generally the people that work hard the first two years are more likely to work hard the second two years and do well on clinical shelfs as well as impress the attendings by going the extra mile.

Does going the extra mile include running laps around the school naked? You gunner you.

 

[Blesbok]

Keep telling yourself that. Lulz.


Does going the extra mile include running laps around the school naked? You gunner you.

I can only hope

 

[45408]

Bear in mind that specialties fall into and out of favor. For instance, not too long ago, anesthesia was much further to the left on charts like the above. So if you are a premed, some of these specialties may move into and out of reach, no point deciding now. Realistically, if you end up on the bottom of your class, the primary care fields will tend to be most attainable, because there are many more residency slots. But certainly don't go into it hoping to squeak by. Med students who try to just pass sometimes misjudge that hurdle and end up having to retake things. Med school is expensive enough without adding another year.

I've heard that back in the '80s, they were practically bribing students to go into radiology, but then the quality and quantity of imaging modalities went through the roof, and now it's on the ROAD.

 

[45408]

I can only hope

PTE should take pics.

 

[Law2Doc]

I've heard that back in the '80s, they were practically bribing students to go into radiology, but then the quality and quantity of imaging modalities went through the roof, and now it's on the ROAD.

Well, there was no Road before radiology (it's the R). Rads was already a competitive specialty by the early 80s, and already the area of medicine exhibiting the most change and modernization by then, so I think your timeframe is off by about a decade. I think before CT, MRI and all the interventional stuff, it was just reading x-rays and harder to get people excited. But that's a long time ago already. Gas, for instance, has gone up and down a couple of times in the interval.

 

[soeagerun2or]

Are you naturally a poor student or are you shooting for the bottom of the class? If it's the former I emphasize with your plight and it is good to understand your situation and make plans for the best. However, if you fall in the latter you should drop out and relinquish your seat for someone who deserves it.

 

[DrJosephKim]

Keep in mind that the location of the residency plays a huge part in how "competitive" it may be to get in.

Those located in small, rural areas often have a difficult time filling. Keep that in mind as you look for potential opportunities.

Good luck to you.

 

[Blesbok]

PTE should take pics.

There will be a paperbag involved.

 

[TheMantaRay]

Are you naturally a poor student or are you shooting for the bottom of the class? If it's the former I emphasize with your plight and it is good to understand your situation and make plans for the best. However, if you fall in the latter you should drop out and relinquish your seat for someone who deserves it.

Former, not the latter. Spouse, kids and mortgage take up precious study time. Chances are, if I want to remain on good terms with spouse and kids, I'll have to sacrifice the grades. I'm a strong to quite strong student and have confidence that given the freedom to study like med school requires, I'd do fairly well. Life just got in the way for me, that's all.

So I'm not necessarily shooting for the bottom of the class. I'm just realistic about knowing that's where I'll probably end up. And if I do better than I thought, great.

 

[Blesbok]

Former, not the latter. Spouse, kids and mortgage take up precious study time. Chances are, if I want to remain on good terms with spouse and kids, I'll have to sacrifice the grades. I'm a strong to quite strong student and have confidence that given the freedom to study like med school requires, I'd do fairly well. Life just got in the way for me, that's all.

So I'm not necessarily shooting for the bottom of the class. I'm just realistic about knowing that's where I'll probably end up. And if I do better than I thought, great.

Even with spending 4-5 hours with your SO every day, you could be a straight A student for the first year and at least an A-B student the second year. (or high honor/honor if your school does something stupid like that)

 

[TheMantaRay]

Even with spending 4-5 hours with your SO every day, you could be a straight A student for the first year and at least an A-B student the second year. (or high honor/honor if your school does something stupid like that)

I have about two hours with the family each weekday right now - job, store, chores, homework, overtime, commuting, cutting grass, paying bills, etc etc etc. Married with kids means I get from 9 to 11 each night to spend with the spouse. Zero time to myself. That's just modern family life. If it was just the spouse, med school would be no problem at all!

That said, I'm guessing nobody in M1 and M2 spends 50 hours a week in class. Could I simply swap the job for med school, spend 50 hours in class/studying a week, and do okay?

 

[ZagDoc]

That said, I'm guessing nobody in M1 and M2 spends 50 hours a week in class. Could I simply swap the job for med school, spend 50 hours in class/studying a week, and do okay?

No doubt. It will average out a bit, less time at beginning of terms, more time around exams, but I'd guess thats about what I'm putting in.

 

[Blesbok]

I have about two hours with the family each weekday right now - job, store, chores, homework, overtime, commuting, cutting grass, paying bills, etc etc etc. Married with kids means I get from 9 to 11 each night to spend with the spouse. Zero time to myself. That's just modern family life. If it was just the spouse, med school would be no problem at all!

That said, I'm guessing nobody in M1 and M2 spends 50 hours a week in class. Could I simply swap the job for med school, spend 50 hours in class/studying a week, and do okay?

I think you could be at least a B student with 50 hours a week, maybe a little more right before the test during second year.

 

[lilnoelle]

That said, I'm guessing nobody in M1 and M2 spends 50 hours a week in class. Could I simply swap the job for med school, spend 50 hours in class/studying a week, and do okay?

Yes, I think that would be fine. Are you considering NOT working now?

 

[BrainBuff]

Former, not the latter. Spouse, kids and mortgage take up precious study time. Chances are, if I want to remain on good terms with spouse and kids, I'll have to sacrifice the grades. I'm a strong to quite strong student and have confidence that given the freedom to study like med school requires, I'd do fairly well. Life just got in the way for me, that's all.

So I'm not necessarily shooting for the bottom of the class. I'm just realistic about knowing that's where I'll probably end up. And if I do better than I thought, great.

Wow.. I guess you really did a good job during your interviews hiding your "reasoning" about how you were planning to handle things in med school. I do not believe that any adcoms would have admitted you over so many other students that are genuinely enthusiastic about working hard, learning and doing their best.

 

[MossPoh]

Well, there was no Road before radiology (it's the R). Rads was already a competitive specialty by the early 80s, and already the area of medicine exhibiting the most change and modernization by then, so I think your timeframe is off by about a decade. I think before CT, MRI and all the interventional stuff, it was just reading x-rays and harder to get people excited. But that's a long time ago already. Gas, for instance, has gone up and down a couple of times in the interval.

Yea, modern CT started to come into play early 80s.

Past radiology training did involve a ton of xrays and they got very good at it. The residency was a year shorter till all the new stuff came up. They also did about 6 months of radiation therapy training and tons of awkward/outdated diagnostic procedures involving the fluoroscope. I can't remember the names of the procedures anymore, but many were not very pleasant experiences for the patient. Cardiovascular radiology, the kind of precursor to the interventional radiology, was around by at least 1970s.

 

[akpete]

What do you want to be when you grow up?

A hobo.

I actually did tell people in high school that I was aspiring to be a drifter.

I guess I sort of accomplished that: 3 different undergrads then med school.

 

[Sartre79]

Wow.. I guess you really did a good job during your interviews hiding your "reasoning" about how you were planning to handle things in med school. I do not believe that any adcoms would have admitted you over so many other students that are genuinely enthusiastic about working hard, learning and doing their best.

Give the guy a break. He has other obligations....spouse and family should NOT be neglected...even if at the cost of not being an allstar student.

 

[45408]

Wow.. I guess you really did a good job during your interviews hiding your "reasoning" about how you were planning to handle things in med school. I do not believe that any adcoms would have admitted you over so many other students that are genuinely enthusiastic about working hard, learning and doing their best.

Yeah, right. If that were the case, my school wouldn't offer the "five year plan" once you get accepted. It's not exactly in the brochures, but all the people I know who are doing it intentionally (obviously other people have to repeat a year due to grades) have families and children to take care of. If my interviewers had asked how I'd rank family, wife and med school, I would've told them in a heartbeat that med school would be #3.

 

[TheMantaRay]

Wow.. I guess you really did a good job during your interviews hiding your "reasoning" about how you were planning to handle things in med school. I do not believe that any adcoms would have admitted you over so many other students that are genuinely enthusiastic about working hard, learning and doing their best.

Spoken like a person with absolutely zero idea whatsoever about how much time and effort raising kids requires, nor how being a good parent is more important than being a superstar doctor. Sorry dude, but having children and being dedicated to a regular medical career are not mutually exclusive.

I'm also not sure where you picked up the idea that I don't want to work hard, learn and do my best. I plan on doing my best with the resources I have at hand, and with the realization that hard-working non-parents with nothing to do but study for four years will likely end up closer to the top of the class than I will.

Thanks for your insight though.

 

[TheMantaRay]

Yes, I think that would be fine. Are you considering NOT working now?

Perhaps. But only if I can borrow enough to pay for the house, food, kids' clothes and activities etc etc etc during medical school. I won't send them to school in rags and feed them Kraft Mac & Cheese every day simply so I can become a doctor. And from what I gather, med schools aren't real big on giving financial aid that supports families.

Savings are insufficient to support the family for more than a month or two. And if the spouse starts working, all of that income gets eaten up instantly in daycare costs.

Is it possible to borrow enough to support a family?

 

[Blesbok]

Perhaps. But only if I can borrow enough to pay for the house, food, kids' clothes and activities etc etc etc during medical school. I won't send them to school in rags and feed them Kraft Mac & Cheese every day simply so I can become a doctor. And from what I gather, med schools aren't real big on giving financial aid that supports families.

Savings are insufficient to support the family for more than a month or two. And if the spouse starts working, all of that income gets eaten up instantly in daycare costs.

Is it possible to borrow enough to support a family?

Your wife can take a weekend job or a night job, when you will already be home from school.

I am not trying to be mean, but med school requires sacrifices from spouses too. She may want to be a stay at home mom, but sometimes that just isn't possible.

 

[TheMantaRay]

Your wife can take a weekend job or a night job, when you will already be home from school.

I guess I'm screwed!

 

[Kris1]

Spoken like a person with absolutely zero idea whatsoever about how much time and effort raising kids requires, nor how being a good parent is more important than being a superstar doctor. Sorry dude, but having children and being dedicated to a regular medical career are not mutually exclusive.

I'm also not sure where you picked up the idea that I don't want to work hard, learn and do my best. I plan on doing my best with the resources I have at hand, and with the realization that hard-working non-parents with nothing to do but study for four years will likely end up closer to the top of the class than I will.

Thanks for your insight though.

I'm having a hard time with your reasoning. I have two children ages 9 and 7. I am doing well in my classes and I have no shortage of time to spend with my children. I do not work and we are all doing very well making the bills. It almost sounds like you're using your children as a crutch or an excuse to do poorly. I agree that your family comes first, but there is still plenty of room for medical school.

 

[lilnoelle]

Is it possible to borrow enough to support a family?

I guess it depends on what your wife's income is and how extravagantly you live. My husband makes less than $40K (actually, I think it was closer to $30K last year). We own a house, mortgage is around $1K a month. We don't live extravagantly, but we hardly live like paupers either. I don't work. I borrow the max I can from the school and my loans will be terrible by the time I graduate. I think they're upward toward $140K now in my second year of school. (I'm an out of state student and so my tuition alone is about $36K a year). I haven't figured out exactly what my school gives for "room and board", but its probably around $20K, and then I borrow an extra $10K for daycare expenses.

Every school is different. Some may allow you to borrow extra to support your family, mine allows extra for daycare expenses.