Messy situation regarding residency apps, any input welcome

[saudades]

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Hi everyone, first time poster here. I have something of a uniquely screwed up situation on my hands. I'm a 4th year at an American MD school, planning to go into psychiatry. Step 1 214 1st attempt, step 2 CS passed 1st attempt. I was originally in the class of 2014 but in the middle of a clerkship I was diagnosed with a new medical condition which (in large part) resulted in me failing my surgery clerkship (because of the shelf, not clinically). I took several months of medical leave to get the condition under control, which bumped me to the class of 2015. I successfully remediated surgery and passed all my other clerkships with good clinical evaluations. My dean said that while this is obviously not good, he can explain the medical aspect in my application and it should be somewhat less of a red flag.

My first-choice residency program is not super competitive, and is at the hospital where my fiance is currently an intern in another specialty. There are no other psychiatry residencies for 100+ miles. I did an externship there and loved it, got very positive feedback and a good LOR, and made sure they knew I was very interested. But... I found out in the middle of the externship that I failed step 2 ck with a score of 207 (I took it shortly after they raised the passing score to 209). Was quite shocked as my practice tests indicated that I should have scored much higher. I'm studying to retake it by mid-October and still going to apply for match this year. I'm trying to avoid a long-distance relationship with my fiance as much as I possibly can. So, aside from matching at another institution (which I obviously realize may be the only way to get a residency at all) my question is this:

If I were to not match at this program (and either didn't match anywhere else or just decided not to go anywhere else), would there be any point in taking a year off for research/a job in a related field/something of that nature, taking step 3 and reapplying next year to the same program (Or similarly, take a year off to do the above and apply for a different specialty nearby)? Or would I be better off just considering a career other than medicine? (I have a bachelor's degree in chemistry, btw).

I know this is a train wreck and of course I realize I can't bank on my #1 goal of matching at this program. Any advice whatsoever is appreciated.

 

[operaman]

Well, obviously applying broadly would be a good idea. If you pass CK this next time, I don't think that should hurt too terribly much since the program already knows you, but it may make things harder elsewhere.

If you are dead set against being away from your SO for any length of time, then I would apply for prelim medicine positions at that hospital in addition to the psych position and maybe even consider applying for a number of specialties. The truth is, if you did an away and interview there and they still don't take you, then they probably won't take you next year either. I would think about other fields that may have additional options there or nearby and see if you can imagine yourself doing them.

To be honest, if it were me, I would make an appointment ASAP to sit down with the program director and lay it on the line and see what he/she thinks your odds of matching there might be.

 

[cbrons]

To be honest, if it were me, I would make an appointment ASAP to sit down with the program director and lay it on the line and see what he/she thinks your odds of matching there might be.

I agree with this part, it is what I would do if I were you.


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[Chewme85]

I am not sure how competitive your home psych residency program is. But I think it's very much possible unless you go to a top 25 school. Believer it or not, I had a chance to talk to the program director at my school (#50~70, East Coast) about this exact topic as a good friend of mine (different med school) who failed his step 2 CK was applying to here. The PD basically told me they care more about psych clerkship performance/clinical eval. and strong LORs. My friend ultimately didn't match, but was interviewed at least. Since you failed the CK, it'd be extremely challenging to match at a competitive program. But if you don't match there, you can always start your residency somewhere else and transfer. I've seen this happening a bit in psych. If you score high on your second attempt (really high to make up for the failed first attempt) and secure excellent LORs, I think you have a good shot at this. Good Luck!!

 

[SouthernSurgeon]

Well, obviously applying broadly would be a good idea. If you pass CK this next time, I don't think that should hurt too terribly much since the program already knows you, but it may make things harder elsewhere.

If you are dead set against being away from your SO for any length of time, then I would apply for prelim medicine positions at that hospital in addition to the psych position and maybe even consider applying for a number of specialties. The truth is, if you did an away and interview there and they still don't take you, then they probably won't take you next year either. I would think about other fields that may have additional options there or nearby and see if you can imagine yourself doing them.

To be honest, if it were me, I would make an appointment ASAP to sit down with the program director and lay it on the line and see what he/she thinks your odds of matching there might be.

I definitely agree with sitting down with the PD and being upfront about everything.

However it varies significantly from program to program how forthcoming they will be with you about your chances. Some just won't as a rule.

 

[Raryn]

Holy crap. 209 is the line for passing on step 2? Can't believe it.

You're lucky in that psych is probably the specialty that cares the least about the steps. Work hard, retake it, and you'll probably be OK. That said, you already have at least one other red flag, so I would recommend applying broadly. It's 4 years (3 if you fast track into a fellowship somewhere else), and the risk you take when shoot yourself into the foot by only applying to one place and not matching is not "oh well, I lost a year" it's "oh well, I'm now not a US senior but a prior grad, and I have a few other red flags, I may never match anywhere". You risk your career, and I hope you and your SO understand that.

 

[saudades]

Thanks, all. Solid advice. I've got everything together for ERAS on Monday, definitely gonna apply broadly and not burn any bridges. Now back to Uworld for me