Much needed advice plz

[raidenxp2005]

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hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean grad....needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

 

[Smokemont]

hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean grad....needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

You will almost certainly not match with these credentials.

 

[raidenxp2005]

hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean...needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule and let these scores expire or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

If i go further with these scores with improvements .........please your advice is much needed

 

[DrAwsome]

hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean...needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule and let these scores expire or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

If i go further with these scores with improvements .........please your advice is much needed

The scores don't really "expire" per se in my understanding, you just need to retake them if it's been 7+ years. I think programs can still see them. I don't think it's realistic for you to match into most of the specialties you posted, with perhaps with a great deal of luck at a FM program. I would be highly skeptical that you could match EM, GS, or even IM with those scores, being from the carib, older grad, and needing a visa. With the increase in AMGs, and much better IMGs, I think it's a stretch.

I would suggest you continue practicing in your country. I think you'll spend a lot of $ to apply here with little to no chances of matching.

 

[dragonfly99]

With the multiple failed boards/retakes, and needing a VISA and being a Caribbean grad,I think your chance of matching into anything in the US is very very low, and surgery and ER would never happen. I don't think you can get fp right now either.
If you really want to get out of your current place, have you considered exploring other places like Canada or Australia? I say this just because I think if you haven't yet taken their equivalent of the USMLE's, you could try and take them and study really, really hard and see if you do better. I don't have a clue about the relative difficulty in general of getting a residency in those countries vs. the US, if you need a visa. Canada might be really hard? I heard a few years back that Australia was actually looking for immigrants of <35 or 30 or so years of age, due to a population that is going to shrink in coming years (low child birth rates, etc.). They might need doctors in rural areas of Australia.

 

[fmgtiger]

hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean...needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule and let these scores expire or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

If i go further with these scores with improvements .........please your advice is much
needed

Unless you know somebody it is not gonna happen man.

 

[Top Gun]

You have five strikes against you: graduation date 5 years ago, low Step 1 and Step 2 CK scores and only 2nd attempt passes, failures on both Step 2 CS attempts, lack of US clinical experience, and Caribbean education. Your best bet would be family medicine or maybe psych. You can forget about general surgery or emergency medicine.

 

[gutonc]

You have five strikes against you: graduation date 5 years ago, low Step 1 and Step 2 CK scores and only 2nd attempt passes, failures on both Step 2 CS attempts, lack of US clinical experience, and Caribbean education. Your best bet would be family medicine or maybe psych. You can forget about general surgery or emergency medicine.

As Top Gun states, you currently have 5 strikes against you. If you wait until your scores "expire" one of those things will definitely get worse for you as you'll be approaching a decade since graduation. And there's no guarantee you'll do any better on the Steps the 2nd time around, in fact, you'll probably do worse.

Honestly if you insist in trying to Match in the US, do it now. Apply to every FM program in the country. Throw in a bunch of no name community IM programs in the northeast. Cross your fingers and hope for the best.

If you don't match (and this has a very high likelihood), head back home and continue your current career. If you do manage to find a spot in the US, prepare to be abused in a malignant program.

 

[NotAProgDirector]

Everyone talks about retaking the USMLE's after 7 years, but I don't know how possible it really is.

Per USMLE policy, I think you only get to retake them if required by a licensing agency. Hence, you might have to actually apply for a licence, then have that state petition the USMLE to let you retake a step.

Second, the 7 year rule is a running total. So, you took Step 1 in 2007, Step 2 in 2009. Not sure when CK, but let's assume its 2010-2012. Once we get to 2014, your Step 1 is now "too far in the past" since you have to pass all three parts of the USMLE in 7 years. So, if the USMLE allows it, you get to retake Step 1. But you can't retake Step 2 until 2009 + 7 = 2016. So, basically you'll be waiting forever to take these exams again.

Third, your old scores will still be on your trascript.

Last, this assumes that, in 2016, you can actually get a better score on the Steps. Perhaps you can, but if you don't then you've just delayed / wasted money.

I've only seen a single person with retakes of their steps. They were an IMG, took the steps, passed with poor scores. Then they enrolled in one of the DO programs that allows for some advanced placement for IMG's. They then took them a second time, did much better.

 

[DrAwsome]

As Top Gun states, you currently have 5 strikes against you. If you wait until your scores "expire" one of those things will definitely get worse for you as you'll be approaching a decade since graduation. And there's no guarantee you'll do any better on the Steps the 2nd time around, in fact, you'll probably do worse.

Honestly if you insist in trying to Match in the US, do it now. Apply to every FM program in the country. Throw in a bunch of no name community IM programs in the northeast. Cross your fingers and hope for the best.

If you don't match (and this has a very high likelihood), head back home and continue your current career. If you do manage to find a spot in the US, prepare to be abused in a malignant program.

Gutonc, to clarify, do programs get to see the step scores if they expire and they are re taken? Or are both sets seen?

 

[Perrotfish]

hey

havent been on the forum in ages, but i need your advice.
My stats
YOG: december 2007
Caribbean...needs a visa
has been practicing medicine in my home country
no USCE/observership
Step 1 - 190 done in 2007 (2nd attempt)
Step 2 CK - 195 done in 2009 (2nd attempt)
Step 2 CS - failed twice

Do you think I should wait out the 7 year rule and let these scores expire or continue with these scores for match into internal medicine, family medicine, emergency medicine or general surgery

If i go further with these scores with improvements .........please your advice is much needed

This forum caters primarily to american medical graduates, I'm not sure how much advice we're going to have to offer you. Or more accurately, I'm not sure how useful the deluge of advice we're going to offer you will be. I would advise you to ask your question on valuemd.com, a forum devoted to foreign medical grads. And even then, be prepared to wade through waves of overly optimistic premeds and medical students to get answers from people who have actually been in a similar situation and suceeded.

I will admit, your stats do make the situation look grim, and emergency medicine, Internal medicine, and general surgery are competitive specialties even for American grads with good scores/grades.

 

[gutonc]

Gutonc, to clarify, do programs get to see the step scores if they expire and they are re taken? Or are both sets seen?

I have no idea...but who cares? At that point, the best you can hope for is a 5 year break in training which is a huge red flag. Even if you went from a 190 to a 290 (which may not be an actual thing, but again, who cares?) You're still out of med school longer than most residencies which is a massive red flag.

 

[Perrotfish]

I have no idea...but who cares? At that point, the best you can hope for is a 5 year break in training which is a huge red flag. Even if you went from a 190 to a 290 (which may not be an actual thing, but again, who cares?) You're still out of med school longer than most residencies which is a massive red flag.

See, this is the kind of advice where I'm not sure if our expeiences are applicable to him. A 5 year break in training is definiltey a HUGE red flag if an American graduate wanders away to do something that's not medicine. I honestly don't know, though, if its a big red flag when a foreign graduate has a 5 year gap between graduating from their foreign medical school and matriculating at one of our Residencies because he is actively practicing medicine. The few (two) residencies that I'm that cater mostly to foreign docs that I'm remotely familiar with seem to take a good portion of older docs with significant experience rather than brand new grads from Indian Medical school.

Similarly, are multiple failures on the steps the same kind of red flag if the graduate is clearly taking the exam in a foreign language, which might be the case here? I don't know, it doesn't seem like it should be. I feel like he should ask someone who knows.

 

[gutonc]

See, this is the kind of advice where I'm not sure if our expeiences are applicable to him. A 5 year break in training is definiltey a HUGE red flag if an American graduate wanders away to do something that's not medicine. I honestly don't know, though, if its a big red flag when a foreign graduate has a 5 year gap between graduating from their foreign medical school and matriculating at one of our medical schools. The few (two) residencies that I'm that cater mostly to foreign docs that I'm remotely familiar with seem to take a good portion of older docs with significant experience rather than brand new grads from Indian Medical school.

Similarly, are multiple failures on the steps the same kind of red flag if the graduate is clearly taking the exam in a foreign language, which might be the case here? I don't know, it doesn't seem like it should be. I feel like he should ask someone who knows.

The OP is an English speaking Carib grad who has multiple failures on the Steps (including no apparent CS pass) and at least a 5 year break since med school. If his/her home country is the same as where s/he went to med school, that's one thing. If s/he is a citizen of somewhere far away from the Carib and now trying to get a US residency, that's something completely different.

And multiple Step failures are multiple Step failures. The end.

Medicine in the US is practiced in English. The end.

It's fine if it's not your first language, but the inability to pass an exam in the language portends a poor chance of successfully training and ultimately practicing in the language.

 

[raidenxp2005]

OK thanks for the information you're being very helpful to me

my first and last language is english
what if i do step 3 and pick up 3-6months USCE with US letters of recommendation

would that change anything for me

 

[gutonc]

what if i do step 3 and pick up 3-6months USCE with US letters of recommendation

would that change anything for me

Not really, or maybe just a little bit, primarily because, as a graduate (not a student), you no longer have the opportunity to do rotations, just observerships. While certainly better than nothing, they won't give you actual USCE and any letters you get will be weak because of that. But since you've currently got nothing USCE-wise, there's really nothing to lose in doing a few.

 

[NotAProgDirector]

Gutonc, to clarify, do programs get to see the step scores if they expire and they are re taken? Or are both sets seen?

Yes, all scores are always reported.

 

[DrAwsome]

OK thanks for the information you're being very helpful to me

my first and last language is english
what if i do step 3 and pick up 3-6months USCE with US letters of recommendation

would that change anything for me

I personally don't think so. I mean you've unfortunately failed step 1 and 2 (both ck/cs) and had to retake, so that in and out of itself is a big red flag, and even a great score on step 3 which few people care about can't really make that up. Given that your first language is also English, I think that that makes it worse. For example my first language was not English and I read rather slow in English and I've passed all my steps on the first time thank God. So it's a problem that you keep having repeat failures.

I think it would be very very very tough for you to match, even in FM. No it does not hurt to try but I think you'd be disappointed in the end. More and more IMGs are having difficulty matching given the increase in AMGs, even for non competitive specialties. I would not try if I were you. The only specialty I could see you in is occupational/preventive med because few if any AMGs apply for it. Otherwise I would save my money and stay practicing where you are.

 

[DrAwsome]

Yes, all scores are always reported.

Thanks, that's what I thought. I guess there is no point then in retaking them then.

 

[Law2Doc]

Thanks, that's what I thought. I guess there is no point then in retaking them then.

None at all. The seven year rule isn't a clean slate rule, it's a must get it all done over a period of seven years rule. Meaning the clock is ticking for OP to finish passing CS and Step 3, or he will be forced to start retaking things.

I think the elephant in the room, besides all the red flags previously mentioned, is that you only get to take these tests so many times before you can't be licensed in many jurisdictions, so that's another thing to watch out for -- I don't know how an expired score counts toward that but I doubt it's good.

OP, you can try and apply but I really wouldn't get your hopes up. If there's no reason you can't stay working in the country you are in, that's probably the best gig you are going to get with the credentials you have described.

 

[dozitgetchahi]

I guess if the OP was really (insanely) hell-bent on working in the US, he could consider the following plan of action...

1) Take MCAT/prereqs
2) Gain admission to a US osteopathic institution (since he hasn't taken the COMLEX series yet)
3) Attempt to do better on those
4) Match on the osteopathic side for whatever specialty he wants

However...I'm uncertain if this would even solve the issue of having failed one set of board exams too many times for licensing in certain jurisdictions etc. OP is probably better off working wherever he's working now...

 

[Flopotomist]

I wonder if this post is a troll... Are there really native English speakers who fail CS TWICE?? I could understand once, it happens to a small percentage of people, but TWICE??

 

[K31]

I wonder if this post is a troll... Are there really native English speakers who fail CS TWICE?? I could understand once, it happens to a small percentage of people, but TWICE??

Yeah, I can see it happening if someone has no experience with how medicine is practiced in the US. Step 2 CS really seems to test if you can behave how Americans expect a physician to behave (at least my impression--I haven't taken it yet), and if someone comes from a completely different medical culture I can see them failing multiple times.

 

[Law2Doc]

Yeah, I can see it happening if someone has no experience with how medicine is practiced in the US. Step 2 CS really seems to test if you can behave how Americans expect a physician to behave (at least my impression--I haven't taken it yet), and if someone comes from a completely different medical culture I can see them failing multiple times.

Agreed. Doing OSCE at a US school is extremely helpful in helping you remember all the non medical niceties like draping the patient, asking before untying things, telling the patient what you are doing, washing hands, etc. Not to mention using the appropriate empathetic comments, getting a good history, counseling about smoking, drinking, drugs. It's easy to forget these things if it's not been beaten into you like they do at a US med school. My impression is most people don't fail due to their lack of being able to come up with medical knowledge -- ie Differential diagnosis or ordering the wrong test, but rather for an accumulation of these little things. The actors are judging you based on their experiences with "good" doctors in the US. If you aren't doing it the mandated way on your rotations, I could see how you might fall into bad habits and fail.

 

[umean2tellme]

Maybe going the DO route is the OP's best chance of getting a US residency, as others have already mentioned. It will obviously add an insane amount of extra years into the process though. I'm assuming if you have graduated and also have taken all the Steps and worked for 5 years that another decade of school (prereqs, MCAT, DO school, residency) is something you're willing to do. Maybe you can talk to your medical school and see if any of the faculty have any connections to a particular US community program that they could use to help you get some clinical experience to prove yourself and also a potential residency spot.