Jun 2, 2020
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Rising fourth year at a mid tier US MD school. Bombed Step 1 (no excuse but got sick that day and underperformed my practice test predictions) and received a 210. Did okay third year- mainly High Passes, but averaged mid/high C to mid B on shelf exams. I want to do rheumatology or Allergy. I've been studying very hard for Step 2 and due to take it end of July. I am currently in Texas and would to know if I have a shot at any program in this state that would give me a good chance to match rheum. I discussed it with my IM advisor and he said my step score makes him feel concerned that I wouldn't do well on the board exams and that I 'barely passed step', and advised me to go for an easier speciality. He said Step 2 doesn't matter that much for IM and can't help mitigate a low score. I have a few research projects, good LOR lined up, decent ECs, and am trying my hardest to do well on Step 2. Covid interrupted my A/I. Obviously I want to go wherever is good, but staying in the state/region would be preferable. Thank you.
Edit: Changed title
 
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NYknicks44

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You will be absolutely fine. I would broaden your search in terms of a good IM program. Go to the best program you can wherever it is, and if you are in a good IM program and work hard in residency, you will get into rheum or Allergy. There are moderately competitive. It is 5 years for all the training. It goes by quick. Then you can live wherever you want.
 
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bobow98

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What is easier than IM? IM has such a wide range of competitiveness. You have lower, mid, and high tier placed and you should apply to mostly the first two with a few reach places sprinkled in.

There's nothing really "easier" than IM. Is this person saying you should do PMR, Psych, FM? These are places that want to see some dedication to the field in the form of multiple rotations and letters usually (I don't know about FM). If you want to go rheum or allergy, do IM and screw your advisor (not literally, that's not professional ;) )
 

DrSnips

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Rheum is competitive? I've never heard that. Allergy I've heard is somewhat competitive, but mainly due to having relatively fewer fellowship spots than other subspecialties.
 

Gambino.

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Rheum is competitive? I've never heard that. Allergy I've heard is somewhat competitive, but mainly due to having relatively fewer fellowship spots than other subspecialties.
Roughly same # of applicant:spot ratio as cards, GI, and hem/onc
 

rokshana

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Rising fourth year at a mid tier US MD school. Bombed Step 1 (no excuse but got sick that day and underperformed my practice test predictions) and received a 210. Did okay third year- mainly High Passes, but averaged mid/high C to mid B on shelf exams. I want to do rheumatology or Allergy. I've been studying very hard for Step 2 and due to take it end of July. I am currently in Texas and would to know if I have a shot at any program in this state that would give me a good chance to match rheum. I discussed it with my IM advisor and he said my step score makes him feel concerned that I wouldn't do well on the board exams and that I 'barely passed step', and advised me to go for an easier speciality. He said Step 2 doesn't matter that much for IM and can't help mitigate a low score. I have a few research projects, good LOR lined up, decent ECs, and am trying my hardest to do well on Step 2. Covid interrupted my A/I. Obviously I want to go wherever is good, but staying in the state/region would be preferable. Thank you.
Edit: Changed title
You need a better advisor.
IM is certainly not out of reach for most US students...apply broadly and widely, especially at places that have a rheum fellowship... but doesn’t mean you can’t get a fellowship... fellowship is much more about what you do in residency, not med school.
 

rokshana

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Rheum is competitive? I've never heard that. Allergy I've heard is somewhat competitive, but mainly due to having relatively fewer fellowship spots than other subspecialties.
It’s getting more competitive, but certainly still doable...it’s below the typical gi/cards/cc, but probably more competitive than endo and a/i
 

thecalccobra

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Jun 23, 2007
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Your advisor doesn’t know what he/she is talking about. Do better on CK (>230 ideally) and you’ll be fine. Apply broadly and if you’re not particularly picky about geography, I don’t see why you can’t match at a low/mid-tier University program with in house Rheum.
 

DrSnips

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Roughly same # of applicant:spot ratio as cards, GI, and hem/onc
No, I was aware a lot of these specialties hover around 30% unmatched applicants, but that is NOT the same as saying they are equally competitive. The average caliber of applicant within the groups might still be dramatically different. Knowing that the applicant:spot ratios are equal only tells us that candidates are appropriately sorting themselves into what is realistic given their stats.
 

studentdocftw

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You are fine OP. Just make sure you get 230+ on Step2, apply broadly and interview well. Rheum is moderately competitive but your USMD status will help, and I think you'll still end up at a decent low to mid tier that will easily set it up for you.
 
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Rheum is competitive? I've never heard that. Allergy I've heard is somewhat competitive, but mainly due to having relatively fewer fellowship spots than other subspecialties.
It's getting more competitive now for some reason. It might be because of lifestyle. Not sure about salary though.
 
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NewYorkDoctors

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Rising fourth year at a mid tier US MD school. Bombed Step 1 (no excuse but got sick that day and underperformed my practice test predictions) and received a 210. Did okay third year- mainly High Passes, but averaged mid/high C to mid B on shelf exams. I want to do rheumatology or Allergy. I've been studying very hard for Step 2 and due to take it end of July. I am currently in Texas and would to know if I have a shot at any program in this state that would give me a good chance to match rheum. I discussed it with my IM advisor and he said my step score makes him feel concerned that I wouldn't do well on the board exams and that I 'barely passed step', and advised me to go for an easier speciality. He said Step 2 doesn't matter that much for IM and can't help mitigate a low score. I have a few research projects, good LOR lined up, decent ECs, and am trying my hardest to do well on Step 2. Covid interrupted my A/I. Obviously I want to go wherever is good, but staying in the state/region would be preferable. Thank you.
Edit: Changed title
Someone else I knew in residency:

US IMG who went to school in another country
Step 1 191 (passing score back then)
Step 2 203
No special honors reportedly
No research

Didnt match
Surgical Prelim Year
Awaited his opportunities and used connections

Transferred to Categorical IM starting PGY1

His evaluations were not that good in residency. CIted professionalism and knowledge deficiencies.

Becomes Chief Resident PGY4 year based on politcking

At the chagrin of the home cardiology division, he is taken to the fellowship program because of Chief Residency. No interviews at other programs.

Accepted into Interventional Cardiology at home location.

Now he is the Director of Interventional Cardiology somewhere in Florida.

This man has won the game.

Use it as inspiration for your journey.

Cheers
 
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NotAProgDirector

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As others have said here, even as a 3rd or 4th quartile US MD, you'll likely get an IM spot. Your post mentions TX, and perhaps that might be a problem. If you're only willing to be in TX for personal reasons, then you might struggle to get an IM position -- but I don't know much about TX programs.

Regarding rheum, it's mid competitive now. Become much more popular now with the rise of biologics -- many more treatment options, more interesting, perhaps more lucrative. But certainly possible with a 210 and your story, if you get to a reasonable IM program, get some research done, etc.

A/I is a bit of a strange field. Its usually very research heavy - the few residents I've known to go this route have had a PhD. Getting a spot is less about numbers and more about research and connections.
 
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deleted1022594

You will definitely be fine matching IM and subsequently Rheum or AI. Rheum has been more competitive recently but US MDs match well. Many community rheum fellowships which can be a backup. AI is more research oriented and you will need some clinical research to be considered competitive. Generally US MDs do well in the fellowship match.
 

jdh71

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Rising fourth year at a mid tier US MD school. Bombed Step 1 (no excuse but got sick that day and underperformed my practice test predictions) and received a 210. Did okay third year- mainly High Passes, but averaged mid/high C to mid B on shelf exams. I want to do rheumatology or Allergy. I've been studying very hard for Step 2 and due to take it end of July. I am currently in Texas and would to know if I have a shot at any program in this state that would give me a good chance to match rheum. I discussed it with my IM advisor and he said my step score makes him feel concerned that I wouldn't do well on the board exams and that I 'barely passed step', and advised me to go for an easier speciality. He said Step 2 doesn't matter that much for IM and can't help mitigate a low score. I have a few research projects, good LOR lined up, decent ECs, and am trying my hardest to do well on Step 2. Covid interrupted my A/I. Obviously I want to go wherever is good, but staying in the state/region would be preferable. Thank you.
Edit: Changed title
if you are an American MD with a pulse your chance of match rheum is very good. Plan to match at your home program, be a quality resident, apply broadly, then match rheum.
 

jdh71

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As others have said here, even as a 3rd or 4th quartile US MD, you'll likely get an IM spot. Your post mentions TX, and perhaps that might be a problem. If you're only willing to be in TX for personal reasons, then you might struggle to get an IM position -- but I don't know much about TX programs.

Regarding rheum, it's mid competitive now. Become much more popular now with the rise of biologics -- many more treatment options, more interesting, perhaps more lucrative. But certainly possible with a 210 and your story, if you get to a reasonable IM program, get some research done, etc.

A/I is a bit of a strange field. Its usually very research heavy - the few residents I've known to go this route have had a PhD. Getting a spot is less about numbers and more about research and connections.
PLENTY of what most of the rest of the country would consider "back water" university IM programs in Texas, especially the "Tech system" and no one wants to live in Temple, where A&M is based at Scott and White. Staying in Texas shouldn't be that big of a deal.
 

Prehealth1011

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if you are an American MD with a pulse your chance of match rheum is very good. Plan to match at your home program, be a quality resident, apply broadly, then match rheum.
Are the combined CCM programs more competitive? I see many ID docs doing ID-CCM. Similar thing with Nephro-CCM, Rheum-CCM etc.
Are these programs a way to convince people to get into ID, Nephro, Rheum?
 

collegestud2013

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A US MD with a 210 on Step 1 should be able to match to a IM residency if they apply and interview broadly. However, for many mid-tier programs and nearly all top-tier programs that score is below their screening cutoff. Your chance of matching in Texas is still pretty good but definitely not guaranteed so I would apply broadly to Texas programs as well as OOS programs that you would be willing to go to.

If you plan on doing any competitive fellowship after IM residency, you should avoid doing residency at a "low-tier" or "no-name" IM program that is not well known (unfortunately there are a lot of those programs in IM) as fellowship programs care a lot of the reputation of the IM residency when screening for interviews.

Rheum is fairly competitive with only about 63-70% of applicants matching in recent years (though that percentage is closer to 90% for U.S. M.Ds). Keep in mind that fellowships, like residency programs will also screen based on your Step scores (except they'll usually also have your Step 3 score in addition to Steps 1 and 2) so low scores alone can also get you screened out at some programs.


 

mszzeta

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Rising fourth year at a mid tier US MD school. Bombed Step 1 (no excuse but got sick that day and underperformed my practice test predictions) and received a 210. Did okay third year- mainly High Passes, but averaged mid/high C to mid B on shelf exams. I want to do rheumatology or Allergy. I've been studying very hard for Step 2 and due to take it end of July. I am currently in Texas and would to know if I have a shot at any program in this state that would give me a good chance to match rheum. I discussed it with my IM advisor and he said my step score makes him feel concerned that I wouldn't do well on the board exams and that I 'barely passed step', and advised me to go for an easier speciality. He said Step 2 doesn't matter that much for IM and can't help mitigate a low score. I have a few research projects, good LOR lined up, decent ECs, and am trying my hardest to do well on Step 2. Covid interrupted my A/I. Obviously I want to go wherever is good, but staying in the state/region would be preferable. Thank you.
Edit: Changed title

Specialities like neurosurgery or even GI can be a little difficult. But rheum is still pretty easy for AMG if you don't screw up like killing a patient in your career. So don't worry at all!
 
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AussieAg

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You'll match IM in Texas without a problem. It may not be your top choice, but you'll be able to stay academic. Step 2 indeed matters... Do well on Step 2 and you'll be able to mitigate your low Step 1. Do mediocre on Step 2 and you'll still match academic IM in Texas. I'm finishing training in Dallas and entering cardiology fellowship. Feel free to PM me.
 
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