Need advice for 2025 Match (DO student)

[comicsanscatastrophe]

Hi everyone,

I'm trying to get an idea of how many pathology programs I should apply to in the upcoming cycle. For some background, I am a fourth year DO student at an established school in the NE graduating off cycle in September and will be participating in the next Match (a cycle later than if I graduated on time). I will be considered a DO Senior for match purposes. This was due to a medical Leave of Absence I took during my third year, it was for severe depression and suicidal ideation, of course I will never reveal this on my application and will leave it as simply a medical leave due to treatment. I was treated and continue to be treated properly and have performed better than ever before. I will mention this in my personal statement and on my application, and I am prepared to be vague and emphasize somatic symptoms if god forbid somebody asks for more details during an interview.

Otherwise, I have no red flags: Passes on Step 1 and Level 1, a 252 on Step 2 and 559 on Level 2, all P on my clinical rotations with a HP on Psychiatry and H on Pediatrics, with generally glowing evaluations, the lowest I got was a 5/7 on Ambulatory Medicine. My class rank will likely be around average. I do not have any research or publications, I know this will generally leave the top programs out of my range.

As of right now, I have a LOR from the pathologist I rotated under in my first path rotation, it was in a community setting. I have a backup letter from my school's pathology faculty department chair, though she is not a practicing pathologist, as such this would be a backup. I intend on doing at least two away rotations, which I am awaiting decisions on, and will get a letter from either, hopefully both. I have one non- clinical letter from the pediatrics rotation I honored.

I know pathology is not the most competitive specialty, though people are saying it is getting tougher (I think this is bluster, though it does kind of worry me at the same time). That being said, I want to avoid SOAPing under absolutely any circumstances, pathology is the field I dreamed of. I have hopes to match in either the West (not necessarily the coast) or the Northeast. I was thinking to apply to 60 programs, prioritizing programs that my school has matched to for pathology previously, and which have taken DO's generally. I would not be applying to any T20 places, upper mid tier at most with some lower tier programs mixed in.

Let me know if this sounds like a rational approach, thank you in advance for your advice!

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[octopusprime]

Do most schools offer 'pass/fail' now instead of letter grades? Interesting.
No idea what "pass" on step 1 and level 1 means -- do the USMLE and COMLEX no longer have number scores?
60 programs is an insane number to apply to, unless the rubric has changed the last 20 yrs or so.
-Apply to programs where you might want to practice: you have a much better chance of practicing in a location/region that you trained.
ie. people in the midwest generally are less inclined to hire a new grad from the coasts...yes maybe you'll be a good candidate if you're derm, but dermpath is notoriously fickle and dermpaths have a reputation. IMO.
-Apply to programs that have fellowships aside from the ubiquitous surg path and cyto. Ideally a place that has both derm and GI or both, and/or GU. I guess heme too but I hate heme lol.

 

[mike-sheree]

Do most schools offer 'pass/fail' now instead of letter grades? Interesting.
No idea what "pass" on step 1 and level 1 means -- do the USMLE and COMLEX no longer have number scores?
60 programs is an insane number to apply to, unless the rubric has changed the last 20 yrs or so.
-Apply to programs where you might want to practice: you have a much better chance of practicing in a location/region that you trained.
ie. people in the midwest generally are less inclined to hire a new grad from the coasts...yes maybe you'll be a good candidate if you're derm, but dermpath is notoriously fickle and dermpaths have a reputation. IMO.
-Apply to programs that have fellowships aside from the ubiquitous surg path and cyto. Ideally a place that has both derm and GI or both, and/or GU. I guess heme too but I hate heme lol.

This^^^

 

[comicsanscatastrophe]

This^^^

What would be a good number? like 40? I'm just worried about my LOA and lack of research being major limiting factors. I want at minimum 15 interviews, at the absolute worst, 10.

 

[octopusprime]

You can say 15 interviews but you're going to a.) spend alot of money and time to do that, and b.) you'll get burned out after 10 at the most. This isn't med school application where you need to cast a wide net. Unless there's some red flags that would be of concern, path residency is about basic competency, decent scores/grades and being able to work with people for 4-6 yrs. Particularly if you're not limiting your applciations to Wash U, Michigan, MGH, JHU, etc, you'll be fine.
If you can communicate, hold a conversation, be amicable, not be a total weirdo and demonstrate a genuine interest in learning the trade and becoming a good diagnostician, you'll be fine. You're way overthinking this.

I guess it's fine to apply to 40 places, but keep in mind if the first 10 places that offer you interviews are lower on your list, and you have another 10 or 20 interviews to go, you're going to bail/cancel them, I guarantee you. Apply to places you actually want to train.

 

[comicsanscatastrophe]

You can say 15 interviews but you're going to a.) spend alot of money and time to do that, and b.) you'll get burned out after 10 at the most. This isn't med school application where you need to cast a wide net. Unless there's some red flags that would be of concern, path residency is about basic competency, decent scores/grades and being able to work with people for 4-6 yrs. Particularly if you're not limiting your applciations to Wash U, Michigan, MGH, JHU, etc, you'll be fine.
If you can communicate, hold a conversation, be amicable, not be a total weirdo and demonstrate a genuine interest in learning the trade and becoming a good diagnostician, you'll be fine. You're way overthinking this.

I guess it's fine to apply to 40 places, but keep in mind if the first 10 places that offer you interviews are lower on your list, and you have another 10 or 20 interviews to go, you're going to bail/cancel them, I guarantee you. Apply to places you actually want to train.

I guess I've just been focusing too much on the one arguably weak spot on my application and going a bit crazy. That and spending too much time on the path reddit where people acting like it's getting competitive (also a horror story about an MD student not matching with 13 interviews). Thanks for talking more sense into me.

 

[hurrycane]

Path getting more competitive doesn’t mean much TBH, because the bar was previously set so low. Like it is probably about as competitive as peds/FM now (not a good comparison, I know). There are still plenty of spots filled by IMGs and any American grad will be on top of the list in most programs. And you also have a decent application it seems like.
I’d say if you apply to 20 top tier programs around the country and don’t match, it means that there something very wrong with your application or personality. I don’t personally know any individual, IMG or not, who did not match to one of their top 3 choices. Granted, one must have interview invites. Things may have changed a bit in the last 2-3 years, but not dramatically.

 

[spes93]

You're getting bad advice from pathologists who are out of touch and don't even know how board scores work anymore. I think 60 is a good number in your case. I was a similar applicant (DO grad with a medical leave of absence), and applied to 80, matched to a program that I would have gotten with just local apps but I do not regret it. I got 18 invites, about 10 I would not have gotten if I didn't cast a wide net. You don't want to be sending out applications at the deadline out of anxiety and getting passed over.

As far as applying to programs your school has taken, I think I know your school bc I am a DO with that graduated from a school with the same evaluating clinical grading scheme (quite a particular and annoying one) --- and having said that, don't just target programs that have taken alumni. I matched to a program that was 100% IMG before me. If I'm right about your school, many students from the school match somewhere new for pathology very frequently. Apply regionally (DOs generally match local to their med school or hometown), apply to additional places you'd like to go, and then to safety programs like HCA programs in Florida (one example of many). 60 is not insane by any means, protect yourself. Also DM me if you have any questions about handling sensitive medical leave of absence/off-cycle application.

As for burnout and cost:
Burnout - I went on 16 and was fine. I heard of people going on 20+ and were fine. The year prior I applied radiology and went on 30 interviews (15 DR and 15 intern years), that felt like too much, but it is the standard for the typical applicant for that field. You are sacrificing a few months of effort for your entire career.
Cost- small investment for your career. Even if $2000 is a sunk cost, and you match, you'll make that back in less than a month as an attending.

 

[octopusprime]

You're getting bad advice from pathologists who are out of touch and don't even know how board scores work anymore. I think 60 is a good number in your case. I was a similar applicant (DO grad with a medical leave of absence), and applied to 80, matched to a program that I would have gotten with just local apps but I do not regret it. I got 18 invites, about 10 I would not have gotten if I didn't cast a wide net. You don't want to be sending out applications at the deadline out of anxiety and getting passed over.

As far as applying to programs your school has taken, I think I know your school bc I am a DO with that graduated from a school with the same evaluating clinical grading scheme (quite a particular and annoying one) --- and having said that, don't just target programs that have taken alumni. I matched to a program that was 100% IMG before me. If I'm right about your school, many students from the school match somewhere new for pathology very frequently. Apply regionally (DOs generally match local to their med school or hometown), apply to additional places you'd like to go, and then to safety programs like HCA programs in Florida (one example of many). 60 is not insane by any means, protect yourself. Also DM me if you have any questions about handling sensitive medical leave of absence/off-cycle application.

As for burnout and cost:
Burnout - I went on 16 and was fine. I heard of people going on 20+ and were fine. The year prior I applied radiology and went on 30 interviews (15 DR and 15 intern years), that felt like too much, but it is the standard for the typical applicant for that field. You are sacrificing a few months of effort for your entire career.
Cost- small investment for your career. Even if $2000 is a sunk cost, and you match, you'll make that back in less than a month as an attending.

TBH I missed the OP's first paragraph and somewhat understand the numbers in this situation...though 60 is still a bit much.
I'm perhaps further removed from the applications process, but I still know people applying, and talk to TYs and non-path residents all the time...rarely do I encounter someone applying to multiple dozens of programs.

Call it bad advice, or call it calling a spade a spade: if you have to apply to 60 programs and are worried you won't get in (particularly if you didn't match in something a year prior and had to scramble), maybe that's the universe telling you to do something else. I get it if you're ortho, or derm, or something uber competitive and your grades are not top notch...but for something like path, which is nowhere near as competitive except at big-name top-tier programs (which don't inherently provide better training), it's overcompensating for something.

 

[KeratinPearls]

TBH I missed the OP's first paragraph and somewhat understand the numbers in this situation...though 60 is still a bit much.
I'm perhaps further removed from the applications process, but I still know people applying, and talk to TYs and non-path residents all the time...rarely do I encounter someone applying to multiple dozens of programs.

Call it bad advice, or call it calling a spade a spade: if you have to apply to 60 programs and are worried you won't get in (particularly if you didn't match in something a year prior and had to scramble), maybe that's the universe telling you to do something else. I get it if you're ortho, or derm, or something uber competitive and your grades are not top notch...but for something like path, which is nowhere near as competitive except at big-name top-tier programs (which don't inherently provide better training), it's overcompensating for something.

Foreign grads and US-IMGs do this all the time and it’s not just Path. They aren’t sure they can match so they go all out and apply to as many programs they can afford or even worse apply to Pathology as a back up to internal medicine.

 

[KeratinPearls]

You're getting bad advice from pathologists who are out of touch and don't even know how board scores work anymore. I think 60 is a good number in your case. I was a similar applicant (DO grad with a medical leave of absence), and applied to 80, matched to a program that I would have gotten with just local apps but I do not regret it. I got 18 invites, about 10 I would not have gotten if I didn't cast a wide net. You don't want to be sending out applications at the deadline out of anxiety and getting passed over.

As far as applying to programs your school has taken, I think I know your school bc I am a DO with that graduated from a school with the same evaluating clinical grading scheme (quite a particular and annoying one) --- and having said that, don't just target programs that have taken alumni. I matched to a program that was 100% IMG before me. If I'm right about your school, many students from the school match somewhere new for pathology very frequently. Apply regionally (DOs generally match local to their med school or hometown), apply to additional places you'd like to go, and then to safety programs like HCA programs in Florida (one example of many). 60 is not insane by any means, protect yourself. Also DM me if you have any questions about handling sensitive medical leave of absence/off-cycle application.

As for burnout and cost:
Burnout - I went on 16 and was fine. I heard of people going on 20+ and were fine. The year prior I applied radiology and went on 30 interviews (15 DR and 15 intern years), that felt like too much, but it is the standard for the typical applicant for that field. You are sacrificing a few months of effort for your entire career.
Cost- small investment for your career. Even if $2000 is a sunk cost, and you match, you'll make that back in less than a month as an attending.

I remember you. You applied to rads and didn’t match. Glad you matched somewhere.