Only 2 IIs

[Taddy Mason]

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So, I applied to 42 programs and currently am sitting with 2 IIs, 2 waitlists, and 2 rejections. 1 waitlist letter specifically mentioned it was for being short 1 LOR - still waiting on LOR writer and have been reminding him weekly. I'm honestly starting to get pretty concerned. I just got my CK score this week and am planning on sending love letters on Monday or Tuesday this week. Is it even worth adding additional programs at this point (honestly seems like wast to me given its already Nov.), or should I just keep (im)patiently waiting and hope for the best? Any other advice?

Stats:
US MD
Step 1 - 220-230
Step 2CK - 240-250 (just got score this week)
Step 2CS - updated - couldn't take until Feb. due to weather/flight cancellations (...and yes I managed to originally bump it up to date that fell into the reporting for to pretty much all programs).
Bottom 2/5 of class. Straight pass with no remediations or failures (grades are H/P/F and no HP).
Really good Psych and IM comments in MSPE, the rest are pretty run of the mill with nothing negative.
Very strong IM and Psych LORs. LOR from psych chair. Waiting on one more IM letter....

 

[wolfvgang22]

You'll probably get more interviews this month, I wouldn't worry so much.

 

[raisinbrain]

When did you first contact this letter writer that hasn't been living up to their expectations? At this point I would find your favorite faculty member from any rotation, set up an asap meeting, let them know that you're in a pickle, and ask them to write you a somewhat speedy letter. Not sure if you have someone you feel comfortable doing this with, but even if it's brief, or if you offer to write a draft for them, it seems like it would only help at this point - at least for any programs that specifically requested 4 letters and you only provided 3? And having your CK score now in, and improved, should help too.

 

[Amygdarya]

Congrats on your CK score! Do send love letters, as you people have had success with them. Do you have a psychiatry mentor/advisor who could call/send emails on your behalf? People do this, too, with some success. If one of the invites is from your home program, and it looks like they really like you, you can breathe a little easier. Also, this statistic has been quoted a lot that 40% of psych interview invites come out after October, so there is still almost half of them to come, especially as interview fatigue sets in and people start cancelling. Finally, have you told the person who's writing your last letter exactly how critical it is for you to have that letter *now*. Some people don't realize how competitive the residency application process has become.
Good luck!

 

[Taddy Mason]

You'll probably get more interviews this month, I wouldn't worry so much.

Thanks. There's pretty much no advising at my school (unless you're going into FM) and most of my attendings are so far removed from the process they don't have much advice to offer. I've been mainly relying on SDN, Reddit, and blogs for advice which just makes me a bit more on edge about the whole process.

 

[FlowRate]

...short 1 LOR
...I just got my CK score this week

Does that mean you submitted two LORs or that you sent 3 and were unlucky that another program cared about the fourth?

Hopefully you'll get more with the CK update and as people cancel their interviews.

Stuff to note for future applicants:

While psychiatry may not be an outright competitive specialty, I've noticed that psych definitely expects people to have submitted Steps 1 and 2 unless your Step 1 was very strong (235+).

Always good to ask for 4-5 LOR's. There's no shortage of posts around here regarding people who got set back relying on one person to finish the LOR. If they're taking a long time to do the LOR, odds are it won't be a great LOR anyway.

 

[Taddy Mason]

I asked for the remaining LOR in mid to late August and did a rotation with that physician starting mid Sept. and just finished 2 weeks ago. Both 3rd year and this year he gave me really good feedback and tends to be pretty blunt so I doubt I did something and he's being passive aggressive. I reminded him every other week I was with him and have left several messages with his clinic nurse. I was really hoping not to have to ask a backup writer at this point, as it just seems almost rude/insulting towards the back-up but I guess I don't have much of a choice. I do have a psych mentor who is also one of my LOR writers, but he finished residency in the early 90s and has had no involvement in academics since so I don't know how helpful he would be in way of contacting programs.

 

[Taddy Mason]

Does that mean you submitted two LORs or that you sent 3 and were unlucky that another program cared about the fourth?

Hopefully you'll get more with the CK update and as people cancel their interviews.

Stuff to note for future applicants:

While psychiatry may not be an outright competitive specialty, I've noticed that psych definitely expects people to have submitted Steps 1 and 2 unless your Step 1 was very strong (235+).

Always good to ask for 4-5 LOR's. There's no shortage of posts around here regarding people who got set back relying on one person to finish the LOR. If they're taking a long time to do the LOR, odds are it won't be a great LOR anyway.

Submitted app with 3 LORs the day ERAS was open for app submissions - 1 Psych, 1 IM, and 1 chair letter. I asked 4 people right off the bat for LORs when I started to fill out ERAS. I figured that the delay in CK would hurt, but that was the earliest I could take it because of scheduling issues due to taking a brief LOA in 3rd year. LOA was for a family emergency and is fully explained in MSPE and app honestly should not be an issue.

 

[zzzdrugs]

You had three letters, so something else is off (I have many more interviews with way fewer applications with only 3 letters and a 230's step 1). Might have been not doing the other tests in time, might have been applying to too many reaches, might have been ranking, might have been an unfortunate combination of the above. I would send updates on your CK score to a bunch of schools. At the very least the waitlists.

 

[Taddy Mason]

You had three letters, so something else is off (I have many more interviews with way fewer applications with only 3 letters and a 230's step 1). Might have been not doing the other tests in time, might have been applying to too many reaches, might have been ranking, might have been an unfortunate combination of the above. I would send updates on your CK score to a bunch of schools. At the very least the waitlists.

Only 2 programs I applied to wanted 4 letters. I based my list of reach/target/safety based on info I could find regarding Step scores, tier/ranking of schools where residents came from, number of DOs, and number of IMGs. I had 15 reaches, 10 safeties, and 17 targets and posted in the WAMC thread way back when and no one said anything about my list being unreasonable. Also had the program director at my home program review my list and he said it was reasonable, however he just started this year and has only practiced as a community psychiatrist for the past 30 years and never been involved in academics so not sure he's the best source for advice in that area.

Biggest issues I can think of are:
1 - LOA - again this was for a family emergency, fully explained in MSPE and app, and didn't have any academic impact or cause a delay in graduation; just a delay in when I could take Step 2 and start 4th year.
2 - Late Step 2 scores
3 - Only 20 people from my school have gone into psych over the past 12 years, and 15-16 of them went to my home program (I didn't apply there as I absolutely do not want to do residency here). So, lack of familiarity with students from my school in psych programs is probably somewhat of a factor, but to what extent I have no idea.

 

[thoffen]

Well, an incomplete application is a barrier, but I'm curious about class rank and lack of even high pass even in psychiatry. That seems in conflict with the notion of strong comments and LORs.

 

[Taddy Mason]

Well, an incomplete application is a barrier, but I'm curious about class rank and lack of even high pass even in psychiatry. That seems in conflict with the notion of strong comments and LORs.

As far as class rank, 1st and 2nd year I always scored around the class mean, sometimes above or below but never significantly below (i.e., I was never near 1 SD on the stats given to us post-test), and actually had the highest scores in my class one block. My school also includes subjective grading into class rank (e.g., how you’re rated by facilitators and classmates during PBL/TBL). My class size is also very small compared to the vast majority of med schools and we lost 18% of my class between 1st - 3rd year. So the combo of those factors don’t help in terms of rank due to number of students/volume. I did the math and based on what I know about a number of my classmates that were lost it definitely bumped me down in ranking. As far as clinical grades my school is H/P/F no HP, and to get honors you have to meet a minimum on your preceptor evals (either a 4 average out of 5, or 90% average depending on the scale used for that rotation - for the most part same thing), as well as a minimum on the shelf (minimum ranged between 88-93 depending on the rotation; Psych was 92). This screwed me over for honors in both IM and Psych where my overall final grades were ~95%, but my shelf score was a 91 for psych, and 2 below whatever the cutoff was for the IM shelf. There’s no explanation about grading in the MSPE, so it just looks like a got a middle of the road P.

Edit - Step 1 score is also factored into class rank. And splitting-up ties in class rank is purely subjective based on input from committees comprised of pre-clinical faculty and admin. So if you end up in that situation, are on the border of two quarters, and don’t have someone to go to bat for you you’re SOL.

 

[thoffen]

As far as class rank, 1st and 2nd year I always scored around the class mean, sometimes above or below but never significantly below. My school also includes subjective grading into class rank (e.g., how you’re rated by facilitators and classmates during PBL/TBL). My class size is also very small compared to the vast majority of med schools and we lost ~15% of my class between 1st - 3rd year. So the combo of those factors don’t help in terms of rank. I did the math and based on what I know about a number of my classmates that were lost it definitely bumped me down in ranking. As far as clinical grades my school is H/P/F no HP, and to get honors you have to meet a minimum on your preceptor evals (either a 4 average out of 5, or 90% average depending on the scoring for that rotation), as well as a minimum on the shelf (minimum ranged between 88-93 depending on the rotation; Psych was 92). This screwed me over for honors in both IM and Psych where my overall final grades were ~95%, but my shelf score was a 91 for psych, and 2 below whatever the cutoff was for the IM shelf. There’s no explanation about grading in the MSPE, so it just looks like a got a middle of the road P.

Edit - Step 1 score is also factored into class rank. And splitting-up ties in class rank is purely subjective based on input from pre-clinical faculty and admin. So if you end up in that situation, are on the border of two quarters, and don’t have someone to go to bat for you you’re SOL.

That sucks. I'm sure you'll get your chance but it seems the school isn't very helpful to its applicants which is weird. The interview packets I've seen so far all have a distribution of where fellow students line up for each rotation. There is quite a bit of variance in how schools grade, and some are shamefully inflated, so I find that data extremely useful.

 

[Taddy Mason]

That sucks. I'm sure you'll get your chance but it seems the school isn't very helpful to its applicants which is weird. The interview packets I've seen so far all have a distribution of where fellow students line up for each rotation. There is quite a bit of variance in how schools grade, and some are shamefully inflated, so I find that data extremely useful.

My school’s #1 goal is to pump out FM docs, especially ones that will practice in rural communities, which unfortunately is really the only area with reasonable support and advising for students. It’s also community based, so finding a mentor in your area of interest that’s still up to date on applying to residency can be a big challenge. Our MSPE lists 3rd year grades and the percentage of the class that got honors, pass, and fail for each rotation but it doesn’t say anything about grading criteria or the fact that there are 3 different rotation/curriculum set-ups for 3rd year (some of which allow for more shelf prep time at the cost of clinical experience, or have you take each shelf twice with the better of the two scores being the one that counts toward your grade) which I honestly feel makes comparing the class as a whole misleading and to a degree, unfair. It is what it is, and I had some awareness of a few of these issues going in; but it’s the price I’m paying for choosing my cheapest option for med school - hindsight is 20/20.

 

[Merely]

It's terrifying that an average USMD is having trouble getting psych interviews...

 

[Taddy Mason]

It's terrifying that an average USMD is having trouble getting psych interviews...

I wouldn’t say I’m average, as I definitely have some things working against me, which I was aware of going in, but nothing I considered to be a glaring red flag; though I was probably a bit too hopeful about the additive effect of those issues. I guess I just wasn’t expecting things to move as slowly as they have despite those, which combined with little, to no, advising is just making me more neurotic about the whole thing.

The feedback everyone has provided is about what I expected in terms of what to do, but is GREATLY appreciated as it eases some of my worst case scenario thinking and makes me feel better as to how to best go about contacting programs. I really hope people with actual advisors don’t take it for granted.

 

[LimpSpatula]

It's terrifying that an average USMD is having trouble getting psych interviews...

There’s something else going on. I know DOs with only comlex, with 15+ interviews.

 

[Taddy Mason]

There’s something else going on. I know DOs with only comlex, with 15+ interviews.

There honestly is nothing else, everything is laid out in this thread. I wouldn’t seek out advice and intentionally leave out, or obscure details as it wouldn’t really be of much benefit. Other than the issues mentioned above, maybe I could’ve applied to more lower tier programs or been open to the SW and SE, but most the lower tier programs in the regions I applied to were pretty on par with my home program; which as mentioned above I have 0 interest in considering which I really don’t feel is unreasonable with my stats. Honestly I would rather SOAP into IM or a prelim/TY spot and reapply than stay here.

 

[Taddy Mason]

Have you read your LoR to know they're "very strong"? There seems to be nothing else that could be a huge red flag unless your med school is known for being really bad or not being accredited or something. What was your personal statement about?

Yes regarding LORs. PS was why psych and talked about my experiences prior to and during med school that influenced my decision with avoiding the memorable pt. or personal/family/friend with mental illness stories. I had 2 friends with MFAs in creative writing review it, and got positive feedback from the 3 LOR writers that have their letters in and 2 other physicians who agreed to review it. As for my school, it’s an established (100+ years old) accredited MD school. Most graduates tend to stay in this area/region, so lack of familiarity with students from my school could be an issue.

 

[OldPsychDoc]

Why do you think that you got the 2 interviews you did? Are there other acceptable programs on your list that have similar profiles to those 2 that you might target with specific inquiries?

 

[3lefts]

Maybe he just got unlucky?

 

[Taddy Mason]

Why do you think that you got the 2 interviews you did? Are there other acceptable programs on your list that have similar profiles to those 2 that you might target with specific inquiries?

The 2 places where I have IIs are regionally nearby and have a long history of taking students from my school in other residency programs, but not psych (again very few people from my school tend to go into psych and the vast majority that do stay here). I sent update/letters of interest to my top 3 programs and to 5 programs that have a history of taking students from my school in other programs, and just a general update letter about my CK score to all others.