Orthopedic Surgery from IM

[bikeforlife]

I have an unusual scenario and would love some advice.

I applied ortho but didn’t match so I SOAPed into IM categorical and just started my PGY-1 year. I chose IM during the SOAP vs a surgical prelim or gen surg because I didn’t think that a prelim would increase my ortho odds given my scores, and I’m not interested in gen surg. During the SOAP, I felt that IM was the best option.
However, I’ve wanted to do ortho since college and I would definitely be willing to complete all 3yrs of IM and then apply ortho surg if that path would yield a match. At present, that’s the way I foresee improving my odds the most.

I plan to do lots of sports med/ortho research during my time in IM, connect with local ortho residencies for research/networking (there are two within an hour), and of course, aim to do very well on STEP 3/LEVEL 3.
Here are a couple scenarios I’ve thought of, and I’d be very grateful for any input:

• I can keep an eye out for any scrambling opportunities into ortho
• I can apply directly out of IM residency (which likely won’t allow me to audition)
• I can work as a hospitalist post IM residency, allowing me to squeeze in several 2wk ortho auditions before applying

Let me preface my stats by stating that I got sick in med school. Lots of treatments and several months of medical leave right before boards. It wasn’t fun and my scores unfortunately reflected it. Made a full recovery though since Dec 2021 and am back to competing in triathlon.

STEP 1 - 221
Level 1 - 486
STEP 2 - 238
Level 2 - 547
64% class rank

• Good ortho letters, one stating I was a top 1% student, another a top 5%.
• Gold Humanism Honor Society member
• 19 research experiences – including one surgical setup video published in the AAOS video library, a casting training video project, and IRB board membership at a state university (I voted for or against protocol approvals).
• 1 journal article and an abstract published, and several manuscripts close to submission.
• 1st place oral presentation and 2nd place x2 poster presentations at regional conferences
• Leadership in 4 med school clubs (president of ortho and research club, VP of Latino medical student association, and SOMA-premed officer)

• 2x ironman and biked across the States for a fundraiser.
• Fluent in Spanish – working on my medical translator license
• 11 work experiences – two of them entrepreneurial
• I had 5 gap years between college and med school: taught English in Spain for 2yrs, worked as a PT aide and med assistant concurrently for 1yr, and worked in sales and as a Health Services Coordinator at a community clinic for 2yrs. Have three kids and own some rental properties.
• College: BA Human physiology and Spanish, minor in biochem – Summa Cum Laude

I did 5 ortho surg audition rotations last year and had only 3 interviews. I think this is due to my low board scores as I connected well with residents and faculty but could partly be due to rotating at programs outside of my region (Midwest vs west coast where I’m from).

I would welcome any advice as I need to think outside of the box on how to approach this. I know I’m adding a lot of years if I complete an IM residency before ortho and I likely won’t have funding for my last three years of ortho residency with this path, but I’m willing to do the extra years of training and my family is willing to scramble for funding or live frugally on my wife’s income. You won’t hurt my feelings by giving me some harsh truth either, I’d rather live reality than a pipedream, but I’ll be damned if I don’t give ortho another shot.

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[DarkHorizon]

I would say at this point it’s a very steep hill to climb.

Your best bet is to do your IM residency at a historically DO program that’s not heavy on boards and just absolutely wow them. Not sure where your IM residency is. Your board scores are below average overall, and likely over 1 standard deviation below Ortho median for both level 1 and 2. Unfortunately that shuts a lot of doors. Match rate for reapplicants is less than 30 percent I believe, so this is going to be very unlikely. Your funding is going to be another issue.

You can try, but you’re likely headed for disappointment unfortunately, unless there’s an unexpected opening somewhere and you slide in offcycle. At this point, I would regroup and focus on IM fellowships, there’s still tremendous opportunities available in terms of medicine fellowship.

 

[akwho]

If you can be talked out of ortho then you shouldn't keep going for it. You're a non-trad and just adding years of training to your life before you can make real money and support your family. Do proceduralist specialty in IM (ie cards/GI/pulm) and I think you will be surprised at how happy you can be doing that.


If you are deadset on ortho regardless of the risk of not matching, the financial & time commitment costs to yourself and your family, then I don't recommend waiting until you graduate IM to get a spot, that will just delay your eventual attendinghood date and won't make you more competitive, no one in ortho cares if you've done an IM residency. This year keep an ear to the ground for any ortho spots that open up, there are usually a couple a year and a more limited candidate pool for off-cycle openings. Keep doing a good job at your IM residency so you stay in good standing there and can get letters if needed. Having Step 3 done & having a good score may help alleviate any concerns about you scoring high enough to pass the ABOS Part 1 exam on the first try. You probably would have your best chance of ortho or bust if you quit your IM residency after the first year and went and worked in an ortho research lab at a place that has a residency program - they usually post spots on orthogate or twitter. I've seen several borderline ortho candidates and IMG's get spots at ortho programs by putting sweat equity in the chairman's lab for 1-2 years. This is a huge risk obviously, you are risking not having a doctor's job with doctor's student loan's by going this route.

So if I were you I'd stick it out in IM and go sub-specialist there. But if you want to full send it for ortho the best pathway is above.

 

[OrthoTraumaMD]

If you can be talked out of ortho then you shouldn't keep going for it. You're a non-trad and just adding years of training to your life before you can make real money and support your family. Do proceduralist specialty in IM (ie cards/GI/pulm) and I think you will be surprised at how happy you can be doing that.


If you are deadset on ortho regardless of the risk of not matching, the financial & time commitment costs to yourself and your family, then I don't recommend waiting until you graduate IM to get a spot, that will just delay your eventual attendinghood date and won't make you more competitive, no one in ortho cares if you've done an IM residency. This year keep an ear to the ground for any ortho spots that open up, there are usually a couple a year and a more limited candidate pool for off-cycle openings. Keep doing a good job at your IM residency so you stay in good standing there and can get letters if needed. Having Step 3 done & having a good score may help alleviate any concerns about you scoring high enough to pass the ABOS Part 1 exam on the first try. You probably would have your best chance of ortho or bust if you quit your IM residency after the first year and went and worked in an ortho research lab at a place that has a residency program - they usually post spots on orthogate or twitter. I've seen several borderline ortho candidates and IMG's get spots at ortho programs by putting sweat equity in the chairman's lab for 1-2 years. This is a huge risk obviously, you are risking not having a doctor's job with doctor's student loan's by going this route.

So if I were you I'd stick it out in IM and go sub-specialist there. But if you want to full send it for ortho the best pathway is above.

I agree
Low class rank and board scores have tanked this application. I wouldn’t waste my time.