question about board scores and applying

[sweetlenovo88]

If applying to a competitive specialty, like EM, does completing an internship negate average board scores?

I am not a good board exam taker but have otherwise hp and honors in the clerkships within my specialty. Also, mostly hp throughout medical school.

Just average board scores on 1 and 2 (let's not talk about the rest of my app right now, I am not getting interviews because of board scores and I have been told so). And probably average on 3 when I take it next year. How long will these average board scores haunt me? And will doing an internship and having that experience give me a bump with competing in the match next year against 4th year students?

PERSONAL experiences are highly preferred to just your thoughts.

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[NotAProgDirector]

In general, no. For several reasons.

1. Many PD's use USMLE scores as a first screen, and may never even really look at your app in depth.

2. If you do an internship next year, you'll be applying in Nov again. By then, you'll have completed 3 months of internship. Your letters are likely to say "Has been working with us for 1-2 months, seems to be doing a good job", so it's not like a few months of internship is really going to change your application. If you wait until the year after you'll have your internship done (and hence some better letters) but then you're getting farther from your med school graduation, so again it's not clearly going to help.

3. Also, trying to interview while doing a residency is very difficult. Your internship is not likely to just give you days off for interviewing, and you'll have limited control over your schedule.

4. A DO internship will not help at all for allopathic programs.

5. If you did a prelim program at a well known program, that might help. But if your scores are not good, that's not likely to happen either.

6. You'll use a year of funding, which might hurt your application.

The only exception to all of this is trying to get into the EM program at the same institution as your prelim. That might definitely help -- they would get to know you and might be willing to take you despite any perceived problems in your app.

 

[sweetlenovo88]

In general, no. For several reasons.

1. Many PD's use USMLE scores as a first screen, and may never even really look at your app in depth.

2. If you do an internship next year, you'll be applying in Nov again. By then, you'll have completed 3 months of internship. Your letters are likely to say "Has been working with us for 1-2 months, seems to be doing a good job", so it's not like a few months of internship is really going to change your application. If you wait until the year after you'll have your internship done (and hence some better letters) but then you're getting farther from your med school graduation, so again it's not clearly going to help.

3. Also, trying to interview while doing a residency is very difficult. Your internship is not likely to just give you days off for interviewing, and you'll have limited control over your schedule.

4. A DO internship will not help at all for allopathic programs.

5. If you did a prelim program at a well known program, that might help. But if your scores are not good, that's not likely to happen either.

6. You'll use a year of funding, which might hurt your application.

The only exception to all of this is trying to get into the EM program at the same institution as your prelim. That might definitely help -- they would get to know you and might be willing to take you despite any perceived problems in your app.

Thanks for the reply. I have 3 EM interviews so far but am planning for the worst now. I applied to 201 programs. They are DO interviews.

It looks like I should be thinking about my plan 'B' specialty if I have to do an internship and not start EM next year.

However, I think I am willing to throw another 4k in ERAS into EM and another 3-4k into specialty B which is less competitive (psych) and apply to both next year. (I am making ERAS rich)

If I have to do an internship, I am thinking it should be at a place that has an EM program and at one that offers electives early in the season allowing me to get some psych letters and show my face at some EM programs (perhaps the ones that I will interview at this year).

I am not giving up on EM. As you can see, I have done everything I could, but at some point I have to face the hard facts and make rational decisions to get on with my life.

Any more words of wisdom?

 

[NotAProgDirector]

That plan sounds totally reasonable. It's unlikely that programs with electives will let you do them in another program (most programs do not allow PGY-1's to do electives at other programs). Hence, you should choose a prelim program with an EM program that you have a decent shot at. Applying to psych is a reasonable plan, although you'll be repeating most of your PGY-1. Once in a prelim you could also apply to the EM programs that start as a PGY-2, although last I checked there were very few of those.

 

[sweetlenovo88]

That plan sounds totally reasonable. It's unlikely that programs with electives will let you do them in another program (most programs do not allow PGY-1's to do electives at other programs). Hence, you should choose a prelim program with an EM program that you have a decent shot at. Applying to psych is a reasonable plan, although you'll be repeating most of your PGY-1. Once in a prelim you could also apply to the EM programs that start as a PGY-2, although last I checked there were very few of those.

that sucks, I thought I could have used those elective months the way fourth years do away clerkships. Would you try for DO internship or EM prelim? I feel that I am getting more love from DO EM programs instead of MD, however, almost all psych programs are allopathic.

If I get the specialty I want, I do not care about repeating rotations.

 

[NotAProgDirector]

that sucks, I thought I could have used those elective months the way fourth years do away clerkships. Would you try for DO internship or EM prelim? I feel that I am getting more love from DO EM programs instead of MD, however, almost all psych programs are allopathic.

If I get the specialty I want, I do not care about repeating rotations.

I highly doubt that many internships will allow you to do away rotations. You certainly could use any elective time to do more ED rotations, but then you should plan for night / weekend work during your elective months which can be tough. I should mention that many IM prelims don't have any electives anyway, so you may not have much control.

Also, as I mentioned before, you may find that interviewing while being a PGY-1 is difficult. Do not expect your program to simply give you those days off.

An osteopathic TRI will not count for much towards allopathic programs. Whether or not it makes you more competitive for DO EM programs, I have no idea.

 

[J-Rad]

...
An osteopathic TRI will not count for much towards allopathic programs. Whether or not it makes you more competitive for DO EM programs, I have no idea.

...Once in a prelim you could also apply to the EM programs that start as a PGY-2, although last I checked there were very few of those.

I am not an EM person (so for any info from an AOA EM expert I would look in the EM forum for the peeps that are. BUT I do know that 100% of AOA EM programs are PGY 2-4. Either a TRI or a specialty-track AOA rotating internship is expected. In that sense, it would most definitely make you more competitive for DO EM.

...Would you try for DO internship or EM prelim? I feel that I am getting more love from DO EM programs instead of MD, however, almost all psych programs are allopathic...

I realize that the psych aspect throws a little wrench into answering your question, however, if it were all about EM I wonder if (combined with the above fact) you've answered your own question.

 

[sweetlenovo88]

I am not an EM person (so for any info from an AOA EM expert I would look in the EM forum for the peeps that are. BUT I do know that 100% of AOA EM programs are PGY 2-4. Either a TRI or a specialty-track AOA rotating internship is expected. In that sense, it would most definitely make you more competitive for DO EM.



I realize that the psych aspect throws a little wrench into answering your question, however, if it were all about EM I wonder if (combined with the above fact) you've answered your own question.

thanks for the reply. I have a question though. If I do the osteopathic internship and apply to osteopathic EM, I would have to be applying to PGY-2 DO EM. Those spots are extremely rare. So, I would then be applying to PGY-1 DO EM and will have to complete the same internship all over again.

My understanding was that if that happens, I would not be eligible for pgy-1 DO EM spots since they would not allow me to repeat the internship (or would they?)

 

[dragonfly99]

This is just an idea, but perhaps the OP should consider doing family practice residency also. The reason I say this is that in 3 years he/she would be done, and a significant number of fp people go into the urgent care area, and sometimes working in ER's. You can't be the guy in chart of a Level 1 trauma ER, but I know several fp grads who work in urgent care centers, or are even part owners in them, etc. There are many fp and some IM docs who work in ER's in smaller towns (like towns with 50,000 people, hospitals with 300 beds, etc.). I'm not sure about the larger hospitals in the big cities - perhaps these are still staffed by all ER docs, but I think it is worth looking in to if you think that you would prefer this ER-type work to being a psych doc. Allopathic fp residency is a lot easier to get than ER residency (and I'm assuming it's probably the same for DO residencie?).

For what it's worth, the fp docs receive more training in ER-like things (putting on casts, musculoskeletal injuries, doing procedures in general) than internal medicine residents, which is something I didn't know when I was a med student. They also learn pediatric and obstetrics stuff which could be helpful in an ER or urgent care type setting. I've seen "help wanted" ads for urgent care places in primary care journals classified ads section, and they usually say that you need to be medicine/peds or family practice, because they want you to be able to treat all ages,and a variety of problems.

Even as an IM residency trained person, I worked in an ER (moonlighting). It was an ER without major trauma (i.e. only ground level falls, drunk people who fell down or old people who fell on floor at home...no big MVA's, etc.) and I was the main doc there at night, had a resident helping me. So being ER trained is not the one and only way you can end up working in an ER, although of course it would be ideal.

 

[sweetlenovo88]

This is just an idea, but perhaps the OP should consider doing family practice residency also. The reason I say this is that in 3 years he/she would be done, and a significant number of fp people go into the urgent care area, and sometimes working in ER's. You can't be the guy in chart of a Level 1 trauma ER, but I know several fp grads who work in urgent care centers, or are even part owners in them, etc. There are many fp and some IM docs who work in ER's in smaller towns (like towns with 50,000 people, hospitals with 300 beds, etc.). I'm not sure about the larger hospitals in the big cities - perhaps these are still staffed by all ER docs, but I think it is worth looking in to if you think that you would prefer this ER-type work to being a psych doc. Allopathic fp residency is a lot easier to get than ER residency (and I'm assuming it's probably the same for DO residencie?).

For what it's worth, the fp docs receive more training in ER-like things (putting on casts, musculoskeletal injuries, doing procedures in general) than internal medicine residents, which is something I didn't know when I was a med student. They also learn pediatric and obstetrics stuff which could be helpful in an ER or urgent care type setting. I've seen "help wanted" ads for urgent care places in primary care journals classified ads section, and they usually say that you need to be medicine/peds or family practice, because they want you to be able to treat all ages,and a variety of problems.

Even as an IM residency trained person, I worked in an ER (moonlighting). It was an ER without major trauma (i.e. only ground level falls, drunk people who fell down or old people who fell on floor at home...no big MVA's, etc.) and I was the main doc there at night, had a resident helping me. So being ER trained is not the one and only way you can end up working in an ER, although of course it would be ideal.

thanks for the idea, but that is something that I would not consider. FP docs working in urgent care centers do not get paid well. Also, in an urgent care center it is work similar to what a PA does in an ER. Ambulances do not deliver there. It would be a watered down version of EM with watered down pay which is not what I am looking for. Also, I plan to live Miami when I am done with my training and am definitely a big city person.

 

[Cirrus83]

I actually know an FP who works in a full blown ER at a Level 1 trauma center. He doesn't work there all the time but he does a couple shifts a week after his outpatient clinic. Of course he's the only FP I know that does that, and he's probably one of *the* smartest physicians I know. I actually think most of the students wonder why he went with FP because his personality really does not fit your normal FP profile-he's the kinda guy you'd expect to be an EM guy but he loves being an FP as well. One of those crazy geniuses who kinda wanna do everything I guess. So I think it is technically possible to do more than just urgent care as an FP, but it's probably not easy.

BTW the guy I'm talking about has the most non-orthodox bedside manner ever. Literally the only physician I've ever seen chucking racial slurs and crazy offensive jokes back and forth with his patients and medical students (by this I don't mean that he was telling racist jokes-I mean he's calling his patients and students all kinds of oddly-creative slurs). I think he gets away with it because his patients know he's wicked smart and kinda self-select for people who enjoy coming up with similarly insulting retorts. If he was anybody else saying that stuff he'd probably get decked every 15 minutes.

 

[dragonfly99]

OK, well, if you don't want to consider it, then don't.
However, I'm telling you I worked in an ER (with only IM training) as the only doc on duty at night (other than 1 resident helping me) at a VA with several hundred beds. And we had some patients who were sick as crap...along with the usual chronic disease stuff. They weren't all "non-sick" and we regularly sent people up to the ICU, and sometimes to the cath lab for acute MI's, etc. And the ambulances brought lots of patients to us, I promise you...no major vehicular traumas (no Level I) but a lot of other sick puppies...chest pain, "found down" at home, major respiratory distress, etc. It wasn't boring, I promise...in fact, more stress than I wanted a good deal of the time.

There's a pretty big difference between EM and psych, though, so I'm not really getting why you would be all over doing psych but not even want to consider fp, but it's definitely your choice.

 

[sweetlenovo88]

OK, well, if you don't want to consider it, then don't.
However, I'm telling you I worked in an ER (with only IM training) as the only doc on duty at night (other than 1 resident helping me) at a VA with several hundred beds. And we had some patients who were sick as crap...along with the usual chronic disease stuff. They weren't all "non-sick" and we regularly sent people up to the ICU, and sometimes to the cath lab for acute MI's, etc. And the ambulances brought lots of patients to us, I promise you...no major vehicular traumas (no Level I) but a lot of other sick puppies...chest pain, "found down" at home, major respiratory distress, etc. It wasn't boring, I promise...in fact, more stress than I wanted a good deal of the time.

There's a pretty big difference between EM and psych, though, so I'm not really getting why you would be all over doing psych but not even want to consider fp, but it's definitely your choice.

FP is underpaid for the hours they put in and I have >250k in loans. So, no way.

 

[gutonc]

FP is underpaid for the hours they put in and I have >250k in loans. So, no way.

If you're choosing a specialty (even a 2nd choice) based on money, rather than interest, you're setting yourself up for a miserable life, especially with Psych (you know those people are crazy, right?).

The FPs and Psychs I know in PP are making pretty similar money and (outside of some boutique NYC/LA practice) the upside of FM is greater than Psych.

But if Psych is a real interest of yours, then it's a good 2nd choice (and far less competitive than EM).

 

[DrMom]

I am not an EM person (so for any info from an AOA EM expert I would look in the EM forum for the peeps that are. BUT I do know that 100% of AOA EM programs are PGY 2-4. Either a TRI or a specialty-track AOA rotating internship is expected. In that sense, it would most definitely make you more competitive for DO EM.

Actually, all AOA EM residencies are now linked PGY 1-4.

 

[J-Rad]

Actually, all AOA EM residencies are now linked PGY 1-4.

Good for the OP to know. Given the history, are there any "significant" number of positions PGY2-4 (that presume that there would be an applicant pool for them) or is it truly "rare" as OP suggests? As already demonstrated, I am out of my element here, but am curious.

 

[DrMom]

At my program the PGY 2 available slots dried up once the AOA switched to a PGY1-4 format. I really can't speak for other programs.

 

[JackADeli]

FP is underpaid for the hours they put in and I have >250k in loans. So, no way.

In general, I do consider primary care to often be underpaid. However, generalized statements as quoted above without any point/s of reference can be misleading. What hours do "they put in" and what do you expect to be compensated for such hours? More specifically:

1. do you plan to work predominantly outpatient?
2. do you plan to work predominantly a Mon-Thurs or Mon-Friday outpatient practice? (again, what actual "hours" are you speaking to?)
3. do you plan to have much on-call that brings you in at night?
4. do you plan to work any weekeends? holidays?
5. do you plan to do OB?

I think those are just some of the questions you will need to ask in order to determine what compensation you expect for what level of work.