Quoted: OCD and residency

[NotAProgDirector]

I went undiagnosed with mild OCD all through out high school and college, but in the first two years of med school my OCD got more severe. I essentially failed step 1 a few times because it was a hard to focus on the exam and not on my obsessions. After being medicated (zoloft with some xanax prn) and doing some serious therapy, I passed all my shelf exams and steps. Also, I honored most of my clinical courses. I didn't match in a FM program, I did the SOAP, unfortunately all programs saw the cover sheet of the application with all the fails and the "Will Take" for step 1 and my passing step 2.

In my personal statement I basically explained my issues with OCD. Every interview basically revolved around the failures, my OCD, how I will function as a resident, and if I would even be able to emotionally handle the pressures of residency. I was honest with every program and stated that prior to starting I would have my psych and therapist involved in a transfer of care and follow up plan. Some places seemed more supportive than others, but ultimately I did not match.
Did disclosing this information hurt my chances in matching?

I am trying to remain positive, but its hard to think that a program just doesn't want to touch you because you failed some tests but have incredible letters of rec and do fantastic clinically. I am fluent in spanish, have an incredible passion for medicine and serving an underserved population, and I am just so confused as to how the programs I interviewed at said they would rank me high because I can bring so much to their program, yet I didn't match.

SOAP, was just so emotionally draining.

I have decided to make a career change since I will have a year off after I graduate. Now I plan on going into psych (I always wanted to go into psych but wanted to still do some medicine but eventually open my own substance abuse treatment facility). However the same problem comes up. I have failures and no one wanted me this match season. How do I explain this to program directors? I don't really want to have another interview season feeling like I am the insane applicant who needs to have their hand held because of OCD.

I think you're going to find it's an uphill battle no matter what field you try to match into. Psych issues like OCD are chronic illnesses. Although they can be controlled by medications, they can always recur / worsen. Unfortunately, a common trigger is stress and sleep cycle irregularities, both common in residency. Hence, many PD's are going to see you as a big risk. I'm sorry that people basically lied to you "you'll be high on our list", but it's unlikely they would say the opposite "Well, we'd rather have you than try to get someone in SOAP."

Whether or not you should try for psych is a complicated issue. You could point out that because you have a psysh issue, you'd be more able to empathize with patients. However, it can pose problems (transference and counter transference) and some psych programs will likewise be uncomfortable considering you.

There's no question that your honesty caused some of this. You could remain mum, simply state that you had a "medical condition" and that it's been "addressed now". Programs may simply decline to interview you if you're that vague, anyway.

It's a tough spot, I have no easy answers. If you're at a US medical school, you should use the last 3-4 months wisely, even consider extending medical school by another year. Consider PM&R, Path, and Occ Med as fields -- they have much less call, better sleep, and are less competitive. If you are interested in any of these fields, you need to do some rotations and get some letters for next year.

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[nitemagi]

To add a couple of thoughts --

I would be sure that you're not choosing psychiatry because you believe psychiatrists will be more understanding of your condition, or because you think it will be less competitive, as neither are likely true. Psychiatrists may on the surface understand your condition, but they also understand how impairing it can be, and no one wants to recruit someone who will be impaired during residency.

I would make sure you have an aggressive exposure based psychotherapeutic approach to the OCD, and that you have taken on how to do this for yourself in new circumstances. Xanax is IMO contraindicated to that approach.

Finally, your best ally will be strong letters of recommendation from faculty that have directly observed you in high stress clinical situations since your condition is under control, and can attest how well you're doing. I emphasize letterS, as in plural.

OCD has a different risk than other mental illnesses, and I would methodically plan out what the risks are in doing residency (such as anxiety over a medical test or exam finding, leading to rechecking and getting behind in work), and realistic approaches that you can do and have already demonstrated you can do. Saying "I'll just not do that" doesn't give confidence that you understand the seriousness of your condition. I would plan out a clear therapy strategy for during residency, with multiple redundancy plans.

 

[K31]

I went undiagnosed with mild OCD all through out high school and college, but in the first two years of med school my OCD got more severe. I essentially failed step 1 a few times because it was a hard to focus on the exam and not on my obsessions. After being medicated (zoloft with some xanax prn) and doing some serious therapy, I passed all my shelf exams and steps. Also, I honored most of my clinical courses. I didn't match in a FM program, I did the SOAP, unfortunately all programs saw the cover sheet of the application with all the fails and the "Will Take" for step 1 and my passing step 2.

Am I correct in reading that you had not passed Step 1 when you applied? If so, I'm sure that's more your problem than your mental health issues (which your clerkship performance shows to be well-controlled).