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Repeating 2nd year in DO school, what are my chances for EM?
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Not enough data.
Did you fail just one course? Multiple? If only one, did you just barely pass the others or was the one failure a fluke? Do you have a good reason why you failed? If yes... is it actually a good reason, or is it just going to seem like an excuse? Why are you so dead set on EM before you've even experienced clinical work?
As for what your chances are, all I can do is echo what has been said in these forums many times over. As a D.O. you are working at a disadvantage to start. Scoring below average on step 1 (225? 229? I don't remember what it is now) isn't a viable option. Breaking 240 is always nice. Higher is better. Having failed your second year is a massive red flag. You may want to take step 2 early and rock it regardless of how well you do on step 1 to again help compensate for this red flag. You will definitely need to do away rotations at several institutions and make sure that everyone you work with loves you.
Much of this advice is still a year early for you, but right now I would say that your primary goal should be to figure out why you failed your second year, fix that part of your life, and crush all your courses the second time around.
Edit: I just read your other thread about whether you should stay in med school or not. I would seriously, seriously consider whether or not you want to be a doctor. I obviously don't know you, and maybe you were just really depressed when you wrote that post, but reading what you wrote sounds like someone who thinks being a doc would be cool ... except for literally everything that goes along with it.
Did you fail just one course? Multiple? If only one, did you just barely pass the others or was the one failure a fluke? Do you have a good reason why you failed? If yes... is it actually a good reason, or is it just going to seem like an excuse? Why are you so dead set on EM before you've even experienced clinical work?
As for what your chances are, all I can do is echo what has been said in these forums many times over. As a D.O. you are working at a disadvantage to start. Scoring below average on step 1 (225? 229? I don't remember what it is now) isn't a viable option. Breaking 240 is always nice. Higher is better. Having failed your second year is a massive red flag. You may want to take step 2 early and rock it regardless of how well you do on step 1 to again help compensate for this red flag. You will definitely need to do away rotations at several institutions and make sure that everyone you work with loves you.
Much of this advice is still a year early for you, but right now I would say that your primary goal should be to figure out why you failed your second year, fix that part of your life, and crush all your courses the second time around.
Edit: I just read your other thread about whether you should stay in med school or not. I would seriously, seriously consider whether or not you want to be a doctor. I obviously don't know you, and maybe you were just really depressed when you wrote that post, but reading what you wrote sounds like someone who thinks being a doc would be cool ... except for literally everything that goes along with it.
Thanks for your response, BoardingDoc. I failed 3 courses. My grades otherwise weren't that good throughout first year, I'm near the bottom of class. I was always the "C gets the degree" type of student, and had banked on kicking ass on Step 1. Having said that, yes I plan on working much harder the 2nd time around, to make up for my failed year.
My reason for failing was a personal family issue that led to anxiety and depression, which I didn't get treated until very late. I have all of this documented.
EM has always appealed to me. I've shadowed an EM and knew it was for me. Of course, my mind can change, but as of now, it's something I always imagined myself doing, and if my chances are significantly diminished now, it's something I want to take into account in order to re-evaluate whether or not I still want to go through with school.
My reason for failing was a personal family issue that led to anxiety and depression, which I didn't get treated until very late. I have all of this documented.
EM has always appealed to me. I've shadowed an EM and knew it was for me. Of course, my mind can change, but as of now, it's something I always imagined myself doing, and if my chances are significantly diminished now, it's something I want to take into account in order to re-evaluate whether or not I still want to go through with school.
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Your chances of matching into EM are significantly diminished. Is it impossible? Of course not. That said, the major concern I have from this post and your other posts on this board is not whether you can do this, but whether or not you even want to try. Much of what you've written elsewhere seems to indicate that you want to be an ED attending, but that you are unwilling/extremely reluctant to do the work necessary to get there.
You are correct in that I have written about being concerned of depression while spending all day at the hospital during 3rd year. But I am mentally preparing myself for it, and am getting ready to pull through and am considering seeking the help of therapy to combat the depression that school will bring to me.
So let's say I do pull through with the work. Are my chances still significantly diminished? What is the main reason for this? Because I'm a DO, or because I failed one year, or both?
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Both. The DO thing is nothing new for you, so you should be aware that several ACGME programs haven't historically taken DO students. Since the AOA-ACGME merger, that might change but there is still a perception (rightly or wrongly) among many programs that DO students have more to prove than MD ones. This bias is even more pronounced with Caribbean students.
The failed 2nd year obviously isn't going to help. What I can say though is that PD's generally don't give a crap about your grades from year 1 and 2, it's all about Step 1, Letters of rec, grades in clerkships of desired specialty, Step 2, and the rest of your 3rd year grades. I never once had a PD ask me about anything from 1st or 2nd year during an interview. In your case, I suspect that will be different, but not an insurmountable obstacle. It will, however, set the bar a little higher for you with all those aforementioned metrics in order for them to consider you.
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While the general rule is that no one gives a crap about your second year grades, FAILING them is entirely different. You need to explain what happened in your personal statement and why it won't be an issue going forward, then prove it with excellent 2nd and 3rd year grades and Step I/II scores.
Personally, if I were a PD, I'd be very hesitant to take someone who had failed a year of school. I've been to medical school. I know what you have to do to fail a year and it's not pretty. I wouldn't want any of the people I knew who failed a year working on my family members. Blunt but true.
I don't think the bizarre schedule and stressful shift work of EM is a very good idea for someone who suffers with anxiety/depression by the way. Make sure you do enough rotations in EM that you really know what you're getting into. It wouldn't be surprising to me to see you pick a different specialty because you want to do a different specialty, and not because you can't get into EM.
Personally, if I were a PD, I'd be very hesitant to take someone who had failed a year of school. I've been to medical school. I know what you have to do to fail a year and it's not pretty. I wouldn't want any of the people I knew who failed a year working on my family members. Blunt but true.
I don't think the bizarre schedule and stressful shift work of EM is a very good idea for someone who suffers with anxiety/depression by the way. Make sure you do enough rotations in EM that you really know what you're getting into. It wouldn't be surprising to me to see you pick a different specialty because you want to do a different specialty, and not because you can't get into EM.
Thanks for your response.
Since I know very little about the clinical years, what does getting excellent grades in rotations entail? Are first and second year grades a useful predictor of clinical grades? I'm not as good with the books as I am with people interaction, and so even though I struggled first 2 years, do I still have a good chance of acing clinical grades?
Btw, I don't have a chronic depression problem. But I know myself and I can definitely get depressed (and have been) when I have very little time for a personal life, such as what would be the case in 3rd year and residency. That's also part of the reason I want to do EM, the lifestyle of course. With enough time for a personal life, and exposure to family and friends, I have never experienced symptoms.
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The only thing that performance in years 1+2 and years 3+4 have in common is that if you have the work ethic required to get good grades, it will typically translate well to your clinical years. That said, your clinical years are completely different. You still have shelf exams, and generally are disqualified from Honors / High Pass if you don't meet a certain threshold on those exams. Beyond that, the rest of your grade is almost entirely based on reviews from your attendings and residents. So to answer the question of "do I have a good chance of acing clinical grades?" the answer is: maybe. If your personal skills are as good as you say, that will help. On the other hand, your grades to date don't seem to indicate that you would do well on the shelf exams.
I also want to echo what white coat investor said about the lability of EM schedules. It is only a "lifestyle" specialty to people who haven't worked in it. Switching from days to nights then having a "day off" where you are basically just resetting your internal clock before you switch back to days isn't really a "lifestyle" specialty. Plus you have to take into account the fact that many of your days off will be on days when everyone else that you want to hang out with will be working. And then when the weekend rolls around and they're free, you will be back at work.
Long story short: don't do EM because it's a "lifestyle specialty." Do EM because you like EM. If you want lifestyle, go for radiology or outpatient IM/Peds.
Of course the hours are wacky in EM, but I like that for some reason rather than a typical 9-5, at least for now. Of course when I get a family, it might be harder. But the good thing about EM is that I can at least control the # of shifts I do. So if it gets too bad, I'd reduce that.
Radiology kind of interests me too, but that would be even tougher than EM. I like Anesthesiology as well.
The reason I am very focused on these specialties is because I also have another non-medical opportunity for work (I'm a non-trad). So I don't necessarily have to return to school. If I knew that I could only do Family or Internal, then I probably wouldn't go back. Hence I really want to get a feel of what my chances would be.
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You can't control the number of shifts during residency.
To be perfectly honest, I think your chances are less that 1% given grades and other factors. You can't really just expect to rock step 1 after failing so many pre-clinical courses.
As a former chief (which mainly involved doing resident schedules), I wouldn't endorse an applicant who could be such a liability and potential burden on the rest of the residency and the department.
Thanks for the reply.
I know I can't control shifts in residency, but I meant as an attending.
As far as my Step 1. Historically I've done well on standardized tests, if that counts for anything; I got above 30 on my MCAT. Not to mention, screwing up the way I did really will give me an extra boost since I really want to redeem myself.
And yes, if I get below average (for EM) scores, then I know my chances are almost nil. But what I really want to figure out is how much better in terms of Step 1, Step 2, grades, clinicals, LOR, research, will I have to do than the average person who gets accepted into an EM program, in order to compensate for my failed year. If I was asking this question in Dermatology, I know the answer would be "infinitely better". So am just trying to get a gauge for EM.
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I'm listening to you and my opinion is that you're not a good candidate for EM. I'd recommend looking for a traditional lifestyle specialty or a part time career in medicine. You sound like you have a lot of personal issues and are not 100% sold on the specialty. If I were a PD, I probably would not strongly consider you unless your board scores were very good along with your clinical grades + outstanding SLORs showing a very clear turnaround with consistency.
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What makes you think I have "a lot" of personal issues? Yes, I failed one year due to some personal issues, but that was temporary and it got resolved. And I stated that I need a social life and can't work constantly, otherwise I get depressed, but I think that is fairly common. It's no secret that Medical Students and Residents have higher rates of depression, probably for that reason.
As far as being sold on EM. I don't think I can be more clear from my posts that I am really drawn to it, and I have been ever since I was a pre-med. I've shadowed in the ER, I've researched the typical work/procedures, the lifestyle, the misconceptions, the burnout factor, and all in all I remain very drawn to it. Who knows, I may change my mind during rotations, but you can say that about any student. As of now though, I remain 100% sold on EM.
When you say my board scores need to be very good - how good do you mean, compared to the typical EM resident?
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You came in here asking for the opinions of the people on this board. They have more experience than either you or I. They are not stating these things to be hurtful, they are honestly answering the question you asked.
Huh? When did I say I'm hurt? The question I asked (which I repeated several times) is how much better on Step 1 and other grades do I have to do to make it to EM, to compensate for my failed year. A few people said I need to do excellent. I was hoping to get a quantifiable number (which one poster did give), and that too from numerous people, so I can receive a wide array of opinions.
While I do appreciate all the advice that's being given to me, I didn't come here to find out whether EM would be a good career choice for me or not, or whether it can or can't be a good lifestyle, or whether or not I am sold on the idea.
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Board score-wise, it's going to be somewhat of a catch-22, especially given the increased competitiveness of the field:
If you get less than 230-240, you won't be considered
If you get higher than 250-260, then people are going to wonder whether you were lazy during pre-clinical years and didn't apply yourself, which you can't do in EM, where you have to be on top of it all the time (one of the reason we work so few shifts is because you have to be on point for 8-12 hours making rapid decisions)
If you get less than 230-240, you won't be considered
If you get higher than 250-260, then people are going to wonder whether you were lazy during pre-clinical years and didn't apply yourself, which you can't do in EM, where you have to be on top of it all the time (one of the reason we work so few shifts is because you have to be on point for 8-12 hours making rapid decisions)
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Not to pile on but this post magnifies why EM probably won't be a good choice for you. You say- I can't work constantly or I get depressed and I need a social life.....residency will cut into those areas of life drastically.
From what I have heard residents at my program and others say is that off service months are rough-icu you will be working long hours, trauma surgery long hours, etc... so your social time will drop significantly.
Also your med school clinical years might be rough for you as well. I can tell you during gen surgery it was up at the crack of dawn and got home 8/9pm. If there were any emergency cases you could kiss sleep goodbye.
Furthermore, from my previous career I can tell you that although everyone loves EM due to shift work it's stressful. You will wonder if you made the right call to discharge patient x or maybe you should have done a further workup for patient y. So please think about these things with your history of depression.
EDIT- I reviewed your old post and you were dismissed from your school? Did you transfer to another school or were you reinstated back into your old one? If you transferred to a new school I think your situation will be even bleaker.
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Interesting, I never heard that a higher score can be bad.
I got reinstated to my same school.
In regards to the long hours during residency, isn't that the case for almost every specialty? It's not fun, but it's a sacrifice we all have to make in order to become Doctors.
I don't have a history of depression, maybe I said it incorrectly. I just need a balanced lifestyle, that's all. I don't think stressors such as whether or not to discharge patients would effect me any differently than peers.
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The bottom line is this:
If you want to have a decent shot of matching in EM (most likely at community DO program) you'll need to bunker down, get good grades M2 year, do above average on step 1 (230+), get great clinical grades, and shine on away rotations.
In order to do this you'll likely need to make sacrifices and give up a great deal of your personal time and social life.
If you want to have a decent shot of matching in EM (most likely at community DO program) you'll need to bunker down, get good grades M2 year, do above average on step 1 (230+), get great clinical grades, and shine on away rotations.
In order to do this you'll likely need to make sacrifices and give up a great deal of your personal time and social life.
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Honestly, aside from Emergency Medicine, I would do some deep soul searching and see if medicine is what you want to do period - regardless of the specialty. While it says a lot to get back on the horse and do your best, you are no different than everyone else who made it into medical school - but they did it on their first try, and somehow mastered getting back on the horse several times a semester to pass. As was mentioned previously, a single shift in emergency medicine will test your resilience more than you can imagine. Imagine having a 18 month old die in your arms after a 2 hour resuscitation only to walk out of the room, in tears, be yelled at by the patient next door because they need a food tray and you were ignoring them, and then handed a stack of charts with a STEMI on top. It happened to me 4 hours into a 12 hour shift, and every one of us I'm sure has a similar example to share.
As White Coat said above, this field is probably not for you. Personally, I would begin focusing on alternatives if I was you.
As White Coat said above, this field is probably not for you. Personally, I would begin focusing on alternatives if I was you.
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This is my thought as well. You state that you have other non-medical employment/income opportunities so you're not reliant on future income as a physician to live your life.
At this point, you need to decide whether continuing on in medicine is the right thing for you to do, regardless of future specialty. You're only out 50K or so at this point, if you're going to cut and run, now is the time, because after this, you're looking at somewhere between $100 and 400K in debt (up to $1M in opportunity costs) depending on how far you pursue this...if you get all the way through.
The question you need to ask yourself at this point is not "can I do EM (or any other specialty)?" but "do I really want to be a doctor?". I won't pretend to know the answer for you but it's worth some serious soul searching before August rolls around an you're signing another promissory note.
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Are there people in medical school who didn't get over 30 on their MCAT? Just kidding. But seriously, that's not particularly impressive. We can't give you a "number" because you haven't done anything yet that matters. You don't have any clinical grades, you don't have any EM grades, you haven't taken any tests that matter to residency directors, and you don't have any SLORs. All you've told us so far is you've got a red flag on your application and you're a DO. Both are bad. You'll need a lot of good to make up for that. If you don't know how to rock your clinical years, start talking to the upper class men at your school. That's where all the good info is.
BTW- I consider the second year of medical school one of the least stressful years of my education. Pre-med was more stressful, MS3 was more stressful, MS1 was more stressful, and residency was certainly more stressful. I think I skiied 30 days and climbed another 60 during MS2. If that's stressing you out, wait until your surgery rotation.
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My 2 cents - you probably won't be able to match in EM. I interview EM residency applicants and contribute to our ranking process. We would not interview someone who failed a year of med school. There are too many other competitive applicants. It's fine for you to hope or pursue your goal, but you should have a back up plan.
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IMO... it seems to me like you should take a step back and just take one day at a time. You're going to drive yourself bananas thinking about all of your USMLE exams, EM away rotations, and third and fourth year rotations that aren't going to happen for literally years. You may not even like EM by the end of it. My suggestion would be to work on succeeding with what is in front of you (i.e.: 2nd year of medical school) and worry about that other stuff when it comes up. What you're doing now is not going to help you during your 2nd year and you'll probably give yourself an aneurysm.
I am applying EM this year, have slightly above average board scores and grades, no failures, and I am worried I won't match. There are a lot of other people like me out there wanting the same thing. I think you will have a difficult road ahead. Never hurts to apply but have a backup plan for sure.
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I don't think you're totally hosed for EM, I think applying to smaller DO programs may still be within reach if you consistently do well from here on out. Going MD is pretty much out of the question though.
Ah, so school finally started and on my first round of exams I got B's. Now that I'm in the trenches, I am not so confident anymore I can get amazing grades, in school or on the boards. I think I can do well, but idk. I want EM and I am simply not into FM/IM/Peds. Given that I have another career opportunity and the uncertainty about me getting EM, I am really tempted to just pull the plug.
I'm sure most of you will say that I should go ahead and leave since most are already saying how slim my chances are in EM.
I'm sure most of you will say that I should go ahead and leave since most are already saying how slim my chances are in EM.
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I feel like this thread is beating a dead horse. I'm not going to tell you to "pull the plug" seeing as you're an adult and you can make your own decisions in life. I will tell you that I agree with pretty much everyone else who has posted here and that your chances of matching into EM are remote. Do with that information what you will.
I agree with all posters here that you have a rough road ahead if you can only be happy if you match into EM, but you may be able to find a way in via an EM fellowship after an FM residency if you're willing to practice in more underserved areas.
Thanks for the replies.
Is the FM/EM residency regarded as lower than a straight up EM residency? Will that mean less chances of getting a good job, lower pay, etc.?
Is the FM/EM residency regarded as lower than a straight up EM residency? Will that mean less chances of getting a good job, lower pay, etc.?
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No, not regarded lower. No change in chance of getting a job, no change in pay.
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I think you misunderstood. He's not talking about a combined EM/FM residency (in which case, your statements are correct), rather doing FM then an unaccredited 1y "EM Fellowship" (in which case I'm not so sure about your statements).
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Ahh my bad, thought he was talking the combined EM/FM residencies.
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The combined family medicine/emergency medicine residency is incredibly competitive and fills every year with applicants who are devoted to eventually practicing in underserved areas. Given that you have failed your second year of medical school, you will not be interviewed for any of these positions. As far as the family medicine residency followed by an unaccredited emergency medicine fellowship, there may still be hope for you. If you are willing to take a rural job that no one else wants then maybe you can still practice some emergency medicine – although it will likely be a walk-in clinic at this point. I will echo what multiple other posters have said on this board: failing a year of medical school is going to kill your chances at most programs. My alma mater would not interview you. Most places are not going to interview you. Reading over the rest of your post I think that you have a large disconnect with what's going to happen in the future. Your best preparation for Step I is the first two years of medical school. If you don't do well during these two years I doubt that you are going to ace Step I as you claim. And although clinical grades do depend quite a bit on subjective factor such as evaluations from attendings and senior residents, you still need to impress them with the knowledge of disease processes that comes from hours of reading independently. I'm not sure about the competitiveness of community DO programs, but the ship has sailed on going the ACGME route. I also read your post where you mentioned that emergency medicine is a lifestyle specialty and that you think you'll be happy in it because you can simply cut down the number of shifts worked as an attending. This won't happen. EM is hard on families given that you have to work so many nights and weekends. Your spouse and kids don't care that you are available on a Tuesday morning to spend time with them. And given that many first time jobs right out of residency are going to expect you to work full time, simply stating that you're going to work fewer shifts may land you in the unemployment line. The few people who I know who can turn emergency medicine into a lifestyle specialty are department chairmen who get the pick of shifts and generally work occasional weekday day shifts and nocturnalists who have set schedules such as working every Sunday, Monday, and Tuesday night. Other than stating that you want a lifestyle specialty, you haven't really mentioned why you are so interested in emergency medicine. Is it the procedures? Lots of specialties have procedures and for some, such as breast surgery, the hours aren't that bad.
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Thanks for the lengthy reply.
I think the one positive I have about repeating the year is that I have a better chance at learning the material, full well knowing I need to rock my Step 1. I am focusing and paying more attention this year, so I think I do have a fair chance at doing above average on the Step 1. Given that second year material matters far more than first year, wouldn't you say I have plenty of time to learn/prepare for it, as I have just began the year?
In regards to the lifestyle specialty, I am well aware of the downsides such as the night shifts, weekends, and holidays. I have family in EM, and have shadowed them, so I have an idea of how it is. I am also a night person, so I think I would better be able to handle the night shifts than peers. Of course, I can't know that for sure until I get there. We all know what the upside is in terms of lifestyle for EM, so I won't mention that.
Perhaps I haven't made it clear in this thread, but I have certainly mentioned elsewhere on the forum why I love EM besides the lifestyle. I like the variety, I like the unpredictability, and I like thinking on my feet. I like that you may be having a mundane day with drug seekers and back pain and all of a sudden you get a trauma patient that you need to stabilize. I also enjoy the challenge of juggling multiple tasks at once. I like the gratification of helping patients who are having true life threatening emergencies (even though many cases won't be like that).
Would it help me if I reach out to several PD's and Residency Programs in my area, particularly those rotation sites affiliated with my school? I am thinking about doing this and asking to meet with PD's to show interest, ask them how I can increase my chances, ask for research opportunities if they have. I'm hoping this will help them to get to know me, and show my passion. I would of course disclose that I am repeating a year.
I've never heard of students doing this, so I don't know if it is good or bad. Any opinions?
I've never heard of students doing this, so I don't know if it is good or bad. Any opinions?
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Can't hurt. Especially with AOA programs, the best way to match is to do a sub-I and convince them that you are so awesome they could barely function without you.
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I think you might be better served not looking for research opportunities and instead hitting the books with those hours instead. You really really need Step 1 to show failing that year was a hiccup. Your chances are already tenuous. Research won't say anything about your aptitude at being taught. Your repeat grades and Step 1 could possibly.
