Residency chances with failed Step 1

[thetimegoeson]

I am at a mid to low-tier USMD school.
I failed Step 1 on my first try. This was shocking since all my practice test scores (NBMEs, CBSEs) were in the 7~80s. Fortunately, I was able to pass on my 2nd try.
I was initially shooting for a competitive specialty (Derm, Plastics, Ortho). I have done amazing research for the past 2 years and I now have four 1st author pubs and numerous 2nd, 3rd author pubs in well-respected journals within the field.

I met with the school after failing Step 1, where I was told that, no matter how well I do from now on, the doors are closed for almost every specialty except for Primary Care. The only exception would be if I have a 280+ Step 2 score, and honor all my rotations that some specialties such as Radiology might consider me but even still it would be highly unlikely.
I was also told that even if I do well on rotations and have a solid Step 2 score, I probably wouldn't match into good academic programs within the Primary Care specialties.
I appreciate the school telling me the reality but it also makes me wonder if I am just destined to end up in a community program at a Primary care specialty no matter how well I do from now on.
I was hoping to hear advice from SDN about this!

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[Rapsidy]

I sent you a DM. Quick reply here, no you are not limited to primary care only. Do you have to work harder than others now? Likely, but many doors are still open to you.

Derm, plastics, and ortho are probably off the table though.

 

[KendallJennerSniperLady69]

I am at a mid to low-tier USMD school.
I failed Step 1 on my first try. This was shocking since all my practice test scores (NBMEs, CBSEs) were in the 7~80s. Fortunately, I was able to pass on my 2nd try.
I was initially shooting for a competitive specialty (Derm, Plastics, Ortho). I have done amazing research for the past 2 years and I now have four 1st author pubs and numerous 2nd, 3rd author pubs in well-respected journals within the field.

I met with the school after failing Step 1, where I was told that, no matter how well I do from now on, the doors are closed for almost every specialty except for Primary Care. The only exception would be if I have a 280+ Step 2 score, and honor all my rotations that some specialties such as Radiology might consider me but even still it would be highly unlikely.
I was also told that even if I do well on rotations and have a solid Step 2 score, I probably wouldn't match into good academic programs within the Primary Care specialties.
I appreciate the school telling me the reality but it also makes me wonder if I am just destined to end up in a community program at a Primary care specialty no matter how well I do from now on.
I was hoping to hear advice from SDN about this!

I think some paths in family medicine/IM can offer you the same sort of lifestyle/similar practice to derm depending on what you're interested in.

I could be wrong, but I think things like neuro, path, which both have great lifestyle and compensation are still open to you.

Agree that the ultracompetitive things like derm/ophtho/plastics etc. are all off the table. I personally think radiology is pretty much off the table too given how much they are known to emphasize grades/scores.

 

[LunaOri]

Your best chance for any competitive specialty may be at your home program (you will still have to do well on Step2). I would suggest meeting with the program director in the specialty in which you have published, and see if there is any hope. If not, honoring your clinicals and doing well in Step 2 will give you the best chance of matching at a decent program in a less-competitive specialty.

 

[Med Ed]

I was also told that even if I do well on rotations and have a solid Step 2 score, I probably wouldn't match into good academic programs within the Primary Care specialties.

No, that's dumb. A solid application with one blemish is still a solid application.

My general advice for people in your situation is to target academic IM programs in less desirable parts of the country (like the upper midwest) and then slingshot into the subspecialty of your choice. By that point your Step 1 stumble will be a distant memory, and you can proceed to a long, productive, and lucrative career.