Residency options question based on interest & STEP

[m1dCwsc]

I truly enjoy suturing (lacerations, cysts, etc) in the clinic and in the OR, however with a low STEP1 score (209) I am realistically excluded from a surgical residency. What options do I have? The only things I can think of are FM and EM. Any insight would be helpful!

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[Anti-PD1]

I truly enjoy suturing (lacerations, cysts, etc) in the clinic and in the OR, however with a low STEP1 score (209) I am realistically excluded from a surgical residency. What options do I have? The only things I can think of are FM and EM. Any insight would be helpful!

According to charting outcomes you still have about a 60 percent chance of matching. Doing well in MS3 and Step 2, applying broadly etc, using connections from your school, general surgery may still be in the cards for you.

 

[OrthoTraumaMD]

Surgery is so much more than “suturing.” Do you enjoy anatomy? Being in the OR? The idea of having responsibility for the patient on the table? Postop issues/complications?
If none of that sounds good, do EM.


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[DrYoda]

EM has gotten fairly competitive as of late and probably isn't any less competitive than general surgery so I wouldn't think of it as a back up option. That said if you are interested in either specialty get good letters of rec, kill it on your away rotations and apply broadly. We've had candidates who looked great on paper ranked low due to poor fit, and people who looked not that great on paper ranked high. That said, myself and many of my fellow EM attending didn't like the OR. We get lots of simple procedures that are short and fast and that's what we like. airway management is also a bigger part of EM. I couldn't stand doing a 45 minute surgical procedure on a regular basis. so although we both do procedures it really depends on what type of procedures you prefer, if your like the OR and if you want to follow patients up after you're done.

 

[neoevolution]

EM has gotten fairly competitive as of late and probably isn't any less competitive than general surgery so I wouldn't think of it as a back up option. That said if you are interested in either specialty get good letters of rec, kill it on your away rotations and apply broadly. We've had candidates who looked great on paper ranked low due to poor fit, and people who looked not that great on paper ranked high. That said, myself and many of my fellow EM attending didn't like the OR. We get lots of simple procedures that are short and fast and that's what we like. airway management is also a bigger part of EM. I couldn't stand doing a 45 minute surgical procedure on a regular basis. so although we both do procedures it really depends on what type of procedures you prefer, if your like the OR and if you want to follow patients up after you're done.

The median Step 1 for both is similar (233 EM vs. 235 Gen Surg), but the match rate drops off more quickly for gen surg than EM as Step 1 drops below their median. EM is 85% at 210 and Gen Surg is 65% at 210

 

[Redpancreas]

Consider OB as well if that’s your thing. EM and Gen Surg are not out of reach per se. People for IM sometimes say a high CK CAN makes up for a low Step 1. I would say for EM, a good CK WILL make up for a low Step 1. I think your prime target should be EM, unless you really feel strong about being in the OR. EM will allow you career flexibility, acuity, and working with your hands. If you don't match, OB, Family, or even community IM program are less competitive and you should be able to find a spot there.

Gen Surg if you must. Otherwise:
EM > Family/OB > IM.

Like someone said below, IM has plenty of procedural opportunities but if that's a selling point to you, that's not really what IM's centered on. Yes, Pulm/Crit. Cardio/GI have procedures, but they're very specific procedures they repeat over and over. Some people also like to say that hospitalists are technically qualified and sometimes are expected to do intubations/ABGs/etc. I just don't really many of them doing this on SDN or in my limited experience, but perhaps you may find a gig in a rural setting.

 

[NotAProgDirector]

Also depends if US MD/ US DO / IMG

 

[moisne]

I'll bet you can easily scramble into a surgical prelim. Get your feet in the door.

Though... I don't think suturing means anything. I like suturing but I hated standing hunched over for 8-10 hours a day, often without breaks.

For now, do well in step2 and your 3rd year.


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[m1dCwsc]

Also depends if US MD/ US DO / IMG

US MD!

 

[m1dCwsc]

Surgery is so much more than “suturing.” Do you enjoy anatomy? Being in the OR? The idea of having responsibility for the patient on the table? Postop issues/complications?
If none of that sounds good, do EM.

Sent from my iPhone

That is a good point. I like working with my hands and I guess I am trying to find out what other specialties I could look out for. I have only had my FM, OB, and surg rotations so far.

 

[m1dCwsc]

What kinds of procedures,suturing,etc can you do if you go into Internal Medicine?

 

[doc05]

There's a ton more to surgery than "suturing." That part gets tedious pretty quickly, Do you have any more insight into what you want in a career?

A 209 doesn't necessarily exclude you from gen surgery spots, but it will keep you out of many good programs.

 

[Gray Fox]

The median Step 1 for both is similar (233 EM vs. 235 Gen Surg), but the match rate drops off more quickly for gen surg than EM as Step 1 drops below their median. EM is 85% at 210 and Gen Surg is 65% at 210

People who aren't going into EM don't know this, but step score is a flawed proxy for competitiveness for EM. Programs put disproportionately higher emphasis on SLOEs, which are standardized recommendation letters. Many schools give automatic honors to students during their surgery sub-is ( that's the joke anyway), but for EM, schools are supposed to differentiate applicants going into EM into top 10%, top 1/3, middle 1/3, Etc. I know plenty of folk who crushed Steps and didn't perform as highly. Others who struggled on Step (poor test takers?) But had godly skills in the ED. i personally believe EM is at least as competitive as GS but more forgiving re: Step, less forgiving re: senior rotation grades and SLOE.

 

[road2residency]

What kinds of procedures,suturing,etc can you do if you go into Internal Medicine?

Critical care physicians are able to do plenty of procedures such as central lines, intubations, bronchoscopies etc.
Depending what area of the country you want to practice in, FM could be possible. FM docs can work in urgent care centers/ ERs in some rural areas. There's even an FM fellowship in emergency medicine

 

[W19]

US MD!

I think gen surg is still in play assuming you get good clerkship grades, a 240+ step2, and some research.

 

[mymembernames]

Gen Surg is 5 years
EM is 3 years
If you love the OR and operating then the choice is clear, otherwise consider EM or GAS
As a US MD you have decent/good chance for Gen Surg and a strong chance for EM or GAS

 

[sss100]

Gen Surg is 5 years
EM is 3 years
If you love the OR and operating then the choice is clear, otherwise consider EM or GAS
As a US MD you have decent/good chance for Gen Surg and a strong chance for EM or GAS

In similar dilemma: US MD, low STEP I but love surgery and honored it during rotation, Believe that i will get great recommendations from the surgeons. Have Strong research background and working on 3 or 4 projects now. Want to do surgery but keeping EM as back up. I have to do 2 away rotations as EM to get 2 SLOE if i want to keep EM as option. Will having only one away rotation in surgery hurt my chances of matching? Any suggestions ?

 

[Gray Fox]

In similar dilemma: US MD, low STEP I but love surgery and honored it during rotation, Believe that i will get great recommendations from the surgeons. Have Strong research background and working on 3 or 4 projects now. Want to do surgery but keeping EM as back up. I have to do 2 away rotations as EM to get 2 SLOE if i want to keep EM as option. Will having only one away rotation in surgery hurt my chances of matching? Any suggestions ?

EM as a backup? EM is as competitive as GS. Assuming you delay your in-house EM and EM away rotations to do 1 or 2 surgery rotations (in-house +/- away), by the time you start your "back up" EM rotation in-house or for an away, you'll already be behind your EM colleagues in terms of experience and competency. I remember a fellow rotator who was on his 2nd EM sub-i while the rest of us were on our 3rd. That dude got blown up. You gotta be 110% to get great EM SLOEs and make up for your low STEP 1. Either kill it in Surgery or kill it in EM and get a better back up plan. Anyone who tells you otherwise either hates you or is an idiot.

Aside, EM is 3-4 years.

 

[moisne]

rumors say some GS is going to 7 years. O_O

 

[Peach Newport]

Holy crap, a US MD with a 210 has a 65% chance of matching gensurg?

Meanwhile, a DO with a 240 has (anecdotally) a 50% chance.

Lol surgeons do NOT like DOs.

Then again I think like 5 people matched ortho with <210 last year so who knows.

 

[W19]

Holy crap, a US MD with a 210 has a 65% chance of matching gensurg?

Meanwhile, a DO with a 240 has (anecdotally) a 50% chance.

Lol surgeons do NOT like DOs.

Then again I think like 5 people matched ortho with <210 last year so who knows.

Where did you get the stats about DO?

We don't know the circumstances of the 5 people who matched ortho with <210 on step1. Anyone with a step1 <230 applying these ultra competitive specialties (e.g., ENT, ortho, neurosurgery, derm etc...) should always have a back up plan...

 

[Peach Newport]

Where did you get the stats about DO?

We don't know the circumstances of the 5 people who matched ortho with <210 on step1. Anyone with a step1 <230 applying these ultra competitive specialties (e.g., ENT, ortho, neurosurgery, derm etc...) should always have a back up plan...

Anecdotally means “have a high index of suspicion of the veracity of this statement.”

I was just so surprised that a USMD actually had a good chance of matching gensurg with a 210, and that ANYONE matched a surgical subspecialty with that score.