Second Try for Psychiatry

[psyqe21]

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DO Applicant - I applied to psychiatry this year: low board scores (but passed on first attempts, only COMLEX); low preclinical grades with one remediation; excellent third/fourth year performance; strong personal statement; no gaps or other red flags). I did not get any interviews save for two which were afforded through connections, but both programs ranked me pretty low. I applied to 60 programs.

Through the SOAP, I matched into a transitional year in a program that does not itself have psychiatry rotations available, but otherwise has a good mix of specialties I will rotate through.

Is this the right way to go about trying to go for psychiatry next cycle? Can I apply to PGY 2 position in psychiatry after applying more broadly, getting new letters of recommendation, and passing my step 3?

Any advice would be greatly appreciated. My dream has been to match into psychiatry. My application had psychiatry oozing from the seams - somehow the transitional year program that doesn't have any psychiatry was the only program that took me in.

 

[futuredo32]

You can and you may get lucky. I didn't match year one, I could only apply to 2 programs because I was the primary caregiver or my Grandma who needed 24/7 care and needed relatives to help while I would be gone. Year 2 I only had the same two programs to apply to, I did apply for a few TRIs and matched into one. Year 3 I matched into psych. I switched psych residency programs after my second year of the psych residency because our PD quit and negative changes were made. The program I switched into actually needed a PGY3 because they had a PGY2 who didn't pass step 3. People leave from psych for another field or they do have open spots because people transfer to other programs like I did or people leave after PGY3 to do child. Apply and see what happens. Just doing a transitional year and doing it well looks good. Congrats on matching into something. If you start as a PGY1 in psych next year, you learned a lot of medicine. I am grateful for my TRI.

 

[solitarius]

I am sorry you didn´t match. You should target programs with a lot of FMGs and DOs among the senior residents. Programs that recently entered the match. On the interview trail, I met successful reapplicants with a huge dose of humility.

SOAP is preferable for most applicants and frankly it should be considered the backup plan as opposed to a transitional year.

For future applicants who do not match, I would recommend the following:
1. SOAP into open psych positions regardless if it´s a community/corporate sweatshop
2. If you are on the cusp of competitiveness and have access to research faculty with likelihood of publications, SOAP into transitional year and do research remotely and re-apply into Psych.
3. If you are not on the cusp of competitiveness, SOAP into primary care.

 

[J ROD]

You are on the right track but many of those second year spots are fairly competitive. Just be prepared to consider family medicine as well.

 

[psyqe21]

Thank you all for the help and guidance. My TY program does not have psychiatry rotations, and was pretty firm in informing me on that. Provided I do well during my residency, does a TY make me a stronger applicant in the next cycle? I would not mind matching as a PGY 1 next cycle; it's ideal if I match PGY 2, but I'm in no position to be picky. Spending the extra year in the broad scheme of my desired career is nothing, and I want to become a more capable physician. I need all the training I can get.

 

[aim-agm]

Thank you all for the help and guidance. My TY program does not have psychiatry rotations, and was pretty firm in informing me on that.

If you can swing Neurology rotations (the more the better, up to two months) that would be helpful to your app.

 

[Merovinge]

Thank you all for the help and guidance. My TY program does not have psychiatry rotations, and was pretty firm in informing me on that. Provided I do well during my residency, does a TY make me a stronger applicant in the next cycle? I would not mind matching as a PGY 1 next cycle; it's ideal if I match PGY 2, but I'm in no position to be picky. Spending the extra year in the broad scheme of my desired career is nothing, and I want to become a more capable physician. I need all the training I can get.

As above, it's basically a hustle and try to use connections based game from here. The more people you talk to, the more doors you bang on (respectfully) the better your chances. Of course, doing well as an intern, crushing step 3, research would all help, but you are talking about very low N if the goal is a PGY2 spot. If you can get a PGY-1 spot I would just view it as a reverse fellowship 🙂.

 

[psyqe21]

If you can swing Neurology rotations (the more the better, up to two months) that would be helpful to your app.

My program does have outpatient neurology electives. I'll definitely try to get that.

As above, it's basically a hustle and try to use connections based game from here. The more people you talk to, the more doors you bang on (respectfully) the better your chances. Of course, doing well as an intern, crushing step 3, research would all help, but you are talking about very low N if the goal is a PGY2 spot. If you can get a PGY-1 spot I would just view it as a reverse fellowship 🙂.

That's a really good way of looking at it. I would be happy with a PGY 1 spot!

 

[vistaril]

Something isn't adding up. I know being a DO is a disadvantage especially with low grades/scores, but if no major red flags beyond just low grades preclinical years and low but passing scores you should have matched somewhere.

Something just isn't adding up. It's been awhile since I was a resident, but it certainly wasn't a competitive field then and based on what I see coming through the pipeline these days that certainly hasn't changed.

Good luck, but I suspect there are problems with the way you are just coming across as a person. because on paper if you applied to that many places it doesnt make a lot of sense....

 

[Sunde]

Something isn't adding up. I know being a DO is a disadvantage especially with low grades/scores, but if no major red flags beyond just low grades preclinical years and low but passing scores you should have matched somewhere.

Something just isn't adding up. It's been awhile since I was a resident, but it certainly wasn't a competitive field then and based on what I see coming through the pipeline these days that certainly hasn't changed.

Good luck, but I suspect there are problems with the way you are just coming across as a person. because on paper if you applied to that many places it doesnt make a lot of sense....

I agree. There has to be something else going on to get only 2 interviews.

@psyqe21 , did you apply late? Non-US citizen?

 

[psyqe21]

Something isn't adding up. I know being a DO is a disadvantage especially with low grades/scores, but if no major red flags beyond just low grades preclinical years and low but passing scores you should have matched somewhere.

Something just isn't adding up. It's been awhile since I was a resident, but it certainly wasn't a competitive field then and based on what I see coming through the pipeline these days that certainly hasn't changed.

Good luck, but I suspect there are problems with the way you are just coming across as a person. because on paper if you applied to that many places it doesnt make a lot of sense....

Psychiatry wasn't this competitive up until these past two years in particular. I was hearing about this, but I did not believe it until going through this cycle myself. One of the programs I got an interview at had somewhere around 4-6 spots, and apparently 20+ students from their own institution applied to psychiatry, with a majority wanting to stay local. The PD said she never saw that many applicants for psychiatry before from their institution (usually it was around 5). These were MD students, also, with very strong scores. One of them had a Step 1 of 260+ (absolutely amazing). I think my problems, in addition to low academic performance, was lacking any research experience or any good extracurriculars, coupled with not applying broader than what I did. My third and fourth years were really good, and I had excellent evaluations from all my preceptors.

The only two interviews I got were through family connections (my parents are both physicians and were able to swing them). I think coming across poorly as a person would certainly be a possibility, but I didn't receive any interviews other than those two and they are all afforded to applicants using only what's on paper. I failed one class and remediated, and had borderline passing Level 1 board score. All this being said, it may very well be personality-related - but trying to be as unbiased as possible, I genuinely don't believe that's the issue. My first draft for my personal statement did have this tone of almost arrogance (which I didn't intend). Thankfully, I was able to rewrite it in the proper tone. After two revisions, I felt confident about it. When I reached out to the program I really wanted to match into (one of the two where I received interviews because my family members are physicians there), one of the program heads asked me to send it to her, along with my CV. She said my PS was perfect and was exactly what they were looking for.

I wish I did have something more concrete that I could point to and say "Aha, that's where I went wrong." Then perhaps I could correct it more easily.

I agree. There has to be something else going on to get only 2 interviews.

@psyqe21 , did you apply late? Non-US citizen?

I am a US applicant and I applied at that earliest possible time. I also have been scratching my head for the past several months, thinking certainly something must be terribly wrong with my application. But I asked my school about this, and they reviewed my application and said there was nothing they could see. They only told me that psychiatry has become quite competitive, so they believe my low boards was a factor, plus not taking USMLE and only taking COMLEX. I am not of American heritage, and the reason I mention this is because my last name is not very commonly heard, and coincidently, my psychiatry preceptor where I did my third year had the same last name. I have even suspected that programs may have thought this letter came from a family member and not an unrelated preceptor who just so happens to share my last name. That's how far I've gone to wonder what's wrong. I am sure something is wrong, but I haven't been able to find it.

Had I received more interviews and then came off with a poor disposition, I would be more inclined to suspect it's how I came off as a person. But you can essentially say I got 0 interviews because the only two I got were through my family connections.

Another thing I thought of was while I got some interview calls during the SOAP, one asked about my LoRs. He said based on the LoRs he didn't know what I wanted to do, because one was from Ob/Gyn, one from FM, one from IM, and one from psych. I got my letters from preceptors from the required rotations we had to take during third year and wanted to show my well-roundedness. By the time I had to apply, I had only finished my required rotations and wasn't even able to do electives, so I had to get letters from doctors who I rotated with. Since I waived my right to see the letters, I am unsure if they were poorly directed regarding my professional interest. I did tell them I wanted to do psychiatry, and I suspect they know how to write letters as they had been doing so for a long time. I am otherwise at a loss of understanding.

 

[CalmAndCollected]

Psychiatry wasn't this competitive up until these past two years in particular. I was hearing about this, but I did not believe it until going through this cycle myself. One of the programs I got an interview at had somewhere around 4-6 spots, and apparently 20+ students from their own institution applied to psychiatry, with a majority wanting to stay local. The PD said she never saw that many applicants for psychiatry before from their institution (usually it was around 5). These were MD students, also, with very strong scores. One of them had a Step 1 of 260+ (absolutely amazing). I think my problems, in addition to low academic performance, was lacking any research experience or any good extracurriculars, coupled with not applying broader than what I did. My third and fourth years were really good, and I had excellent evaluations from all my preceptors.

The only two interviews I got were through family connections (my parents are both physicians and were able to swing them). I think coming across poorly as a person would certainly be a possibility, but I didn't receive any interviews other than those two and they are all afforded to applicants using only what's on paper. I failed one class and remediated, and had borderline passing Level 1 board score. All this being said, it may very well be personality-related - but trying to be as unbiased as possible, I genuinely don't believe that's the issue. My first draft for my personal statement did have this tone of almost arrogance (which I didn't intend). Thankfully, I was able to rewrite it in the proper tone. After two revisions, I felt confident about it. When I reached out to the program I really wanted to match into (one of the two where I received interviews because my family members are physicians there), one of the program heads asked me to send it to her, along with my CV. She said my PS was perfect and was exactly what they were looking for.

I wish I did have something more concrete that I could point to and say "Aha, that's where I went wrong." Then perhaps I could correct it more easily.



I am a US applicant and I applied at that earliest possible time. I also have been scratching my head for the past several months, thinking certainly something must be terribly wrong with my application. But I asked my school about this, and they reviewed my application and said there was nothing they could see. They only told me that psychiatry has become quite competitive, so they believe my low boards was a factor, plus not taking USMLE and only taking COMLEX. I am not of American heritage, and the reason I mention this is because my last name is not very commonly heard, and coincidently, my psychiatry preceptor where I did my third year had the same last name. I have even suspected that programs may have thought this letter came from a family member and not an unrelated preceptor who just so happens to share my last name. That's how far I've gone to wonder what's wrong. I am sure something is wrong, but I haven't been able to find it.

Had I received more interviews and then came off with a poor disposition, I would be more inclined to suspect it's how I came off as a person. But you can essentially say I got 0 interviews because the only two I got were through my family connections.

Another thing I thought of was while I got some interview calls during the SOAP, one asked about my LoRs. He said based on the LoRs he didn't know what I wanted to do, because one was from Ob/Gyn, one from FM, one from IM, and one from psych. I got my letters from preceptors from the required rotations we had to take during third year and wanted to show my well-roundedness. By the time I had to apply, I had only finished my required rotations and wasn't even able to do electives, so I had to get letters from doctors who I rotated with. Since I waived my right to see the letters, I am unsure if they were poorly directed regarding my professional interest. I did tell them I wanted to do psychiatry, and I suspect they know how to write letters as they had been doing so for a long time. I am otherwise at a loss of understanding.

I feel like your letters or personal statement might have been the issue here.

I think psychiatry programs value commitment to the specialty a lot more than other specialties, partially because it is a difficult patient population that requires a lot of patience, but also because it was historically a back-up specialty. Now, with people going into psych more for the lifestyle, I can see many programs being concerned that they are getting people who are going in because psych is "easy" or "less busy" rather than true interest in the psychiatry.

General advice I received was to write a personal statement that does a good job to show your interest in psychiatry as well as to have three letters from psychiatrists plus one letter from an IM or FM. I ended up with four psychiatrist letters instead.

I would suggest you increase your amount of psych letters as much as you can and try to have them be with people who are open to talking to you about how to best write it.

It might also be a good idea to reach out to programs before interview season to talk about transferring as a PGY1 or PGY2. There are many PGY2 positions available, both through unexpected openings (Psychiatry Residency Training Program Vacancies) as well as through programs that offer PGY2 positions off the bat (like Yale and UW).

 

[kopftonmd]

General advice I received was to write a personal statement that does a good job to show your interest in psychiatry as well as to have three letters from psychiatrists plus one letter from an IM or FM. I ended up with four psychiatrist letters instead.

Wow three psych letters? At my school they made it sound like 2 psych letters, one IM/peds/FM, and one research (if we do that).

 

[PepDr]

@psyqe21 , just wanted to post and say you are not alone. I am basically the same situation academically-- applied with low (but first pass) COMLEX scores, lower preclinical grades w/o remediations, and good clinical evaluations. I also had consistent psych volunteering during med school, some research poster presentations, and national leadership experience in a student org. I got 6 interviews, didn't match, and scrambled into a transitional year.

Best of luck re-applying! Hopefully we both end up in Psych this time next year 🙂

 

[samac]

General advice I received was to write a personal statement that does a good job to show your interest in psychiatry as well as to have three letters from psychiatrists plus one letter from an IM or FM. I ended up with four psychiatrist letters instead.

I would suggest you increase your amount of psych letters as much as you can and try to have them be with people who are open to talking to you about how to best write it.

I had 1 psych letter, 1 FM, 1 Peds and the department chair (who was actually a family med doc. Yay DO school) and matched no problem. I had it brought up in an interview that they liked the diversity represented in my letters.

I am so sorry this happened to you, and you @PepDr
I hope it works out better for you both this round. Seems like you guys just slipped through the cracks.

 

[BiscoDisco]

Happy to review and/or critique a personal statement. I believe myself to be a pretty good writer (and have been told as such on the interview trail) and think my PS was one of the strongest points of my app. Happy to do whatever I can to help you out the second go around.

 

[Stagg737]

Something isn't adding up. I know being a DO is a disadvantage especially with low grades/scores, but if no major red flags beyond just low grades preclinical years and low but passing scores you should have matched somewhere.

Something just isn't adding up. It's been awhile since I was a resident, but it certainly wasn't a competitive field then and based on what I see coming through the pipeline these days that certainly hasn't changed.

Good luck, but I suspect there are problems with the way you are just coming across as a person. because on paper if you applied to that many places it doesnt make a lot of sense....

Psych has changed quite a bit in the past 5-10 years in terms of applying. If for no other reason, solely due to volume of applicants. Had a fellow interviewee tell me they had talked to the PD about the process and PD said that 2-3 years ago almost all of their applicants were FMGs and IMGs. They told the applicant that the previous cycle had been 75% US MDs, and less than 10% of applicants were from schools outside the US. Idk how true this is across the board, but it is also true for my program (mostly USMDs at my interview dinners, and all of the matching class are US MDs with a couple of local DOs). DOs often fall into the same category as FMG/IMG at mid to top tier programs and if you check the forums there are many similar stories to OP's. Psych is not a highly competitive field, but it's certainly not a sure match anymore either.

OP may have also just applied to too many reach programs or not applied wisely geographically. They may be coming from one of the less reputable DO schools, which may have automatically excluded them at some programs. They could have just gotten unlucky.

The only two interviews I got were through family connections (my parents are both physicians and were able to swing them). I think coming across poorly as a person would certainly be a possibility, but I didn't receive any interviews other than those two and they are all afforded to applicants using only what's on paper. I failed one class and remediated, and had borderline passing Level 1 board score. All this being said, it may very well be personality-related - but trying to be as unbiased as possible, I genuinely don't believe that's the issue. My first draft for my personal statement did have this tone of almost arrogance (which I didn't intend). Thankfully, I was able to rewrite it in the proper tone. After two revisions, I felt confident about it. When I reached out to the program I really wanted to match into (one of the two where I received interviews because my family members are physicians there), one of the program heads asked me to send it to her, along with my CV. She said my PS was perfect and was exactly what they were looking for.

So addressing the bolded for a second, the first one would raise the question of how independent/motivated are you? You had poor pre-clinical grades and the only interviews you got were because of parental connections. Programs may have seen something which made them question whether you'd have the appropriate work-ethic and attitude to be successful. The second bolded portion also raises questions. The fact that you were able to notice that the initial tone of your PS was inappropriate may mean there were other parts of your app that came off that way without you realizing it. There may have also been things mentioned in LORs that may not have sat right and played a role. Were you able to read any of the LORs? Many applicants think they have great LORs when in reality they're not. It's difficult to actually know their quality without reading them unless an interviewer comments on it, so that may be another point to consider.

Not saying that any of the above is legitimately true for you, but what is actually true doesn't really matter as it's the perception of you that will go into deciding your fate (end dramatic statement).

Some general advice:
Apply broadly but also in a targeted manner. In other words, apply to many programs but have a reason you're applying to them. Are they geographically in an area you want to be and can you express that clearly in your app/interview? Do they accept people from your area/school/degree type? Are they looking for a specific type of candidate (minority? IMG? research stud? etc)? Make sure you can be seen as a fit there before just taking a shotgun application approach.

Get more psych LORs. I disagree that you need 3 or 4, but certainly more than 1. This is the field your passionate about, you should have more people in your corner going into it than just one. Your letters also need to be strong(er at this point). You know you're lacking in several areas of your application, so make sure other areas stand out positively. Along the same lines, don't highlight your weaknesses but don't hide them either, be able to openly discuss them and talk about how you have either fixed that problem or how you are continuing to address it to ensure you'll be successful going forward. Passing Level 3 with a decent score will likely alleviate fears about the previous poor board scores, so just get it done.

Have a few people who are brutally honest read your PS. Different people have different opinions, but if you start seeing a trend in something they're all picking up on then that should be a big red flag for you. Do the same thing with mock-interviews. Most people think they're better at interviews than they actually are and have poor self-awareness about them. Hire a company if you need to, it'll be worth it if it's the thing that gets you into the program you want (or any in your case).

Finally, start trying to make connections for next year now. Intern year is busy and you may be under a lot of stress with not enough time to really reach out to as many psych programs as you want. I think now is a bit of a lull for most program coordinators/PDs, so send out some feelers (but don't be obnoxious) about what you can do to improve your chances at programs you really want to go to.

 

[aim-agm]

As someone who was in a similar spot, another piece of advice: you have to impress your PD. Getting an LoR from them is an absolute requirement and programs will want to talk to them. Pretty much every PGY2 spot I applied to this year wanted to talk to my PD, often times as a prerequisite for offering an interview. Reading between the lines, even though I was a very strong candidate it was vital to getting a psych spot that my PD is a strong advocate.

The sole advantage you have going into this coming cycle is the opportunity to definitively prove you are a good resident. You have to capitalize on that.

 

[MacDonaldTriad]

Of course PDs will want to speak to your current PD before offering an interview. It would be negligent not to check references and your current employer is an obvious one.

 

[aim-agm]

Of course PDs will want to speak to your current PD before offering an interview. It would be negligent not to check references and your current employer is an obvious one.

I just didn't see it mentioned earlier in the thread and it's an aspect of the reapplication process that is important to be cognizant of.