Medical Seeking Residency application advice: Derm applicant with low Step scores and a second choice being Surgery

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Raryn

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Dear experts,
I am in a sticky situation and I would love to get your honest advice!

I am a US MD/MPH candidate who is between MS3 and MS4 right now. I have been planning to apply to derm since 1st year. did a lot of research, have good mentors. But my step 1 score is not competitive for derm (Step 1 232). After step 1 I was told to do a research year and try to get a good score on step 2, and I'll have a lower but okay chance. So I worked very hard on step 2, however just recently (after I just started my derm research year) I got my score back and scored 20 pts lower than my practice tests predicted and got a 235. I have average grades and now with very average step 1/ below average step 2 I m worried that derm may not be realistic anymore. And since I can also see myself in surgery, despite the harder lifestyle, I am wondering if I should just give up on derm and try to maximize my chance with surgery for the rest of the research year. It's been a hard decision though because I ve done so much work for derm already that I feel like it's a pity to throw it all out.

Should I still apply for derm OR cut my losses and spend the rest of the years on research for surgery?

Heres more stats for your reference:

Things I have for derm:
1. 2 great mentors I can potentially get letters from
2. 13 publications so far (4-5 are chapters)
3. research year set up for derm
4. MPH degree

Cons: Step score/grades, alot of my research is in Mohs (i was told this is not favorably looked at by dermatologists)

Things I have for surgery:
1. maybe 4 publications (3 of which are book chapter that over lap w derm cause some of my work was in dermatologic surgery, 1 was pure surgery paper)
2. MPH degree
3. Extracurricular: president of woman in surgery group

Cons: only have 1 mentor I can ask for LOR, less research, scores also not great for surgery?

I would really appreciate any advice you can afford!
If we look at the 2020 Charting Outcomes for US Seniors, we see that of the 55 applicants who had a Step 1 Score between 231 and 240, 43 matched, for a match rate of about 78%. Unfortunately, it's worse for step 2 scores in the same range, with only 22 of 36 matching (61%). No data is given for whatever subset of applicants has similar scores for *both* tests.

The overwhelming majority of derm applicants had 5 or more Abstracts, Presentations, and Publications - and the mean number for a successfully matched applicant was *19* (which personally I find ridiculous, but it is what it is). I can't speak to the quality of either your publications or those, because of course the only thing reported is the numbers.

A non-PhD graduate degree did not seem particularly helpful, with 81% of people who had one matching as opposed to 86% of people who didn't have one.

At this point, I would probably estimate your chances at matching derm, on the standpoint of numbers alone, as closer to 50/50. That is - not zero - but not as high as you might like.

The problem is this - you can coapply and have surgery as a backup, but everything but the personal statement and the letters of rec must be the same for all programs you apply to. That is, your derm-focused activities would be front and center. You'd still be a fine candidate for a surgical program - but you may get fewer interviews coapplying because they'll see they're clearly a backup.

At this point, there's no 100% right or wrong answer here. Many people would go all in and see if they can be in that upper half and match derm. Others might cut their losses. What does your home derm PD say?
 
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Raryn

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First, Thank you so much for your analysis on my behalf and for your advice! I personally have not been in contact with our Derm PD (I've heard he is hard to get in contact with so I haven't yet tried), but I can try to reach him and get his take on it.

In terms of having both step scores in that lower range, I have that exact same concern. I m thinking most people who scored lower on one test probably got in because they had a high score in the other one to make up for it. I don't know if I an interpreting this correctly, but on the interactive charting outcome tool I plugged in stats and checked all of the applicants with the same stats and lower (especially with my Step 2 score and lower) and got this result, which, in combination with my step 1 score seems to suggest I have about a 30% chance? I'd love to get your thought on this.

View attachment 320332

Looking at that same tool, I'm getting numbers anywhere from 1/3 to 2/3 depending on what other inputs I put in.

But here's the other problem: We're talking about a fairly small sample size. Over 5 years of data, 56 people without a PhD and both a Step 1 AND Step 2 score between 230 and 239 applied to Dermatology. 39% of those 56 people matched.

Filter out those with <10 publications and the numbers are better - 67% of non-PhD applicants with scores in those range but 10+ publications matched. But that's 12 out of 18 people. Add "had another graduate degree" and your sample size is four people over 5 years (3 of them matched).

Your research experience is your strength, and I think that it probably puts you above the 30% mark, but not above the 60% mark. Of course, there's a million ways you can split the data and you can only apply once, so we'll never know your *actual* odds.

Oh, and one last point here: The data in charting outcomes is biased. Because to be included for any given specialty, you must actually get an interview in that field first and rank at least one program. So the people who get zero interviews aren't included, and for more marginal candidates, odds may very well be lower than what is actually listed. I don't think you're so marginal as to risk getting zero interviews, but that is a consideration.
 

Raryn

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Oh, and I just realized I forgot to set the most important filter: US senior applicants only. Surprisingly, it didn't make much of a difference.

non-PhD US senior applicants with both steps in the 230s had a 38% chance of matching - but it went up to 67% if you filtered to 10+ publications. Of course, that's 6/9 applicants over 5 years. If you add a filter to include only people with additional graduate degrees that's 100% - with a sample size n=1.
 

GoSpursGo

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Of course, that's 6/9 applicants over 5 years. If you add a filter to include only people with additional graduate degrees that's 100% - with a sample size n=1.
I'll add that there is another bias--the people who applied are likely the ones who received support from their home program; there are probably plenty of potential applicants who elected not to apply once they saw that their application was not competitive.

I think you need to talk with the PD at your home institution, or at least a mentor who knows something about the residency selection process. They can give you a much better critique which can help determine if your odds are closer to 60% or 30%.
 
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TheBoneDoctah

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I would also say that the people who match with sub-240 matched:

1. home program
2. connections

The two derm PDs I know don't even look at applicants under 240 and the programs are low-medium tier.

I guess you gotta check and see how much risk you can handle. If you REALLY want derm...I would still apply. The rest of your app looks good. You could also dual apply, but you really gotta sell loving general surgery and wear two hats which can feel awkward.
 

tantacles

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You certainly have a chance at derm. However, I don't think you need to specifically have surgery research to match into surgery. Either way, if applying to derm, I suggest you at the very least apply to some programs in a less competitive specialty, like internal medicine, given your step 1 score.
 
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GoSpursGo

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Thank you for your honest input. My home program is very very competitive. So I will likely not be able to stay. And Im a 1.5 generation immigrant so my family really have very little connections here. In terms of risks, I am generally a risk adverse person and I definitely want to make sure I match in the next cycle, derm or not. Taking this research year is already financially hard on my family and I personally also don't want to be one of those people who has to apply over multiple cycles. So I want to prioritize matching and maximize what I can achieve. So honestly if my chances with derm are marginal (in my head that's if I will only get 2-3 interviews) + not applying derm means I can get into a better surgery program otherwise I would be willing (because I do really like surgery and think I can make a fulfilling career out of it).
I see. Thank you so much for the perspective. I finally told my mentor about the low score today and asked him for his thoughts on talking to our home PD. Knowing our PD is very score-focused, he advised that I don't talk to him about it directly. But he said he will talk to him w/o mentioning my name to get an idea of what this would mean for me. So I guess i ll have to wait and see what he comes back with.
Honestly, this is what is meant by "connections"--of course it's nice if Daddy Warbucks knows some bigwigs, but a big part of the currency in academic medicine is who your mentor is, how much they are willing to vouch for you, and how much pull they have.

Ordinarily, I recommend against dual-applying because I think it really handicaps you--all of the time you spend getting LORs in surgery and at least making it appear that you're "equally interested" in surgery is energy that could be spent maximizing your chances for derm. And if you wind up not matching, the prospect of re-applying the next year to a less competitive specialty isn't the end of the world, and at least you would know you "gave it your all" to your preferred specialty.

In your case, having already done a research year, being in a difficult spot financially to support re-applying, and not having a friendly home program... I think you're in a tough, tough spot. You're definitely competitive enough where it's not crazy to apply to derm, but there is undeniable risk.
 

TheBoneDoctah

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Thank you, I agree and I understand the chance would be slim. I guess Im trying to figure out how slim... I am not the "it can only be derm" type. Surgery is actually a very close second choice for me. It's just that I have done so much in derm that I feel like if I can just get ~ 5 interviews (with the help of my mentor), then it'd be worth it for me to give it a try and not have everything I've done be wasted. I feel like it's a privilege that I can even consider derm a choice (albeit a very risky one).

I actually also just heard back from my mentor and he said the PD from our home program said something along the lines of suggesting I should apply to the least competitive programs and try my luck. (which I was gonna do any way so thats not that helpful). I m guessing that means they def wouldn't take me? My mentor was saying that he is optimistic that step scores will start to hold less weight with step 1 becoming P/F and I think he likes me enough that he would be willing to vouch for me, but I don't know how much he is capable of in terms of helping me get interviews. His past fellows all had stellar scores so though they matched well, they were probably less dependent on him.
Give it a shot then!
 
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