Should I give up on becoming a physician???

[psychMDhopefully]

So long story short, I am a US md student that has failed Step 1 3 times, the last time by one point, my score was 191 and passing was 192. I go back and forth between giving up completely and asking my school to let me retake it a 4th time. I've only ever wanted FM ,maybe community IM, or Psych. Honestly if I didn't miss this damn test by 1 point I would shamelessly withdraw, but I know IMGS who have taken the test up to 5 times and they are here practicing in the US. Given the amount of debt I have, and the fact that I am a US MD, I think my school should allow me to stay enrolled until I retake, what do they have to lose???

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[UTsksk]

What do you think is causing you not to do well?

 

[Merely]

How much debt do you have? Is English your primary language? Why do you keep failing? If you memorize first aid at a minimum you are guaranteed to pass. Do you have a learning disability? Do you have a way to pay off your loans without becoming a doctor? These are questions you need to answer before any others

 

[togaedere]

i think the answer to your question depends on if your school is supporting you and if they think you have a reasonable shot at obtaining a residency. there are people with failures who match, but with more failures there are states that will no longer provide you with a license past a certain threshold. not all states, but some, put limits on how many attempts you make at step 1, and if your home state is one of these your chances may be pretty low. i recommend talking with your school if they would support a fourth attempt.

this site has the lowdown on what the states will require for licensure -- good luck!

Federation of State Medical Boards

So long story short, I am a US md student that has failed Step 1 3 times, the last time by one point, my score was 191 and passing was 192. I go back and forth between giving up completely and asking my school to let me retake it a 4th time. I've only ever wanted FM ,maybe community IM, or Psych. Honestly if I didn't miss this damn test by 1 point I would shamelessly withdraw, but I know IMGS who have taken the test up to 5 times and they are here practicing in the US. Given the amount of debt I have, and the fact that I am a US MD, I think my school should allow me to stay enrolled until I retake, what do they have to lose???

 

[psychMDhopefully]

How much debt do you have? Is English your primary language? Why do you keep failing? If you memorize first aid at a minimum you are guaranteed to pass. Do you have a learning disability? Do you have a way to pay off your loans without becoming a doctor? These are questions you need to answer before any others

about 200k in debt

Yes English is my primary language

I'm not sure if I have a learning disability, but is it normal to be able to memorize 750 pages of an 800 page book??? I will say this, my first 2 scores were 165, 170, then I started getting treated for ADHD about 5weeks before the test and got 191.

I'm very poor and community I'm from has very VERY limited opportunity for work, so no I couldn't pay off the loans without a high paying job, I've been thinking about applying to Anesthesia Assistant school if this thing does not work out.


Lastly why do I keep doing so poorly? honestly, I think it has something to do with memory, starting off with weak knowledge base, and the questions on the real test being confusing BS gottcha questions. I'm just not good at those types of questions and Uworld and the NBMEs don't replicate those types of questions. ONLY NBME 18 and 19 come close to the ridiculousness that is Step 1. I have improved my knowledge base dramatically, and I think given a little more time I could pass Step 1.

 

[psychMDhopefully]

i think the answer to your question depends on if your school is supporting you and if they think you have a reasonable shot at obtaining a residency. there are people with failures who match, but with more failures there are states that will no longer provide you with a license past a certain threshold. not all states, but some, put limits on how many attempts you make at step 1, and if your home state is one of these your chances may be pretty low. i recommend talking with your school if they would support a fourth attempt.

this site has the lowdown on what the states will require for licensure -- good luck!

Federation of State Medical Boards

Yeah I'm in one of the states that only allow 3 failures, I've looked at this and I would be able to practice in 26 states plus DC if I were to pass the 4th time. I guess, if your state is one of the states that only allow so many attempts, when you go past those attempts, they say " Well, we wouldn't be able to give him a residency if nobody else did , so may as well dismiss him" but I'm just speculating , I don't know how that works.

 

[ThoracicGuy]

Yeah I'm in one of the states that only allow 3 failures, I've looked at this and I would be able to practice in 26 states plus DC if I were to pass the 4th time. I guess, if your state is one of the states that only allow so many attempts, when you go past those attempts, they say " Well, we wouldn't be able to give him a residency if nobody else did , so may as well dismiss him" but I'm just speculating , I don't know how that works.

Just an FYI, sometimes state medical boards will waive the step number requirement if you have been licensed in another state and board certified, sometimes for a period of years.

 

[VanDiemen]

Since you are a USMD, I would say that you should absolutely NOT GIVE UP on being a physician. But you have to understand that whatever the hell you have been doing has not been working.

The Step 1 exam is NOT that difficult to pass. Getting a 240+? That can be tough. But I knew some people in med school who were doing terribly during MS1 and 2, yet still passed on their first attempt.

You should look into resources that your fellow students used. Try out different things to see what can help you memorize. Some people use drawing pictures, others retain info from patient vignettes, etc. There is a product out there for every type of learner. DO NOT just do more of the same. It is obviously not working. Experiment with different resources, try to get at least 3 months of study time, and don't let this test intimidate you. Just keep thinking positive. A lot of students psyche themselves out.

 

[psychMDhopefully]

Since you are a USMD, I would say that you should absolutely NOT GIVE UP on being a physician. But you have to understand that whatever the hell you have been doing has not been working.

The Step 1 exam is NOT that difficult to pass. Getting a 240+? That can be tough. But I knew some people in med school who were doing terribly during MS1 and 2, yet still passed on their first attempt.

You should look into resources that your fellow students used. Try out different things to see what can help you memorize. Some people use drawing pictures, others retain info from patient vignettes, etc. There is a product out there for every type of learner. DO NOT just do more of the same. It is obviously not working. Experiment with different resources, try to get at least 3 months of study time, and don't let this test intimidate you. Just keep thinking positive. A lot of students psyche themselves out.

Yeah I mean I don't get how someone would struggle the first 2 years, where the exams were a lot smaller and you knew the material that was going to be tested, then do well on an exam that is comprehensive over the first 2 years of med school. I honestly wonder if I have a problem with memory decay, but I never have before, maybe I have a problem with effectively memorizing, though I never have before. I came real close to passing the third time when I could actually focus, but not good enough.

 

[Crayola227]

Yeah I'm in one of the states that only allow 3 failures, I've looked at this and I would be able to practice in 26 states plus DC if I were to pass the 4th time. I guess, if your state is one of the states that only allow so many attempts, when you go past those attempts, they say " Well, we wouldn't be able to give him a residency if nobody else did , so may as well dismiss him" but I'm just speculating , I don't know how that works.

Also it doesn't matter if the state your medical school is in would not grant you a license for the number of attempts you have made. You need the medical school to give you an MD/DO and then you would just apply for residency in another state. Most students do not stay at their institution on average (some schools many might in some specialties, I digress) or even their state for residency. Residency is a regional game, most stay in the same region of the country, there are factors on the applicant and the program side that favor this but it is also not a rule, plenty of people go cross country.

Fact is, if you are not at ALL picky about what specialty or where, and you can pass this damn test on your 4th time, and you do well in clerkships and get good LORs (so much of that is likeability, I swear to God, and my sense is you are), I think you can be a practicing doctor and do fine.

Step 1 horror stories and comebacks abound, truly.

I can't speak for you, but I would take the damn thing until someone stopped me.

I'm not sure what went into prep for the other attempts. It's not unheard of for someone to take a gap YEAR to study for the damn thing. That's up to the school, and I certainly can't recommend any gaps in training in general, but my point is that while I would continue to take the steps, with a very tiny window of attempts left I would throw everything at the last one.

I have written posts on Step 1 and lifestyle recs, but I'll spare you by boiling it down to two things: you have to know yourself. Exactly how you actually work, your weaknesses, and how to work around them. And the test. Gotta game the test. If I needed to see a learning specialist and go through 2 weeks of intensive neuropsychiatric testing etc etc, get accommodations, take legally prescribed drugs - trials after trials of cocktails if needed to find a magic bullet - I would do that.

My next post I might talk about various medical conditions and the dramatic difference treatment can make on test scores. Like miraculous.

I think you can do this. I don't know if the school will let you. I don't know if you'll get all the things together to get the souffle to rise. But I have total faith in you if these variables are maximized. No one makes it this far and gets this close that can't do it under the right circumstances.

 

[Crayola227]

Not medical advice, statement of a general truth, many times it's anxiety, attention deficit issues, processing, sleep, the list goes on. Usually one or the other or a combo.

Have you been fully evaluated by a neuropsychiatrist? A friend of mine went to one and was surprised to discover that they had some weird visual processing deficit in one eye from a childhood vision issue that resolved but left residual effects. It didn't have a huge impact but it did have a measurable impact on some of the testing times to where it showed up. Just saying, you can be surprised what is holding you back that you might not be aware of if you don't evaluate for it.

They also had a sleep study and discovered that they didn't have ADHD, they had sleep apnea 2/2 some crazy adenoids. They had surgery, slept like never before in their life, and got off ADHD meds and did better than ever.

Leave no stone unturned.

 

[NotAProgDirector]

It will all depend upon your school's policies. That should be your next step, reviewing them. Whether or not you'd make an OK doctor is beside the point, unfortunately. The their policies state that students are dismissed if they fail 3 times, you'll likely end up dismissed. You can try to appeal based upon your improved performance. Arguments that "others have succeeded" or "I have lots of debt" won't matter much.

 

[Crayola227]

It will all depend upon your school's policies. That should be your next step, reviewing them. Whether or not you'd make an OK doctor is beside the point, unfortunately. The their policies state that students are dismissed if they fail 3 times, you'll likely end up dismissed. You can try to appeal based upon your improved performance. Arguments that "others have succeeded" or "I have lots of debt" won't matter much.

I think you're missing the point.

It's a given that the student must have the school's blessing in order to stay enrolled, and that additionally they need the school's blessing to sign up to sit for the Step.
What wasn't a given was whether the student should bother to try to obtain it, and then to take the step.

 

[Osminog]

What was your MCAT score?

 

[AdmiralChz]

It will all depend upon your school's policies. That should be your next step, reviewing them. Whether or not you'd make an OK doctor is beside the point, unfortunately. The their policies state that students are dismissed if they fail 3 times, you'll likely end up dismissed. You can try to appeal based upon your improved performance. Arguments that "others have succeeded" or "I have lots of debt" won't matter much.

Very good point. My school required remedial work (usually, repeat 2nd year) with two failures and didn’t allow people to continue after a 3rd. After a 1st failure they poured a ton of effort into getting you to pass, so i don’t know if this was ever enforced.

If you think you have some sort of a disability, you can apply for non-standardized testing administration for your USMLEs and most specialty boards allow for it as well. That being said, a special marker on your transcript comes up so you’ll need to convince residencies/employers that you can do the clinical work as there aren’t many special allowances in real life.

 

[psychMDhopefully]

It will all depend upon your school's policies. That should be your next step, reviewing them. Whether or not you'd make an OK doctor is beside the point, unfortunately. The their policies state that students are dismissed if they fail 3 times, you'll likely end up dismissed. .

They make exceptions to their policies, I've had experience with that.

 

[WingedOx]

If you think you have some sort of a disability, you can apply for non-standardized testing administration for your USMLEs and most specialty boards allow for it as well. That being said, a special marker on your transcript comes up so you’ll need to convince residencies/employers that you can do the clinical work as there aren’t many special allowances in real life.

As someone who once treated a med student who got an approval for extended time on Step 1, let me tell you that these accommodations are NOT easy to get approved.

 

[singasongofjoy]

I'm clearly not familiar with the STEP, but for students in psychology who are studying for EPPP and similar, you often hear that the best way to learn something is to teach it to someone else, and I do think that's true, because if you're trying to teach it to someone else you're having to recall, present, and process in several different ways, and having to present it without the text in front of you makes you realize wehre the gaps in your memory are. Takes longer to study this way, but my partner and my cats sure learned a lot about psych that they never wanted to know and I went thorugh a lot of chart paper and markers, but it most certainly helps me to learn. Throughout grad school I had a couple of friends with whom I would take turns teaching material as our method of studying. For me it also keeps me more engaged; I have a hard time keeping my mind focused if I'm just reading a book or listening to audio. Might be worth a shot if you think knowledge base / recall is still part of the problem, since clearly you need to try something differently.

 

[Shikima]

Go for it and attend a licensing review course. In for a penny, in for a pound. You've sold your soul to guido and gotta stick with it.

 

[rokshana]

about 200k in debt

Yes English is my primary language

I'm not sure if I have a learning disability, but is it normal to be able to memorize 750 pages of an 800 page book??? I will say this, my first 2 scores were 165, 170, then I started getting treated for ADHD about 5weeks before the test and got 191.

I'm very poor and community I'm from has very VERY limited opportunity for work, so no I couldn't pay off the loans without a high paying job, I've been thinking about applying to Anesthesia Assistant school if this thing does not work out.


Lastly why do I keep doing so poorly? honestly, I think it has something to do with memory, starting off with weak knowledge base, and the questions on the real test being confusing BS gottcha questions. I'm just not good at those types of questions and Uworld and the NBMEs don't replicate those types of questions. ONLY NBME 18 and 19 come close to the ridiculousness that is Step 1. I have improved my knowledge base dramatically, and I think given a little more time I could pass Step 1.

Have you taken a review course or are you just trying to study on your own...the pass program is very good for those that have failed step 1.

 

[AdmiralChz]

As someone who once treated a med student who got an approval for extended time on Step 1, let me tell you that these accommodations are NOT easy to get approved.

Maybe, but what else does OP really have to lose here?

 

[GoSpursGo]

If you are allowed to stay enrolled, I think by all means you should try to take the test again. After 4 years of pre-med, 2 years of med school and 3 step attempts and failing by only one point, trying a fourth time seems like a pretty small step to take.

Whether your school will let you keep trying or not is the question, and honestly it may come down to how charitable your dean feels. You are going to be at risk for failures on future step exams as well as specialty board exams, so your school might justifiably say they don't want to invest the resources of your third and fourth years with the clinical rotations into someone who may not manage to become a board certified physician at the end. So unless you are best friends with your dean, you need to go into your meeting with him or her with a good argument for what went wrong the first three times and what you will do to change the outcome this time and for future testing experiences.

 

[WingedOx]

Maybe, but what else does OP really have to lose here?

If he's going to do it, best to do it right and not waste further time and effort expecting he'd be able to get this approved on his own. A regular ol' letter from a psychiatrist probably won't cut it (probably because we're asked to write so many BS ones, sadly). My patient had to find some attorney in Brooklyn (I'm in Chicago) who specializes in dealing with the NBME to get it done, and it still was quite the hassle and required quite a bit of additional documentation from me.

 

[Crayola227]

Not sure why it's only now that fear of success occurs to me....

Is there some part of you that really truly doesn't want to become a physician? But doesn't know how else to let yourself off the hook?

No judgement here - I don't assume that is the case, because I get that you are hurt and working very hard, and I'm talking crazy talk.

Still, I think it makes sense to hold council with yourself over whether or not this is something you truly want, aside from the question of whether or not you can achieve it.

We all experience varying degrees of ambivalence and approach/avoidance conflict, and sometimes fear of success is just as powerful as fear of failure, just less talked about. Not a bad one to look up.

 

[psychMDhopefully]

Not sure why it's only now that fear of success occurs to me....

Is there some part of you that really truly doesn't want to become a physician? But doesn't know how else to let yourself off the hook?

No judgement here - I don't assume that is the case, because I get that you are hurt and working very hard, and I'm talking crazy talk.

Still, I think it makes sense to hold council with yourself over whether or not this is something you truly want, aside from the question of whether or not you can achieve it.

We all experience varying degrees of ambivalence and approach/avoidance conflict, and sometimes fear of success is just as powerful as fear of failure, just less talked about. Not a bad one to look up.

I think like most med students, I started off with some imposter syndrome, if I really didn’t want to do this, I would probably have subconsciously knocked myself out of the game way before now. I did not fail any classes the first 2 years but there were times that were hard where I could have justified quitting before I racked up so much debt. I'm pretty sure I really want to do this, having done research and an early preceptorship in psychiatry, psychiatry is something that I would love to do and could do passionately, but in order to be a psychiatrist I have to get pass Step 1 of course.



Edit: And for the pre-med guy that asked what my MCAT Score was, it was 29, but the MCAT and Step 1 are 2 completely different tests. The MCAT is like “given this information, can you analyze it and come up with an answer?” Step 1 is like “ given this information, can you remember that obscure enzyme that you last studied a month ago, you know the one that is almost identical to 6 other enzymes with similar spelling. ”

 

[Crayola227]

I would still urge you to look into any issues with fear of success.

Even if you're 100% not trying to knock yourself out, unconscious fears of success could certainly be part of holding you back. Given what you're saying about MCAT, the first 2 years, it does sound like there is some psychology behind what's going on. Which isn't a slam on you at all - I think a lot of docs spend their entire career dealing with how the job makes them feel.

And I agree the test is mostly ridiculous.

 

[Oso]

Let's say you decide to retake a 4th time/your school continues to support you/ etc:

Perhaps if you discuss your study methods for each attempt here, we can help you figure out what has worked and what hasn't and provide some suggestions for studying a 4th time?

Also, I will second @Crayola227 's important sentiments that if you have anxiety or any similar issues, you should look into those ASAP, as even if you pass step 1, those types of issues could still provide roadblocks in the future.

I believe in you!

 

[ThrowAwayStepDO]

@psychMDhopefully just passing through, wishing you all the best! echo @Oso i believe in you good sir/ madam!!!

 

[857770]

Find out first if you can actually take the test again. Then go for the licensing review course and work with a USMLE tutor.

 

[psychMDhopefully]

Hi all, I just wanted to say thanks for all the support. I have exactly 2 weeks before I make my case on why they should let me try a 4th time, and to anticipate what questions they will ask me. So I’ll start writing that. I wish the meeting was earlier so that I could go into full grief or full preparation mode. Currently not knowing what is going to happen I’m half grieving the loss of a medical career and half preparing for a retake, its weird.

 

[Crayola227]

I'm glad you're at least going to get a chance to make a case for yourself and get heard out

 

[AdmiralChz]

I'm glad you're at least going to get a chance to make a case for yourself and get heard out

I agree, and I hope you succeed, but you need to be honest with yourself going forward. This is the first of many standardized exams you will take with Steps 2 and 3 being even longer. If there is some major aspect of your preparation that can be changed for the better then go for it, but realistically at some point futility will come into play. Good luck.

 

[Crayola227]

OP, I went and read about fears and success and really think it might have some relevance to you predicament. I really hope it's something you consider thinking about. The subconscious is powerful.

 

[psychMDhopefully]

Welp, dismissed. Now I just have to break the news to my family and have them look at me with pitty/disappointment. All day I've been getting " this is part of Gods plan' from various people and that **** just makes me want to punch a wall,, there is no God, what god wouldplan something this ****ty

 

[Mad Jack]

So long story short, I am a US md student that has failed Step 1 3 times, the last time by one point, my score was 191 and passing was 192. I go back and forth between giving up completely and asking my school to let me retake it a 4th time. I've only ever wanted FM ,maybe community IM, or Psych. Honestly if I didn't miss this damn test by 1 point I would shamelessly withdraw, but I know IMGS who have taken the test up to 5 times and they are here practicing in the US. Given the amount of debt I have, and the fact that I am a US MD, I think my school should allow me to stay enrolled until I retake, what do they have to lose???

Try again I guess, what else can you do

 

[W19]

If I were you, I would do a postbacc that has a linkage with a DO school. Assuming you still want to be a doc... DO schools are more forgiven than MD.

 

[Postictal Raiden]

If I were you, I would do a postbacc that has a linkage with a DO school. Assuming you still want to be a doc... DO schools are more forgiven than MD.

OP has failed step1. THREE times. Although this is no reflection of his/her intelligent, it strongly indicates that they are not fit for a career that has endless standardized exams.

Best thing at this point is to try alternative routes (PA, NP, CRNA, PhD, etc...). Trying to pursue medicine again, via MD/DO/Caribbean, would be a mistake.

On the bright side, OP's options now are endless. This whole ordeal may actually be a blessing in disguise.

 

[W19]

OP has failed step1. THREE times. Although this is no reflection of his/her intelligent, it strongly indicates that they are not fit for a career that has endless standardized exams.

Best thing at this point is to try alternative routes (PA, NP, CRNA, PhD, etc...). Trying to pursue medicine again, via MD/DO/Caribbean, would be a mistake.

On the bright side, OP's options now are endless. This whole ordeal may actually be a blessing in disguise.

It might be a hail mary pass. I'm also assuming that OP absolutely wants to be a doc since he trying to go for a 4th time retake...

PA/NP/CRNA are not bad choices, but some people want to be the top dog...

 

[Oso]

Welp, dismissed. Now I just have to break the news to my family and have them look at me with pitty/disappointment. All day I've been getting " this is part of Gods plan' from various people and that **** just makes me want to punch a wall,, there is no God, what god wouldplan something this ****ty

I'm really sorry, that sucks.


If you wanna talk about other potential options, we'll be here

 

[GypsyHummus]

If they aren’t kicking you out, sit for a 4th time. Stay the course and be a doc.

If they do give you the boot, look into other healthcare professions that are a more “Lateral” move. If you did well in your classes, I would recommend looking at Dental or Podiatry school if they kick you out. The coursework for pods are at the same level, but from what I have seen in comparision, boards are easier because they are competency based (pass fail) instead of grades on a score system. You also have a focus on lower extremities, although all of medicine shows up on those boards. 29 MCAT is great and might even bet you scholarship money at Pod school.

Dental would have less boards, and it seems you did well enough on MCAT, getting a good DAT score wouldn’t be too difficult.

 

[psychMDhopefully]

On the bright side, OP's options now are endless. This whole ordeal may actually be a blessing in disguise.

No. my options are extremely limited. I've wasted years of my life and racked up hundreds of thousands in debt.

 

[FutureDR2023]

No. my options are extremely limited. I've wasted years of my life and racked up hundreds of thousands in debt.

I couldn't imagine what you may feel after hearing that, but do not let someone tell you "no you can not do it". Many people have failed but stayed persistent and succeeded. Stay open minded, and try to reach out to someone who may have gone through the same thing as you. Reach out to advisers, professors, and other doctors who work in the field. Sit down and write out your options after, and yes, pray. I hate to say it but the devil doesn't want people to succeed. When someone hits bottom, there is only one way to go-UP, and your family are your best supporters.

 

[W19]

If I were in OP's position, I would use everything in my arsenal to see if my school would let me take it a 4th time... And if I am unsuccessful, I would do these in the following order:

1) Do a 1-year postbacc that has a linkage with DO school in an attempt to get into med school again

2) Podiatry

3) PA/NP

I know one person that was booted out at Nova and went to ROSS; he is an internist now.


I know another person that left one the worst carib school after a year and he is graduating at WVSOM...

 

[DexterMorganSK]

If I were in OP's position, I would use everything in my arsenal to see if my school would let me take it a 4th time... And if I am unsuccessful, I would do these in the following order:

1) Do a 1-year postbacc that has a linkage with DO school in an attempt to get into med school again

2) Podiatry

3) PA/NP

I know one person that was booted out at Nova and went to ROSS; he is an internist now.


I know another person that left one the worst carib school after a year and he is graduating at WVSOM...

Why would a DO school take someone that has failed STEP 1 3 times?
If COMLEX is similar in difficulty to the STEP 1 then how would OPs app convenience an Adcom that he/she will be successful in a DO program?

 

[W19]

Why would a DO school take someone that has failed STEP 1 3 times?
If COMLEX is similar in difficulty to the STEP 1 then how would OPs app convenience an Adcom that he/she will be successful in a DO program?

The majority of DO students who have taken both exams think USMLE 1/2 are more difficult than COMLEX...

 

[DexterMorganSK]

The majority of DO students who have taken both exams think USMLE 1/2 are more difficult than COMLEX...

Yes, I know, but isn't it is also true that now with the merger and all, every DO student "should" take the Step 1 as well?

 

[W19]

Yes, I know, but isn't it is also true that now with the merger and all, every DO student "should" take the Step 1 as well?

No... It is still optional for DO. Though one might be limited in the type of program you can apply without it.

 

[DexterMorganSK]

No... It is still optional for DO. Though one might be limited in the type of program you can apply without it.

Good to know that option still exists, as of now.

@psychMDhopefully: if medicine is what you want to do, even at this stage, and you can't imagine doing anything else, then go for it. You should definitely contact your program of interest and explain your situation before starting an application.

Good luck!!

 

[GypsyHummus]

Do you think OP should try Pod school? To my knowlage, the Pod privileges are independant of STEP.

Good to know that option still exists, as of now.

@psychMDhopefully: if medicine is what you want to do, even at this stage, and you can't imagine doing anything else, then go for it. You should definitely contact your program of interest and explain your situation before starting an application.

Good luck!!

 

[Danny Archer]

I say keep on trying. If you need to feel better about your position right now, read my first post yesterday. It can be way way worse.