starting MS4.... realistic chances

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I wouldn't worry too much. While your early basic science course failures suck, they were early and you fixed the problem.

Don't take USMLE. Just rock COMLEX 2. I used the Kaplan videos and went from a fairly low step 1 score in the mid-400’s to the mid-500's.

There will still be tons of places that will give you the time of day, especially if your interest is sincere.

Regarding your interests, I'd be looking hard at U New Mexico. They take DO's regularly, aren't that competitive due to location, and do some of the things you talked about. I'd try and rotate there probably.

Good luck!
 
preventive medicine is more of a fellowship in that most good programs require you to have completed a residency in the first place. you then do a 1-yr MPH followed by 1 year doing public health practice, which is not direct patient care related and certainly has nothing to do with combining lifestyle options etc. that is more of a way of practicing that of course you would be able to carve out. there is thus no point looking for some 'dual residency', just apply for psych and then if after you are still interested you can do a preventive med training but i suspect this is not what you're interested in from what you are describing. it's more related to administration, policy, management, collecting data, doing studies, healthcare communication etc.
 
I agree with digitlnoise: 1) ROCK COMLEX2 (I mean, leave NO DOUBT). The class rank/GPA stuff will recede in its shadow.
2) Find a psych (or psych-oriented primary care) elective that will get you a great letter that highlights your passion for lifestyle interventions in mental illness, your research interests, your aptitude for contributing to advance patient care in this field, etc...
 
Thanks so much, Digitlnoise and Oldpsychdoc, for your comments. I will work really hard to do well on my step 2, but doing a LOT of qbank beforehand. I think getting used to as many questions as possible will be best.

Digitlnoise, I am very glad to know that you were successful in obtaining your specialty of choice, despite starting out with a 400s COMLEX score. This gives me hope. I will certainly look into Univ of NM's residency program.

Splik, thanks for taking the time to describe preventive medicine. You are absolutely correct. I know preventive medicine and integrative medicine are different, but I'm interested in both. 🙂 My ideal job would be to work 2 days a week in outpatient psychiatry (incorporating lifestyle approaches), 1 day a week teaching medical students and participating in clinical research (at the medical school), and 1 day a week working at a local public health department on community health outreach/behavioral health programs. And then (in my dreams) I'd also like to go abroad for 3 months out of the year, like to India, working on community outreach programs in behavioral health there as well. Realistically I don't know if my jobs would allow me to do all this, but this is what I dream about.
 
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Thanks Dr. Toaster! That link is really helpful. 🙂
 
I not only got the specialty I wanted, but my #1 choice! I also got WAY more interview invites than I ever expected.

You will probably be asked what happened. Have a story prepared. There's debate on this board about whether you should reveal a history of mental illness as a psychiatrist. My personal opinion is that its likely ok to reveal minor things that are now treated appropriately. Maybe bring up the attention issues but leave out the depression...others will have dissenting opinions and say its better to hide it. My view is based on a belief that if a program is going to turn you down because of mild ADD or MDD, then how do they view/treat their patients? Still though, it does look "better" to be healthy. Tough call.
 
Glad to know you matched your first choice, Digitlnoise. Congrats! I'm happy for you, and it gives me some hope also for myself. 🙂

Do you all have any thoughts on dual residencies - such as Psych/ Internal Med? Next to psych, I also really enjoyed my IM rotation, and getting an internal medicine residency specialization is only one extra year. I'm wondering how competitive it would be to apply to such a program. Also, I wonder what gets sacrificed from the psychiatry electives to accommodate the IM work. I hope it wouldn't be the psychotherapy as I'm interested in learning that. Furthermore, I am wondering... if one applies to psych only, can that person add on another specialty (like IM or peds) later after starting residency if he/she so chooses? Thanks!
 
Don't dual board. Most people who do only practice one specialty. If you enjoy medicine work in addition to psych, then look at Consult Liason or a mental hospital job where patients tend to be more medically sick.

I get PLENTY of time to practice medicine on my psych patients.

I don't think you can become dual after you've applied. Most programs don't do it, and its so schedule intense that the spots are limited and must be scheduled very carefully.
 
Thanks again Digitlnoize for taking the time to answer my questions. You are super helpful, and I really appreciate your guidance. :bow:

I had actually done some reading through old posts on this forum, and I found another thread where people were discouraging the dual boards as well. So after reading through all that, I think you are right, that I should just focus on psych... and forget about the dual residencies.

There is one area I have an interest in, which I'm not sure can be done purely through psych or not. I had mentioned my interest in lifestyle approaches to health. I'm also wondering if I could have a career working with people with food addictions/compulsions. I see that there are endocrinologists working on the issue of obesity, and I know there are fellowship opportunities in nutrition/obesity for people with an internal medicine background. I'd love the fellowship, but would then have to go through IM for that (and there are very few programs in this field, so no guarantee of getting accepted). Is there any such possibility for those in psych? I know there are addiction psychiatry fellowships, but I think that is related to drugs and not compulsions related to food. I don't know how much scope there is in eating disorders. I am more interested in obesity, but could work in eating disorders in general, if that's the only possibility. Thanks!

Edit: I found a group of psychiatrists who do specialize in eating disorders. Some of them state that they've done fellowships in eating disorders, though it isn't really clear where they did them from. http://eatingdisorder.org/the-center/staff/#psychiatrists
 
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I'm not so sure that some of what we call over-eating isn't actually something more like glucose addiction. In animal studies, glucose has been found to be more rewarding than opiates. An addictions fellowship could be helpful perhaps. Or going to a place that has some specialized treatment for eating disorders (which is rare), although I suspect you'll see it everywhere.
 
I just wanted to post an update...

I had my first outpatient psych day today in child/adolescent psychiatry. (Up until now my only rotation was adult inpatient with SMI.) My school wasn't giving me any outpatient psych experience, but I had to seek this day out... and I am sooo glad I got this chance.

I have to say that today was my favorite day in the whole of 3rd year. I LOVED it. The kids were great.... and I enjoyed the adolescents the most.

My desire to go into psych has been cemented. I'm so thrilled to finally know for sure what I want to do with my life. 😍

Now I just gotta find a way to get accepted into a program! :luck:
 
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You're lucky. Most people don't get to do outpt psych as a med student.
 
Ok, so I'm trying to schedule audition rotations at my top residency program choices... I hope this is a good idea. Not taking any sub-I's as they are just rotations at ACGME residency sites. I'm trying to schedule electives like adult inpatient, child psych, and outpatient psych, eating disorders, etc. One of my friends was suggesting that I might be better off only taking adult inpatient... as that probably would be viewed as more rigorous by potential residencies than child or outpatient psych. Any thoughts?
 
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digitlnoize said:
You're lucky. Most people don't get to do outpt psych as a med student.
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At my school, most people actually get outpatient psych... since we make use of preceptors mostly. I actually sought out the inpatient rotation initially as I wanted to see more extreme cases as I thought I'd see more pathology this way. I thought the experience was great, though I also wished I had seen outpatient as well... since this is more along the lines of what I would actually practice. But had I seen outpatient psych before, I probably would have been convinced on psych a lot earlier.... as I like the therapy aspect which is easier to do with higher-functioning people, as opposed to people in psychosis.

But yes, I am lucky that I am getting to see a bit of both. I found another psychiatrist (my department chair) who is offering me a day of adult outpatient at his clinic next week, so I'm excited about that.
 
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elftown said:
It looks like they're not on VSAS anymore.
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Yes, I guess they genuinely cancelled their rotations to visiting students. I just was surprised when my COMLEX score was brought in, as part of the reason.

Anyway, I don't know if anyone is particularly interested in my updates or not (sorry if I am troubling), but I just wanted to say that I'm thrilled today as I got offered 3 visiting-student psychiatry rotations (2 electives and one sub-I, in that sequence) from a large university program, that happens to be in my top 3 choices for residency. So I couldn't be more pleased, as I'd love to spend 3 months at that program as I know I will learn a lot there. I will get to see a combination of inpatient, outpatient, forensic, and child psych. One door may have closed, but another one opened... thankfully. I am determined to work hard and excel at these rotations. 👍
 
Is it common for programs to request your personal statement and reasons for wanting to do a sub-i/rotation at their program?
 
C O M 2014 said:
Is it common for programs to request your personal statement and reasons for wanting to do a sub-i/rotation at their program?
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Are you referring to applying for rotations? I did not have to do any such thing. I submitted my applications through VSAS. It states there what you have to submit (stuff like CV, comlex/usmle score, HIPAA, insurance card, immunization forms, etc).

elftown said:
Congrats!

I still don't have my electives secured but hopefully soon.
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Thank you. I sympathize with the waiting that you are going through. Until today I was feeling stressed about it, as I had nothing lined up despite applying to 30+ rotations for a 4-month audition season timeframe (I applied to 7-8 electives for each month available). I had to keep meticulously organized of what rotations I had applied for, which ones declined me, and where I should focus my efforts. Somehow the stars aligned for me today, and I got all 3 in a row from a university hospital that I'm thrilled to be at (I did my bachelor's degree at this university, so I have a great affection for the place, and will be glad to live there again for those 3 months). But I did email and call them to get my application noticed. You have to be persistent to get what you want... just not to the point of being annoying, as I'm sure they are very overwhelmed with so many students trying to get electives. Had I not tried contacting them, I'm sure all the spots would have been gone by the time they finally got to my applications. That is exactly what happened to my other top choice places.... while I was patiently waiting for the prior residency programs to get to my VSAS applications, they all filled up in the interim. So I realized the importance of being on the ball with this stuff. I hope you will get your rotations secured soon and can be relieved of this waiting stress.
 
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C O M 2014 said:
Is it common for programs to request your personal statement and reasons for wanting to do a sub-i/rotation at their program?
Click to expand...

I've had to do that for a couple, one of which was actually on VSAS. OHSU likes to see a letter of intent and a letter of rec on top of all the usual documentation. Seems to be less common, though. Most places just ask for the basics.
 
rkaz said:
I talked to Loma Linda today to find out why my visiting student rotations were denied. The externship coordinator told me that they weren't taking visiting students this year (?). Then she mentioned that my COMLEX was below 500 and they weren't considering people with sub-500 scores.

Ouch... burned.. 🙁

So sad, as Loma Linda was actually one of my top residency choices outside of Arizona. 🙁 My sister did her residency there and told me that I would totally fit in with the culture there, as I'm a vegetarian and spiritual type person. I really wanted to apply there for residency, but I'm not even being considered for a rotation. I will work hard to ensure my COMLEX 2 is well above 500, but I don't know if it even matters since my COMLEX 1 isn't.
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u SDA?
 
PrideNeverDie said:
u SDA?
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Don't know what that means. 😕

Edit: Oh... no, I'm not a 7th day adventist. I'm more of the spiritual, yoga and nature-loving, vegan, introspective, holistic type. 🙂
 
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elftown said:
I'm vegan too. 🙂 But they don't even have caffeine at Loma Linda from what I hear so that might be a problem for me. :meanie:
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Wow, I didn't know Loma Linda was so intense. I personally do avoid caffeine and alcohol... so I'd be just fine without either. But I didn't realize there was any place in the country where you couldn't get a cup of coffee nearby. 🙂
 
Hi guys. I have a question about taking the COMLEX level 2 CE / USMLE part 2 CK for anyone who has been part of the interview processes.

My level 2 exams are scheduled in mid-to-late August. As such my scores won't be available until late-September or early October.

I recently came to know that it is best to submit one's application to ERAS at the beginning of September. I am wondering if I should submit my ERAS at that time even though my level 2 scores won't be available yet. In my case, my COMLEX level 1 has a low score (though passing). So I'm afraid that many places may throw out my application without waiting for my level 2 scores to come out. I am studying really hard, so I hope my level 2 scores will be MUCH better.

So I could just wait until October to submit my ERAS application, waiting until after my level 2 board scores become available (to prevent my application from being prematurely tossed out for a poor level 1 performance). But I hope that won't be too late. I don't want to receive less interviews by applying in October rather than September. I could conversely take my level 2 boards in the first week of August in hopes to make it back before the beginning of September. But at the same time, I want to have enough time to do really well on my exams.

I start my psych away electives at the end of July, so I hope that they won't be too negative about me using my Saturdays to take my boards, as both of my boards are scheduled on Saturdays.

Any thoughts on the best course of action?? Thank you!
 
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rkaz said:
Hi guys. I have a question about taking the COMLEX level 2 CE / USMLE part 2 CK for anyone who has been part of the interview processes.

My level 2 exams are scheduled in mid-to-late August. As such my scores won't be available until late-September or early October.

I recently came to know that it is best to submit one's application to ERAS at the beginning of September. I am wondering if I should submit my ERAS at that time even though my level 2 scores won't be available yet. In my case, my COMLEX level 1 has a low score (though passing). So I'm afraid that many places may throw out my application without waiting for my level 2 scores to come out. I am studying really hard, so I hope my level 2 scores will be MUCH better.

So I could just wait until October to submit my ERAS application, waiting until after my level 2 board scores become available (to prevent my application from being prematurely tossed out for a poor level 1 performance). But I hope that won't be too late. I don't want to receive less interviews by applying in October rather than September. I could conversely take my level 2 boards in the first week of August in hopes to make it back before the beginning of September. But that same time, I want to have enough time to do really well on my exams.

I start my psych away electives at the end of July, so I hope that they won't be too negative about me using my Saturdays to take my boards, as both of my boards are scheduled on Saturdays.

Any thoughts on the best course of action?? Thank you!
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(sigh)

Submit your eras application when it's possible to. Take your step2 as you are already planning. Programs won't 'throw out your app' without your step2 scores being in. That's the most ridiculous idea I've ever heard.
 
vistaril said:
(sigh)

Submit your eras application when it's possible to. Take your step2 as you are already planning. Programs won't 'throw out your app' without your step2 scores being in. That's the most ridiculous idea I've ever heard.
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Thank you, Vistaril. I hope you are right about this. I had read elsewhere on SDN about applications being thrown away for low Step 1 scores, without waiting for Step 2. However, this might have just been anxious medical student speculation and paranoia as opposed to fact. I don't know if those students had any legitimate sources for that.
 
vistaril said:
Programs won't 'throw out your app' without your step2 scores being in. That's the most ridiculous idea I've ever heard.
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Wrong. Some programs do. There are programs that do a hard screen on the Step 1. Meaning, if you do not make their cut-off for the Step 1, you will not receive an interview, regardless of the rest of your application.

That said, rkaz, for those programs, even if you had had the Step 2 in hand (i.e.: deferred applying until you had your Step 2 results), it wouldn't have made a difference.

For folks with less-than-stellar applications, the advice is always the same: Apply early and apply broadly. Do that and you'll find a home.
 
notdeadyet said:
Wrong. Some programs do. There are programs that do a hard screen on the Step 1. Meaning, if you do not make their cut-off for the Step 1, you will not receive an interview, regardless of the rest of your application.
.
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I think you are misunderstanding what I'm telling the guy. My point was that programs aren't going to have a policy in place where they throw his app out when they download it on Sept1(or whatever) because his step2 score isn't up yet. That's th essence of his question- should I submit app on sep1 without step2 scores being in yet or wait and submit app when my step2 scores can be downloaded at the same time my app is in.

Of course there are some programs(even in psychiatry) that are going to use a step1 cutoff.
 
Also, even if there was one or two programs that would throw out his app immediately based on Step 1, most programs won't, and its still far better to apply early.
 
digitlnoize said:
Also, even if there was one or two programs that would throw out his app immediately based on Step 1, most programs won't, and its still far better to apply early.
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Yep. That's why I bolded it.
 
Ok, thanks so much you guys... I really do appreciate your guidance. You are awesome. 👍

I will go ahead and just take my COMLEX part 2 (and possibly USMLE part 2) in late-August as planned, to give me enough time to study. But I will then just submit my application in early September, even though the COMLEX results won't be available.
 
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Dude you are overthinking things. Just think about how to do well on your auditions and in the interviews. I'm guessing you are going to do AOA only? I believe there is a new program in FL that has a 5 year child fellowship, is that one of your rotations.

Don't worry about taking days off for interviews, in fact humble brag about them and let the programs know you are hot stuff.

If you don't mind me asking, why did you stop your anti-depressants? As someone going into the field I'm curious as to why you of all people would stop something that had worked for you? I'm dealing with patients refusing to believe they are depressed after serious suicide attempts. But to see a perspective psychiatrist be non compliant with meds is just heart breaking.
 
😕
I haven't had meds for many, many years... it was long before I was considering a career of psychiatry back then. I wasn't in medical school. So there wasn't any recent stopping of anything. During medical school, I've gone for individual counseling though. Getting periodic counseling and doing daily meditation and some exercise has kept me feeling well. No issues.
 
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By the way, I should also add that I'm not still "overthinking things" by posting my updates here. The initial purpose of this thread was to ask about my chances, which people were very kind to help me with. At this point, I'm just using this thread to post any updates or questions I have about the process, rotations etc, for anyone who is still following my story and who might feel like giving some advice.
 
gibits said:
If you don't mind me asking, why did you stop your anti-depressants? As someone going into the field I'm curious as to why you of all people would stop something that had worked for you?
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As you get further in your training you'll find the Meds for Life philosophy of mental illness is bad psychiatric practice. It's easy to get lazy and fall prey to it, because its easy for us as psychiatrists to load a patient up and just keep them on meds the rest of their life, because, hey, it works. But mental health is more subtle than this.

We don't know her, but she described a bout of depression in her first year of medical school. Advising her to therefore stay on an SSRI because it "worked" is bad psychiatry. Its akin to keeping someone on a pain killer for life because its easier for the clinician than going to the trouble of evaluating whether they are dealing with something acute, chronic, or episodic. After symptoms have been in remission for some time, it's appropriate for patients so inclined to be tapered down on SSRIs, particularly when they are in therapy. Having a blanket advisement against this is bad medicine and is counter to evidence based psychiatry.
But to see a perspective psychiatrist be non compliant with meds is just heart breaking.
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I wouldn't throw "non compliant" around like that. A patient who formerly took meds and now doesn't does not make her non compliant. Since she's a medical student and in treatment, why would you assume she's non compliant? She probably has a decent psychiatrist who treated her appropriately, saw the symptoms go away, saw improved coping skills to stressors, and was appropriately advised a taper in conjunction with follow up care..

SSRIs should NOT be seen as automatic meds for life, tidbits. THAT approach to psychiatry is what's "heart breaking."
 
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Awesome post, NotDeadYet. I would also encourage others to possibly think of any confounding factors. I was found to be anemic, and my vitamin D levels were almost non-existant (the Doctor I had said she hadn't seen such low levels in all of her practice. I think mine was like a '4'). Once my Vitamin D and anemia was corrected, and I started with a new CBT therapist and incorporated better eating and exercise habits, my functioning increased substantially.
 
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notdeadyet said:
As you get further in your training you'll find the Meds for Life philosophy of mental illness is bad psychiatric practice. It's easy to get lazy and fall prey to it, because its easy for us as psychiatrists to load a patient up and just keep them on meds the rest of their life, because, hey, it works. But mental health is more subtle than this.

We don't know her, but she described a bout of depression in her first year of medical school. Advising her to therefore stay on an SSRI because it "worked" is bad psychiatry. Its akin to keeping someone on a pain killer for life because its easier for the clinician than going to the trouble of evaluating whether they are dealing with something acute, chronic, or episodic. After symptoms have been in remission for some time, it's appropriate for patients so inclined to be tapered down on SSRIs, particularly when they are in therapy. Having a blanket advisement against this is bad medicine and is counter to evidence based psychiatry.

I wouldn't throw "non compliant" around like that. A patient who formerly took meds and now doesn't does not make her non compliant. Since she's a medical student and in treatment, why would you assume she's non compliant? She probably has a decent psychiatrist who treated her appropriately, saw the symptoms go away, saw improved coping skills to stressors, and was appropriately advised a taper in conjunction with follow up care..

SSRIs should NOT be seen as automatic meds for life, tidbits. THAT approach to psychiatry is what's "heart breaking."
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hey I didn't mean any offense by it. I was just trying to get some more info. I didn't want to assume she was non compliant, just feared that she was. Now I see things are taken care so no worries. IIRC you only need be symptom free for 2 years before weaning. It has been a while since I really went through the APA guildlines.
 
gibits said:
hey I didn't mean any offense by it. I was just trying to get some more info. I didn't want to assume she was non compliant, just feared that she was. Now I see things are taken care so no worries. IIRC you only need be symptom free for 2 years before weaning. It has been a while since I really went through the APA guildlines.
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The last APA Guidelines I know for depression (from 2010) stated you could consider tapering after the continuation phase lasting 4-9 months (clock starts after stabilization), providing the patient does not require maintenance therapy (indicated if they have had 3+ major depressive episodes).
 
notdeadyet said:
SSRIs should NOT be seen as automatic meds for life, tidbits. THAT approach to psychiatry is what's "heart breaking."
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👍👍👍

same goes for benzos, antipsychotics, lithium and anticonvulsants. the reality is most psychiatrists have no training in how to stop psychiatric medications and so they don't.
 
splik said:
👍👍👍

same goes for benzos, antipsychotics, lithium and anticonvulsants. the reality is most psychiatrists have no training in how to stop psychiatric medications and so they don't.
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Not to derail this topic but what are the guildlines for tapering naltrexone? Got a guy on it (from rehab). I just continued his naltrexone script but was wondering what the long term plan was. Not something I want him on in the long term, especially if he needs opiates one day for a tooth extraction.

@notdeadyet: dude the name calling really isnt called for, I never meant any harm by asking a question and stating why I felt the need to ask it. If you have something to say people would listen better if had a better tone.
 
gibits said:
Not to derail this topic but what are the guildlines for tapering naltrexone? Got a guy on it (from rehab). I just continued his naltrexone script but was wondering what the long term plan was. Not something I want him on in the long term, especially if he needs opiates one day for a tooth extraction.
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There are none, because, really there's no need to taper it, and frankly, the clinical experience is that patients just plain stop it on their own all the freakin' time. :annoyed:
 
gibits said:
@notdeadyet: dude the name calling really isnt called for, I never meant any harm by asking a question and stating why I felt the need to ask it. If you have something to say people would listen better if had a better tone.
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i really dont think he was name calling, just making a general observation that the default of lifelong psychiatric medication is not good practice, i do not think he was saying 'you are a bad psychiatrist'. of course sometimes patients do need lifelong medication, the frustration is this has become the default and psychiatrists are not receiving training in how to withdraw psychiatric drugs
 
OldPsychDoc said:
There are none, because, really there's no need to taper it, and frankly, the clinical experience is that patients just plain stop it on their own all the freakin' time. :annoyed:
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If you mean stop it and relapse, then yeah.
 
splik said:
http://lib.adai.washington.edu/clea...28-Naltrexone-and-Alcoholism-Treatment-85.pdf
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Thanks for that--though it said basically what I said. 😉
"Successful Termination Of Naltrexone--The usual naltrexone dose of 50 mg/day can be discontinued without tapering the dose because there is no withdrawal syndrome associated with naltrexone therapy. The same appears to be true for higher doses of naltrexone. Nonetheless, dose reductions may be useful psychologically for some patients"
 
gibits said:
If you mean stop it and relapse, then yeah.
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Well--relapse wouldn't be any fun if they kept taking it, right? 🙄

[And just to be completely serious for a moment--that's why chemical dependency treatment is really NOT about the meds, or even about the "rehab", but about the long term continuity of care that's necessary to achieve and maintain sobriety. Naltrexone is merely an adjunct that can help a subset of patients.]

Now then--back to assessing the chances of our MS4 colleagues....
 
gibits said:
@notdeadyet: dude the name calling really isnt called for, I never meant any harm by asking a question and stating why I felt the need to ask it.
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There was no name-calling, but if I hurt your feelings, I apologize. That was not my intent. I was just strongly voicing disagreement with the philosophy you implied. No harm in disagreeing, but I'll try to use a softer tone next time.
 
notdeadyet said:
There was no name-calling, but if I hurt your feelings, I apologize. That was not my intent. I was just strongly voicing disagreement with the philosophy you implied. No harm in disagreeing, but I'll try to use a softer tone next time.
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You called me tidbits, I'm guessing you have auto correct, so sorry if I misunderstood you.
 
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