Step 1 190 step 2ck 225 IMG US citizen ..would love some good adivce

Discussion in 'General Residency Issues' started by ElapidaeEnigma, 09.27.14.

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  1. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    Last edited: 11.06.14
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  3. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Why only NY?

    You're in do or die time here. Not the time to be geographically choosy.
     
  4. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    I was away from home for 4 years and prefer to stay in New York b/c I'd like to marry and settle down here rather than just get bounced around here and there for the next 4 years.
     
  5. crafted222

    crafted222 2+ Year Member

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    NY is attractive to many applicants, you will be competing with high scoring AMG and IMGs. To increase your chances, looking into programs in the midwest would be good. Depending on the number of interviews you get, you can decide to attend only those in NY.
     
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  6. PharmacyStud

    PharmacyStud Junior Member 10+ Year Member

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    Those would be nice scenario to have. Most likely thing to happen with your failed cs 3x, poor step scores, one year out of match, is that you might settle in ny area without a residency. With your stats, you will get bounced around to become a md. Widen your geographic preferences
     
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  7. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    You don't have the luxury of being choosy.

    And a dead-end prelim position at a crappy NY surgery program is almost a worse fate than not matching.
     
  8. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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  9. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    perhaps there are other options. BTW i failed cs twice not three times. how about observer ships or applying into broader medical fields rather then geographical
     
  10. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Your options are poor, period. Your step 1 is at the absolute minimum for passing, and the multiple CS failures - for an apparently native US/english speaker - are big red flags.

    You need to be applying to literally a hundred plus programs in FM, medicine, possibly psych or other low competitiveness fields depending on your interests, in a wide geographic range.
     
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  11. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

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    You need to be applying to >100 programs in a variety of fields in a variety of areas. I understand wanting to settle down, I do, but do you want to settle down as a physician, or a guy slinging slices in NYC?

    Anesthesia is low likelihood for you, not no, but low. If you want to match Gas, you need to apply to all the programs...yes, all of them. If you absolutely want to stay in NYC, you need to apply to every residency program in IM, FM, Psych and Gas in the metro area (besides the top ones unless you like throwing money away).

    I assume you're familiar with the saying that beggars can't be choosers. But you actually can be a chooser here. You can choose an irrational path (your current one) or a rational one (like the one everybody else in this thread has pointed out).

    [​IMG]
     
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  12. rokshana

    rokshana Member 10+ Year Member

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    more than getting a residency spot?
     
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  13. rokshana

    rokshana Member 10+ Year Member

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    once is enough to raise a red flag….twice is a nail in the coffin….widen your search if you really want a chance to get a residency spot (and even then your crappy step scores could hold you back, passed on the 1st try or not).
    observerships are worthless.
     
  14. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    Unfortunately, I am going to agree with the sentiments here. And I'm not 100% certain you understand the situation completely, so let me be very honest and direct:

    The bad news: You have failed CS 2 times. Your Step 1 score is horrible. Your Step 2 score is better, but not by much -- the average Step 2 is now 238 with a minimum pass of 209. All of your electives are in Anesthesia which is moderately competitive -- if you apply to other fields, they may not interview you because you don't have experiences there and PD's may worry that you'll bail and apply to anesthesia again. Not clear if your electives were in the US or not -- if not, another huge problem.

    The good news: Technion is a well respected school.

    Result: You chances of getting ANY residency are very limited. Read that sentence again, slowly and clearly. You need to do everything you can to get a spot ASAP. You should have applied much more broadly. Applying to categorical IM programs is mostly a waste of time with your application, especially if all of your letters say you're interested in anesthesia. Prelim IM and Prelim GS are reasonable, although Prelim IM is competitive enough that you may not get much interest.

    Options:

    1. You could apply to many more prelim GS positions in this year's match. It's probably not too late.
    2. If being in NY is the most important thing, then you've done all you can do. If nothing comes of this, look for another career.
    3. Step 3 is a waste of time. You haven't done well on any of the other steps, I honestly doubt you're going to do any better on Step 3, especially without any internship experience. Failing Step 3 would be a catastrophe.
    4. If you fail to match this year, then next year is your last chance. You will be applying across the country, focusing on geographically undesirable locations. I would try to get more US experience this winter, although the benefit will be small.
     
  15. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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  16. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    how can i apply into FM psch or any other program without having lor ..i need observerships to get lor to have a complete app
     
  17. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    No. This isn't like a take your time, lackadaisical process. If your application is not in, and complete, at programs within the next 1-2 weeks (*at the absolute latest), the door will be closed. Many programs have an October 1 deadline.

    The term is "shotgun apply" - you need to cast the widest possible net and hope for something.
     
  18. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    That doesn't mean you'll get one of them


    No. Going through the match, this year, is by far your best chance. The odds go down precipitously every year from now.
     
  19. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    You've made a terrible mistake.
     
  20. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

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    You don't really have many options here. I don't think you really understand that.

    It is a completely dead end spot. Your chances of having a 1 year spot increase, sure, but your chances of getting a full residency, Anesthesia, GS or otherwise, do not appreciably change.

    I think you're being pathologically naive. But whatever.
     
  21. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    Ok lets say hypothetically speaking I do apply broadly, I am still limited into anesthesia and prelim spots because of my LORs. What do I do now from October until the end of interview season to somehow increase my chances in solidifying a position in New York.. There must be something
     
  22. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    You're falsely limiting yourself in terms of fields. You also, realistically, can't do much else, because you haven't prepared yourself well for the match this season. These were questions you needed to be asking in April-May, not September 28th.
     
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  23. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    I'm well aware of my status now but i would like to see what i can do now. If i apply into FM and IM cat now without LORs and look for a research or observer ship position, ill be able to complete my application for FM IM cat by mid November, Is this an option that is even remotely possible. There must be something that can be done from now to mid January. Many non competitive programs interview applicants until the very end.
     
  24. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    No, you would need to apply now with the letters you have.

    Look you started this thread looking for advice.

    The best advice has been given above, you appear to largely be choosing to ignore it.

    You need to geographically expand your applications - apply to literally every anesthesia program in the country.

    You also need to expand the fields you're applying to (and the geography in which you apply to those fields).

    The odds are already stacked against you, and you are making a very short-sighted decision to try and stick to NY. You also don't seem to understand the competitiveness and timing of the application process. You are out of time.
     
  25. MU420

    MU420 5+ Year Member

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    It seems from reading your posts that your priority is staying in NY.

    In that case, your chance of getting into anesthesia is basically none. To be fair, even if you apply to every program in the country, anesthesia is still a very low possibility given your status of IMG and your test records.

    FM/IM or prelim surg are your options of staying in NY. And by IM I don't mean prelim IM, which is actually fairly competitive, but categorical IM positions. You said you've already applied to all prelim surg, so you will need to get on adding every single NY FM and IM programs as soon as possible.

    Who wrote your letters? It can be problematic for FM/IM if all your letters are from anesthesiologists or surgeons. You obviously don't want a FM letter that says "he will make a great anesthegiologist", so you need to check on that. Prelim surgery spots can be realistic, but like everyone above this post has already said, you need to be aware that those spots often lead to nowhere for IMG's.
     
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  26. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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  27. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    As others have said, you're assuming your application is limited because of your LORs.

    I would counter that they are unimportant at this point in time.

    You admit you don't know how ERAS and the match works:

    1) Most programs will filter out your application simply based on your Step 1 score. They will never review your LORs for content, for the specialty of the writer, so thats unimportant at this time.

    2) Residents who go through SOAP do not obtain new letters in other specialties; they are often happy to take any position, often in a field they never applied to in the first place, without LORs in that field.

    3) While programs interview throughout the season, they may not review late applications. So spending a month doing an observership, asking for a letter, waiting for the letter, and getting the letter uploaded may not change things if programs either filter you out because of your Step 1 score, or CS failures, or because of a late application.

    4) Applying without LORs results in an incomplete application which may not be reviewed either.

    Since you state that you are unwilling to go out of state or consider another field, I'm worried you're being unrealistic because those are honestly two very likely outcomes of this process. If you must stay in NY (and I'm going to assume its because you are Jewish and think you cannot find a suitable partner outside of NY, which is ridiculous but that's an argument for another day), then you need to apply for every program, in every specialty and try and convince any program that offers you an interview that you had a change of heart about specialty.
     
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  28. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Also, not to pile on, but let's revisit the prelim surgery issue:

    If you are going to go the prelim surgery route (which is probably your best bet of finding a spot overall), this is a one year position.

    Your goal during that one year is to secure a categorical position the following year - in anesthesia or surgery or radiology or whatever.

    The most likely outcome is NOT that you will be offered a categorical position at the program you do your prelim year at, but rather that you find a position elsewhere (either due to attrition or connections).

    So this whole "stay in NY" thing - is talking about ONE YEAR in the case of a prelim spot.

    If you're going to do a gen surg prelim year, you should do it at the most supportive program you can find, with a track record of successfully placing residents into categorical positions. That's not going to be in NYC
     
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  29. rokshana

    rokshana Member 10+ Year Member

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    i don't think you are getting it….doing anything now is TOO LATE…
    ERAS opened sept 15…it is sept 28…if everything…Steps, LoRs, and so forth weren't in that day, for an IMG, you are behind the 8 ball.

    yes, you are limited to anesthesia and that is because of your lack of foresight…why on earth did not think to do clerkships in more general programs…IM , FM? etc…did your school not talk to you about the importance of being more diverse and getting things done early?

    at least if you apply to all the anesthesia programs in the country (yes every single one of them), then you may have a slim chance to get a spot…

    look at this way…you're not gonna be much of a catch in NY if you have a worthless MD (and MD without residency just makes you overqualified for flipping' burgers at the Mickey Ds)…
     
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  30. AMEHigh

    AMEHigh 7+ Year Member

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    Why can't you complete the application now?

    Although it's ideal to have a specialist write you a letter in the specialty you're applying, it's not 100% necessary unless the program specifically mentions that in their requirements.

    Have you looked at the application deadlines for the IM and FM programs? Many programs across specialties have deadlines Oct 1 or Nov 1. And even programs with later deadlines, students have been submitting their applications since Sept 15, so you're already behind.

    We all have ideal locations we'd like to stay in, but unfortunately residency doesn't work out that way for many people. You have to be realistic.

    I'd recommend broadening your geographical search and applying to different specialties asap.
     
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  31. rokshana

    rokshana Member 10+ Year Member

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    they EXTEND those invites now…if you are going to submit in nov don't bother…that will be just a big waste of your money.

    didn't you do IM and FM as a 3rd year? can't you get letters from them?

    realize that for those "non competitive" programs…you are not a godsend…
     
  32. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    Last edited: 11.06.14
  33. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    No, I'm saying you should apply to any and every program willing to entertain your application with the LORs you currently have.

    If your letters say, "EE would make a wonderful anesthesiologist" and you are in contact with the letter writers, it might not be too difficult to ask them to delete/edit that line and make the letter less specialty specific.

    No one is suggesting that you let the "stats take its [sic] coarse" but we are concerned that you are not being reasonable about the difficulty ahead of you. So yes, its not a bad idea to get some experience and possibly specialty specific LORs for use in the future should you secure some interviews.

    We don't want "fully certified physicians" (which you would not be anyway; Step 3 only allows you to apply for a license. Being "certified" requires completion of a residency and specialty specific board exams), we want good residents.

    We have told you the way: apply geographically broadly.

    You may not see yourself as a "bad applicant" but you barely passed Step I, have a below average Step II score, a CS failure, no US LORs or USCE, so I would categorize you as a poor candidate. I'm not sure where you get the idea that "most programs see CS as a useless examination". I would argue the exact opposite especially for an IMG: the CS is a good way to ascertain command of the English language (please have someone proofread your PS because although I realize this is an internet bulletin board, your posts here are rife with spelling, punctuation and grammatical errors) and ability to effectively consolidate information and impart that in the medical record and to the patient. Thats a very difficult thing to teach and is a key element. 98% of US medical students and 80% of non-US medical students pass it on the first try, so when someone doesn't it sends up a red flag.

    I cannot speak specifically for certain programs but in general LORs from non-US physicians are not very valuable. I would assume that some of your medical school faculty and classmates have trained or are currently training in the US. You need to call in all your favors and ask them for help as well; they may have a colleague here in the US who would be willing to take you on. Otherwise you can start checking the websites of all programs in your area and contacting them.
     
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  34. AMEHigh

    AMEHigh 7+ Year Member

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    No, multiple people have recommended that you apply anywhere and everywhere with the letters you have now. As in you should've had your application in last week. At least apply with the 3 letters you have so your file is complete since most programs require 3 letters, then you can add an additional one later if you get another one. But for now, apply with what you have because waiting to apply is going to do you no favors.
     
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  35. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Right.

    There seems to be some kind of disconnect.

    1) No one is saying apply without letters. If you apply without LORs, programs will most likely consider your application INCOMPLETE and never review it. We are saying apply now to these other fields, with the letters you have now, acknowledging that these LORS may be suboptimal.

    2) A LOR in a month and a half from now does you little to no good (at least, this cycle). If your application is not COMPLETE by the program's deadline (usually Nov 1 at the latest), your application will never get reviewed. It might help you if you submit your app with the letters you have now, and then update with a new LOR in a month and a half, but I wouldn't count on it.

    3) I'm really not trying to be an ass here, but it doesn't really matter how you see yourself. By any objective measure, you ARE a bad applicant. 90% of programs are going to throw your application in the trash without ever reviewing it.

    4) I think it is actually pretty likely that you will get a prelim spot in NY. I suspect that when you do so you will say, haha I told you so. Doesn't matter. That's a short-sighted goal. One year in NYC does you no good if you can't find a categorical spot elsewhere.
     
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  36. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    Thank you all.. I actually applied into anesthesia prelim Surg prelim IM last week, and applied into IM, FM PM&R Gen S just now. You are right I might end up attaining a dead end job in prelim surgery or hopefully matching in a cat in the SOAP.
     
  37. jakeislove

    jakeislove MS IV 2+ Year Member

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    PM&R (in NYC) is a pretty competitive backup plan.

    Just sayin'.
     
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  38. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    How many programs total?
     
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  39. gladlyfocused

    gladlyfocused 2+ Year Member

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    NY has the highest Jewish population second to Israel. So, I'm assuming that plays a huge factor in applying ONLY there... That has to help somewhere...am I right OP?
     
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  40. rokshana

    rokshana Member 10+ Year Member

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    what? as in NY programs are more apt to to look at a Jewish applicant? Maybe…but there are plenty of Jewish applicants with good (actually great) step scores to pick from.

    residency is a short term thing and many of us end up in places that geographically don't plan to settle in…but its a means to an end…you do residency to be able to practice in the US…as an F/IMG you need to optimize your chances as much as possible…meaning that you should get the highest Step scores as possible, everything should be done as early as possible, a complete application into ERAS on the 1st day it is opened, applying as widely and broadly as possible, etc….we have a lot of hurdles placed in front of us as foreign grads when it comes to securing a residency spot…there is no need to add to them by not doing the most you can do to make yourself the most competitive applicant you can…

    hopefully the OP will get some interviews in NYS but the goal should be to get A residency, period…and to do all that you can to achieve that goal…even if it means you have to live somewhere that isn't ideal for a few years.
     
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  41. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    The NY schools are by far the most comfortable with the reputation of Technion. That's not directly because they are jewish...it's just a correlative thing. (NYers more likely to go to Technion, Technion students more likely to rotate in NY and apply to NY programs)
     
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  42. ThoracicGuy

    ThoracicGuy 2+ Year Member

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    Which makes it harder for the OP with his below average step scores. There's alot of competition out there, and frankly, alot better competition that will leave the OP with the SOAP or in a dead-end position like Gen Surg prelim.

    If the OP wants to become a US trained doctor, they should go anywhere and everywhere that will interview them across the US. Who cares that you want to eventually live in NY. There is plenty of time to find a job and move there after training is completed.
     
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  43. rokshana

    rokshana Member 10+ Year Member

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    and that is probably true…a graduate from an Israeli school m/l has a better chance at a program in NYS because of the close connections the state has…but they are still going towant the best and the brightest…a Technion grad that has an applicant comparable to a US grad may get a shot moreso because of the school…but a crappy student isn't going to get a chance just because they went to an Israeli school...
     
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  44. ElapidaeEnigma

    ElapidaeEnigma 5+ Year Member

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    Last edited: 11.06.14
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  45. aProgDirector

    aProgDirector Pastafarians Unite! SDN Advisor SDN Moderator 10+ Year Member

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    Well that's much more than I thought would happen. Good luck!
     
  46. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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    That's fabulous - I'm pleased for you.
     
    ElapidaeEnigma likes this.
  47. AMEHigh

    AMEHigh 7+ Year Member

    Joined:
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    Resident [Any Field]
    Uhh, wait...so can the rest of just start meeting with program directors and telling them our story to get some interviews?? That would be heavenly!

    OP, good luck.
     
  48. cubguy83

    cubguy83 Member 10+ Year Member

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    What an interesting thread. Got to hand it to the OP for being gutsy.

    An observation though: If I was an Anesthesia attending/PD I would care more about Step 1 than 2 because mastery of physiology and pharmacology basic science is really important to general anesesthesia. Just my 2 cents. Curious what the NRMP/ERAS historical data shows, too lazy right now to look it up.
     
  49. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    Joined:
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    I have kept the 2014 Charting Outcomes file open on my computer for just this sort of question (since it comes up pretty much hourly between 9/1 and ROL deadline day).

    Chance of an independent applicant matching Anesthesia with a Step 1 of 190 is 25-30%. For AMGs is 55%. Median Step 1 is 230. 90+% chance of matching for independent applicants at 12+ ranks.

    So clearly, the OPs chances aren't 0, but it's an uphill climb.
     
    DermViser and Winged Scapula like this.
  50. jakeislove

    jakeislove MS IV 2+ Year Member

    Joined:
    10.29.12
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    Location:
    Upstate, New York
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    I'm not the least bit surprised, considering it's NYC.

    I've met others (with similar backgrounds) that managed to get help even after missing the match and SOAP.
     
  51. Attending1

    Attending1 Where the senses fail us, reason must step in

    Joined:
    09.01.14
    Messages:
    45
    You listened to, and USED the good advice given to you in this thread. Best of luck
     

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