step 1 220s

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Would a year off be necessary for less desirable programs as well? I am in a similar position too (high 220s) and have heard mixed things.
 
I'm in a slightly worse situation. I just got my step 1 score back and I got 219. I am interested in neurosurgery, and this was devastating for me. My practice exams scores were around 230 (which in itself is not optimal for neurosurgery), which is why I am so surprised that my actual score was so much lower. Is there any hope at all for a future in neurosurgery, or even general surgery? Can a strong Step 2 and amazing MS3 grades/evals make up for a poor Step 1--enough to be considered for any neurosurgery residency program?
 
I'm in a slightly worse situation. I just got my step 1 score back and I got 219. I am interested in neurosurgery, and this was devastating for me. My practice exams scores were around 230 (which in itself is not optimal for neurosurgery), which is why I am so surprised that my actual score was so much lower. Is there any hope at all for a future in neurosurgery, or even general surgery? Can a strong Step 2 and amazing MS3 grades/evals make up for a poor Step 1--enough to be considered for any neurosurgery residency program?
Not any program. Some have hard Step 1 cutoffs. Obviously if the rest of your application is rock solid like you say it will be, you'll get a chance at many programs despite your score.