Time off AFTER med school? Please help.

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keysersoze

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Hello all. Please forgive the double post if you've seen the one in the General forum...

I know that discussing "weakness" is a taboo subject among the young and self-assured, but I find myself at an impasse and I need help. I am a 4th year at a reasonably well-respected institution in NYC. I have not yet taken Step 1, and realistically, I know I have only 6 or so more weeks until I must take this exam or I put myself at a disadvantage in the application process. I am finding it exceedingly hard to focus on this, since in the next 6 weeks I am also taking 2 straggler core clerkships that did not fit into my 3rd year schedule.

The following list does not imply that my life is harder than that of anyone else. It simply is an accounting of what I have been dealing with in addition to medical school for the past 3 years:

-My mother's chronic spinal cord disease took a great turn for the worse in terms of pain, coming at a time when I lived in a different city for the first time in my life.

-Buckling under the stress of family-related issues and a very unhealthy physique and lifestyle, my father has a cardiac event during my first year

-Around the time of spring break my first year, my mother was subjected to an intrathecal overdose of dilaudid and baclofen via the pharmacy mixing the drugs and misreading the decimel point resulting in a ten-fold higher dose than intended. She nearly died from this incident, and spent almost 10 weeks with varying degrees of auditory and visual hallucinations that are associated with baclofen withdrawal.

-2nd year, my future brother-in-law, whom I love very much, was diagnosed with colon cancer (requiring resection) at age 38. This disease killed his father at age 45, and seems to be the first familial proof of HNPCC.

-My fiancee, who lives with me, and who I love even more, became very depressed. She has become very close with my parents due to the absence of her own, and seeing them and her brother suffer took its toll.

-Over 2nd year, it becomes apparent that my mother has suffered short term memory losses from the overdose, and now has frequent panic attacks...a problem that she NEVER faced before, even as a disabled chronic pain patient.

-Nearly bringing my fiancee and I to our knees in disbelief, my other would-be brother-in-law dies in the Rhode Island "Station" nightclub fire, February 20, 2003.

-In the meantime, my mother no longer enjoys the pain relief that her intrathecal pump delivered before her overdose, and is in 10/10 pain almost all the time.

I wish the above timeline were either 1) bull****, or 2) stretched out over 10-20 years instead of 3 years in med school. But this is how and when it has all come down. The stuff with my mother...how sad to admit this...is all but expected in my life. Her medical history is a sad series of events, I can assure you. Our whole family has worked through it bit by bit for 20 years. The other events, on top of her misfortune, are what has really thrown me off kilter here.

Despite maintaining High Pass/Honors grades in my clinical clerkships this past year, I still have not taken this god forsaken Step 1 exam, and I HEAR THE CLOCK TICKING DAY BY DAY. Focusing on more than one thing at a time right now (clerkship + Step 1) is beyond my ability.

My question for those who have stayed with me up to this point is this: I want to go into anesthesiology, I have always known this, but I really feel as though taking one year off and getting the hell out of New York City would do me a hell of a lot of good. Is it reasonable for me to take a year off after I graduate to get focused again and get ready for the medical road ahead? I sincerely hope it is feasible, otherwise I do not know what I'm going to do. As far as explaining it to residency directors next year, I believe I can do that without seeming like a "slacker." While there is nothing wrong with needing time to find one's self, I do not need to find myself in this instance. I simply need to pick up a few of the pieces I lost while I've been getting the **** kicked out of me these past few years.

Will I really be hurting myself by doing this? My feeling is no...given that I will surely attain a higher Step 1 score when I can take longer than 6 weeks to study for it...but I really need reassurance right now.

To those who read my entire diatribe, I thank you sincerely. I do look forward to your responses. Best of luck to each of you as you continue on the road ahead.

Keyser Soze
 
Definitely. Take the time off.
 
Thanks for the speedy reply, Old MD.

To your knowledge, would I be hindered significantly by applying the year after I graduate, even if I'm able to attain a higher board score because of the respite?

I'll be applying to anesthesia programs all across the South.
 
Take this for what it is worth b/c I am not a residency director, nor have they consulted me on what they are looking for. However, I have heard people recommend that unless you have a good reason, it may be a red flag to take a year off. You seem to have one the best reasons I have heard in this regard. Even though medicine takes extreme dedication, there are some things in this life worth more than your career. If you feel that you need some time with your fiancee, mother, father and even yourself to get things back to "normal" then your decision is obvious. My humble opinion is that programs will understand this. If not, then that may not be the type of place that you want to be. Sorry for the hard couple of years.
 
Thank you, Carm, for your reply. I might add that I would also be looking to do some research in my time off, not just sit back and do nothing. It is simply all the curricular things on top of one another that is a problem right now.

I'm starting to work with my Dean about what I can do here. I welcome any more replies or advice.
 
I don't think taking a year off will solve any problems. I am much more stressed out in residency than I was in Med School.

Do a cush internship.... I know at my Transitional Year program(in Philly) people were getting away with a lot. PM me and i can give you the details.Let's just say, I had more sleep and vacation during my TY than med school 😀 . Of course i didn.t learn a thing.

But I was able to finish Step 3 with ease and obtain a Full Medical License in my home state.

By the way.... the ACGME requires that you finish Step 3 by the start of the CA-3(PGY-4) year. In Louisiana... you'll be kicked out of your residency by the state board if you don't pass step 3 by your CA-3 year. (Talk about pressure)
Best of Luck....
Khanh Pham
 
I have 3 kids under 5 years old and my wife has MS. She's a 6/10 pain every day. I gave up my flying career to take care of her and my kids. And I found another one (medicine, although still in school) that is difficult, but is easier for my family to deal with than my previous career. What am I saying? Take care of your family. There's nothing more important than your family. Put first things first, and the rest will fall into place.
 
Thanks to everyone for the replies. Heeed!, I am sorry to hear of your wife's condition. My mother has arachnoiditis, and her correspondence with several chronic pain patients has led her to believe that MS pain is similar in character to the pain of her disease. Not easy to watch, I know.

I am working with my Dean to look into taking a research year before I graduate, which has several benefits over taking a post-graduation year. This, most likely, will be the direction I take. The research certainly won't hurt, and the more laid back schedule will mean a lot to me and my family. I've spoken to several residency coordinators around the country, and the response from them has been positive. All but one has said that they don't feel a year of research will be detrimental to my application. That is certainly reassuring.

I welcome any other opinions out there. Thanks again to those who have offered their views already.

Keyser
 
the most important part of your app is your step I score if you wish to get into the very competitieve programs; columbia, cornell, and sinai are in that league. you get screened on this score, and even after screening it's a big deal. there is a nyc program that takes certain applicants out to dinner but not others based upon step I scores. i don't want to say which, but it's not one of those three.

in my uneducated opinion, I think the anesthesia letter can only really say 2-3 things about you: your punctuality/work ethic. personality, and whether you could respond to their pimping, which is usually pretty light. maybe your rotatin has a written test, the results of which could help or hurt your letter. research is another component of the letter, but won't spend too much time on that here.

i personally would not mention why you took time off...just say you wanted to do research and leave it at that. there are tons of very successful med students who do a research year simply because they want to.

i matched at a HMS hospital in boston with no step II score and average grades. all of my experiences on the interview trail showed me that step i is not the only, bt it is probably the most important part, of an application to the "top 10"(whatever that means) programs. i don't think this is right.

after the step I, good clerkship grades and other strong letters are important, as well as not bombing the interview.

hope my lone perspective helps.

it may be helpful for people to post step i cut off scores they know or supect in a new forum, to help guide people who want to go to certain programs before they take their step I. of course there are exceptions. with a 250 Step I and average grades (no clerkship honors), I did not get an interview at stanford, UCSF, columbia, duke, or MGH. stanford and duke really surprised me. i got a hopkins interview the day after i submitted my app; does that mean it was granted straight on my score? word on the street was they interviewed a lot more than they needed to based on the program's paranoia, including among other things people not wanting to move to baltimore, chair/faculty changes. caught the flu when i was supposed to interview there.

maybe badass step II scores can get you screened in, who knows.
 
on the badass step II, it can help out a bunch. Person from our school last year had a 210 on Step I, but got AOA and then went out and got a 250+ on Step II. She got all the "top 10" interview places and matched at her #1.
 
are you USIMG? I think you mentioned that in another thread. I figured a 250 Step I would at least get you interviews anywhere.

joshmir said:
with a 250 Step I and average grades (no clerkship honors), I did not get an interview at stanford, UCSF, columbia, duke, or MGH. stanford and duke really surprised me. i got a hopkins interview the day after i submitted my app; does that mean it was granted straight on my score?
 
no. us grad, non-ranked MD school nobody's heard of...which makes it harder to show up with average grades, especially considering our class step I average was >90% nationally. I hear U missouri, another less well known school, busts out phenomenal boards, >99%.

is it true that many IMGs take a year off and bust out ridiculously high scores? do PDs hate on this?
 
Joshmir, you mentioned that one program took some of their interviewees out to dinner based on their step I score. any idea what was the score cut off for interviews and also for going to dinner? just curious,

lefty
 
no idea. and it was floated by the residents who took us out as a possible reason why we qualified. i feel like a tool for not saying which one, but i promised...plus if it gets out, they'll probably stop doing it, which would defeat something that serves as a great way to know that program is very interested in you...ie after that happened, i stopped interviewing at "back-ups". plus that dinner was radiculopathy sweet- the nicest meal i will ever had in the city.

but, still nothing compared to the fact that programs used to fly you and your spouse out to their interviews when gas was in the doldrums.
 
It's called "wellness," not "weakness."

Take the time off [I'd advise NOW], slow down, gather yourself, try to disengage a bit [with professional support] from the tremendous emotional demands. IMHO, you're too tied up with other issues to be a safe or effective physician in the near future -- you owe it not only to yourself, but to your future patients, to be emotionally sound and cognitively focused. The amount of stress and distraction you report can only lead to unsound judgment and bad outcomes. Let the others heal by other means -- give yourself the time and permission to heal yourself. No "cush" year 1, no research -- just catch your breath. If medicine is your true vocation, you can ALWAYS come back.

Good luck -- keep us posted.
 
I wouldn't take a year off after medical school if I were you. Instead I would try to do the 4th year over 2 years. You could incorporate research time into that if you wanted, plus give yourself ample study time. I have a few friends who spread out their 4th year like this and it worked out really well for them. They were burned out too. This would allow you to take Step 1 and 2. Step 2 requires much less preparation than step 1 so you should knock it out of the way before you graduate. The longer you wait to take step 1, the more preparation you will have to do. Plus I think it would be easier to apply to residency while you are still a student at the school rather than on a year off.

One thing to consider when deciding about taking a year off afterwards if you have student loans is that they will go into repayment. You can get them into forbearance if you don't have much income, but interest will start accumulating. If you spread out 4th year over 2 years, you can continue to defer them.
 
gaslady said:
I wouldn't take a year off after medical school if I were you. Instead I would try to do the 4th year over 2 years. You could incorporate research time into that if you wanted, plus give yourself ample study time. I have a few friends who spread out their 4th year like this and it worked out really well for them. They were burned out too. This would allow you to take Step 1 and 2. Step 2 requires much less preparation than step 1 so you should knock it out of the way before you graduate. The longer you wait to take step 1, the more preparation you will have to do. Plus I think it would be easier to apply to residency while you are still a student at the school rather than on a year off.

One thing to consider when deciding about taking a year off afterwards if you have student loans is that they will go into repayment. You can get them into forbearance if you don't have much income, but interest will start accumulating. If you spread out 4th year over 2 years, you can continue to defer them.


As far as loans, you need to be "full time" for them to no go into repayment.
 
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