To SOAP or not...

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psychm

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Hello all. I did the couples match this year with both of us going into psych. We received about 20 interviews out of 35 programs, and went on about 15. Several of these were highly ranked programs. We didn't match. Sure, not everyone who interviews is a good fit but it is likely because one of us didn't receive their passing CS score in time (the score came out the end of January, which we released and tried contacting programs) or it is because she passed it on their 3rd chance. We are both US MDs and this whole year has been crazy and I still can't fathom how this happened.

We are both pretty competitive (230-240s on the Steps, no red flags except for this CS debacle) and I think we were lumped together near the end or wholeheartedly not ranked for this reason. We created the list with every possible combo as well as those with just one of us matching. We still didn't match. Its been quite shocking and pretty miserable the last day but I am struggling with what to do. We are trying the SOAP out and I can provide more information if needed but this whole thing just seems too odd and I really could use some advice.

Also, we are exploring the psych programs and transitional years, as well as prelims, but I am not sure I feel that desperation for these since I really think a perfect storm of flukes resulted in this. I'm just not sure if taking a year off or doing a research year of some sort while re-applying would be any worse than doing a transitional year.

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Hi. I'm a fourth year like you so I don't have any experience with the SOAP, but, having also couples matched (Psych and a different specialty), I just wanted to send warm wishes and I hope everything works out well for you. The couples match has been incredibly stressful and I can't imagine being in the position of trying to match somewhere near each other in the SOAP. From anecdotes online and from my colleagues, it seems like Psych was rough this year and having to couples match added an additional element of competitiveness. Regardless, there are many in your position (with strong scores like you two) who did not match--you're not alone.

You guys need to talk about whats more important: you both trying to SOAP into a Psych position (with the possibility of being away from each other for 4 years) OR trying to SOAP into a less competitive SOAP specialty and be together. If I were to speculate, I would think trying to match in the same FM program would give the best odds of being together + being a licensed board certified physician. From my area in the NE, there were multiple FM programs last year that had more than 1 unfilled spots. However, the whole SOAP process seems stressful and competitive and I dunno how realistic this would be. If you were both to match in prelim/transitional years, I don't know how realistic it would be to match together for a PGY-2 Psych position. You run the risk of: 1) one of you gets Psych and the other has to find a diff specialty close by or not match at all 2) neither of you match and neither of you are in a program that allows you to become a board certified physician 3) both match Psych but not near each other. If you both SOAP into a program that will make you a licensed physician (FM/IM/etc), than at least you guys will be together + be a board certified physician at the end (+ the possibility that you can reapply the following year for Psych + having a secure job to pay back both of your loans). I know it sucks having your dreams of being a psychiatrist crushed, but at the end of the day, being together and having a job is more important. Just because it might take longer for you to become a Psychiatrist in the end, it does not mean you failed. In fact, you'll be a stronger Psychiatrist for having a stronger medicine foundation.

Again, I'm only a fourth year so take my advice with a grain of salt. Because I've also couples matched, I've thought about the scenario in which my partner and I had to go through the SOAP and this was my plan if we had to do it--I thought I would share. I really hope things turn out well for you both and you guys find a spot together.
 
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2 failed cs attempts is a HUGE red flag. All interviews and applications should focus on less competitive programs. Try soap.

Otherwise, consider transitional programs and apply as pgy-2’s. This may help. Programs will struggle to see even a passing 3rd cs as redeeming. It’s a large mountain to climb.
 
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2 failed cs attempts is a HUGE red flag. All interviews and applications should focus on less competitive programs. Try soap.

Otherwise, consider transitional programs and apply as pgy-2’s. This may help. Programs will struggle to see even a passing 3rd cs as redeeming. It’s a large mountain to climb.

There must be more to the story for the US MD with 230-240s listing 15 options to match solo with no red flags not matching. It's pretty obvious why the double CS fail individual didn't match, and thus why the couples match didn't go through, but psych has not gotten so competitive that 230-240 no red flag US MDs aren't matching.
 
There must be more to the story for the US MD with 230-240s listing 15 options to match solo with no red flags not matching. It's pretty obvious why the double CS fail individual didn't match, and thus why the couples match didn't go through, but psych has not gotten so competitive that 230-240 no red flag US MDs aren't matching.

Did they inform programs of the desire to couples match? I could imagine that programs that knew would not desire to take 1 and not the other applicant. The accepted applicant may be more likely to transfer out or be upset with the program for not taking both.

Matching in the same program can be more difficult anyway as relationships don’t always last which can result in drama within the program.
 
Did they inform programs of the desire to couples match? I could imagine that programs that knew would not desire to take 1 and not the other applicant. The accepted applicant may be more likely to transfer out or be upset with the program for not taking both.

Yeah I agree, in general residency programs are very risk adverse. Matching half a couple would be quite risky, at worst you risk a situation where they ultimately decide not to show up and at best your matching someone who is devastated their significant other didn’t match.
 
Of course we did! Most of our interviews were the same day since we told every program coordinator/director this and of course made it clear through ERAS. Being transparent was literally the number one goal, and ultimately why neither of us matched. We each talked about it with every program director. All the while everyone praises us and tell us how we are guaranteed to match and be great psychiatrists but hopefully we rank them high yada yada. We literally made such good friends between the dinners and interview days I text/email a few applicants and residents every one in a while.

I know that you guys are looking for some obvious red flag besides the CS fails, but I think psych was so overwhelmed this year that I was basically discarded by each and every program director. Enough program directors told me we would each be ranked on merit, and not just together, that contacting them all to tell them to rank us separately seemed like it could only backfire. I mean, we literally turned down invites from Ivy League and top 10 schools last minute due to the feedback we received about us and CS as a whole. Its this simple, some programs quite possibly weren't right for us but many that were didn't care to check ERAS for the updated CS score even though we contacted them about it, or it was too late which is also possible.

Why did your spouse fail CS twice? What was the reason?
 
Of course we did! Most of our interviews were the same day since we told every program coordinator/director this and of course made it clear through ERAS. Being transparent was literally the number one goal, and ultimately why neither of us matched. We each talked about it with every program director. All the while everyone praises us and tell us how we are guaranteed to match and be great psychiatrists but hopefully we rank them high yada yada. We literally made such good friends between the dinners and interview days I text/email a few applicants and residents every one in a while.

I know that you guys are looking for some obvious red flag besides the CS fails, but I think psych was so overwhelmed this year that I was basically discarded by each and every program director. Enough program directors told me we would each be ranked on merit, and not just together, that contacting them all to tell them to rank us separately seemed like it could only backfire. I mean, we literally turned down invites from Ivy League and top 10 schools last minute due to the feedback we received about us and CS as a whole. Its this simple, some programs quite possibly weren't right for us but many that were didn't care to check ERAS for the updated CS score even though we contacted them about it, or it was too late which is also possible.

The process is like dating. People say things and sometimes don’t mean it. Other times, the people saying reassuring things have little say in the process.

I’ve seen a program chair walk in and tell the residency director to not rank anyone with a failed step. I’ve seen other faculty vote down someone couples matching because they don’t like the pair. I’ve seen residents vote down a couple based on their short interaction.

I’ve personally seen a couple divorce during residency which made things awkward for the program. Some programs avoid this if they can.

Interviews from Ivy League programs mean nothing when there is a failed cs. It’s too big of a red flag to be worth interviewing there in my opinion. There is too high a chance that someone will down-rank you.

Maybe none of this occurred in your instance. Maybe it was a fluke. I have no idea. It’s terribly upsetting that a failed cs can lead to such difficulty matching. I certainly feel for you.

If soap fails, I’d choose transitional programs over re-applying. Quality performance could lead to pgy-2 positions at good programs.
 
There must be more to the story for the US MD with 230-240s listing 15 options to match solo with no red flags not matching. It's pretty obvious why the double CS fail individual didn't match, and thus why the couples match didn't go through, but psych has not gotten so competitive that 230-240 no red flag US MDs aren't matching.

Are you saying that if you fail cs twice with an otherwise solid record you can’t even match psychiatry anymore?
 
Are you saying that if you fail cs twice with an otherwise solid record you can’t even match psychiatry anymore?

If you fail CS twice you should be applying at 20-30 low tier programs to be safe.
 
Are you saying that if you fail cs twice with an otherwise solid record you can’t even match psychiatry anymore?

I think the issue is that applicants and their advisors know about their entire academic history and convince themselves massive red flags such as multiple step failures are easily overlooked. But on the other side you have program directors meeting someone for 10 minutes then two months later a committee is looking at 50+ interviewers with no red flags and suddenly it’s hard to justify not ranking the applicant with objective red flags above the 50 people without any.

I would advise any applicant with a otherwise good application but a red flag like that to figure out the absolute least competitive programs in their quarter of the country and make a point to interview at them as a fail safe. When you have red flags plenty of good programs may roll the dice and give you an interview just to be sure they aren’t missing a diamond in rough, but actually getting ranked to match is much tougher.
 
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This is a tough time for those who didn't match. My advice would be to try and match into an open prelim IM or transitional year and then re-apply during intern year for psych to try and start as a psych PGY2. 6 months of intern year in general psych are neuro/FM/IM/EM anyway, so doing a prelim or TY year really won't set you back and you could still finish residency in 4 years, or at most 4.5 (but probably 4 since a large part of 4th year is electives anyway).
 
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Are you saying that if you fail cs twice with an otherwise solid record you can’t even match psychiatry anymore?

Its literally this. I can PM you the truth while others here provide generic, vague responses. I poured my heart out into these forums but I deleted most of it. I don't even think any of us can trust you. This is probably not the safest place to discuss any of this. At best, we get contradicting advice from program directors and others connected assuming we must suck and have other red flags as applicants.
 
Its literally this. I can PM you the truth while others here provide generic, vague responses. I poured my heart out into these forums but I deleted most of it. I don't even think any of us can trust you. This is probably not the safest place to discuss any of this. At best, we get contradicting advice from program directors and others connected assuming we must suck and have other red flags as applicants.

I think you’re just underestimating the impact of failing CS twice... especially if you only looked at “top programs.”
 
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couples matching already pulls you down and reduces the chances of matching. as has already been mentioned 2 CS failures can be the kiss of death and kills both of your applications. often the med student advisors are clueless (even the ones that are psychiatrists themselves) if they arent involved in GME. doing research in this case is not going to be helpful. the concern we have about people who fail CS is their clinical ability and the best way to remedy this is by having outstanding LoRs from prelim programs. this would also allow one to start as a PGY-2. PGY-2 spots, as Ive mentioned elsewhere are still much, much less competitive than PGY-1 spots, are usually not in the match, and would potentially allow for couples with programs where they have several spots. In addition, this would mean you still complete residency on the same time line rather than extending.
 
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Are you saying that if you fail cs twice with an otherwise solid record you can’t even match psychiatry anymore?

I certainly feel for those that didn’t match, but it appears like many received bad advise.

Failing cs 2x makes it hard to match anywhere and into anything. Massive red flag. States have license requirements for passed steps. My understanding is that states will refuse to license applicants with 2 step failures (Alaska) and many others have limits of 3 attempts. If an applicant were to match into a state with a 3 step limit and the resident failed cs a 3rd time, I would expect immediate termination with cause. Therefore, most programs would rather SOAP an applicant than match someone that may have to be terminated. Not to mention that failing cs 2x means that there are possibly significant clinical interaction deficiencies.

Applicants with 2 step failures should be applying to mostly bottom 40 places and brand new programs. I’d even add safety fields like FM and peds. Academic programs like Texas Tech are as competitive as I would apply on the psych side.

While my comments sound harsh, it is important to realize how difficult this situation is. Prelim and transitional years are highly recommended along with passing all steps.
 
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I certainly feel for those that didn’t match, but it appears like many received bad advise.

Failing cs 2x makes it hard to match anywhere and into anything. Massive red flag. States have license requirements for passed steps. My understanding is that states will refuse to license applicants with 2 step failures (Alaska) and many others have limits of 3 attempts. If an applicant were to match into a state with a 3 step limit and the resident failed cs a 3rd time, I would expect immediate termination with cause. Therefore, most programs would rather SOAP an applicant than match someone that may have to be terminated. Not to mention that failing cs 2x means that there are possibly significant clinical interaction deficiencies.

Applicants with 2 step failures should be applying to mostly bottom 40 places and brand new programs. I’d even add safety fields like FM and peds. Academic programs like Texas Tech are as competitive as I would apply on the psych side.

While my comments sound harsh, it is important to realize how difficult this situation is. Prelim and transitional years are highly recommended along with passing all steps.

I agree with everything in this post. But just a note: I would caution doing a prelim/transitional over SOAPing into FM/IM/etc. Theres a transitional program at my home school and observing some of my friends, its a stressful position going into the match the 2nd time around without a backup (ie. How will you pay back your loans if you don't match after a transitional year? What job will you obtain if you don't match?). You likely are in this position not matching the first time around because you did not have a backup plan (ie. ranking enough safety schools or not applying to a backup specialty). By SOAPing into a FM/IM/etc program, at least you'll be on your way to being a board certified physician and having a job to pay back your loans if things don't work out reapplying for a PGY-2 Psych position.
 
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I think you’re just underestimating the impact of failing CS twice... especially if you only looked at “top programs.”

I understand. It has been a really rough few days. I just wish I was not discarded because of the couples component. We would have gladly done anything and everything to have the other SOAP or match in another specialty as close as possible if we knew this could happen. Thank you though for making it clear. We weren't only looking at top programs though, but either way I appreciate your input and I see your point.
 
It doesn't sound like you did anything wrong.

However from a practical stand point you probably should not have couples matched. Your partner was unfortunately a figurative live grenade strapped to your leg. And seeing as to how many others didn't match into psych-- I doubt many people could have matched into psych this year with two attempts on CS even at these "low tier" programs that didnt have to rank an applicant with a red flag when there's plenty of blemish free apps to sort through.

Despite the differences in your profiles, you guys were probably ranked closely together and that was perhaps just too low on the list. Why would they rank you #3 and her #57 when you are couples matching into the same program? Unfortunately for you guys this is just bad timing and bad luck. I genuinely feel for the predicament you are in. This system literally asks people to pick their career or their loved ones. How are people suppose to answer that?? You guys did what you thought was best.

Good luck going forward.
 
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Well, I sort of had a freakout but I appreciate everyone's help. My home program fortunately created a new spot for me so I am going to be a psychiatrist. I don't know how it happened exactly or if this ever happens but I feel really lucky. My SO will be doing research with psychiatry faculty for a year. I could not be more thankful and excited now after having what felt like the week from hell. I also wanted to thank everyone for taking the time to give such thoughtful responses after I really stressed out immensely.

I highly suggest that future applicants a) Take CS early and prepare properly b) Do not do the couples match in the same specialty if possible. If both of you are passionate and dead set on one properly communicate to program directors if you are okay with being ranked jointly or completely separately etc. Like, really communicate to all of them what you want. I wish I mentioned to rank us separately. I have basically received feedback from my PD as well others I interviewed with that if not for the couples match, I would have matched, and possibly pretty well. Life is strange.
 
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Well, I sort of had a freakout but I appreciate everyone's help. My home program fortunately created a new spot for me so I am going to be a psychiatrist. I don't know how it happened exactly or if this ever happens but I feel really lucky. My SO will be doing research with psychiatry faculty for a year. I could not be more thankful and excited now after having what felt like the week from hell. I also wanted to thank everyone for taking the time to give such thoughtful responses after I really stressed out immensely.

I highly suggest that future applicants a) Take CS early and prepare properly b) Do not do the couples match in the same specialty if possible. If both of you are passionate and dead set on one properly communicate to program directors if you are okay with being ranked jointly or completely separately etc. Like, really communicate to all of them what you want. I wish I mentioned to rank us separately. I have basically received feedback from my PD as well others I interviewed with that if not for the couples match, I would have matched, and possibly pretty well. Life is strange.


Glad everything worked out for you!
 
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