Unmatched medical student re-applying to FM

[ARDS987]

Hi all,

I am a 4th year DO student who applied this past residency cycle (2020) to 100+ IM programs, received 7 interviews, and ultimately did not match. I received a few phone interviews during SOAP, but did not get into any positions. I think a factor that affected me was the fact that I had two failed PE on my transcript and did not receive the pass until later in the application cycle.

I am set to graduate from DO med school this May. I took time to think about my future, and am very interested in pursuing primary care. I am considering re-applying this time mainly to FM instead of IM positions this September for the 2021 match.

Stats were as followed: Step 1/Level 1 ~230/530 1st attempt, Step 2/Level 2 ~220/510 1st attempt, PE pass 3rd attempt

My questions are:

1. Considering that I will have a one year gap between graduation and residency, what are my chances for FM residencies? I'm thinking about applying to ~100+ FM residencies.

2. For the gap year, would it be sufficient to do some form of paid research and/or observership/externship in FM? Again, my ultimate goal is to match FM.

3. Would I need to use new LORs? Do I need to get a letter from an FM doctor? I am overly concerned, because I have 2 LORs from IM doctors and 1 LOR from an EM doctor. I assume my letters were at least good since I received interviews in the last cycle.

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[deleted480308]

You need a letter from fm

 

[V5RED]

Hi all,

I am a 4th year DO student who applied this past residency cycle (2020) to 100+ IM programs, received 7 interviews, and ultimately did not match. I received a few phone interviews during SOAP, but did not get into any positions. I think a factor that affected me was the fact that I had two failed PE on my transcript and did not receive the pass until later in the application cycle.

I am set to graduate from DO med school this May. I took time to think about my future, and am very interested in pursuing primary care. I am considering re-applying this time mainly to FM instead of IM positions this September for the 2021 match.

Stats were as followed: Step 1/Level 1 ~230/530 1st attempt, Step 2/Level 2 ~220/510 1st attempt, PE pass 3rd attempt

My questions are:

1. Considering that I will have a one year gap between graduation and residency, what are my chances for FM residencies? I'm thinking about applying to ~100+ FM residencies.

2. For the gap year, would it be sufficient to do some form of paid research and/or observership/externship in FM? Again, my ultimate goal is to match FM.

3. Would I need to use new LORs? Do I need to get a letter from an FM doctor? I am overly concerned, because I have 2 LORs from IM doctors and 1 LOR from an EM doctor. I assume my letters were at least good since I received interviews in the last cycle.

You do not need an FM letter to apply to FM, but it helps. You do need 3 clinical LOR and you need at least one of them to be from a PCP. My best letter was from an Internal Medicine PCP.

 

[V5RED]

I actually disagree with this recommendation. I would encourage OP to get at least one FM letter.

First, some programs do require an FM letter specifically (or at least some did when I applied in 2019). OP needs to keep as many doors open as possible, and closing some over something as silly as not having an FM letter is less than ideal.

Second, FM programs/PDs really value a commitment to family medicine. I'm guessing that at this point, OP does not have much on his resume that supports that commitment, if only because that's not what they were initially planning on applying to. Getting a letter from an FM doc who can speak to OP's interest and qualifications for the specialty may help a bit to bridge that gap.

You disagreed by repeating what I said. It is not required, but it helps.

 

[ARDS987]

Yeah, I understand how important a FM letter could be. Since I'm graduating in May, I was thinking of doing an observership/externship for like a month or so to fulfill it.

However, for the gap year, is it preferable to do some kind of paid research if my goal is to get into FM? Or would any kind of paid position/volunteer work be fine? Considering how I would be applying in September, I'm not sure if I can produce anything substantial from research to improve my app.

 

[ARDS987]

Perhaps I was unclear. You seemed to imply that no program requires you to have an FM letter - that is not accurate. Many programs also consider an FM letter to be a tacit requirement, not just something that "helps." Similar to, for example, clinical experience for med school applications - there aren't many schools out there that explicitly require a certain number of hours to be considered for admission, but if you don't have it, it's highly unlikely you'll get in.


Research doesn't really make a big difference for FM. I would focus your efforts on clinical work, particularly in FM with an underserved patient population of interest to you - homeless, rural, veterans, LGBT...whatever floats your boat. Some public health or community research might be a nice feather in your cap but is not necessary, and would probably not be helpful in the absence of other things on your CV that support an interest in family practice.

Have you checked with your school if there's any way you can delay graduation and continue doing rotations? Do you have a mentor or advisor in FM, a home program PD or faculty member, etc. who could help you figure out how to strengthen your applications?

And I'm so sorry you're dealing with this. It sucks. Wishing you the best.

ETA: Also would be worth attending the AAFP Students & Residents Conference in Kansas City in August (if things are back to normal at that point) to check out programs and make connections.

Well, I spoke with my advisor who recommended that I do some kind of observership/externship or research during the gap year to fulfill time. Additionally, I was recommended not to delay graduation if the only thing I needed was a FM LOR.

 

[n3xa]

ETA: Also would be worth attending the AAFP Students & Residents Conference in Kansas City in August (if things are back to normal at that point) to check out programs and make connections.

This is a great place to make connections with various family medicine programs. Our program definitely took note at those who came up to our booth and showed an interest.

And agree with keeping the clinical skills fresh instead of research.

The rest of your board scores look great, btw. Best of luck to you.

 

[Ironheme]

There's something else that's missing with your app. Either your LOR's weren't stellar or there is something else. I find it strange a DO with fairly good board scores (minus the fail) would only get 7 interviews out of 100 applications. Did you apply to a mix of programs? Also, I'd ask someone to give you interview feedback. It only takes one interview to match. You'll want to maximize your chance by performing well in the interview to make up for the fails. A great interview goes a long way.

 

[Sardonix]

I would also agree that an FM letter is mandatory, not optional. FM PDs are always on the lookout for being second fiddle or safety options. FM letters explicitly stating intent to go into FM help counter that.

 

[Splenda88]

This time is go big or go home. 150+ FM programs.

 

[Make Or Break]

Start your search for good fm programs you would want to match into now. Also consider opposed vs unopposed FM that gives you more procedures, depending on the program, since there is no EM, gen surgery or ob residents. More central lines, LP’s, intubations, etc for you to do yourself.

 

[septoplasty]

OP, you've gotten some sound advice above.. all I will wish to say is best of luck to you.
We could use another FM doc!

 

[hallowmann]

Well, I spoke with my advisor who recommended that I do some kind of observership/externship or research during the gap year to fulfill time. Additionally, I was recommended not to delay graduation if the only thing I needed was a FM LOR.

I'm just going to put this out there that your school would prefer you graduate and be out of their hair. This is not always the case for med schools (many go out of their way to create "fellowships" you can do while still a student so you can reapply as one the following year), but I've seen it done a lot with DO schools. They often rather you leave with less of a chance at residency than have to deal with you more.

Assuming you're not getting close to the 6-yr cutoffs, if you can delay graduation, even just a few months, that is likely in your best interest. Being able to apply in Sept as a student will help, plus you'll get the opportunity to do a rotation and get an FM letter hopefully with real clinical experience (although I don't know that's happening much right now). Ultimately, you'll have to decide if its worth it and there are likely financial considerations, but having an LOA in school while you do something productive is actually slightly better than having a big gap after you graduate.

A big gap after graduation with no appreciable clinical duties is honestly a huge red flag. Another option would be seeing if you can scramble into a pre-lim year or intern year somewhere, but it might be hard to find anything right now.

I agree with others above that you will need to apply very broadly, research any programs that are open to failed board scores, and get an FM LOR.

 

[betamale]

Go to Missouri and work as an Assistant Physician to prevent gaps and obtain experience, salary

 

[AlbinoHawk DO]

I would suggest being painfully honest in your next personal statement. I would even go as far as saying you should write that your goal is to become an FM hospitalist. You could center your essay around the fact that you failed to match and then learned much more about FM. You can say you had a misperception that hospitalist work was only done by IM and that you're now excited that you can do it as FM plus add OB/Gyn work to your mix. Do a rotation with FM hospitalist to confirm this desire on paper.

In the coming years it appears they want to make intensivist fellowships for FM, so you may want to look into that if it is attractive to you.

Hi all,

I am a 4th year DO student who applied this past residency cycle (2020) to 100+ IM programs, received 7 interviews, and ultimately did not match. I received a few phone interviews during SOAP, but did not get into any positions. I think a factor that affected me was the fact that I had two failed PE on my transcript and did not receive the pass until later in the application cycle.

I am set to graduate from DO med school this May. I took time to think about my future, and am very interested in pursuing primary care. I am considering re-applying this time mainly to FM instead of IM positions this September for the 2021 match.

Stats were as followed: Step 1/Level 1 ~230/530 1st attempt, Step 2/Level 2 ~220/510 1st attempt, PE pass 3rd attempt

My questions are:

1. Considering that I will have a one year gap between graduation and residency, what are my chances for FM residencies? I'm thinking about applying to ~100+ FM residencies.

2. For the gap year, would it be sufficient to do some form of paid research and/or observership/externship in FM? Again, my ultimate goal is to match FM.

3. Would I need to use new LORs? Do I need to get a letter from an FM doctor? I am overly concerned, because I have 2 LORs from IM doctors and 1 LOR from an EM doctor. I assume my letters were at least good since I received interviews in the last cycle.

 

[Gos81238ia]

Hi all,

I am a 4th year DO student who applied this past residency cycle (2020) to 100+ IM programs, received 7 interviews, and ultimately did not match. I received a few phone interviews during SOAP, but did not get into any positions. I think a factor that affected me was the fact that I had two failed PE on my transcript and did not receive the pass until later in the application cycle.

I am set to graduate from DO med school this May. I took time to think about my future, and am very interested in pursuing primary care. I am considering re-applying this time mainly to FM instead of IM positions this September for the 2021 match.

Stats were as followed: Step 1/Level 1 ~230/530 1st attempt, Step 2/Level 2 ~220/510 1st attempt, PE pass 3rd attempt

My questions are:

1. Considering that I will have a one year gap between graduation and residency, what are my chances for FM residencies? I'm thinking about applying to ~100+ FM residencies.

2. For the gap year, would it be sufficient to do some form of paid research and/or observership/externship in FM? Again, my ultimate goal is to match FM.

3. Would I need to use new LORs? Do I need to get a letter from an FM doctor? I am overly concerned, because I have 2 LORs from IM doctors and 1 LOR from an EM doctor. I assume my letters were at least good since I received interviews in the last cycle.

If you do end up re-using some of your letters (which is fine if they are presumed strong), I would ask specifically if your letter writers can include a line that you are applying to FM and they think you would be a good fit for that specialty. BEWARE if your letters mention a different specialty at all, that can be an instant no to an interview at a lot of programs.

 

[Gos81238ia]

I would suggest being painfully honest in your next personal statement. I would even go as far as saying you should write that your goal is to become an FM hospitalist. You could center your essay around the fact that you failed to match and then learned much more about FM. You can say you had a misperception that hospitalist work was only done by IM and that you're now excited that you can do it as FM plus add OB/Gyn work to your mix. Do a rotation with FM hospitalist to confirm this desire on paper.

In the coming years it appears they want to make intensivist fellowships for FM, so you may want to look into that if it is attractive to you.

Its not unreasonable to mention you want to become a hospitalist, especially at larger, more academic programs. For many community programs, it may scare them off if you go too hardcore in that direction as it kind of ignores the spirit of FM - the peds, the public health, the integration with the community etc.

 

[Gos81238ia]

Start your search for good fm programs you would want to match into now. Also consider opposed vs unopposed FM that gives you more procedures, depending on the program, since there is no EM, gen surgery or ob residents. More central lines, LP’s, intubations, etc for you to do yourself.

Unopposed for the win! All the ER, deliveries, inpatients and procedures galore.

 

[Gos81238ia]

I would also agree that an FM letter is mandatory, not optional. FM PDs are always on the lookout for being second fiddle or safety options. FM letters explicitly stating intent to go into FM help counter that.

Agree. I would say from the position of having reviewed applicants for FM, 95%+ had an FM letter.

 

[Sardonix]

I actually disagree with this a bit. This may be a regional thing (I only interviewed in the midwest), but I interviewed at a mix of academic and community programs last year. All of the academic programs (university hospitals, brand-name hospitals, etc) had most of their grads doing strictly outpatient primary care without OB/inpatient responsibilities. You mentioned the value of unopposed programs in your other comment - most academic programs are not unopposed. All of the programs I interviewed at with a large proportion of alums doing hospital medicine, and that truly prepared you for full scope practice, were community programs. That said, that is not the case for all community programs, so OP should do their research, check out the curriculum, see what alums are doing, etc. before the apply.

Of course, if you've seen one FM program, you've seen one FM program, so it's tough to paint any particular type of program with broad strokes.

Agreed.

In my experience on the interview trail, community programs were much more eager to talk about working as hospitalist, stating what grads were working part time or even full time inpatient. Large academic centers didn't shun the idea by comparison, but there was always the implication that you're competing with other services.

 

[AlbinoHawk DO]

Its not unreasonable to mention you want to become a hospitalist, especially at larger, more academic programs. For many community programs, it may scare them off if you go too hardcore in that direction as it kind of ignores the spirit of FM - the peds, the public health, the integration with the community etc.

You probably know better than me when it comes to FM in general, but when I spoke to some of my friends, they told me it was very common even at community programs that they had FM hospitalist attendings and inpatient FM rotations. Maybe it's regional? Most people I know are from CA programs

 

[Gos81238ia]

You probably know better than me when it comes to FM in general, but when I spoke to some of my friends, they told me it was very common even at community programs that they had FM hospitalist attendings and inpatient FM rotations. Maybe it's regional? Most people I know are from CA programs

Now that I'm reading all the replies, I think it must be just very program dependent. I trained at a community program and we did have inpatient family medicine rotations led by both IM and FM hospitalist attendings; our hospital did not differentiate between an IM trained or an FM trained hospitalist. A hospitalist was a hospitalist. It was great to get both perspectives and our inpatient FM training was excellent, leading to 1-2 grads a year becoming full time hospitalists. I do some inpatient work myself as a result too as part of my practice. Interestingly, despite all that, when people were applying and interviewing our program would often comment negatively against applicants who said they intended to become hospitalists; they wondered why they didn't apply to IM and worried they would be closed off to the other aspects of FM that were also important to being successful at our program.

I guess just tread carefully if you don't know how certain statements will be received at certain programs. You could always express interest without a firm commitment to a certain job pathway - e.g. "I admire the strong inpatient training at this program and I think I could make a great impact by bringing a family medicine continuity of care perspective to the inpatient world."

 

[hallowmann]

I actually disagree with this a bit. This may be a regional thing (I only interviewed in the midwest), but I interviewed at a mix of academic and community programs last year. All of the academic programs (university hospitals, brand-name hospitals, etc) had most of their grads doing strictly outpatient primary care without OB/inpatient responsibilities. You mentioned the value of unopposed programs in your other comment - most academic programs are not unopposed. All of the programs I interviewed at with a large proportion of alums doing hospital medicine, and that truly prepared you for full scope practice, were community programs. That said, that is not the case for all community programs, so OP should do their research, check out the curriculum, see what alums are doing, etc. before the apply.

Of course, if you've seen one FM program, you've seen one FM program, so it's tough to paint any particular type of program with broad strokes.

This is all very program dependent. You want to aim for an inpatient heavy program. You can get that at a community program or university program, opposed or unopposed. Depends mainly on the program and department culture. I'm in the midwest at a big academic center. The FM program here is inpatient heavy and sends half of their grads out as hospitalists and half as outpatient docs, some doing OB. It really just depends on the program.

 

[Tozanzibarbymotorcar]

Wait. Why did you not apply for a TRI? From what I'm hearing, a good number of new ones opened up.

 

[Lossrx]

Wait. Why did you not apply for a TRI? From what I'm hearing, a good number of new ones opened up.

I have not seen any Tri open up

 

[mlexi83]

I'm just going to put this out there that your school would prefer you graduate and be out of their hair. This is not always the case for med schools (many go out of their way to create "fellowships" you can do while still a student so you can reapply as one the following year), but I've seen it done a lot with DO schools. They often rather you leave with less of a chance at residency than have to deal with you more.

Assuming you're not getting close to the 6-yr cutoffs, if you can delay graduation, even just a few months, that is likely in your best interest. Being able to apply in Sept as a student will help, plus you'll get the opportunity to do a rotation and get an FM letter hopefully with real clinical experience (although I don't know that's happening much right now). Ultimately, you'll have to decide if its worth it and there are likely financial considerations, but having an LOA in school while you do something productive is actually slightly better than having a big gap after you graduate.

A big gap after graduation with no appreciable clinical duties is honestly a huge red flag. Another option would be seeing if you can scramble into a pre-lim year or intern year somewhere, but it might be hard to find anything right now.

I agree with others above that you will need to apply very broadly, research any programs that are open to failed board scores, and get an FM LOR.

what is a 6-year cut off

 

[hallowmann]

what is a 6-year cut off

You have to complete DO school within 6 years, start to finish. This is required by accrediting bodies (may vary a bit by state) and I think COCA. Its been a while since I've had to look into this, so certainly confirm, but that was the case when I was in school.