want to match into specific city

[monkeypenny]

I'm a M3 right now and I've been dating my boyfriend (now fiance) long distance for 3 years now. We want to make sure we land in the same city after I graduate so that we can get married in settle down.

We are specifically thinking about Dallas since that's where his family is. I'm currently at a MD program at a state school (not Texas) and I have a very average GPA, and I had to take Step 1 twice.

Would it be risky if I only applied to programs in Dallas? i'm interested in family, IM, peds, and psychiatry (I know, I haven't really narrowed it down). I'm worried about not matching at all since I'm not a very competitive student but at the same time, location really matters to us because my fiance has to be able to find a job in that city (he's currently in DC) and we want to be near family.

Am I risking being unmatched by limiting myself this way?

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[peppy]

Yes, there is a risk of being unmatched by applying very narrowly like that. I've seen it happen to other people who focused only on programs in a certain geographic area for family reasons.
It certainly makes sense to rank programs in your preferred geographic area highest on your rank list, but I would encourage you to apply broadly as a safety net. A medical degree without a residency is useless for employment, and it would be a shame to throw all the hard work you've already done away so close to the finish line.
What kind of work does your fiance do? Is it really something that he can't do in any other city? Does he make enough money that he can support you and pay your student loans for you if you don't match?

 

[DrAwsome]

I'm a M3 right now and I've been dating my boyfriend (now fiance) long distance for 3 years now. We want to make sure we land in the same city after I graduate so that we can get married in settle down.

We are specifically thinking about Dallas since that's where his family is. I'm currently at a MD program at a state school (not Texas) and I have a very average GPA, and I had to take Step 1 twice.

Would it be risky if I only applied to programs in Dallas? i'm interested in family, IM, peds, and psychiatry (I know, I haven't really narrowed it down). I'm worried about not matching at all since I'm not a very competitive student but at the same time, location really matters to us because my fiance has to be able to find a job in that city (he's currently in DC) and we want to be near family.

Am I risking being unmatched by limiting myself this way?

I would not restrict myself to just one city. With that said, I would imagine that Dallas and surrounding cities in Texas would have enough programs in the primary care specialties you mentioned that you should be able to match into. Texas is huge, and has a hugeeeeeee # of programs. Quickly looking, it seems there are 27 FP programs and 20 IM programs alone. Psych 11 programs. So it seems that you'd likely match. Sure, some programs may not consider you since you had to retake step 1 twice, and Texas has some quirky laws regarding licensing that are based on the # of times USMLE's have been taken, so I would look into that as well. However, if you think you would be happy in other cities, by all means apply. Can you fiance work in a place other than Texas for a few years?

 

[monkeypenny]

Thanks for the response DrAwsome.

I tried googling some information regarding TX licensing laws but wasn't able to find anything definite so I'll keep looking at that. Thanks for bringing that up since I wasn't aware of it before.

It would be possible for my fiance to look for a job somewhere else but I guess the reason we didn't want to look for other places is because we wanted to be near family. Also, I was hoping that if it seemed likely I would be able to match somewhere in Dallas, that he could get a head start on job searching before I matched there.

Does that sound like a bad idea? (I already feel like it is just from typing it haha). A lot of my concerns just stem from the anxiety of being matched in a city where he can't find a job and then also not being near family either. I've spent the last few years going to med school far away from both fiance+family and nervous that this will extend into my residency years.

Thanks to anyone who is bothering to read my nervous concerns haha

 

[monkeypenny]

Peppy,
My fiance is a consultant and is relatively flexible about finding a job in a bigger city (ie Dallas, DC, NYC, etc). He would be able to financially support me but like you said, who wants to be unmatched after all that hard work in med school?

At this rate, I am thinking about being geographically focused in maybe 2 or 3 cities instead of just 1 to protect against unmatching.

 

[gutonc]

Peppy,
My fiance is a consultant and is relatively flexible about finding a job in a bigger city (ie Dallas, DC, NYC, etc). He would be able to financially support me but like you said, who wants to be unmatched after all that hard work in med school?

At this rate, I am thinking about being geographically focused in maybe 2 or 3 cities instead of just 1 to protect against unmatching.

Residency (at least in the specialties you're discussing) is 3-4 years long. You don't have to stay where you do residency. So why limit yourself geographically at that point? You can always move later if you're so inclined. Also, it is rare for people to apply to multiple specialties in the way you're planning. Programs won't really be interested in someone who's not really interested in their specialty. So pick one and run with it.

Make yourself somebody that programs want to have around. Take Step 2 early (and do 30 points better than you did on Step 1). Get honors on your clerkships. Do a couple of away rotations...make PDs want you.

If you scour this site, you will find numerous sob stories from people in your position and with your plan, who didn't match. Don't add to those statistics.

 

[monkeypenny]

Thanks gutonc. Point well made. I definitely don't want to be unmatched. That is a bigger priority than being in an ideal city.

 

[DrAwsome]

Thanks for the response DrAwsome.

I tried googling some information regarding TX licensing laws but wasn't able to find anything definite so I'll keep looking at that. Thanks for bringing that up since I wasn't aware of it before.

It would be possible for my fiance to look for a job somewhere else but I guess the reason we didn't want to look for other places is because we wanted to be near family. Also, I was hoping that if it seemed likely I would be able to match somewhere in Dallas, that he could get a head start on job searching before I matched there.

Does that sound like a bad idea? (I already feel like it is just from typing it haha). A lot of my concerns just stem from the anxiety of being matched in a city where he can't find a job and then also not being near family either. I've spent the last few years going to med school far away from both fiance+family and nervous that this will extend into my residency years.

Thanks to anyone who is bothering to read my nervous concerns haha

I think it's important for you to match the first time around if possible and given the step 1 issue, even though the specialties you are thinking about are not that competitive, it may be a slight issue. As I mentioned before, sure there are lots of programs in TX and it's likely that you would match, but you never know so it's best to be geographically diverse. I think it would be easier for your fiance to find a job than for you to figure out what to do if you don't match. If I were you, I'd try to expand the cities where you could possibly be happy geographically.

Your family lives in TX? It may not be ideal if you can't be close to family, but if you are with your fiance/then hubby I think it's a much easier situation and it'll only be for a few years. You can move closer to family after you finish. If your fiance is a consultant and can find jobs in major cities, then I would focus my energy on applying certainly to programs that are close to family, but also to programs in major cities so that your fiance has an easier time of getting a job once you match. Unfortunately the residency process is becoming more and more competitive and it's not always easy to match where we'd prefer. Again though, it would suck big time not to match and your first time around is usually your best chance, so I'd suggest to give it all you got.

Best of luck.

 

[mlw03]

I'm a M3 right now and I've been dating my boyfriend (now fiance) long distance for 3 years now. We want to make sure we land in the same city after I graduate so that we can get married in settle down.

We are specifically thinking about Dallas since that's where his family is. I'm currently at a MD program at a state school (not Texas) and I have a very average GPA, and I had to take Step 1 twice.

Would it be risky if I only applied to programs in Dallas? i'm interested in family, IM, peds, and psychiatry (I know, I haven't really narrowed it down). I'm worried about not matching at all since I'm not a very competitive student but at the same time, location really matters to us because my fiance has to be able to find a job in that city (he's currently in DC) and we want to be near family.

Am I risking being unmatched by limiting myself this way?

Yep. Welcome to adulthood, where tough decisions abound. Not trying to be flip in particular, but there's just not an easy answer. You're a below-average candidate from a PD's perspective, and matching may be a challenge if you don't limit yourself at all. Limiting to one city, even one of the size of Dallas, makes you risk of not matching go even higher. I think your best chance to match at a program in Dallas would be to do an MS4 sub-I in a low-tier program in Dallas (in the specialty you ultimately pick) around October-November of MS4, do an absolutely outstanding job, and hope to whatever deity you believe in that's enough.

 

[monkeypenny]

Thanks for the tips and for the honest advice. I am ditching my idea of limiting myself to one city and I will look into some other locations.

 

[commenteitor]

Continuing on what was said in other posts: You shouldn't limit yourself to Dallas, as it is too risky. But there are plenty of places that are "close" to Dallas (less than 4 or 5 hours driving/ less than 1 hr. flights) and have training programs, including: San Antonio, Houston, Austin, Shreveport, Oklahoma City, Tulsa, etc. So you can even look at places outside of Texas.

 

[monkeypenny]

Thanks commenteitor. I have started to look for some cities in Texas including Austin and Houston and also some other ones in other states. I appreciate your advice.

 

[dragonfly99]

Agree with the above...although I believe people were being a little harsh.
I think the biggest obstacle in her application is/was probably the having to take Step 1 twice.
OP, it sounds like you still have >>1 year left in med school, and several months before you have to apply. I think you should concentrate right now on trying to figure out which specialty you want to apply to. Usually it is better to apply to just 1, though occasionally people apply to more than one. It wouldn't be that crazy to apply to both IM and fp, if you really really wanted one particular city, but I wouldn't advertise that fact to anyone interviewing you, because it does make you look like you aren't committed to their specialty. So if you can, try to decide between psych/fp/IM. Also, make sure you pass the Step 2 on your first try, so probably want to take a reading elective or very easy rotation the month before that. Also arrange 1-2 subI's in the specialty (or specialties) you are considering, and make sure you do well on those. A lot of internal medicine is just taking a good history and physicial, and then following up on the details (your patients labs, imaging studies, etc.). I don't know what advice to give for psych.

One thing to think about when deciding on a specialty is what kind of patients you like seeing and how do you envision your career after residency. I think one thing to realize with IM is that a lot of patients are older (particularly in inpatient medicine) and have a lot of comorbidities. It's hard to "fix" people sometimes. Also you will have to do several ICU months during residency, which for some people is stressful (well, for most of us...) and if you want to do primary care later, such as all outpatient medicine, may not be that necessary. For family practice, you have to deal with trying to know a large number of things (OB/Gyn, peds, and medicine) but on the other hand it's a good specialty to have for job hunting (lots of places want to hire outpatient primary care docs, urgent care doc that can see both adults and peds, etc.). Also, they tend to have on average in their clinics, more of a mix of some healthier, younger patients along with the usual internal med patients who are over 50 and somewhat decrepit. My general impression is that fp residencies tend to be more chill, although you do have to deal with the phenomenon of often being the "off service" intern who knows less than the others. My impression is that most fp residents take less call and do more outpatient months than we did in IM.
Psych is a good specialty if you like talking to people and want to have good work hours when you are in practice. They are one of the few specialties that can/could sometimes still set themselves up in a private practice type setting, with renting or sharing an office with other docs, and not have to necessarily be someone's employee...unless they want. Also, when in practice they tend to work fewer hours than IM and fp docs.

I do agree with not limiting yourself to 1 city. I feel like if you pass Step 2 the first time and concentrate on doing well on your sub-I's, I don't see any reason why you won't match unless you limit yourself to too few programs.

 

[Socrates25]

I just spent 5 months and $1800 getting my full (non-training) Texas medical license -- taking step I twice is not a problem for licensure.

How do I know that? Because its one of the minutiae tested on the Texas medical jurisprudence exam.

 

[monkeypenny]

Good to know Socrates25! thanks

 

[gutonc]

I just spent 5 months and $1800 getting my full (non-training) Texas medical license -- taking step I twice is not a problem for licensure.

How do I know that? Because its one of the minutiae tested on the Texas medical jurisprudence exam.

There are no states that won't license you simply for a single Step failure. The strictest state is AK which limits you to 2 attempts/step. 2nd strictest is WY which allows 7 attempts (total) to pass all 3 steps. Most states are either 3 attempts/Step or no limits at all, with a few odd variations in the middle there.

 

[sprinkibrio]

The IM and peds programs in Dallas likely wouldn't take you, but you have a chance in the family med and psych programs.