What are my realistic chances for matching into peds?

[freedo]

Hi future colleagues (hopefully).
I am a 3rd yr DO student who has had a terrible experience with medical school thus far. Ive been pretty dead set on doing peds but now worry that my chances are slipping through my fingers, if not already gone. What are the chances for a student with 1 preclinical repeat year (left middle of 1st semester of medschool, if that even matters) and a COMLEX level 1 failure to match into peds? I am scheduled to take both COMLEX 1 and Step1 in 1 month. Id like to stay in my homestate CA (or anywhere in the west/mt states) and would prefer to train at an academic or university-affiliated community institution as I plan to become a neonatologist. I understand its going to be tough battle up ahead, but what are some other things I can do in the year I have left to improve my chances at a match?

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[freedo]

The first and foremost thing - focus on passing the boards. Then do well in all third year rotations and exams and of course Level 2. Good Luck!

My clinical rotations so far (although it’s only been a couple) have all gone well. Got honors and had an absolute blast! I have yet to take a shelf exam. Given my already riddled history of poor testing results, any suggestions for performing well?

 

[ortnakas]

I’m not peds, but from what I’ve seen people in your situation can afford to be picky about geography or specialty but not both. California is possible, and pediatrics is possible, but pediatric residency at an academic institution in California is quite the reach.

 

[Schwifty]

So fortunately the biggest thing you have to do to match peds is literally apply to peds. Your comlex failure is a big red flag, but having a pass on step will help. Do as well as you can on step/comlex 1/2 and Apply broadly. Academic peds in CA is unlikely, you need to apply to community programs and don’t limit it just to CA. Good luck!

 

[Mr. Babe]

I agree with @ortnakas. You seem to have way too many pigeon holes when your application at this point kind of sucks (repeat year and board failure). You need to apply broadly and increase your application number to well above 50. An academic institution......forget it unless you have ties somewhere. Apply to lots of academics, but be realistic that your chances are much greater at a community hospital that is more forgiving of a board failure. Your focus has to be on boards right now because you can't fail again.

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[DO2015CA]

Peds is one of the easiest specialties to match but they’re less forgiving about board failures than say FM. If you pass and do well on step 1 then they most likely won’t care about the comlex 1 failure (well it won’t be as impactful) but if you don’t do well then don’t expect to stay out west for residency. Good thing is neo doesn’t fill every year so you really doesn’t matter which peds program you go to.

 

[calvinhobbes]

Don’t do peds. Do FM.
I have heard that peds boards are the most expensive and hardest out of any specialty, its very easy to fail, and close to 3 thousand dollars. And FM makes more money than peds, and in FM you can still see kids if you want.

I would apply FM if I were you, save yourself the money and trouble. NPs are taking over most neonatology jobs from what I have seen, so if I were you, def apply to FM as a back-up. Good luck!

 

[freedo]

Don’t do peds. Do FM.
I have heard that peds boards are the most expensive and hardest out of any specialty, its very easy to fail, and close to 3 thousand dollars. And FM makes more money than peds, and in FM you can still see kids if you want.

I would apply FM if I were you, save yourself the money and trouble. NPs are taking over most neonatology jobs from what I have seen, so if I were you, def apply to FM as a back-up. Good luck!

thanks for the insight. definitely didnt know about this part of the process, post-residency. ill have to do some more research

 

[freedo]

Peds is one of the easiest specialties to match but they’re less forgiving about board failures than say FM. If you pass and do well on step 1 then they most likely won’t care about the comlex 1 failure (well it won’t be as impactful) but if you don’t do well then don’t expect to stay out west for residency. Good thing is neo doesn’t fill every year so you really doesn’t matter which peds program you go to.

would it still be important to attend a program that focuses on inpatient care as opposed to outpatient care? theres a new local, community facility that really focuses on ambulatory care. if this ends up being one of the few in state programs that offers an interview, should i be concerned about prospects post residency in regards to completing a neo fellowship?

 

[DO2015CA]

would it still be important to attend a program that focuses on inpatient care as opposed to outpatient care? theres a new local, community facility that really focuses on ambulatory care. if this ends up being one of the few in state programs that offers an interview, should i be concerned about prospects post residency in regards to completing a neo fellowship?

Won’t matter because neo doesn’t fill. Also, peds is an inpatient specialty. Unless there is a primary care track then it’s an inpatient specialty. Peds is IM for small people. IM is a hospital specialty. Peds is a hospital specialty. That’s why it irks me about the invention of this completely bogus hospitalist fellowship that really only gets cheap labor for another 2 years and adds nothing unless you want to go into academic medicine. Which I still are doesn’t add skills, only hierarchy.

 

[calvinhobbes]

thanks for the insight. definitely didnt know about this part of the process, post-residency. ill have to do some more research

Sure, just letting you know! Also, all peds fellowships are 3 years as I understand it, and most (not all) salary wise coming out, may be less then gen peds. Some places even now make you do a 2-3 year hospitalist fellowship just so you can work as an attending on the floor (which FM or IM doesn’t require, to be a hospitalist on the floor).
So, the path to working only with kids is harder and the salary isn’t better. I would recommend FM so you can do whatever you want and have more opportunities and also make more salary! This is what my peds friends always gripe about, that they are overworked but paid much less. So, just some insight! Good luck to you

 

[calvinhobbes]

Won’t matter because neo doesn’t fill. Also, peds is an inpatient specialty. Unless there is a primary care track then it’s an inpatient specialty. Peds is IM for small people. IM is a hospital specialty. Peds is a hospital specialty. That’s why it irks me about the invention of this completely bogus hospitalist fellowship that really only gets cheap labor for another 2 years and adds nothing unless you want to go into academic medicine. Which I still are doesn’t add skills, only hierarchy.

Yeah I think the peds hospitalist fellowship is ridiculous. My friends are really mad about that

 

[DO2015CA]

Yeah I think the peds hospitalist fellowship is ridiculous. My friends are really mad about that

Yes, I’m a little tilted too haha. A pediatric resident is way more equipped to come out and be a hospitalist than outpatient if anything.

 

[DOVinciRobot]

Unfortunately your chances of matching anything are 0 until you have passed boards. Focus on that, and that alone, and only after you’ve passed should you start planning all strategies.

once you pass you should be able to match peds somewhere.

 

[ohmanwaddup]

Peds is one of the easiest specialties to match but they’re less forgiving about board failures than say FM. If you pass and do well on step 1 then they most likely won’t care about the comlex 1 failure (well it won’t be as impactful) but if you don’t do well then don’t expect to stay out west for residency. Good thing is neo doesn’t fill every year so you really doesn’t matter which peds program you go to.

This is something I have noticed and find very interesting. The peds programs I am looking at are BIG on wellness and are very friendly, but there websites are full of "no failures or any kind allowed, decently high baords cut offs (220 for step 500 for comlex)" and thats just for a smattering of midwest programs, not just the fancy ones too.

 

[DO2015CA]

This is something I have noticed and find very interesting. The peds programs I am looking at are BIG on wellness and are very friendly, but there websites are full of "no failures or any kind allowed, decently high baords cut offs (220 for step 500 for comlex)" and thats just for a smattering of midwest programs, not just the fancy ones too.

Yes. I suspect that there is a high correlation with step/level failure and ABP board failures. More so than other specialties.

 

[ohmanwaddup]

Yes. I suspect that there is a high correlation with step/level failure and ABP board failures. More so than other specialties.

I've heard peds boards are hard AF. I just wonder too that in order to have those wellness programs and be nice, they have to have students who can manage to still perform well with the extra time off.

 

[freedo]

This is something I have noticed and find very interesting. The peds programs I am looking at are BIG on wellness and are very friendly, but there websites are full of "no failures or any kind allowed, decently high baords cut offs (220 for step 500 for comlex)" and thats just for a smattering of midwest programs, not just the fancy ones too.

does anyone know (even anecdotally) any specific programs that have accepted students with a board failure?

 

[DO2015CA]

I've heard peds boards are hard AF. I just wonder too that in order to have those wellness programs and be nice, they have to have students who can manage to still perform well with the extra time off.

Haha Idk about all the extra time off.. at least from my experience in my program. It’s pretty similar to the IM program and certainly more than our FM program. We are 80% inpatient like the majority of peds programs

 

[DOVinciRobot]

Haha Idk about all the extra time off.. at least from my experience in my program. It’s pretty similar to the IM program and certainly more than our FM program. We are 80% inpatient like the majority of peds programs

Yeah wellness doesn’t really translate to extra time off.

 

[Neopolymath]

Yeah wellness doesn’t really translate to extra time off.

It's basically extra emails to delete

 

[ohmanwaddup]

Yeah wellness doesn’t really translate to extra time off.

I know some programs that give afternoons off for wellness, or dont make ICU interns stay for nights or weekends

 

[DO2015CA]

I know some programs that give afternoons off for wellness, or dont make ICU interns stay for nights or weekends

That’s dumb. You are a resident as an intern and should be treated as such. We don’t make our off service do overnight PICU shifts but that’s more because we don’t want them left to their own devices rather than wellness stuff.

Also, wellness is the biggest hot topic in residency and just lead to more work through wellness lectures, etc. I have yet to see anything productive come from a wellness curriculum.

 

[AlbinoHawk DO]

Peds is easier to match than FM. If you can't match peds, you'll be without any residency

 

[DO2015CA]

Peds is easier to match than FM. If you can't match peds, you'll be without any residency

Unless you’ve failed a step then the paradigm shifts. You will still match peds but it becomes harder than FM just sheer number of FM programs that will still interview applicants compared to peds. But as a whole I agree

 

[ohmanwaddup]

That’s dumb. You are a resident as an intern and should be treated as such. We don’t make our off service do overnight PICU shifts but that’s more because we don’t want them left to their own devices rather than wellness stuff.

Also, wellness is the biggest hot topic in residency and just lead to more work through wellness lectures, etc. I have yet to see anything productive come from a wellness curriculum.

You may missunderstand, Pgy1-Pgy3 at these programs get a specific protected afternoon off if they are not on the floors. The residents at all of them talked a lot about how it was a massive quality of life change, they suddenly had a slot they could schedule appointments, things that needed to get done, or just sleep.

If you didnt, well lol what do you want? you say you have yet to see anything productive but think that actual measures that are being taken (fail to see how anyone could think that a protected weekly afternoon off would not improve "wellness") are dumb?

 

[hallowmann]

You may missunderstand, Pgy1-Pgy3 at these programs get a specific protected afternoon off if they are not on the floors. The residents at all of them talked a lot about how it was a massive quality of life change, they suddenly had a slot they could schedule appointments, things that needed to get done, or just sleep.

If you didnt, well lol what do you want? you say you have yet to see anything productive but think that actual measures that are being taken (fail to see how anyone could think that a protected weekly afternoon off would not improve "wellness") are dumb?

I think you need to put this into perspective a little. What they are actually saying is that maybe once every quarter they are getting a scheduled 1/2 day (i.e. 4 hrs) of admin time instead of working in a slow outpatient clinic (maybe seeing 4-6 people) or off-service outpatient rotation. That means that unlike all other times when they are no doubt working even on the light rotations over the full work day, they can actually schedule things they need that are rarely open during non-business weekday hours (e.g. doctor appointments, dental appointments, etc. - you know things that people in other professions or even midlevels can just say, "Oh I'm going to leave early today for a doctor's appointment" and hand in a note).

The categorical FM program here implemented something like this 1-2 yrs ago. Obviously residents liked it because they didn't have to use actual vacation time for doctor appointments, but I know of no programs actually giving people a half day off every week. And just to be clear what you don't realize in residency is that when you're on those outpatient rotations, you're not just working the 8-5 in clinic and done, you're also probably taking call over the weekend, you're probably spending extra time doing documentation, extra time completing random tasks of which you get emails about almost everyday, you're contacting patients about test results, etc.

Is this better than not having it? Absolutely. But don't fool yourself into thinking this will completely change how you feel.

 

[ohmanwaddup]

I think you need to put this into perspective a little. What they are actually saying is that maybe once every quarter they are getting a scheduled 1/2 day (i.e. 4 hrs) of admin time instead of working in a slow outpatient clinic (maybe seeing 4-6 people) or off-service outpatient rotation. That means that unlike all other times when they are no doubt working even on the light rotations over the full work day, they can actually schedule things they need that are rarely open during non-business weekday hours (e.g. doctor appointments, dental appointments, etc. - you know things that people in other professions or even midlevels can just say, "Oh I'm going to leave early today for a doctor's appointment" and hand in a note).

The categorical FM program here implemented something like this 1-2 yrs ago. Obviously residents liked it because they didn't have to use actual vacation time for doctor appointments, but I know of no programs actually giving people a half day off every week. And just to be clear what you don't realize in residency is that when you're on those outpatient rotations, you're not just working the 8-5 in clinic and done, you're also probably taking call over the weekend, you're probably spending extra time doing documentation, extra time completing random tasks of which you get emails about almost everyday, you're contacting patients about test results, etc.

Is this better than not having it? Absolutely. But don't fool yourself into thinking this will completely change how you feel.

I mean it’s not admin time, they don’t have any hospital responsibilities. I’ve talked to residents who started at these programs before it was implemented and say the difference is huge now that they have that protected time

 

[DO2015CA]

I mean it’s not admin time, they don’t have any hospital responsibilities. I’ve talked to residents who started at these programs before it was implemented and say the difference is huge now that they have that protected time

Good news if true. But I think acgme curriculums are starting to implement wellness as one of their core focuses (idk exactly how tbh, didn’t pay attention in this years acgme milestone lecture). I think most specialties will start some kind of wellness curriculum in the next couple years. How that’s done will depend on the program. A 1/2 day per quarter is what my program does to schedule appts as you said above.

 

[ohmanwaddup]

Good news if true. But I think acgme curriculums are starting to implement wellness as one of their core focuses (idk exactly how tbh, didn’t pay attention in this years acgme milestone lecture). I think most specialties will start some kind of wellness curriculum in the next couple years. How that’s done will depend on the program. A 1/2 day per quarter is what my program does to schedule appts as you said above.

Interesting, Ill be honest I dont really follow ACGME stuff yet. Id hope it would be actual improvement and not the infamous wellness lectures but I know the latter will be most likely

 

[calvinhobbes]

Peds is easier to match than FM. If you can't match peds, you'll be without any residency

That’s actually not true. Plenty of people don’t match peds and match/SOAP into FM bc peds programs are less forgiving about poor grades and step scores/failures. Many people who apply peds actually use FM as a back-up.

 

[hallowmann]

I mean it’s not admin time, they don’t have any hospital responsibilities. I’ve talked to residents who started at these programs before it was implemented and say the difference is huge now that they have that protected time

It's still admin time. You technically have no responsibilities. But it's classified as admin time to get past the RRC limitations on total days off. Also, like I said, residency is full of non-recorded work that eats into your personal time. Again, it's better than nothing, but just wanted to put it into perspective.

 

[AlbinoHawk DO]

That’s actually not true. Plenty of people don’t match peds and match/SOAP into FM bc peds programs are less forgiving about poor grades and step scores/failures. Many people who apply peds actually use FM as a back-up.

I looked back at the data because it certainly was the case 3-4 years ago that the average pediatrics step was lower. It appears this has changed as of the last couple of cycles, so I stand corrected

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