What to do during gap year (didn't get residency)

[LookingForAnswers81]

BACKSTORY:
My friend (I swear) did not get a residency position. He is a US-IMG (went to st. james in Anguilla, which from my understanding, is not a good Caribbean school). He applied to peds, family med, and internal medicine (sent 100+ apps for each field). I'm not sure what his step 1 and 2 scores were, but I do know that he passed them both on the first try, and that they were not sky high (e.g. he said his classmates who got a residency position had higher scores than him on step 2). Similarly, I know that he only received 5 interviews last cycle.

I'm just a lowly pre-med, but I've familiarized myself with the medical field enough that I'm concerned for him, and am posting this in hope that I can get some solid advice for him. I'm concerned because he is not doing anything substantial to improve his app. I've read on here that taking Step 3 is one of the best things to do for a reapplicant, but he doesn't seem to be taking that seriously (e.g. he won't be done studying in time for when the cycle begins [although he may take the exam by the time interviews start, if that makes a difference]). As of today, I do not believe he has added a single thing to his resume, although he will be working with a psychiatrist for a few weeks soon.

The psychiatrist is a family friend, so I think it's fair to assume this person will write a great letter of rec., and will add some additional time (e.g. will say he worked more months than he really did). The thing is, he's not applying to psych residencies (applying peds/family/internal again), so it's unclear to me how beneficial this letter will be. Similarly, since he has no new experiences, he will be using the same letters from his last application.

I'm also concerned that other details, such as him not having an undergraduate degree, and not having any research experience (or any work experience during his time in medical school, which lasted something like 6 years [he was studying for the Step 1 & 2 seemingly forever, although, to be fair, that seemed to be the case for all of his classmates, some of which got a residency spot]) will come back to haunt him. Similarly, I believe his last rotations were about 2-3 years ago, so I'm sure residency programs will be concerned about his skills diminishing.

Finally, I'm concerned about how he views the last application cycle. He seems to think one of the main reasons he didn't get a spot is because his personal statement didn't mention a story about a patient, which to me seems unlikely. Also, and this may not matter at all, but I'm also concerned that his lack of understanding about broader healthcare problems/the healthcare system in general, will make him look bad in interviews (e.g. he doesn't read and couldn't answer a question about EMR's, reimbursement, the ACA, end-of-life care, or anything remotely similar). Similarly, he has never read a medical journal, so he could not intelligibly answer questions about research or anything similar (to be fair, a lot of his classmates don't know anything about these topics and got residency spots, so it's unclear if this matters at all, but I just want to paint the best picture of him that I can).

QUESTIONS I'M HOPING CAN BE ANSWERED:
What should I tell him he should be doing over the next few weeks until applications open up again? As noted, taking step 3 in time for application is not an option (should I tell him to ensure he has it scored by the time applications are reviewed? If so, when is that?). Should he not work with the psychiatrist, and instead, find work with someone in a field he's applying to (or should I tell him he needs to apply to pysch if he ever wants to practice medicine?). Is it simply too late for him to improve his app enough to make him competitive? Does not having a bachelor's degree and taking 6 years to take step1 & 2, meanwhile not working/doing research, matter? Should I make sure he reads prominent medical literature (e.g. Atul Gawande's work)? Any other advice would be greatly appreciated.

P.s. I'm sure someone will comment saying he should be figuring this out himself... trust me, I recognize this.

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[ddjamb]

Application cycle starts in 1 month. Not sure what he can accomplish in such short period. Nonetheless, I think that working with a Psych for whatever period does not show commitment to Peds/FM/IM.
You said your friend received 5 IVs last year. It means that some programs where interested in his profile (his scores, background, medical school, the gap etc...were not an issue). The question he should ask himself is what went wrong. Maybe he should practice interviews with someone with experience. 5 IVs may seem not a lot but many of my friends got residency with less than that.
Best of luck to him.

 

[GoSpursGo]

QUESTIONS I'M HOPING CAN BE ANSWERED:
What should I tell him he should be doing over the next few weeks until applications open up again? As noted, taking step 3 in time for application is not an option (should I tell him to ensure he has it scored by the time applications are reviewed? If so, when is that?). Should he not work with the psychiatrist, and instead, find work with someone in a field he's applying to (or should I tell him he needs to apply to pysch if he ever wants to practice medicine?). Is it simply too late for him to improve his app enough to make him competitive? Does not having a bachelor's degree and taking 6 years to take step1 & 2, meanwhile not working/doing research, matter? Should I make sure he reads prominent medical literature (e.g. Atul Gawande's work)? Any other advice would be greatly appreciated.

Honestly, this is waaaaay too late to be asking these questions--people who failed to match in March have been scrambling this whole time to find something to do in their gap year. I would not be "working with" a psychiatrist if he's not applying to that field, let alone that you are telling me that he's going to commit fraud by saying he worked more than he actually did. Unfortunately, not having an undergrad degree probably also limits what jobs he would have been eligible for in the first place, so I'm not sure he would have gotten anything better.

I'm frankly surprised he got 5 interviews last cycle if his last rotations were 2-3 years ago and he's done *nothing* between then and now. If he wants to roll with this psychiatry job, that's probably the best he can do, and yes he needs to take step 3 this year and have it in by the time that residencies put together their rank lists. Reading literature is probably irrelevant. He should apply to literally every peds/FM/IM program under the sun and cross his fingers that one of them buys that the psychiatry experience is meaningful--if he fails to match this year, I suspect he never will.

 

[hmockingbird]

If this is truly your friend I think you need to let it go. His app is not your problem to solve.

 

[togaedere]

Especially cus this person doesn’t seem to be too motivated to do the work himself.

“Should I make sure he reads prominent medical literature?” Even if this would help him, how would you make him do it?

I also am pretty concerned about working with a psychiatrist who wouldn’t think twice about lying about time spent with them.

If this is truly your friend I think you need to let it go. His app is not your problem to solve.

 

[NotAProgDirector]

P.s. I'm sure someone will comment saying he should be figuring this out himself... trust me, I recognize this.

Although this is the last thing you wrote, it's the most important. If he isn't willing to do the work needed to get a spot, nothing you do is going to make any difference. I realize you're trying to help, but this is a problem you can't solve. It hurts to watch, if you're close to him.

went to st. james in Anguilla, which from my understanding, is not a good Caribbean school)

Correct, not a good school.

I've read on here that taking Step 3 is one of the best things to do for a reapplicant

Sometimes. This assumes he does well on it. S3 covers what you tend to learn in internship, so taking it beforehand requires some work. Perhaps more importantly for him, you must pass S3 within 7 years of passing your first step (usually S1, but whichever you take first). Given his timeline, he might be getting close to that limit. Also, there might be value in taking S3 now, so that he can focus on studying for other things during residency.

The psychiatrist is a family friend, so I think it's fair to assume this person will write a great letter of rec

This should be disclosed in the letter, which will minimize it's impact. In addition, a psych letter won't add much to an application for IM/FM/Peds.

and will add some additional time (e.g. will say he worked more months than he really did)

This is fraud. If discovered at any time, your friend can be fired immediately, especially if he knew about it (and since you seem to know about it, I assume he knows about it)

I believe his last rotations were about 2-3 years ago, so I'm sure residency programs will be concerned about his skills diminishing.

This is an enormous problem. It means that either he hasn't matched for several cycles, or delayed taking the step exams after his clinical work was done (which is crazy), or that he's been out of medical school for some time.

He seems to think one of the main reasons he didn't get a spot is because his personal statement didn't mention a story about a patient, which to me seems unlikely.

This is magical thinking. It has nothing to do with why he didn't get interviews and spots.

QUESTIONS I'M HOPING CAN BE ANSWERED:
What should I tell him he should be doing over the next few weeks until applications open up again? As noted, taking step 3 in time for application is not an option (should I tell him to ensure he has it scored by the time applications are reviewed? If so, when is that?). Should he not work with the psychiatrist, and instead, find work with someone in a field he's applying to (or should I tell him he needs to apply to pysch if he ever wants to practice medicine?). Is it simply too late for him to improve his app enough to make him competitive? Does not having a bachelor's degree and taking 6 years to take step1 & 2, meanwhile not working/doing research, matter? Should I make sure he reads prominent medical literature (e.g. Atul Gawande's work)? Any other advice would be greatly appreciated.

You should stop trying to help him, because you can't. He should have been answering all of these questions in March when he didn't get a spot (and perhaps much earlier if he really finished his clinical rotations 2-3 years ago).

Getting some clinical exposure is really important. Psych is less than ideal but better than nothing. Not having a BA/BS isn't a huge problem for residency programs, but may be an issue for getting a job outside of medicine. being able to interview better would help.

All that said, the best thing you can probably do is help him practice interviewing.

 

[LookingForAnswers81]

Although this is the last thing you wrote, it's the most important. If he isn't willing to do the work needed to get a spot, nothing you do is going to make any difference. I realize you're trying to help, but this is a problem you can't solve. It hurts to watch, if you're close to him.



Correct, not a good school.



Sometimes. This assumes he does well on it. S3 covers what you tend to learn in internship, so taking it beforehand requires some work. Perhaps more importantly for him, you must pass S3 within 7 years of passing your first step (usually S1, but whichever you take first). Given his timeline, he might be getting close to that limit. Also, there might be value in taking S3 now, so that he can focus on studying for other things during residency.



This should be disclosed in the letter, which will minimize it's impact. In addition, a psych letter won't add much to an application for IM/FM/Peds.



This is fraud. If discovered at any time, your friend can be fired immediately, especially if he knew about it (and since you seem to know about it, I assume he knows about it)



This is an enormous problem. It means that either he hasn't matched for several cycles, or delayed taking the step exams after his clinical work was done (which is crazy), or that he's been out of medical school for some time.



This is magical thinking. It has nothing to do with why he didn't get interviews and spots.



You should stop trying to help him, because you can't. He should have been answering all of these questions in March when he didn't get a spot (and perhaps much earlier if he really finished his clinical rotations 2-3 years ago).

Getting some clinical exposure is really important. Psych is less than ideal but better than nothing. Not having a BA/BS isn't a huge problem for residency programs, but may be an issue for getting a job outside of medicine. being able to interview better would help.

All that said, the best thing you can probably do is help him practice interviewing.

Thank you very much for taking time out of your busy schedule to answer this. I will follow your advice and do my best to help him prep for potential interviews. I just have one follow-up question: As you and others have pointed out, lying about the time spent with the psychiatrist is not a white-lie, but fraud. Similarly, the psychiatrist (who I'd imagine was not planning on disclosing their actual relationship in the letter) is the mother of his long-time girlfriend. Best case, it seems he could be accepted to residency, inevitably people will meet/find out about his girlfriend who has the same last name as the letter writer, which will cause them to find it odd that the writer did not mention the relationship, causing more investigation, ultimately leading to dismissal because of fraud (the psychiatrist doesn't own their own clinic, so i'm sure hours are documented and stored by a neutral individual, which would easily be discoverable). Combining that with him not applying to psych programs, it seems that this experience will have no upside and could totally backfire.

I mention this to say: I've been a research assistant for many years and could possibly get him a job as a research assistant doing translational research in a MD's lab (zero patient interaction though, and no shot at any publications or mentored independent research experience by the time match lists are made). Will this look better on his resume than the psych experience (even if I convinced him to be honest about the experience timeline/relationship with letter writer)?

Thanks again!

EDIT: Or, would it be better if I tried to make him realize that his actions over the past few months are unacceptable and are not going to get him into a residency program, and that he should apply next year instead (start 2020), and do everything ASAP to improve his app by that time (e.g. clinical experience/LOR's related to family medicine, rock the Step 3, maybe some research on the side, etc.)? Or would the gap in time between his clinical rotations kill his chances?

 

[TraumaLlamaMD]

It’s already August. I don’t believe there’s anything this person can do in the next 2-3 weeks that will make up for the numerous red flags on his application.

It sounds like you are far more invested in this person’s career than he is - if he doesn’t care enough to work this stuff out for himself, it doesn’t sound like he’s all that interested in making it work. The best thing for him would be to find a career that actually motivates him.

 

[GoSpursGo]

Thank you very much for taking time out of your busy schedule to answer this. I will follow your advice and do my best to help him prep for potential interviews. I just have one follow-up question: As you and others have pointed out, lying about the time spent with the psychiatrist is not a white-lie, but fraud. Similarly, the psychiatrist (who I'd imagine was not planning on disclosing their actual relationship in the letter) is the mother of his long-time girlfriend. Best case, it seems he could be accepted to residency, inevitably people will meet/find out about his girlfriend who has the same last name as the letter writer, which will cause them to find it odd that the writer did not mention the relationship, causing more investigation, ultimately leading to dismissal because of fraud (the psychiatrist doesn't own their own clinic, so i'm sure hours are documented and stored by a neutral individual, which would easily be discoverable). Combining that with him not applying to psych programs, it seems that this experience will have no upside and could totally backfire.

I mention this to say: I've been a research assistant for many years and could possibly get him a job as a research assistant doing translational research in a MD's lab (zero patient interaction though, and no shot at any publications or mentored independent research experience by the time match lists are made). Will this look better on his resume than the psych experience (even if I convinced him to be honest about the experience timeline/relationship with letter writer)?

Thanks again!

EDIT: Or, would it be better if I tried to make him realize that his actions over the past few months are unacceptable and are not going to get him into a residency program, and that he should apply next year instead (start 2020), and do everything ASAP to improve his app by that time (e.g. clinical experience/LOR's related to family medicine, rock the Step 3, maybe some research on the side, etc.)? Or would the gap in time between his clinical rotations kill his chances?

I'm just going to say what we're all thinking--based on what you are describing in terms of how shady and fraudulent this gig with a psychiatrist is, I'm not sure your friend SHOULD be a practicing physician. If he truly believes that some line in his personal statement is what kept him out of residency and that lying about this "job" with his girlfriend's mom in an unrelated specialty is an appropriate course of action, I'm not sure what you're going to tell him that will change what seems to be pretty fundamental character flaws.

fwiw, he should apply this year because additional years from graduation will completely kill any fading chances he has. I'm not sure there's anything he can do at this point to fix his application, he probably has to just roll with what he's got, hopefully being honest about this experience. If he figures this out on his own, more power to him, but I think your time will be better spent getting yourself into med school.