What to do with an MD if you can't get into the field you want?

[brownsdawg]

---

Members don't see this ad.

I have a friend (yes, a friend, not a "friend" i.e. me) who was a long shot to get into the field he wanted, but just got his step 2 scores back and now feels like he for sure won't be able to get into that field. He has already sent of applications, but he's being honest about his chances at this point.

The problem is, this friend's stats otherwise would be good enough to get into internal medicine, or probably a few other fine fields of medicine. But he feels that the only field that he wants to go into is the one he was applying to, and nothing else. I tried to convince him that there are so many different options in IM once you get started...but he feels like he wouldn't be happy going into IM. It is kind of too late to even think about other specialty fields too, as he'd have to get letters and even figure out if he likes them at all.

So my question... what other options are there? He is already applying to a prelim year... Should he just take the prelim and maybe consider trying to convert it into a categorical if he likes medicine?

What options are there outside of actually practicing medicine that one could do with an MD that are realistic? I didn't even know advice to offer in terms of resources to look at to find this type of thing out.

I feel really bad for my friend, and really want things to work out for him...I just don't have great advice to offer.

Any help would be appreciated.

 

[Blade28]

We need a few more details.

You said he's not interested in Internal Medicine. What is he interested in? Is it one that allows a Prelim Medicine/Surgery/Transitional year?

And he's so disinterested in every other field that he's willing to just graduate with an MD and not go through residency?

And you mentioned a poor Step 2 score - why did he take Step 2? Because his Step 1 score was only average? Or because his Step 1 score was already good, but he wanted extra "beefing up" of his app?

 

[brownsdawg]

Thanks for the reply...

I might as well be complete with my info because he doesn't post on here and this place is anonymous enough...

So the field was Derm. He's applying to prelim medicine programs already. Step 1 score was a good score... high 220s... but of course because it's Derm, that isn't good enough and he was hoping to score higher on the Step 2 to help a little bit. The problem is, he went down by close to 10 points. Not AOA.

So basically feels like it won't happen for Derm for sure now. But doesn't know what to do. Feels like he wouldn't be happy doing medicine. He was possibly interested in other fields, like even OB/GYN, but without any months scheduled and no letters of rec at this point, its too late to apply for that.

I'm trying to get some suggestions for advice. I know his opinions might seem different to some, but that's not what this is about... I just want to have something to offer him in terms of giving hope, or helping him out.

Hope that info helps some Thanks.

 

[Blade28]

Wow. I don't know what to tell you - if he's gung-ho about Derm and can't see himself doing anything else, well, that's tough. Prelim Medicine will probably help since he has to do that anyway (so he could reapply, theoretically), and maybe some subspecialty will interest him.

 

[Winged Scapula]

You are right about the competitiveness of Derm...his scores are low, but it is a small field and there might be a small chance that an away or a phone call/LOR from someone held in prestige in the field might help him.

He should also analyse what it is he likes about Derm. Is it the Path? If so, would Path interest him? Or is it the procedures? In that case, he might consider Plastics...albeit not any less of a competitive specialty. But the scope of general surgery is so broad that he could do a lot of skin and soft tissue work if he wished, but of course would have to do general surgery residency as well.

The good thing is that as a Prelim, in many programs, you can do electives...which he should try and arrange early to get LORS from next year's match (presuming he doesn't match into Derm). He could try for Derm again, or consider Ob/Gyn or whatever. There is a chance that he would have to repeat intern year, but if its that or doing nothing...I'd take the former.

If you do a search, you can find lots of threads on what to do with an MD and no residency...FWIW, the options aren't great especially if you have a fair amount of loan debt.

 

[Blade28]

He should also analyse what it is he likes about Derm. Is it the Path? If so, would Path interest him? Or is it the procedures? In that case, he might consider Plastics...albeit not any less of a competitive specialty.

OK, I just had to interject here for a second...

Procedures? In Derm?

 

[Winged Scapula]

OK, I just had to interject here for a second...

Procedures? In Derm?

Ok, its not like an esophagectomy, but they can be trained in Moh's and to do biopsies. And of course some do plastics procedures, especially in office stuff.

Its not all spreading salve, ya know.

 

[TRAMD]

50% of people in medical school get over the fact that they can't get into derm, go into something else and love it.

 

[DJ LACTULOSE]

are you kidding me? he loves derm pathology??? i can't even stay awake while reading the derm section for step 2.

he's probably just feeding you the usual derm applicant b.s. (i.e. i find it so interesting!) who would go into derm it wasn't for the lifestyle and money?

he could easily match into a good IM program and then do allergy or rheum, both of which are almost as cush as derm.

 

[Pir8DeacDoc]

If he really wants derm, he needs to apply and see what happens. If he doesn't get it, he should speak honestly with his home program and see what they recommend. A year of research or something similiar might be all it takes to put his application over the top. I had a good friend in med school who didn't match Derm. Did a medicine prelim year at our home program and got involved with the program as much as possible. They matched him the next year and he got a year to moonlight and play golf before starting in derm. If you really want something, you can make it happen if you put in the time/effort.

 

[fineline]

He should also analyse what it is he likes about Derm. Is it the Path? If so, would Path interest him? Or is it the procedures?

he's probably just feeding you the usual derm applicant b.s. (i.e. i find it so interesting!) who would go into derm it wasn't for the lifestyle and money?

This took four posts to get to the answer when in fact it should have taken (less than) one. That disturbs me (but doesn't surprise me).

 

[deleted87716]

This took four posts to get to the answer when in fact it should have taken (less than) one. That disturbs me (but doesn't surprise me).

Occasionally, people on these forums actually try to be helpful. Shocking, I know.

 

[Winged Scapula]

This took four posts to get to the answer when in fact it should have taken (less than) one. That disturbs me (but doesn't surprise me).

Well as suspicious as you know I am, I usually try to give the poster the benefit of the doubt and assume the best.

 

[fineline]

Well as suspicious as you know I am, I usually try to give the poster the benefit of the doubt and assume the best.

This attitude lets me exploit wimmen greatly and repeatedly. Therefore, I approve.

 

[hans19]

Knowing you want to do derm means you have to bust ass from the very beginning to be top of the class, destroy the boards, do some research and make lots of friends in the derm department. Then after 3.5 years of all that hard work, you scrape all of your academic capital together and your dream of doing derm, place your bets and enter the match then roll the dice. It may or may not pay off. Thats derm.

Was your friend one of those brilliant people who could get ridiculous grades with minimal effort? And if (s)he wasn't did (s)he compensate by busting his/her hump? If the answer is no, then I don't know what to tell your friend.
Advancing in the medical profession is about paying dues to get where you want. Its about a lot of delayed gratification. If you don't pay you can't play.

So if your friend can't do derm, but likes the procedures there are still options. FP's do quite a bit of basic 'derm' procedures, including freezing warts, botox. Infact everyone is getting into botox, including some OMFS friends of mind from med school. I've seen IM trained docs opening up 'medispas'. You don't have to be a derm, to cash-in on the skin. (Johnnie Cochran would be proud of me).

We all want what we can't have. Things happen to us that we'd rather not happen to us. Thats life! Then you figure out how to deal with it.

 

[buckley]

Delayed gratification...

I can't think of a phrase more perfect than that to describe the medical profession


AWUGUWHUHJSJAJSJAKHUGUGETE**(^*#^(&Y#IH!!!(*(*)*#(*#()@(!!!!!!

translation: frustration!!!

 

[spumoni620]

i agree with the advice above. ask him to analyze what it really is that he loves about derm. That will also be a litmus test for whether he *really* likes derm vs the derm lifestyle. If he just likes the path, rashes, skin cancers, cosmetic stuff, etc. etc. he could get the same exposure in other fields - path (i think you can do a dermatopathology fellowship after path, correct? that would provide lots of opportunities for research, etc.), FP (you can concentrate on and gain expertise with cosmetic procedures, although you wouldn't be board certified). On surgery (I was on surgical oncology) I feel like we did 10000 wide local excisions a day for melanomas and such, so if he absolutely adores the prospect of taking care of skin cancer there's a possibility. Peds, I have heard, offers exposure to a lot of rashes (although a lot of other stuff as well, obviously...) Even in some IM programs, at least among those I've applied to with a more primary care focus, some actually offer dedicated derm months.

But after all this if it's still derm and nothing else...well, then maybe a year of research is his best option. Or, if your home institution has a derm program, why not talk to a mentor/faculty advisor there?

 

[fineline]

i agree with the advice above. ask him to analyze what it really is that he loves about derm.

Translation: counsel him to start knocking over banks between 12 PM and 2 PM, Mondays through Wednesdays.

 

[Meatwad]

path (i think you can do a dermatopathology fellowship after path, correct? that would provide lots of opportunities for research, etc.)

True, you can, but from what I've read in the Pathology forum, it's about as hard to secure a fellowship in dermatopath as it is to get into a Derm residency anyway.

 

[Long Dong]

I posted a reply to similar thread in the derm forums, so I'll cut and past my response again below.

How do you expect to go out with the hot girl at the club if you don't even try to talk to her. Same thing with the match, if you don't apply how are you going to know if you'd match. And if you didn't match at least you know you tried, and got rejected by the hot girl, instead of going the rest of your life saying what if.

Don't let rumors of cut offs dissuade you from applying. Like the poster ND said above "Those who are truly driven can land a spot in any field, regardless of their numbers." If you look at the match stats people with 180s and 190s have matched in derm. While I was doing 4 year rotations one program had about 1/3 of their derm residents not match the first time around. Many of the residents there had done research fellowships after internship and a few actually even done 2 research fellowships (something like 4 years of research) before they matched. One of the residents told me "if derm is what you want, then derm is what you'll get. If you work hard, someone well eventually take notice, even if you don't have the numbers."

Research fellowship after internship is only one option if you don't match, there are many options which I thought about myself to beef up my application if I didn't match last cycle. One option to beef up you app before applying would be to work your butt off during 3rd year, try to honor all rotations and make AOA. You can also take step 2 early enough so that you can show improvement on it. Another option would be to take a year off to do research in derm and at the same time study for step 2 like there is no tomorrow. If you feel inclined even get an extra degree while you are at it, masters or phd. If you don't match I've seen people do other residencies and apply, there are people who have done a full path residencies and then a dermpath fellowship to eventually match in derm. The one option that I was going to do if I didn't match was to not graduate in 07, but take a year off to do basic sci research and reapply as a senior graduating in 08. And if that didn't work do my internship, then a fellowship and then reapply. And if that didn't work do a path residency and dermpath fellowship, before I gave up.

Derm is a tough match, even those with 260+ have been known not to match. So I think it would be smart for most applicants to be prepared for the worst, in case your match codes on you, you have a plan of attack. But in the mean time you have to get the rest of ur application in order. Like others have said the match is more then ur step 1.

 

[Long Dong]

OK, I just had to interject here for a second...

Procedures? In Derm?

It is my understanding derm invented liposuction. They also do hair transplants. Derms/mohs do most of the reconstructions/flaps of the skin CAs they remove. Some programs I've interviewed at said they'd teach blephs and minor facelifts as well.

 

[chocomorsel]

I posted a reply to similar thread in the derm forums, so I'll cut and past my response again below.

How do you expect to go out with the hot girl at the club if you don't even try to talk to her. Same thing with the match, if you don't apply how are you going to know if you'd match. And if you didn't match at least you know you tried, and got rejected by the hot girl, instead of going the rest of your life saying what if.

Don't let rumors of cut offs dissuade you from applying. Like the poster ND said above "Those who are truly driven can land a spot in any field, regardless of their numbers." If you look at the match stats people with 180s and 190s have matched in derm. While I was doing 4 year rotations one program had about 1/3 of their derm residents not match the first time around. Many of the residents there had done research fellowships after internship and a few actually even done 2 research fellowships (something like 4 years of research) before they matched. One of the residents told me "if derm is what you want, then derm is what you'll get. If you work hard, someone well eventually take notice, even if you don't have the numbers."

Research fellowship after internship is only one option if you don't match, there are many options which I thought about myself to beef up my application if I didn't match last cycle. One option to beef up you app before applying would be to work your butt off during 3rd year, try to honor all rotations and make AOA. You can also take step 2 early enough so that you can show improvement on it. Another option would be to take a year off to do research in derm and at the same time study for step 2 like there is no tomorrow. If you feel inclined even get an extra degree while you are at it, masters or phd. If you don't match I've seen people do other residencies and apply, there are people who have done a full path residencies and then a dermpath fellowship to eventually match in derm. The one option that I was going to do if I didn't match was to not graduate in 07, but take a year off to do basic sci research and reapply as a senior graduating in 08. And if that didn't work do my internship, then a fellowship and then reapply. And if that didn't work do a path residency and dermpath fellowship, before I gave up.

Derm is a tough match, even those with 260+ have been known not to match. So I think it would be smart for most applicants to be prepared for the worst, in case your match codes on you, you have a plan of attack. But in the mean time you have to get the rest of ur application in order. Like others have said the match is more then ur step 1.

Ok, seriously, is it that detrimental to someone's health not to match into derm? I mean, some of the scenarios above describe essentially being in residency for a DECADE!!!! Ok, NINE YEARS, but come on!!! What the hell is soo serious that one would go to such drastic steps in order to pop a few zits, slather on some salve (like Kimberly eluded to), and laser off a few warts/skin cancers? I mean, come the **** on, for crying out loud. It cannot be that damn serious, that there CANNOT be anything even remotely gratifying in this vast field of medicine that someone would go as far as essentially whole decade of residency to get into derm!!!! WOW, I'm floored.🙄🙄

 

[DJ LACTULOSE]

but derm is so interesting!!!

 

[chocomorsel]

but derm is so interesting!!!

Dude, I love, looove popping zits!! 😉

 

[fineline]

Ok, seriously, is it that detrimental to someone's health not to match into derm?

You can never underestimate just how little a person actually wants to work while hauling in lots of money. If it weren't for these go-getters we wouldn't have lifestyle specialties.

 

[deleted50478]

Knowing you want to do derm means you have to bust ass from the very beginning to be top of the class, destroy the boards, do some research and make lots of friends in the derm department. Then after 3.5 years of all that hard work, you scrape all of your academic capital together and your dream of doing derm, place your bets and enter the match then roll the dice. It may or may not pay off. Thats derm.

Was your friend one of those brilliant people who could get ridiculous grades with minimal effort? And if (s)he wasn't did (s)he compensate by busting his/her hump? If the answer is no, then I don't know what to tell your friend.
Advancing in the medical profession is about paying dues to get where you want. Its about a lot of delayed gratification. If you don't pay you can't play.

So if your friend can't do derm, but likes the procedures there are still options. FP's do quite a bit of basic 'derm' procedures, including freezing warts, botox. Infact everyone is getting into botox, including some OMFS friends of mind from med school. I've seen IM trained docs opening up 'medispas'. You don't have to be a derm, to cash-in on the skin. (Johnnie Cochran would be proud of me).

We all want what we can't have. Things happen to us that we'd rather not happen to us. Thats life! Then you figure out how to deal with it.

I agree. If he just likes skin diseases and make-up he can do family medicine residency. Afterward, he can hang up a sign that says Dr. Whatever, Board Certified Family Medicine, Focus on Dermatologic Disease, or something like that approved by his lawyer. There's nothing stopping a family doc from treating skin diseases. If your friend takes the time to learn about them, he'd do fine. I'd imagine it's a very small percentage of patients he wouldn't feel comfortabe treating. Of course he'd only get to bill at the family medicine rate...

 

[What the pho]

Ok, seriously, is it that detrimental to someone's health not to match into derm?

Well for some it can be.

but derm is so interesting!!!

Yes it is.👍

Dude, I love, looove popping zits!! 😉

Me to.👍

You can never underestimate just how little a person actually wants to work while hauling in lots of money. If it weren't for these go-getters we wouldn't have lifestyle specialties.

Yes this is a strong motivater. And even if I didn't have that to goto and I opened my own practice, in 6 months of hanging a shingle I'd still have a 3 month wait to see new patients.

To the OP, if I didn't get into derm I was going to do my internship get my license and then go into pharm sales. See all you haters on the golf course or maybe not because you guys well be working to hard.

 

[DJ LACTULOSE]

what if IM creates a derm fellowship? i don't see any reason why they wouldn't...

 

[What the pho]

what if IM creates a derm fellowship? i don't see any reason why they wouldn't...

That's what it was before.

 

[fineline]

See all you haters on the golf course or maybe not because you guys well be working to hard.

Uh oh, he's gonna be playing golf while the rest of us are curing diseases, guys. Look at how he showed us all! Owned by the dermatologists. Anyone want some Eucerin samples?

 

[TRAMD]

Well for some it can be.

Did you know her? How did you find that story? I wonder why she didn't match into derm.

 

[What the pho]

Uh oh, he's gonna be playing golf while the rest of us are curing diseases, guys. Look at how he showed us all! Owned by the dermatologists. Anyone want some Eucerin samples?

Are you even in med school yet. You talk like you've never even heard of skin cancer, psoriasis, stevens johnsons etc. Get back to me when you get in to med school or at least start studying path. And if you are in med school or a doc, I nominate you for a PhD (playa hater degree).

Did you know her? How did you find that story? I wonder why she didn't match into derm.

No I did not know her. I only knew of her because her story was a major tragedy and an issue of major gossip on the dermboard a few years back when she didn't match and commited suicide. The gossip was that she was a great candidate and was assured to match by her home program and at other programs.

 

[fineline]

skin cancer

Uh oh, Mr. Golf Course does skin cancer. Well, he doesn't really diagnose it because the pathologists do. Or treat it because the surgeons do. But I guess he can pick it up when he does his annual inspection of your nevi. Way to go, "playa." Way to go. Steroid cream, anyone?

 

[DJ LACTULOSE]

derm is fine. but you're not bragging about your career (which is boring as hell). all you're talking about is how you only have to work 9-5 and will make a lot of money. why didn't you just go into business? at least then you wouldn't have 200 grand of debt and would've been making that much right out of college.

the best part of medicine is the respect and appreciation your patients give you for being their doctor. that's the satisfying part, not the money. sorry to get all personal statement on you. 😉

 

[primadonna22274]

Not nearly as much fun as extracting a giant comedone though.

Dude, I love, looove popping zits!! 😉

 

[What the pho]

Uh oh, Mr. Golf Course does skin cancer. Well, he doesn't really diagnose it because the pathologists do. Or treat it because the surgeons do.

Now I know for sure your just a premed because if you were a doc you'd know that derms remove skin cancer BCC, SCC and melanoma. Derms can cut the out the CA, read the path to make the diagnose and also read the path to see if the margins are clear. Like I said holla back when you get into med school.

derm is fine. but you're not bragging about your career (which is boring as hell). all you're talking about is how you only have to work 9-5 and will make a lot of money. why didn't you just go into business? at least then you wouldn't have 200 grand of debt and would've been making that much right out of college.

the best part of medicine is the respect and appreciation your patients give you for being their doctor. that's the satisfying part, not the money. sorry to get all personal statement on you. 😉

Look what I do isn't boring. I'm like Beckham. He said "my family comes first, then soccer" and he is still great at it. My family comes first then medicine. I'll be the first to give you a scooby snack if you have no life, and serving your patients is your life. You sound like a person I'd love to hang out with at a bar or club.🙄

As for business, haven't you watched the apprentice. Those people maybe educated but they are some of the nastiest, lying, back stabbing, finger pointers around. Those guys on the contender, some who haven't even graduated HS, have more heart and intergrity then most of those Ivy league educated 2 faces in business. As for debt, I don't have none. Everything has been paid for. That's the life derm families live, don't hate.

Who said making made cheese and respect n appreciation of your patients is mutually exclusive. I will enjoy the money and appreciation. Plenty of other docs do the same, just look at spinal surgeons they make a killing and not all their patients are happy. In derm most of the patients are pretty happy just look at the kids with cystic acne and low self esteem, when they clear up they are very happy and more out going. Look at the airline attendent who had such bad psoriasis that her bosses told her she couldn't work because her skin lessions were scarring the passangers when she served them their meals, because the passengers thought she was contagious or had AIDS. When we got her to clear up so did her depression. I could go on and on.

 

[Winged Scapula]

Instead of attacking each other and each other's choice of specialty, how about you get back to the OP and their questions.

 

[Coastie]

WOW, so that's why that girl died. I always wondered when I interviewed at that program for a prelim spot.

Although, if anyone else interviewed there, you can quickly see why someone would be depressed working there: In the hood, with no US grads, and 10 months of wards during intern year in a hospital where scut is redefined to a new level in the middle of nowhere, alabama. Did I mention that on the wards, you have to take care of ICU and floor patients at the same time, with no reasonable cap according to residents? I wonder why she picked that place for an IM categorical?

Are you even in med school yet. You talk like you've never even heard of skin cancer, psoriasis, stevens johnsons etc. Get back to me when you get in to med school or at least start studying path. And if you are in med school or a doc, I nominate you for a PhD (playa hater degree).



No I did not know her. I only knew of her because her story was a major tragedy and an issue of major gossip on the dermboard a few years back when she didn't match and commited suicide. The gossip was that she was a great candidate and was assured to match by her home program and at other programs.

 

[fineline]

Now I know for sure your just a premed because if you were a doc you'd know that derms remove skin cancer BCC, SCC and melanoma. Derms can cut the out the CA, read the path to make the diagnose and also read the path to see if the margins are clear. Like I said holla back when you get into med school.

Is that why Derms will even refer people to Surgery for biopsies of skin lesions? Holla back when you figure it out, playa!

 

[TRAMD]

Not nearly as much fun as extracting a giant comedone though.

Nothing better than dissecting out a perfectly intact complete cyst capsule and sewing someone up so nicely you know they won't have a scar.

I love surgery but I love sleep more, so . . . PM&R.

 

[Dicey]

I'm sorry if i sound newbish..
but, cant he try again, next year maybe?
I've heard some interns who rotate for more than the required amount because they're undecided bout their specialties

 

[Blade28]

Ok, its not like an esophagectomy, but they can be trained in Moh's and to do biopsies. And of course some do plastics procedures, especially in office stuff.

Its not all spreading salve, ya know.

Yeah, yeah, I know. 🙂

 

[What the pho]

Is that why Derms will even refer people to Surgery for biopsies of skin lesions? Holla back when you figure it out, playa!

Wrong again turbo. Derms do most of their own skin lesion biopsies, skin biopsies are bread and butter for derm. The only person the derm might refer a skin biopsy to is to their PA, so they can still bill for it. With every comment you make your level of training/ignorance shows. Like I said holla back youngin when you get a clue or into med school.

 

[fineline]

LOL, I've seen a number of people referred to Surgery from Derm because they didn't feel comfortable doing the biopsy of the skin lesion. Holla back at me when you get done applying the ointment, playa, word up!