What to do?

Discussion in 'ERAS, SOAP, and NRMP Match' started by godawgs39, Dec 15, 2008.

  1. godawgs39

    godawgs39 Senior Member
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    Currently I'm a 3rd year who is dating a 2nd year. I've done plenty of searching and reading on this topic, but I still don't know what would be best.

    Here's the setup:

    Me - want to match into IM, some leadership experience/award/volunteery goodness, pass/high pass (not honors) rotation grades with consistent praise for hard work, team player-ness, bedside manner, etc... Step 1 not what I was hoping for (less than avg, but >210), with my eyes on a fellowship that most consider non-competitive.

    She - not sure what she wants to do, though she's leaning primary care, honored every 2nd year class thus far (so I'm fairly confident she'll easily exceed my step 1 score), also hard worker/easy going/well liked/yadayadayada.

    Some options, from what I gather, are:
    1a) Go on with match, shoot for a big city and hope she has similar luck the following year...
    1b) Go on with match, then if she doesn't get in the same city the following year, one of us transfers, potentially making it two years apart. Probably our last choice.

    2) Shoot for a prelim spot at home program, then couples match the following year, if that's even possible. (At this point I don't know if we want to stay at our home institution, especially given that there are potentially only two programs to choose from in our not so big city)....or...

    3) Shoot for a prelim spot at a big city place, then couples match with the hopes of parlaying that spot into a PGY2 position if possible. This seems like the least logical, but I thought I'd throw it out there...oooorrrrr...

    4) Take a year off, maybe shoot for an MPH, then couples match. I seriously thought about this, but in the end, I really don't want to take on any more debt. I want to pursue an MPH eventually, but it's time to get out and start working in the still-not-independent real world.

    I just don't know what would be easiest in terms of guaranteeing that we both end up at a program we both like in the same city. Working a year, then couples matching seems like it would be, but I've received some less than supportive feedback regarding that idea, so I don't know what to think.

    We're okay living separately for a year, but my fear (other than her not matching close by) in taking a categorical spot somewhere is that she ends up having to settle for a program just to be close. I'm sure I'll be limited by my score, so I'm working hard and know that I can do a lot better on Step 2. I think we're both better than the average bear on a social awkwardness scale, so hopefully that will help us out when we get interviews. I think I've written way too much at this point, so I'll just thank anyone in advance for advice/suggestions.

    I'll hang up and read...
     
  2. Law2Doc

    Law2Doc 5K+ Member
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    Choices 2 and 3 aren't good ones. Generally you are better off matching into both preliminary and categorical/advanced programs at once, rather than match into prelim and then try to couple match into the remainder. The biggest problem with this is going to be difficulty in getting away to interview while in the midst of a preliminary medicine internship year. Most people tend to do option #4 and then couples match together.
     
  3. Winged Scapula

    Winged Scapula Cougariffic!
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    I agree --- the best option is for you to take a year off, graduate together and couples match.
     
  4. dragonfly99

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    #1 or #4. I'd go with #1, but that's just me. You certainly have a while to think about this. As far as internal medicine goes, I don't see your Step score being that much of a hindrance, unless you were shooting for Harvard/UCSF/WashU/Duke type places. IM doesn't get a ton of applicants with super high board scores. If you can honor your subI next year, and try to do as well as you can on medicine and peds clerkships this year (and all the rest of course) and get good LOR's, I don't see the step score being much of a problem. If you aim for a big city like Chicago, New York, Houston, etc. I really don't see there being a big problem with you all being able to match into somewhere decent in the same city, even if you go through the Match in different years. However, if you really want ot make sure you match into the same program, then going into the couples match (as PGY4's together) would be the best way in guarantee that.

    Another option that you didn't mention is to try to either
    a) do a research year between your 3rd and 4th years (or stop your 4th year after a few months, like doing a subI plus a couple of other rotations, then start a 1 year research gig). There are some advantages to maintaining your student status, like being able to use your school's career advising office, maybe being able to keep your health insurance if that's provided by the school, etc. You could maybe get a research stipend from NIH, your school, the American Heart Association, etc. You say that you are thinking of doing a particular specialty...if it's rheum or endocrine, etc. you could probably get a stipend to do related research. If you could publish something, that would help your fellowship application later, plus if you are doing research you'll be getting paid something rather than paying tuition like you would to get an MPH.
    b) graduate and then do a research year
     
  5. Samoa

    Physician Pharmacist 10+ Year Member

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    Research or MPH are definitely your best options. If you're committed to this relationship, you and she need to couples match. Any other option will potentially require a career-damaging level of sacrifice from one or the other of you. And that's bad for the long-term health of your relationship.
     
  6. aProgDirector

    aProgDirector Pastafarians Unite!
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    There are reasonable options other than taking a year off.

    1. Apply broadly, see what happens. As you mention, her application looks to be "stronger" than yours. Thus, she is very likely (i.e. almost certain) to match wherever you match. Else, your program risks losing you, which they won't want to do. So, if you get an interview at a good program that she thinks she would be happy at, you could take a spot there and then she would apply there and anywhere else in that city that she would be happy at.

    Perhaps her third year could be flexed a bit, to allow her to interview with you.

    In this scenario, you spend one year apart.

    2. Apply for a prelim at your home program, with the plan to transfer as a PGY-2 into whatever program / city she finds a spot in. This is a bit risky, but I can guarantee you there will be open PGY-2 spots in Boston / NYC / DC/ Chicago / etc (insert your favorite large city here). Even smaller programs will have open PGY-2 spots. I did this a few years ago for a couple, and basically promised a PGY-2 spot if the partner matched to the PGY-1 program. The nice thing about this plan is 1) it keeps you together for all years, 2) you don't "lose" a year, 3) it staggers your PGY-1's, and 4) It puts you in the tough spot, not her. She gets to play in the match next year and try for any program she wants, with you having to find a matching PGY-2.

    Anyway, food for thought.
     
  7. Samoa

    Physician Pharmacist 10+ Year Member

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    aPD's #2 would work nicely, if you're both going into the same field. It would be much harder if she decides in 3rd year that she wants something other than primary care.

    The other issue there is that once you go that route, if you find all your potential programs unsympathetic, you are stuck. Or, in a less pleasant scenario that no one wants to think would ever happen to them, if you somehow wind up on the bad side of your program, you could have difficulty transferring to wherever she ends up matching.

    However, this scenario does also eliminate the unknown (and fairly unpredictable, despite all attempts to do so) variable of your performance as an intern, which is a major hazard of matching in separate years. If you stay at your home institution, your reputation is already established. All bets are off when you go somewhere else.
     
  8. Doowai

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    Oh God, please don't let me reply.....let me keep my replies to myself


    ok heres my advice..

    no no

    I musn't

    haha what you should do is...


    no don't say anything....

    geez man, obviously what you should do is..

    no... fight the urge
     
  9. bluealiendoctor

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    Don't mean to be harsh but........this is someone you're dating?........In the tone of Elmer Fudd...be wary, wary careful. Scenerio: You go to an 'okay' program to keep together....she spends 80+ hours/week with the tall dark resident...giggles, late nights.....next thing you're looking for a one bedroom apartment in a town you're not real happy in...hoping not to run into your ex out with her new boy.....it happens.
     
  10. dragonfly99

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    After rereading this whole post, I kind of agree with bluealiendoctor.
    I mean, it's not inappropriate to be thinking about this kind of stuff, but on the other hand it's kind of premature. You don't really know if you'll still be together in a year or two. Also you don't know how you and your girlfriend are going to do during 3rd year, nor whether one of you will change your mind to want some more competitive specialty.

    If things are still going strong in a year or so, then you can consider taking a year off to do research or something (or MPH, etc.). If you really want to guarantee doing residency together @the same place, then couples matching is definitely the best/easiest way to do that. If you both end up wanting not very competitive specialties (fp, psych, path, IM, maybe a few others) and both are willing to shoot for some specific big city with multiple residencies, I still don't think that matching in the same city (if not definitely @the same program/hospital), even if not done the same year/via couples match, would be that difficult assuming you both do decent during 3rd year. It would be a bit trickier if one of you decides you want a competitive specialty, though.
     
  11. sprinkibrio

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    BUMP.

    I'm in the same situation. I don't understand those of you who said wait a while and then decide if you want to do research for a year. Those applications for Doris Duke, etc, have passed already. How else are you supposed to get funding for a year of research between MS3 and MS4 so last minute?

    Godawgs, have you decided what you are going to do? Our #1 choice right now is to have my bf match into a big city and me follow. He's an extreme superstar and I'm above average, but undecided on what to enter.

    Btw, career-changing decisions like these are not lightly made.
     
    #11 sprinkibrio, Feb 17, 2009
    Last edited: Feb 17, 2009
  12. Law2Doc

    Law2Doc 5K+ Member
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    How else are you supposed to get funding for a year of research between MS3 and MS4 so last minute?
    ...

    At most research oriented med schools it is actually quite easy to find faculty with significant research grant funding looking for med students/residents who want to research in their lab. It's the small minority of people who do research at research programs like Doris Duke or NIH.
     
  13. lapooh

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    Currently in a similar situation. My S.O. matched into a highly competitive specialty last year in a moderate city with a limited number of residency programs. Me applying for a "non-competitive" field this year, but very few programs on my radar......so kinda freaking out.

    It wasnt possible for us to do a couple s match for so many reasons, but yes, if possible, i would definitely advise anyone else in a similar scenario to make all-out efforts to go for a couple s match instead. The "I match now, you match next year scenario' is just a very painful way of torturing yourself for 2 years at a stretch. Plus one of you, or both, will end up feeling that you have had t sacrifice a lot to be together. I agree that even a couple's match may well end up that way, but atleast you are over and done with it in a year
     
  14. godawgs39

    godawgs39 Senior Member
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    Hey all,

    First of all, a long-overdue thank you is in order for all of those that have given advice. The more and more I thought about it, the more I warmed up to the idea of doing research and taking a year off so that we could couples match.

    It's a sacrifice for me, but I felt that if I had matched and had her follow, that would have been a big sacrifice for her, and I suppose for the two of us given that we would have been limited to programs in big cities.

    We discussed the option of me matching, then her matching in the program she likes the most with me attempting to transfer, but that just seems less than ideal.

    In the end, I've decided to take a year to do research. Had I warmed up to that idea 4 months ago I could have applied to some of the formal programs, but as Law2Doc points out, there are plenty of options at most research universities. I was fortunate to find such a position thanks to the help of one of my mentors. In the end, I'll get some great experience in research in an area of interest, which in my opinion has no downside. I may end up loving it, but even if I don't, I will have (re)learned a lot about basic science, I'll know if research will be a part of my career, and I'll get to couples match.

    If anyone is worried about such a decision and does not have any research opportunities locally, there is a program through the NIH called the "Year-off" program. There is a rolling application, so it's not too late to throw your hat in that ring.

    This is a decision that has consumed me for quite some time, but I think I'm doing what's best for me, for her, and for us. And don't worry, I wouldn't even consider this option if I had any doubts about our future together. :) It's a huge decision, so if there's any way that I can help others going through the same process, I'd be more than happy to share my thought process in more detail.

    I don't know the end result, but I'm happy and have a decent amount of weight off my shoulders. Now I just need to figure out when to take Step 2!

    Thanks again to everyone and good luck to those in the same spot!
     
  15. lapooh

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    Good decision. Good luck to you !
     
  16. Winged Scapula

    Winged Scapula Cougariffic!
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    Glad to hear it worked out well for you and your SO.

    Please do let us know when the couples match comes around in a few years, the end of the saga!
     
  17. BlondeDocteur

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    Agree-- and if you DO stay together, and are planning the next step after residency is over, it's great to be on the same cycle. Else you'll be repeating this drama with the fellowship match, the job search, etc.
     

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