You call him doc

[FrodoBaggins9]

---

Members don't see this ad.

So I'm a second year US allopathic student who can't sleep tonight. I'm at the very bottom of my class, and it looks like I'm going to live out the "what do you call the person who graduates at the bottom of his class?"

Well, you don't call him a neurosurgeon or specialist. And the problem is, a large part of me has wanted to specialize in an IM speciality (I forget which one) for a long time. A failed dream, in all likelihood. I will graduate from a non-impressive US MD school, really, not a good one. Like all US MD schools, every year there are impressive grads, but I'm talking rep.

So what will life be like? If I stay regional, I'll probably be helping the people who either don't have access to better care or aren't that ill. I'm not saying that's what I believe of myself, but people seek care via reputable hospitals. My standing will likely lead me to a non reputable hospital, though I don't claim to know this 100%.

So the positive spin is that this way I'll get to help the poor and not the rich. Great, except I've grown to appreciate my critique of the rich I've held my whole life growing up around them (arrogant, greedy, their belief in work over family, their denial about the limitation of money, and their surprising complacency about social change) doesn't outweigh my overall respect for them. It'd be nice to serve them. Many doctors are miserable. Please don't barrage this thread with all the potential or even most common reasons for their miserable. That would take a week to write. Specifically, do a lot of doctors find their patients bore them? Do they find their cases monotonous? Do they feel inferior to their colleagues who did more challenging and interesting things? How does the transition feel when suddenly people went from everyone appearing equal to some rising while others, ahem me, fall?

If I dropped out of clinical medicine, if I never even did a residency, are there any interesting options that aren't incredibly evil like helping insurance companies deny claims?

Really, I know my best approach, ideal wise, is to center myself and find joy in every moment. Where I match and the rest is the wrong attention relative to that focus on everyday living and studying, which I do a lot of, most definitely more than average at my school.

And I'm not dumb. I got between a 31-33 on my MCAT. I do that to remain more anonymous, even though clearly no one knows who I am.

My problem is that I don't laugh when viewing serious things. Some people laugh because they don't quite know that this stuff is real and serious. The best laugh while comprehending it all. I also may be a touch depressed and ADD. But don't clinicalize. That's bitching out.

I've started taking the legal cocaine that helps me symptomatically, but that's new. That's part of the reason I can't sleep. Anyone have anything funny to say about all this?

 

[Slide]

1) Preclinical grades are low on the totem pole in the grand scheme of things.
2) Don't worry your rank until after you take the Step 1.

 

[xanthomondo]

Sorry to go a little off topic, but how often do you find out your rank? After every year, semester, quarter?

 

[njbmd]

So I'm a second year US allopathic student who can't sleep tonight. I'm at the very bottom of my class, and it looks like I'm going to live out the "what do you call the person who graduates at the bottom of his class?"

Well, you don't call him a neurosurgeon or specialist. And the problem is, a large part of me has wanted to specialize in an IM speciality (I forget which one) for a long time. A failed dream, in all likelihood. I will graduate from a non-impressive US MD school, really, not a good one. Like all US MD schools, every year there are impressive grads, but I'm talking rep.


I've started taking the legal cocaine that helps me symptomatically, but that's new. That's part of the reason I can't sleep. Anyone have anything funny to say about all this?

Nothing in medicine is over until it's over. In this manner, medicine is like a tennis game. You can be at Match Point, down 0-40 in the game, serve an ace and you can get back into things. If you are at the end of your first year and you are at the bottom of your class, you can pull your grades up second year and raise your rank. You can also ace USMLE Step I and help yourself greatly.

If you are starting third year, you can do an excellent job in your clinical clerkships (all of them) and greatly increase your chances of matching into a solid program. Even if you are set on neurosurgery, a solid third-year coupled with good performance on USMLE Step I, some meaningful research plus a strong recommendation from your department chair can get you into that game.

The same thing goes for Dermatology if you make yourself marketable to the department (chair, program director and faculty) at your medical school by your interest and excellent clinical skills. In short, until you match, many options are open if you are willing to work for them.

Will this be an easy road for you? No, but nothing great in medicine is easy anyway. Yes, the folks at the top of the class have a easier time controlling their fate but you have the same opportunity at they when it comes to doing well on USMLE Step I, doing a excellent research project, performing well during your clinical clerkships, and on USMLE Step II (CK and CS).

What you don't have is the "grade cushion" which is only one criterion by which you would be judged in terms of competitiveness for a particular specialty. You still have control over the other criteria and you can decide at this very minute that you will put the past behind you and concentrate on producing excellence in everything that is ahead of you.

Your MCAT score, once you matriculate into medical school, is meaningless. There are so many variables between matriculation and graduation that are totally under your control. Whatever grades that have passed are history and sitting around plotting a future of "doom" while easy, is neither helpful nor "set in stone" unless you take the easy way out and do nothing except pity yourself.

Professional school is not undergraduate school. In professional school, you have options. You have passed your courses and by passing, you have kept your options alive. In medical school, you pass or fail. If you are not being dismissed, you have options and it is up to you to seize those options and set your future because you are either your best support or your worst enemy.

Let's take those IM specialties for example. Even if you match at "podunk department of IM", you can ace the in-service exam each year (takes hard work and dedication to good academics), do research (on your elective time) with a quality researcher (yes, you may have to move to the city to accomplish this) and perform at a high level clinically (have a good third-year in medical school and learn to do this). Armed with a couple of good publications, a strong mentor and a strong residency performance, you have created a shot at the internal medicine subspecialties for yourself.

The world of medicine is far more than graduate at the top of your class and you will be handed everything from here on out. The world of medicine is far more than graduate at the bottom of your class and you are sent off to "doom and misery". The world of medicine is figure out what you want and figure out a way to make it happen for yourself because nothing is over until it's over.

What price do you have to pay? That price is totally up to you. Every time you compare yourself to those "impressive graduates" out there,you are going to come up short because that is the nature of comparing yourself to anyone else. Run your own race and do what YOU need to get the career that YOU want.

 

[TRAMD]

Graduating from a US MD school and passing Step 1 make you moderately competitive alone. Rock your Step 1 and clinical years (and possibly Step 2 too) and you will be fine. You might not be a plastic surgeon or dermatologist but an internal medicine subspecialty is not out of the question. Match into an IM residency that has an affiliated fellowship in your specialty of choice and work hard (maybe even become chief) and you should be fine.

 

[PeepshowJohnny]

Don't minimize your depression. That's the only advice I have for you.

Oh, and for someone who asked about rank....I've never heard what my medical school rank is. The only information we're given is after a test where we get a histogram of class performance. So you get an idea, but not concrete. (I.E. let's say 10 people did better on me in a biochemistry test. I don't know how those ten people did relative to me in anatomy and physiology, so it's difficult to sya who's in the lead). When we graduate, our dean's letter does the "outstanding/excellent/advanced/proficient" whatever codeword for our rank, but other than that I don't think we ever learn.

 

[Green Chimneys]

Okay the first thing that confuses me here is that you claim to have forgotten what your lifelong dream is? How committed can you be to a specialty when you can't remember what it was?

Second, you haven't screwed the pooch yet. Step 1 and your clinical years are still on the way. If you score decently on this exam, demonstrate that you are a good worker on your rotations, make some connections during 3rd and 4th year, and perhaps make a positive impression as a couple away rotations, you will do just fine in the match.

Third, if an IM sub specialty truly is your dream, take head in the fact that IM is not terribly difficult to get in to on a generic level. Your attractiveness for fellowship is based primarily on your work and connections made as a resident, not your grades in medical school. Yes, the institution you are from makes a big difference, and yes it is very difficult to get in to IM at a top academic program. It is however conceivable that you could get in to some academic program if you perform well on step 1 and in your 3rd and 4th year. If a community program turns out to be more realistic, look for a large one that also has a fellowship program in your desired specialization. Realize that the odds are that 5 years from now, you will no longer desire to pursue this.

Once you're done you can practice wherever the heck you want to practice. Don't worry about where you'll go, because it really has no bearing on what you're doing now. Tough it out until May, then buckle down because that's when the important evaluations start.

 

[-Goose-]

Yes, the institution you are from makes a big difference.

Not really true. Yes, it matters somewhat where you go to medical school, but it is low on the totem pole compared to step 1, clinical grades, research, etc as long as you go to an accredited US Allo school.

 

[Re3iRtH]

"So the positive spin is that this way I'll get to help the poor and not the rich. Great, except I've grown to appreciate my critique of the rich I've held my whole life growing up around them (arrogant, greedy, their belief in work over family, their denial about the limitation of money, and their surprising complacency about social change) doesn't outweigh my overall respect for them."

I don't get it. So you can't stand the rich, but you are upset at yourself
if you land one of the bottom-of-the-totem-pole, lower paying specialties?
Am I the only one that finds this a bit contradictory?

 

[deleted77919]

Yes, it matters somewhat where you go to medical school, but it is low on the totem pole compared to step 1, clinical grades, research, etc as long as you go to an accredited US Allo school.

I think he means the place you do your IM residency matters in obtaining a fellowship and it's tough to get into the best IM programs as a below average medical student.

 

[Taurus]

With class size increasing and no increase in residency spots, it's dangerous to assume that even if you're at the bottom of the class you'll get a residency. That may longer be true, especially if you're from a low ranked MD school or DO school.

 

[NotAProgDirector]

With class size increasing and no increase in residency spots, it's dangerous to assume that even if you're at the bottom of the class you'll get a residency. That may longer be true, especially if you're from a low ranked MD school or DO school.

This is overly pessimistic. There are still many more residency spots than US allo grads. As the allo schools increase class size, the osteopathic students and IMG's will get squeezed out first - they are the ones that need to worry in the next 5-10 years.

To the OP: As an IM PD (and hence the person you will presumably be trying to impress in the future) I agree that pre-clinical scores are a very small piece of the puzzle. You don't even need to "rock" step 1 -- any decent score would be fine. Do well on your clinical rotations, take Step 2 early and score better on it, do an away rotation at a more "prestigious" institution if you feel your medical school is really "not that good" (although I agree with the above poster that all US Allo schools are reasonably good) and you will do fine.

 

[Green Chimneys]

I think he means the place you do your IM residency matters in obtaining a fellowship and it's tough to get into the best IM programs as a below average medical student.

This is exactly what I was saying. You've got a lot better shot at landing that coveted GI fellowship if you do IM at a prestigious academic medical center versus a small community hospital in the midwest, based largely on the professional connections you will make at the former.

But the point I was trying to make is that 1) IM at an academic medical center is not out of the question or even highly unlikely for the OP at this point in medical school, and 2) If he/she really is set on what a specific field, it will be much more feasible to make decisions (such as where to apply for IM) that will allow that goal to become a reality.

 

[MonkeyNuts!]

If you're not at the top, means less stress and more chillaxing for you.

Have fun with life in med school.

P=MD!!!