An osteopathic medical student writes that she is older than most students, failed a course in her first year of med school, had to take the COMLEX (osteopathic equivalent to USMLE) several times before passing. She has earned good grades in her third-year rotations.
She said, "I found your blog one night earlier this
week while doing research on obtaining a surgical residency. After reading your
blog, I thought you might be able to help. What can I say to programs and put
in my application to make me stand out as someone who they would value and
honestly consider?"
I appreciate your reading my blog. As you have correctly pointed
out, you have some problems. I hope you can handle the truth (from the movie
"A Few Good Men").
1. You are an osteopathic student, which may adversely
affect your ability to obtain a general surgery residency by a little to a lot,
depending on where you apply.
2. You are a non-traditional student (not so bad) but your
age of 33 is another issue. Should it matter? No. Does it matter? In my
opinion, yes.
3. You had some trouble in the first year of school. That is usually a red flag, and many program directors would not get
past that part of your dean's letter and transcript.
4. You have "struggled with the COMLEX and have had to
take it multiple times" and you have not taken the USMLE.
With the disclaimer that this is strictly my opinion and I
cannot say how you would be viewed by other PDs, your chances of matching to a
categorical position in general surgery are slim.
What can you do to improve the odds? Here's what I would suggest.
To counteract the COMLEX issue, try to take at least USMLE
Part I and do very well on it.
In your personal statement, you should own up to the concerns
just as you did in your email to me except that you need to condense everything
into a much shorter document. You should emphasize that you have conquered
these shortcomings. You need to find med school teachers, particularly
surgeons, who know you well and are willing to write exceedingly strong letters
of recommendation. A letter from someone who a PD might have heard of would not
hurt.
You then have to wait and see if you are invited for any
interviews. If you are, you need to impress everyone with your charm, work
ethic and intelligence.
You also need a "Plan B." Would you take a
non-designated preliminary slot hoping for someone to falter or quit so you
could transfer into a categorical position? It is risky because you might end
up wasting a year or two and have to take a residency in something else anyway.
That's not a big deal if you are 26 when you graduate from med school, but for
you it would be.
Another option would be to do an internal medicine residency
and specialize in GI or cardiology which are procedure oriented. It's not surgery,
but it might be satisfying and certainly would be easier to achieve.
You didn't mention whether you had significant student loan debt
or not. That needs to be factored in if you are considering the non-designated
prelim choice.
I hope this helps. Let me know how it turns out.
Good luck.
Unfortunately in residency I would encounter similar people far too often who had become 'prelim' intern journeymen, bouncing every year between different surgery programs (I even saw one take a 'prelim' PGY2 spot - something I had never even heard of until then - likely just to be a warm body to fill in the schedule for someone else who flaked). Often they are trying to get a spot in a very competitive specialty, like Ortho or Optho. Its hard to talk to them about their career path because you know how extremely unlikely it is that they will get what they want, and doing all of these prelim years seems like a form of self-abuse. In this context I think your advice, as usual, is exactly right.
ReplyDeleteJosh, thank you for the comment. You provided a little more detail than I about the dark secret that is the non-designated preliminary surgery position. I do not know the percentage of NDPs who eventually get categorical positions, but I think it's pretty low.
ReplyDeleteThe possible bright spot is that there is a 20% or so attrition rate of categorical residents but it is spread out over the years. It's probably not more than 10% for PGY-1s.
Cardiology and GI are insanely competitive fellowships coming out of internal medicine. Nephrology fellowships drool over the candidates that cards rejects. The fellowship selection leans heavily on USMLE scores so recommending that career option may just be kicking the pain down the street a few years.
ReplyDeleteJoel, thanks for bringing this to my attention. I looked at the NRMP stats for the matches in cardiology and GI. You are correct that they both filled nearly all (but not all) of their positions. The link is here http://www.nrmp.org/fellow/match_name/msmp/stats.html.
ReplyDeleteThere does appear to be a bit of wiggle room however. The percentage of foreign grads accepted is fairly high for both. As an aside, the NRMP has apparently not received the memo that the correct term is now "international," not "foreign."
Can you elaborate on why age is likely to be an issue? Is it an issue of stamina? Something else?
ReplyDeleteI have so much help from your blog.thnx
ReplyDeleteGS resident in Europe.
Age is a problem because this student will be 35 when she graduates. General surgery residency is 5 years long. Add a year or two for a fellowship which 85% of trainees now take and she'll be 41 or 42 when she's ready for practice.
ReplyDeleteIt's about the rigors of training, the years of low pay, the shortened duration of practice and the abundance of younger and equally or better qualified applicants.
It may not be fair and it may not be just, but age is an issue.
I started med school at 33, finished general surgery residency at 42 and am now 49. Life is a journey and not a destination. Sure, I am playing catchup retirement savings wise, but I love my job and wouldn't think of doing anything else. Age is not a factor.
DeleteIMHO
James Cain
James, thanks for commenting and congratulations on your success. I agree that age should not matter. You are proof of that. I'm a lot older than you and I have felt the sting of age discrimination myself.
DeleteI think the problem for older applicants is that the pool of people wanting to be surgeons is large and all other things being equal, PDs may tend to favor the younger ones. I have no data to back that up.
Igor, thanks for reading and for the kind words.
ReplyDeletePlease explain to this layperson why being an osteopathic student might be a negative when applying for a general surgery residency.
ReplyDeleteI'm not sure I can completely explain it. There is a certain stigma with osteopathic grads. They still have to take manipulation courses. The schools are not perceived as being as good as allopathic schools. Here's a link to some data from the allopathic match that shows the only 3-4% of applicants who match in general surgery are from osteopathic schools. In internal medicine it's about 20%. http://www.nrmp.org/data/resultsanddata2013.pdf
ReplyDeleteThere is some misinformation that needs to be corrected. The medical student does not need to take the USMLE because there are Osteopathic residency positions available in general surgery in which case they would not be competing against allopathic medical students. Additionally, starting in 2015 the ACGME will be overseeing both MD/DO residencies. With this new change osteopathic medical school students can take the USMLE and then enter an allopathic residency whereas allopathic medical students cannot enter an osteopathic residency. Essentially, the DO will now have more options available. http://www.osteopathic.org/inside-aoa/Pages/acgme-frequently-asked-questions-students.aspx
ReplyDeleteJason, thanks. I had heard that there was a merger of the two matches pending but didn't know the time line. I may not have made my thoughts clear enough. I had suggested that the student take the USMLE to offset the poor performance on the COMLEX. She is aware that USMLE is not absolutely necessary and not needed at all if she enters the osteopathic match. She tells me she is planning to take USMLE hoping to get a better score.
ReplyDeleteMy local med school (UofCalgary) is known for accepting and embracing older applicants. Back in the mid-80s I had a intern attending my child who was hitting 40! He had been an engineer and switched gears. He reluctantly admitted somewhat (body language betrayed him) that it was hard to accept what I would call now, condescending behaviour from people younger than himself. I asked him that because I witnessed the chief resident being arrogant towards him. I wonder if I'd put that young whippersnapper (the CR) in his place now if I witnessed the same bad behaviour--while keeping his 'image' intact of course. I can pull the 'mom' card easily now that my kids are adults.
ReplyDeleteI am in the same boat but in the Social Work faculty. My age wasn't an issue until I started SOWK last fall (I graduated at age 51 with my first degree). It is an odd feeling to feel invisible, but I shake my head and motor on. Strange folk these social workers.
I agree, it shouldn't be an issue, I've been tempted to tell people that they'll get a good solid 10-15yrs out of me which is more than they would from a 20something. At 40ish she could give 20-30yrs to medicine. And would be bringing a maturity (theoretically) to the table. I just read that women are raring to go at 50...we've done the maternal journey now we are ready to take on the world! I can agree with that!
Libby, that's an interesting perspective, especially your last paragraph, which is sound thinking. I never looked at it that way, but a number of women in the so-called traditional pathway go to med school, finish residency practice for a few years and either go part-time or drop out of medicine entirely.
ReplyDelete@Skeptical Scalpel, as the former Surgical PD you are it is very commendable Sir, that you are willing to discuss topics that aren't readily discussed elsewhere by people "in the know" so to speak.
ReplyDeleteAs an IMG Surgical Applicant it is specially helpful to understand the odds one is up against. I understand matching into Categorical Surgery will be difficult, but is it really impossible even with relatively stellar scores in both Steps (>260), first try, as well as LORs from American Board Certified Surgeons? Will Step scores significantly higher then the US average for GS really make absolutely no difference? From your advice I gather that a ND prlim in GS is always a dead-end? The reason I wonder if this is really so etched in stone is because several GS residencies on their web pages request IMG applicants to have 12 months of previous clinical experience or to be currently enrolled in a ACGME program, these same programs frequently have "some" IMG's in their categorical resident list in years > PGY1 (i.e.: PGY2,3,4,5), so is it all possible that after an excellent performance in a ND prelim in GS, with good ABSITE scores, one could apply to a PGY2 position at another institution? I have read online that in certain institutions (Hopkins and Mayo) the PD makes a point of helping the ND prelims find a position elsewhere, do you think this might be the case? I have also read many horror stories of IMGs spending multiple prelim years in GS and never really going anywhere, and I understand the later case is probably the rule and not the exception, but my question is if as a PD you did in fact hear of certain particular institutions helping their ND GS prelims secure a categorical spot elsewhere?
Any reply is quite appreciated.
It is not impossible for a non-designated preliminary PGY-1 to convert to a categorical surgery position. Thanks to @mhabibzubair, who sent me these two links (http://bit.ly/182Ojz0 & http://www.ncbi.nlm.nih.gov/pubmed/16373169) which show that about 1/3 of NDPs can do so. The problem is that since 2/3 do not, what do they end up doing.
ReplyDeleteAlso, the mots recent match data show that very few graduates of international schools match in categorical or prelim slots. (http://www.nrmp.org/data/resultsanddata2013.pdf) Note that this includes US citizens who graduate from international schools.
You would have to be an exceptional international graduate to make it.
Yes, PDs do help exceptional IMGs find categorical positions.
Good luck.
Thank you for your reply Sir.
DeleteHi this is a great website for surgery info. Thank you. I am an older IMG (42 y) and currently studying for step 1. I graduated in 2012. I wanted to ask you how competitive I would be for a surgery residency. I have lots of research experience (1 publication plus 5 submitted as 1st author) and about 8 or 9 national conferences. I was hoping to get a prelim spot in the scramble or post scramble after writing the usmle's. Would you think just based on research and step 1 scores that I would be competitive for a prelim spot? My LOR would be from 2 community surgeons, 1 community ortho surgeon, and 1 academic ortho surgeon.
ReplyDeleteI think you should be quite competitive for a non-designated prelim position. The problem is going to be obtaining a categorical slot when you will be 43 years old. It's possible, but I would say it will be quite difficult.
ReplyDeleteHello again: Thank you for replying to my query. Could you provide some tips on how to make myself competitive for a categorical spot at 43 years old? As a former PD if you had a 43 year old non-designate is there anything that would help him stand out and convert to a categorical spot?
ReplyDeleteThere area few things. You need to get a great score on the American Board of Surgery In-Training Examination (ABSITE). You should try to produce a couple of publishable clinical research papers. You should strive to be the hardest working PGY-1 categorical or prelim that the program has ever seen. Gain the confidence and trust of the attendings and senior residents. Make everyone want to keep you.
ReplyDeleteGood luck. Let me know how it turns out.
Student usually find it much easier to understand.
ReplyDeleteDifficult decision to choose the speciality to be honest.
ReplyDeleteI had to play around with medicine vs surgery and eventually chose medicine based on hostile and racist surgical teams i did internship with.
Now i wonder maybe that was due to the team i was in and maybe surgery is good choice for me. I love to get in and sort things out rather than deal with chronic issues.
I am not sure if i might do procedural medicine or surgery.. still deciding.
Before you make your decision, keep in mind that it is difficult to switch from medicine to categorical general surgery or a surgical subspecialty. Many surgical program directors do not even look at applications from people who have started out in other disciplines.
DeleteYou would need to have excellent USMLE scores and a very good reason why you didn't try for surgery in the first place.