Quoted: Getting another residency

[Doodledog]

I am a prelim surgery resident at a semi-academic program. I am worried about having a job next year. I applied last year to competitive fields and did not match. I applied this year and still have 3 interviews in an extremely competitive field, but doubt that I will match. My step scores were both around 190 and I failed the first attempt on Step 2. I will get my Step 3 results soon. My resident evals have been below average and I don't know how much support I will get from my pd for another residency. I work and study my butt off, but I look stupid when I am pimped b/c I usually have no idea what my attending wants me to answer. I overanalyze everything and don't know how I can get the cycle to stop.

I don't know what my options are right now, I am still working my butt off, but I feel it is to no avail since I am with the same senior resident that I have recieved bad evals in a few prior rotations. I teach the med students everything I know, I get to work an hour earlier than the rest of the interns and usually see more patients than they do and I go to clinic unlike the other interns who never show up, but I know they still get better evals than I do. Do my seniors or PD know this, NO? Will I start to slack off more, NO, I don't know how because I have always had a strong work ethic. Sometimes

I wonder if family medicine is the only residency that might take me. After being a surgery resident it is hard to go to fam med or med, but i would at least like to do em, anes or rad instead of primary care. Any advice. I am more worried about whther my step 3 results are poor and my in training exam results are too. I feel like fam med may be my only route.

I'm not sure I can help you much other than to suggest that you not do FM given your view of it. Consider that if you like specialty care, going IM and doing well at that might lead to a chance to do a fellowship in an area that you would like more than primary care.

Also, consider whether taking a year to do research might be helpful. I doubt this would change much, but it is an option to consider.

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[NotAProgDirector]

A couple of thoughts:

1. 3 interviews is more than none, so there is always some chance you will match. That being said, I agree that it's in your best interest to develop a plan B.

2. Your list of other interests -- ER, Anesthesia, Rads -- are all competitive also. You stats are not going to make any of those pathways easy either. And, you probably don't have the rotations / letters / research to compete well in those fields, because you've been focusing on your current target.

3. Going to clinic will NEVER impress the surgeons. In fact, if some of the interns find a way to get out of clinic, that will be seen as a strength. Many surgical residents (*** Warning -- major generalization coming up ***) hate clinic and feel that any time spent not in the OR (and /or sometimes the ICU) is a waste of time. Worst case scenario is that you're doing other people's clinic shifts as a way to look like you're working harder -- if so, they're laughing at you for being "foolish".

4. You are drowning in your program. You have bad exam stats. You haven't mentioned whether you're a US grad or an IMG. Either way, you best shot was to shine in your residency such that your PD would tell other programs to overlook your poor exams. That's not happening, and at this point you're unlikely to change any minds even if you start to improve.

5. Prelim surgery is often a road to nowhere. You will be tempted to do another prelim surgical year, potentially trying to get one in the scramble. It's a job (which does pay a salary) but it's likely a bad plan for you in the long run. You're unlikely to get a "better" prelim spot than the one you have now.

You need to figure out what you enjoy, and what's reasonable. Fields with relatively low competition would be FM, path, and PM&R (last I checked, which was awhile ago). IM and peds are also possible. At this point, it's very late to apply.

I agree you could do an IM residency and then a fellowship. However, be aware that the procedural fellowships (like Cards and GI) are very competitive. With your scores, you're unlikely to get a spot.

If you'd like more specific advice, please feel free to PM me directly.

 

[dragonfly99]

Agree with APD that getting a cards or GI fellowship spot would be hard with the failed Step 2 and low overall step scores.

You got a few interviews in a field you say is very competitive, so it seems like your application must not be too terrible, aside from the lower step scores.

You don't sound like you want to do primary care. I am thinking you might have a shot for ER or anesthesia at some program. ER spots outside the match don't open up that often, but there might probably be a few in the scramble. Anesthesia I have seen quite a few open spots pop up here and there...it's not an easy field though and does require a lot of studying...my anesthesia friends were always stressed about their in training exams. The positives to anesthesia are it allows you to do procedures and you could use your surgery prelim year as PGY-1. Physical med/rehab and psych are alson noncompetitive, but you probably would not want to do psych I'm guessing. You could maybe try neurology but your USMLE's are low for that field too.

If there are any surgery attendings who like you/support you, you could start looking around for open general surgery spots...there are occasional categorical ones. A friend of mine kept interviewing for those, and almost got one, while she was a surg. prelim intern. Eventually she didn't get in and switched to anesthesia, which she likes.