Advise the advisor

Hi everybody – I have a little dilemma that I’m having trouble thinking through and hoping for fresh perspective from OPMs. I was recently introduced to a non-trad med school graduate who has possibly THE most non-trad story I’ve ever encountered, and I’m not sure how to advise her.


A synopsis of her story: Dr V, age 50, had a previous career as a phlebotomist and then became involved in administration with infectious disease clinics during the HIV crisis late 80s, early 90s. Her father, who grew up in India as the son of American missionaries, attended medical school in India, then returned to the US for residency, and is now a semi-retired rural FM doc in TN. When Dr V was in her 30s, she decided to pursue a similar path and went to India after being accepted to her father’s alma mater. She had some health problems during medical school, had to return to the US for a year, and then went back and finished her MBBS. Instead of doing her internship in India, which is the norm, she returned to the US. She got through a couple of rotations, only to have the health problems flare up again. This time she opted for definitive treatment with surgery, which meant more time off for recovery and a looming medical bill (no health insurance). The financial burden became too much, so she stopped her rotations, went back to work as a phlebotomist. After she worked off the debt and saved enough to return to her clinical rotations, she stepped it up and accumulated some really valuable experience, including an extended stint on an Indian reservation in the Southwest. During this time she was also able to accumulate the required clinical experience to secure the ECFMG certification, which allows foreign medical grads to apply for US residencies. This was 4 years ago, and she has been applying for FM residency positions every fall without so much as an invitiation to show for it. She is now back to working in infectious disease administration, doing well and enjoying working with hepatitis C patients and families, but is not willing to give up the dream just yet either.


The problems as I see them: 1) Poor showing on Step 1 (failed twice) but did fine on Step 2 CK and CS. These scores are now nearly 10 years old. 2) Extended time between medical school and residency. 3) Repeatedly falling off track. #2 and #3 are not really her fault, but from a program administrator’s perspective I can see why she hasn’t gotten past the screening process. On paper, she looks terrible; lack of commitment, academic issues, health problems that might make her fall off track again, etc.


But in spite of all this, after being introduced to Dr V and getting to know her a little, I am convinced she has what it takes to make a great FM doc. She’s bright, honest, optimistic, already a great advocate for her hep C patients and families AND she wants to practice in a rural, underserved area.


So, there’s the story in a nutshell. As her mentor, I will have to remove myself from the evaluation process when and if she decides to apply to our FM program. But I’m more than willing, and at this point feel somewhat obliged to helping her retool her application. I just don’t really know where to start…


Is there a time limit on step exams, like there is on the MCAT? I’ve never heard of anyone going back and taking step exams after they’ve passed, but again these scores are approaching being 10 years old.


I’ve advised her to try to get more clinical experience where she is hands-on, but this is much harder to find than 10 years ago, especially in private practices where everybody is already working their tails off and have little time to teach/mentor.


Then there’s the question of when to apply. This year’s window is closing fast, especially if she intends to take the step exams again. Would it be better to wait another year? I took the step exams 8 years ago, and I would NOT be comfortable taking step 1 now, because so much of the basic science has changed.


Any advice is appreciated and mulled over. Also any other red flags OR things that we should “play up” in the application would be helpful. I really want to help Dr V finally get that brass ring! Thanks guys…

Jackie,


As far I can research, the USMLE doesn’t have an expiration date, but it now has a limit of six attempts. Time limits are imposed at state medical board level


“If you have not yet passed Step 3 and wish to retake a previously passed Step 1 or Step 2 examination in order to meet a time limit imposed by a recognized authority other than a medical licensing authority, you should understand the implications for Step 3 eligibility of a failing performance on a retake. Specifically, if a failing performance on a retake is the most recent administration of that examination, that failing score will preclude Step 3 eligibility.” (Link to STEP retakes)


This website from a private medical licensing consulting firm (Link state license matrix) will probably give the basic answers to Georgia time limits on STEP


As an outsider looking in I would think that a retake with a higher score would be something Dr V could do to show competency, commitment, and motivation.

Thanks Richard. It never occured to me that the state licensing boards would set the statute of limitation on step exams, but that makes perfect sense. I’ve recommended that she check with all the boards in states where she would consider practicing, then decide whether or not to repeat steps 1 and 2 based on the lowest common denominator. Agreed that retaking them regardless is also a good idea, to clear up lingering doubts about academic ability and commitment.


As always…I appreciate your input! Great weekend everybody…

  • jmdmd Said:
Thanks Richard. It never occured to me that the state licensing boards would set the statute of limitation on step exams,



That's why my father calls me son 'cause I'm so bright (sorry, could resist)

The problems as I see them: 1) Poor showing on Step 1 (failed twice) but did fine on Step 2 CK and CS. These scores are now nearly 10 years old. 2) Extended time between medical school and residency. 3) Repeatedly falling off track. #2 and #3 are not really her fault, but from a program administrator’s perspective I can see why she hasn’t gotten past the screening process. On paper, she looks terrible; lack of commitment, academic issues, health problems that might make her fall off track again, etc.


Hmm Interesting case. I am a resident, but here are my thoughts:


I would think that if you have received the ECFMG accrediation then the Steps should not matter. However, I would check with the accrediting council to see they have more stringent requirements in respect to the age, etc.


Also, if she has applied four times to residency in FM without any response, then she needs to contact those programs and find out if they have any constructive advice. Also, is she limited in where she is applying to-location? Would she be willing to go to a small town to get it done.


I suspect, that with the increased applicants and leveling off of the number of spots, that most IMG/FMG are having a very difficult time- there are enough US applicants and therefore the foreigners tend to be at the absolute tops of their class/profession to getinto a US residency right now.


My best advise to her would be to pick some programs and see if she can get in and do a month long rotation at those programs (like a med student) where she can get to meet and know people over a month and be a SUPERSTAR. It would greatly increase her chances of them overlooking her app.


Hope that helps!


Marcia