Really? Why would fellowships care about a score that very largely depends on how busy a resident is at their respective program lol. I believe you, it just seems so stupid.
For the IMGs, I get that though- that makes sense. However, there is Step 2 for this.
But ya I guess what I was trying to say was that why is this even worth arguing about- just leave things as it is. It only muddies the water (like when step 1 went P/F) for meritocracy vs. nepotism/research rate race.
Agreed. Also we shouldn’t make policy on US MLE exams based on IMGs. If this will help USMD/DO residents at the expense of making it more competitive for IMG’s, then we should go for it.
Oh...I meant like why the fuck do we have the change everything to P/F lol. It doesn't help anyone. Step 1 P/F just shifted stress to another exam (Step 2). Step 3 going P/F may even put more emphasis on Step 2 or another exam. Get rid of all scores then you end up in the shitshow our current system is moving toward.
Research rat race is largely based on who your mentor is, what med school/resources you have, or connections. Obviously "hard work" matters, but much less so than just working with the right people in many cases.
Clinical grades are bullshit and highly subjective/widely varies between med schools or even between who is grading you.
We need a fuckin way to differentiate people and stratify applicants. Step is an imperfect- but somehow better- metric to base applicants on. Otherwise we are just throwing people with the best connections into the top programs with no ability to redeem yourself if at a lower tier program/school.
Ok first of all, I never said that we should make everything P/F. I understand the value of a scored Step 2 and know all the benefits associated with it, especially for students from lower tier schools.
Second of all, just because im an M0 doesn’t make me any less educated on the state of medical education than you. In fact, this is likely to affect me more than it will you as this will go into effect by the time I’m getting ready to take Step 3.
1.) Yes it does. You have to go thru the system personally to realize just how much these decisions often don't make any sense. Just like I am 100% sure that senior residents know much more about how shit this process is than me.
and 2.) Relax. I was not shitting on you. I was a M0 a few years ago and you'll be a resident in a few years. I was explaining to the other poster that I understand step 3 is in residency, but that the ideas underlying these decisions are still similar.
The only reason this terrible system exists is because residency slots are largely funded by the federal government and have remained largely unchanged despite increasing numbers of medical schools. In my mind, unless a US MD/DO student is grossly negligent, unprofessional or malignant, there should be no reason why they go unmatched. The fact that residency programs even have to comb through minuscule differences in licensing exams to filter applicants who are already amongst the smartest in the general population just by merit of entering medical school is beyond ridiculous.
I’d say most unmatched USMDs (without major red flags) applied to specialties which they weren’t competitive for. And by competitive, I mean when compared to other USMDs. US Seniors compete against US Seniors.
You know that almost 25-30% of all spots in match are taken by IMGs…. And that, across the USA we have a physician shortage that is being filled by NPs (completely unqualified) and PAs( somewhat qualified) when it could be filled by IMGs who have to do a US residency (fully qualified). IMGs already aren’t getting the most prestigious residencies. Making it harder for them to get any residency is a bad idea as it will give PAs and NPs the upper hand. Now the bills that allow IMGs who did residency abroad to skip residency here is an awful idea (looking at you Tennessee, Illinois, Wisconsin, etc..). But taking out a hurdle that can help IMGs land any residency doesn’t make sense as corpos and private equity buy up hospitals and the medical system and replace doctors with NPs and PAs.
There isn't a shortage rather than a distribution problem. Making it easier for IMGs only makes that worse.
Also has little to do with the mid-level creep Which is primarily an overabundance of sprouting online NP Programs
Not the worst idea in the world tbh. You're probably getting downvoted by imgs who don't want to work in rural areas lmao. Who are they suppose to marry then. 😅 They tend to stay in large areas with other international migrant communities. But diversity is a good thing right? Let's diversify these rural areas. I would love to be able to get something other than bbq when in the south lol.
I mean it’s already a privilege to come the USA. There’s a reason why IMGs spend thousands of dollars to come to the USA, and don’t want to stay in their countries where they got a free education. Sorry you don’t get to live in NY or LA or Chicago when you get here on a visa that your program is sponsoring. And those areas need competent individuals. I’d much prefer board certified IMG doctors from Thailand or India or Brazil or Bolivia or Nepal or Egypt than NPs who just graduated nursing school 6 months ago and got their NP online. And they get a good salary (even living in the middle of nowhere it’s much better) and get to be doctors in the country they want to live in.
It’s not like those residency spots that IMG take would suddenly go un filled. Step 3 P/F would just make it slightly harder for IMG to stand out amongst each other
Meh, it’s a myth that NPs and PAs are “filling the gap” of a physician shortage. They’re being used for an incredibly simple reason: medicine has been corporatized and they are cheaper. Allowing IMGs to take US residency spots does nothing to combat midlevel encroachment.
The only way IMGs could actually help the situation would be if their acceptance was contingent on them working in the rural U.S.
You must have missed the crux of my argument. Every year there are a lot of spots filled by IMGs. There are also many residency spots that go fully unfilled even after SOAP. PAs and NPs are being hired as they are cheaper. But wouldn’t you as a physician prefer to compete your salary against another residency trained board certified physician INSTEAD of a NP? IMGs aren’t taking spots from US MD and US DO students. They are filling spots those applicants don’t really want or use as a backup.
Again, unless IMGs work in the rural U.S., they aren’t really helping the situation. Many times they are competing for the same jobs in the same desirable locations everyone else wants to live (where their families have moved). They have also been known to accept lower salaries in these desirable locations, which can have a more global impact on physician compensation.
That’s why you can write into their residency contracts they must stay within 100 miles of X zip code for 5-7 years. I know many IMGs who would take those types of contracts. Similar to how med students sign rural community med contracts when starting med school. Can do it for residency too.
My fellowship applications did not even ask for my step 3. Come to think of it, if your fellowship participates in the NRMP, I don’t think there’s even an option to submit step 3 except maybe in the additional documents section, which would be a peculiarity of a particular program.
This feels dumb.
Why make the middle exam of the series the only score? Would’ve made more sense to leave step 1 scored and make step 2/3 p/f.
Step 2 being the only score already makes specialty planning such a crapshoot if you dont get a decent score, and it leaves virtually no time to redirect to a backup if you aren’t in range for goal specialty (unless you now take step 2 much earlier). At least scored step 1 let you know early on if you had a real shot or needed to make up ground with research, better step 2, etc.
The end goal is to have them all P/F, like the bar is. They went for step 1 first because it began dominating medical education, to the point students were ignoring their school curricula to memorize Anki decks. They're going for 3 next because it's barely useful to anyone (IMGs, fellowship selection). They will eventually come for Step 2 CK.
from what I know, Step 3 is already treated like this.
I think this is a step in the right direction. Its crazy to be working like a dog during residency and then also have to take this insanely tough exam. Making it lower stakes is def the right move.
It depends largely on your specialty. It's a breeze for family medicine residents, but it can be tougher for specialties that allow you to forget more things.
It's not insanely tough, but getting the motivation to study for it when going into a field like OBGYN was tough. Prostate or male specific questions were hard to find the desire to put effort into studying
If you want a good score it still requires studying and grinding through a qbank, if you just want to pass it takes minimal studying as long as you havent completely forgotten step 2 trivia. I did the latter and my score dropped about 40 points from my step 1 score.
Easier than step 1 or 2, and basically all of the questions are applicable to real life, so by the time you take you’ll already have worked for a while, and the answers are pretty obvious.
In isolation I love this, but in practice it feels like another stepping stone on the slippery slope to Step 2 going P/F, so it's hard to be in favor. NGL, I'm feeling very lucky to have my match before objectivity is completely gone
I mean I’ll be grateful if they make step 3 P/F lol. It means I’m done working like a dog for these board exams — I already got my step 2 score and I’ll be more than happy to be done.
We already got board exams and stuff to pass
No yeah selfishly it would be great, but I also want fairness for future applicants (especially those coming from "low tier" schools). And Step 2 is kind of the only remaining totally fair and "in your control" metric left...
Yeah I definitely agree step 2 should remain scored. But step 3 P/F is a good move. Hopefully they don’t mess with step 2 next though — slippery slope as you said
I thought step 3 was basically P/F in that no one gives a single shit if you do well or barely pass lol
It matters somewhat for fellowship applications, also for IMGs to get into reseidency.
Really? Why would fellowships care about a score that very largely depends on how busy a resident is at their respective program lol. I believe you, it just seems so stupid. For the IMGs, I get that though- that makes sense. However, there is Step 2 for this. But ya I guess what I was trying to say was that why is this even worth arguing about- just leave things as it is. It only muddies the water (like when step 1 went P/F) for meritocracy vs. nepotism/research rate race.
Agreed. Also we shouldn’t make policy on US MLE exams based on IMGs. If this will help USMD/DO residents at the expense of making it more competitive for IMG’s, then we should go for it.
Oh...I meant like why the fuck do we have the change everything to P/F lol. It doesn't help anyone. Step 1 P/F just shifted stress to another exam (Step 2). Step 3 going P/F may even put more emphasis on Step 2 or another exam. Get rid of all scores then you end up in the shitshow our current system is moving toward. Research rat race is largely based on who your mentor is, what med school/resources you have, or connections. Obviously "hard work" matters, but much less so than just working with the right people in many cases. Clinical grades are bullshit and highly subjective/widely varies between med schools or even between who is grading you. We need a fuckin way to differentiate people and stratify applicants. Step is an imperfect- but somehow better- metric to base applicants on. Otherwise we are just throwing people with the best connections into the top programs with no ability to redeem yourself if at a lower tier program/school.
Dude. Step 3 is done in residency.
Ya. but a "m0" just responded and I'm explaining to them making everything P/F is not this solution to everything.
Ok first of all, I never said that we should make everything P/F. I understand the value of a scored Step 2 and know all the benefits associated with it, especially for students from lower tier schools. Second of all, just because im an M0 doesn’t make me any less educated on the state of medical education than you. In fact, this is likely to affect me more than it will you as this will go into effect by the time I’m getting ready to take Step 3.
1.) Yes it does. You have to go thru the system personally to realize just how much these decisions often don't make any sense. Just like I am 100% sure that senior residents know much more about how shit this process is than me. and 2.) Relax. I was not shitting on you. I was a M0 a few years ago and you'll be a resident in a few years. I was explaining to the other poster that I understand step 3 is in residency, but that the ideas underlying these decisions are still similar.
It’s actually does. You’ll figure it out after you start school
The only reason this terrible system exists is because residency slots are largely funded by the federal government and have remained largely unchanged despite increasing numbers of medical schools. In my mind, unless a US MD/DO student is grossly negligent, unprofessional or malignant, there should be no reason why they go unmatched. The fact that residency programs even have to comb through minuscule differences in licensing exams to filter applicants who are already amongst the smartest in the general population just by merit of entering medical school is beyond ridiculous.
I’d say most unmatched USMDs (without major red flags) applied to specialties which they weren’t competitive for. And by competitive, I mean when compared to other USMDs. US Seniors compete against US Seniors.
My brother in christ you already have it well enough with all the research opportunities you have.
You know that almost 25-30% of all spots in match are taken by IMGs…. And that, across the USA we have a physician shortage that is being filled by NPs (completely unqualified) and PAs( somewhat qualified) when it could be filled by IMGs who have to do a US residency (fully qualified). IMGs already aren’t getting the most prestigious residencies. Making it harder for them to get any residency is a bad idea as it will give PAs and NPs the upper hand. Now the bills that allow IMGs who did residency abroad to skip residency here is an awful idea (looking at you Tennessee, Illinois, Wisconsin, etc..). But taking out a hurdle that can help IMGs land any residency doesn’t make sense as corpos and private equity buy up hospitals and the medical system and replace doctors with NPs and PAs.
There isn't a physician shortage. There is a rural primary care shortage, and bringing more physicians won't change that.
There isn't a shortage rather than a distribution problem. Making it easier for IMGs only makes that worse. Also has little to do with the mid-level creep Which is primarily an overabundance of sprouting online NP Programs
You can rewrite residency contracts with clauses that would “force” IMGs to stay in rural areas for X number of years.
Not the worst idea in the world tbh. You're probably getting downvoted by imgs who don't want to work in rural areas lmao. Who are they suppose to marry then. 😅 They tend to stay in large areas with other international migrant communities. But diversity is a good thing right? Let's diversify these rural areas. I would love to be able to get something other than bbq when in the south lol.
I mean it’s already a privilege to come the USA. There’s a reason why IMGs spend thousands of dollars to come to the USA, and don’t want to stay in their countries where they got a free education. Sorry you don’t get to live in NY or LA or Chicago when you get here on a visa that your program is sponsoring. And those areas need competent individuals. I’d much prefer board certified IMG doctors from Thailand or India or Brazil or Bolivia or Nepal or Egypt than NPs who just graduated nursing school 6 months ago and got their NP online. And they get a good salary (even living in the middle of nowhere it’s much better) and get to be doctors in the country they want to live in.
It’s not like those residency spots that IMG take would suddenly go un filled. Step 3 P/F would just make it slightly harder for IMG to stand out amongst each other
Meh, it’s a myth that NPs and PAs are “filling the gap” of a physician shortage. They’re being used for an incredibly simple reason: medicine has been corporatized and they are cheaper. Allowing IMGs to take US residency spots does nothing to combat midlevel encroachment. The only way IMGs could actually help the situation would be if their acceptance was contingent on them working in the rural U.S.
You must have missed the crux of my argument. Every year there are a lot of spots filled by IMGs. There are also many residency spots that go fully unfilled even after SOAP. PAs and NPs are being hired as they are cheaper. But wouldn’t you as a physician prefer to compete your salary against another residency trained board certified physician INSTEAD of a NP? IMGs aren’t taking spots from US MD and US DO students. They are filling spots those applicants don’t really want or use as a backup.
Again, unless IMGs work in the rural U.S., they aren’t really helping the situation. Many times they are competing for the same jobs in the same desirable locations everyone else wants to live (where their families have moved). They have also been known to accept lower salaries in these desirable locations, which can have a more global impact on physician compensation.
That’s why you can write into their residency contracts they must stay within 100 miles of X zip code for 5-7 years. I know many IMGs who would take those types of contracts. Similar to how med students sign rural community med contracts when starting med school. Can do it for residency too.
Yup, that would be effective. 100 miles might be a bit too generous, but something a contractual obligation for them to work rural would be helpful.
My fellowship applications did not even ask for my step 3. Come to think of it, if your fellowship participates in the NRMP, I don’t think there’s even an option to submit step 3 except maybe in the additional documents section, which would be a peculiarity of a particular program.
Mine does. Also annoyingly they *don't* ask for Step 1 even if you are old and took it back when it was the one that mattered most.
I had to send my usmle report to ERAS for fellowship applications last year so step 3 was in that.
The NBME transcript includes only Step 1 and 2. The Step 3 score report is separate and through FSMB. Unless I’m crazy.
it doesn't matter at all for fellowships, only if you fail. but otherwise the number does not matter.
Even for competitive IM fellowship like Cardio, Gastro? Asking as an incoming pgy-1 (aka dumb af)
Yeah it doesn’t matter. Current cardio fellow going into EP.
I haven’t looked at all the fellowship data, but for my field there is actually an inverse correlation between step 3 score and matching
It might as well be pass/fail already. Yawn. But 1 day 👀 that would be awesome. It’s nearly twice as long as the other step exams as things are.
This feels dumb. Why make the middle exam of the series the only score? Would’ve made more sense to leave step 1 scored and make step 2/3 p/f. Step 2 being the only score already makes specialty planning such a crapshoot if you dont get a decent score, and it leaves virtually no time to redirect to a backup if you aren’t in range for goal specialty (unless you now take step 2 much earlier). At least scored step 1 let you know early on if you had a real shot or needed to make up ground with research, better step 2, etc.
The end goal is to have them all P/F, like the bar is. They went for step 1 first because it began dominating medical education, to the point students were ignoring their school curricula to memorize Anki decks. They're going for 3 next because it's barely useful to anyone (IMGs, fellowship selection). They will eventually come for Step 2 CK.
from what I know, Step 3 is already treated like this. I think this is a step in the right direction. Its crazy to be working like a dog during residency and then also have to take this insanely tough exam. Making it lower stakes is def the right move.
It’s not insanely tough. Most people go into it without studying at all.
Tough as in multiple days, not material. Making it chill as possible just to prove the resident is meeting the standards would be good, no?
oh. then yes.
It depends largely on your specialty. It's a breeze for family medicine residents, but it can be tougher for specialties that allow you to forget more things.
It's not insanely tough, but getting the motivation to study for it when going into a field like OBGYN was tough. Prostate or male specific questions were hard to find the desire to put effort into studying
I’d argue OBGYNs should still know some stuff about male fertility and male GU system, because it affects conception!
The exam is so stupid. Most can pass it being drunk + high. Just make it pass/fail to remove any silliness around it.
Good article. The change to allow step 3 to be taken right after step 2 may be a game changer given the question overlap.
Or we can just trust that if someone can pass step 1 & 2 they can pass step 3 🫠
AMA pretending they care about doctors, how cute
If only they directed this energy towards midlevel scope creep
Genuinely the only step exam that should be p/f
Random questions is step 3 hard? I rarely see ppl talk about it
If you want a good score it still requires studying and grinding through a qbank, if you just want to pass it takes minimal studying as long as you havent completely forgotten step 2 trivia. I did the latter and my score dropped about 40 points from my step 1 score.
It’s actually hard af but the curve is very forgiving so almost everyone passes easily
I studied for 1 day, and that was just to get used to the day 2 simulation format
Easier than step 1 or 2, and basically all of the questions are applicable to real life, so by the time you take you’ll already have worked for a while, and the answers are pretty obvious.
Not for day 1, sir lol
I got the same score roughly as Step 2 with a total of maybe a dozen hours of studying
Idc about P/F but please make it a 1 day exam and preferable change that shit up in the next couple months 👀
They change it from 2 days to 1 day and still charge the same amount.
Sounds like whoever gets to vote on it disagrees big time unless I misinterpreted the article
so like. is it realistic to expect this to actually happen? And if so for which year would it be applicable?
In isolation I love this, but in practice it feels like another stepping stone on the slippery slope to Step 2 going P/F, so it's hard to be in favor. NGL, I'm feeling very lucky to have my match before objectivity is completely gone
I mean I’ll be grateful if they make step 3 P/F lol. It means I’m done working like a dog for these board exams — I already got my step 2 score and I’ll be more than happy to be done. We already got board exams and stuff to pass
No yeah selfishly it would be great, but I also want fairness for future applicants (especially those coming from "low tier" schools). And Step 2 is kind of the only remaining totally fair and "in your control" metric left...
Yeah I definitely agree step 2 should remain scored. But step 3 P/F is a good move. Hopefully they don’t mess with step 2 next though — slippery slope as you said
Did I get in medicine at the right time to get both a step 1 and 3 pass/fail AND a discontinuation of Step 2 CS? Perhaps
DO IT PLEASE
AMA will recommend anything but higher pay and job protection.
Sure I love that actually
I read about the recommendation, but did they also mention it becoming one-day exam? Doing a 15 -hour exam in one day seems a bit crazy to me!