Question About Applying Without The USMLE
Currently, I am starting the intern year as a categorical surgery resident. I know I would be happier as a radiologist, but now I am in a tricky situation. I am a D.O. with decent scores. Unfortunately, I did not take the USMLE (I entered medical school thinking of pediatrics, and my advisor told me to focus on just one examination). Even though I have not taken the USMLE, I have published research from undergrad in pediatrics from an excellent medical school. Moreover, I was a part of the medical honor society, a tutor during medical school, had prior work experiences, and plenty of volunteering/club involvement. I know the radiologist I worked with would be willing to write me a persuasive letter of recommendation.
As a student, I initially applied for general surgery due to a passion for anatomy, and because I enjoyed working with breast cancer patients. I thought I wanted to be a breast surgeon. However, I had the pleasure of working with a radiologist working in breast/women’s imaging. I loved it. Being able to detect subtle changes in breast tissue was fascinating. From the mammograms, stereotactic biopsies, and needle localizations, the days would seem to fly by. I couldn’t get enough of it. Never did I think I would be so interested in radiology, but without any prior exposure in the field, I would have never known.
I guess at this point I am unsure what to do. The current hospital I am at does not offer a radiology residency but is a part of a healthcare system that is about an hour away. What is the best advice you have for someone in my position? Any help would be much appreciated.
Thank you for your time!
What To Do?
As an intern in surgery, you are well within the window to change specialties from the standpoint of government medicare funding. But, if you make your decision to enter radiology too late, that may no longer be the case. Applying later will reduce the number of residencies that will give you an interview. So, there is no better time than now to apply for radiology, as that is your area of interest.
Also, you may not want to hear this. The best way to ensure that you will get a spot in radiology would be to take the USMLE Step I and II exams. Many residencies disregard the COMLEX scores. Now that the AOA has merged with the ACGME, the USMLE tests are the standard throughout the country. A good score on the USMLE Step I would go a long way to giving your application some more “street cred.” (Eventually, in 2022 the USMLE Step II will be more critical exam since Step I will be a pass/fail test only).
If you only have the COMLEX exam, you will be limiting the number of residencies that will seriously examine your application. I would try to take these exams as soon as possible so that the residency programs will have your scores. (Not sure if you can fit it in before this application cycle ends, but if you can, that would be great!)
All the other stuff that you have done, such as research, tutoring, and volunteering, is excellent. But, everyone else applying for radiology residency has done the same. So, although you need to add it to your ERAS application, it’s not going to differentiate you.
A recommendation from a radiologist within a health care system that has a residency can still support your application. Even if there are no other residency programs within the healthcare system, it will still help a little bit (but not as much).
The bottom line is that all is not lost. It will take a bit of work to study for the USMLE Step I and start your application soon. If you can’t get those USMLE scores before the application cycle, you can try to apply regardless. However, the chances of getting into radiology residency will be a little bit less. I think it is still worth a shot because you don’t want to lose out on government funding. Alternatively, you can take off a year of residency and find a job in research. That would potentially postpone the medicare funding issue and allow more time to study for the USMLE. When there’s a will, there is a way!
Barry Julius, MD