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Why is the USMLE Important?

The best way to understand why the USMLE is so important to you is to understand why it’s so important for residency programs. Throughout this process, it will be in your best interest to be able to put yourself in someone else’s shoes. Whether it be dealing with friends & family, writing a personal statement, or sitting down for a residency interview, your success will be dependent on the people that are in a position to help you along the way.

In the case of the USMLE, let’s put ourselves in the shoes of the Residency Program Director. Imagine that your days are spent running a busy teaching program, caring for your patients, and dealing with the politics of hospital administration. Now add hundreds (and if you’re, ‘lucky’, thousands) of applications you need to consider to fill 20 spots on next year’s 1^st year residency roster. It’s Sept 1^st and you have a couple of months to decide which candidates you want to invite for a select number of interview spots. How would you do it?

Balance In the Force

This is where the USMLE comes in. The exam is designed to play a very important role when it comes to balancing the very diverse pool of applicants that apply for residency each year. There are doctors from all over the world with varying backgrounds, educational histories, medical training, and experiences. Even within the United States, where medical education is technically supposed to be standardized to some extent, there can be a vast divide between students trained among the country’s numerous medical schools. The USMLE serves to EVEN THE PLAYING FIELD. It puts everyone in the same boat, poses the same problems to each candidate, and says, ‘DEAL WITH IT’. It plays no favorites. There is so much weight put on the USMLE because they are both RELIABLE & VERIFIABLE.

First Filter

Knowing this, and being in the program director’s shoes, the USMLE now makes the initial part of the process relatively simpler for you to screen candidates. You set your agenda for the match season and part of doing that would be to first filter out on minimum accepted USMLE scores. Depending on the specialty & how competitive your program is how high (or low), you’ll set the bar.

Making this, ‘first filter’ doesn’t guarantee candidates that you’ll grant them an interview. It just means you’ll look at their application more in depth. Someone could have a very impressive background – loads of published research, US Clinical experience, and a letter of recommendation from Barack Obama…but the application will likely never be seen unless the minimum USMLE score is met.

Scores = Specialty

So now step out of the program directors shoes and back into your own. You need to choose a specialty. Before you can do that, you need to be realistic, and that means understanding that your USMLE score will play a MAJOR role in which specialties you can get into. We won’t get into specific numbers here as it depends on your situation. Regardless of which specialty you choose, your goal is to give them a score that they CANNOT ignore, regardless of your background.

The primary care programs tend to have lower score requirements. This does not mean that they are not searching for excellence. They are. But they have a greater number of positions to fill, so they have to cast a wider net to fill them. For example, you can get a 185/75 and get into a lower tier family practice program in the middle of nowhere…or you could get a 218/90 and get a PRE-MATCH offer at a higher level institution for that same specialty. So the minimum USMLE score allows you to judge if you should bother applying, but you need to aim much higher than that so that you can essentially CHOOSE your hospital.

More competitive specialties like radiology or anesthesiology have higher minimum score requirements. These programs tend to have more attractive lifestyles, with higher salaries and less demanding hours, so everyone wants them, but compared to the primary cares, there are relatively fewer number of spots to be filled. Your goal in this case is to submit an upper end score so they look at your Curricula Vitae (similar to a resume). Your background should then have equally strong components, such as the Letters of Recommendation, US Clinical Experience, and so on.

Go Do Your JOB

Some people will tell you there are some specialties & hospitals that are IMPOSSIBLE to get into. If you believe that, quit now. Go become a lawyer. Impossible does not exist for doctors. If it did, we wouldn’t have any of the technology used today to save lives.

To secure your future position as a practicing physician in the United States, you have a JOB to do now. Everyone talks about how hard residency is – the hours, the abuse, and the low pay. No one ever talks about the path to get there – the hours, the abuse, the complete LACK of pay. Studying for the USMLE is your JOB. Treat it with the respect it deserves and you’ll earn the promotion you’re looking for – residency.

Do Anything and You can have Everything (at least professionally)

I had a foreign medical graduate* student that came to me at the beginning of his studies and said to me, “I want ortho (Surgery), I’ll do anything you tell me I need to do.” My immediate response was, “Ok, let’s get a 99 (~238+) on Step 1 and then go from there”. As we went through the process together, we made adjustments to his studies, and sure enough, after watching him study tirelessly, he got his 99 on Step 1. I then advised him to go after significant Ortho-related research experience, which he did. Then 99 on step 2ck and as a result of that strong score, it made the 99 on Step 3 easier to attain. 99’s on all three Steps. He’s now a foreign medical graduate at the world-renowned Columbia Presbyterian doing his residency.

Impossible does not exist for you.

Good luck & Study Well! ~ Dr Brian

*Some say that US grads have an unfair advantage with the exam over international medical graduates (IMGs), arguing that they were trained specifically for the exam. While that may be true, bear in mind that those students usually have about 1 month immediately following their 2^nd year to review 2 years of basic science material. IMG’s can take as long as they need to prepare, which is oftern a necessity as most havent seen the basic sciences in a few years. While a U.S. grad may have advantages and have a lower minumum score requirement, the IMG can shorten that gap with a higher score. It’s one of the many examples towards how this exam serves to balance the scales used to measure you as a candidate.

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written by MattM, July 11, 2009

I like how you explained that. Time to go do my JOB! smilies/grin.gif

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written by Narciso, July 26, 2009

I agree totally with the perspective on the important of scores and reaching for the stars. While I here of some people that have matched with regular scores because they knew the person that made the decision, this is not the norm. I also would like to add that studying and getting a high score does increase your knowledge base and makes you a better doctor. This is something that is hardly talked about. After some time it can be a joyfull experience to learn.

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Why is the USMLE Important?

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