Third-time applicant with a low Step 1 score matches internal medicine
Anonymous
An applicant with a low Step 1 score applies to neurosurgery residency for the third time, despite being told that she will likely never succeed. She goes all in, risking utter failure if God does not come through. He responds in ways she did not expect.
“There are people in this field who will never get over your Step 1 [board exam] score.”
“You’ve graduated.”
“I understand that you had to support yourself financially, but now you’ve stepped completely away from medicine. People will have questions.”
“This is your third time trying, and not much has changed on your application. In fact, it’s gotten worse over time. I think it’s time you did something else. You know, the definition of insanity…”
I sat silently staring at my computer screen, barely succeeding in keeping my tears in check as one of my oldest and dearest neurosurgery mentors rattled off the many reasons why I was no longer a candidate for the field. It had always been a long shot, but the list of “red flags” had grown exponentially since my second attempt at matching. It wasn’t my first time hearing any of this, but hearing it from him—formerly one of my biggest champions—was unexpected and particularly painful.
After what seemed like forever, he reached the end of the list. His kind eyes awaited my response. I took a deep breath, trying in vain to ease the catch in my voice. “I understand. Your points are very well taken…but I still feel that I have to try. The application process is different this year.” Almost as an afterthought, I added, “And I’m different.” It was true. The internal, spiritual changes that had taken place since my second unsuccessful Match Week Monday in March had outpaced the changes to my actual residency application.
When the call ended, I remained composed for a few moments, long enough to remind myself, “Man. I really messed everything up.” Then, the dam broke. The familiar grief over the self-imposed delays to my destiny washed over me. Thankfully, though, my faith rose up just as quickly. Through tears, I said aloud, “Yes, I messed up, big-time. But God can still fix this!” My pastor’s voice thundered in my head: “Make your plans big enough for God to be honored to show up and for your failure to be colossal if He doesn’t!”
Well, this was certainly one of those plans! I had finally, truly reached the end of my natural ability. I let go of my need for control and allowed God to take what remained in my hand and do whatever He wanted to with it. My main asset this time around was the assurance that I had obeyed God to the best of my ability, even when things made no sense.
When I initially applied, I was hopeful that my interesting backstory, generally strong grades and research profile, reportedly strong letters of recommendation and endorsement from the residents and faculty at my home institution, and significantly improved performance on Step 2 would overcome my abysmal Step 1 score. I received just two interviews that cycle: one from my home program and one from my mentor’s program. When I didn’t match, I was informed that Step 1 was the determining factor. I was devastated. There was nothing I could do about the score itself that I hadn’t already done. But I was determined to try again.
When the application season rolled around again, after applying to almost every program in the country, I was initially offered interviews at my home program and the place where I did an away rotation. I ultimately was offered three more interviews but was unable to attend any of them. The fact that two of the offers came in January and coincided with my existing interviews felt like God’s hand was at work. I moved forward, telling myself I was trusting God. But I stumbled right at the finish line.
God had given me specific instruction on how to rank the programs, but I reordered my list out of fear and offense and leaned on my mentors to advocate for me instead of allowing God Himself to fight for me. I figured that I was still operating in faith because who enters the neurosurgery match for the second time with just two interviews?! Surely God would work it out where I would match at “the right program” no matter how I ranked them. I told myself that I would be happy with whatever place He chose.
But God was not pleased. I had forgotten the truths of Hebrews 11:6 and James 1:6-7—that without faith it is impossible to please God and that a double-minded person cannot expect to receive anything from the Lord. In fact, that same lack of faith and double-mindedness, among other spiritual missteps, had kept me from matching the first time. I clearly was not yet ready to move forward.
It was easier to submit to the Lord’s correction the second time around. I graduated, which was bittersweet, and moved back home to await further instructions. I still wanted to do my part, though, so I consulted with mentors and looked into neurosurgery pre-residency fellowships, general surgery preliminary positions, and research coordinator positions. People sent emails and made phone calls to their connections all over the country. But nothing seemed to be happening. Finally, I resolved to wait on the Lord to open the right door, even if it was at the midnight hour. I felt in my heart that I would know my next move by August 1.
In the meantime, as my finances dwindled, I sowed seeds of my time into my church and family. As I learned about faith in our church services, those lessons were being put to the test. Each week was an exercise in trusting God for His provision. Part-time contracting opportunities with small businesses started trickling in. People would give me free food, pay for my gas, and send me money right when my bank account was running on fumes. Finally, one of the companies that hired me as a contractor asked me if I wanted a full-time position. The start date would be August 1. God’s answer had arrived just in time!
My boss was 100% supportive of my reapplication to residency. She had prayed earnestly before offering me the job, partly because she wondered whether working in business would actually hinder my reapplication. But she ultimately got the go-ahead, and during our conversation, we agreed that working for her was what God wanted me to do in this season. We both believed that some program out there would actually view my work with the company as an asset. I had no idea what kind of program that would be, but I knew God must have had something in mind already!
I received one interview the third time around. It was in a city I had never considered and from one of the few remaining programs I to which I had not yet applied because I did not meet their application requirements the first two cycles. The interview seemed to go amazingly well. Still, Match Week Monday came around again, and I had not been accepted into the program. When I spoke with my pastor this time, he told me, “I think it’s time to do something else.” I knew he was right. He instructed me to spend some time praying—not thinking—and asking the Lord what He wanted me to do next. In tears, I made my way to the church to pray. It wasn’t long after my knees hit the altar that the answer came. The Lord reminded me how much I loved critical care in medical school. There are multiple paths into critical care medicine, but internal medicine was the clear way forward. There were hundreds of open internal medicine spots in the Supplemental Offer and Acceptance Program (“SOAP”), but I focused my application on programs in my home state. One special program caught my eye, and fortunately, I caught theirs as well. During my interview, my small business job was a main point of conversation. I highlighted the skills that I was attaining on the job. The program director told me, “We could use someone like you here!” This was what my boss and I had believed for when I took the job.
When the first round of SOAP offers came through, I was pleasantly surprised to have two from which to pick! I went from being rejected three times to selecting the program I would attend. On Match Day, I was finally able to celebrate matching with some of my friends. Even though I had graduated, my medical school made a special announcement and allowed me to walk across the stage during the Match Day celebration. My family and friends later rejoiced with me as I celebrated my prior graduation and entrance into the next season of my life.
It’s been some time since I started residency, and I know that I am exactly where I am supposed to be. I am thriving and very fulfilled in my work. I am making a difference in my program as one of the chief residents, using skills I learned as a neurosurgery hopeful and during my year in business. While I never expected to go into internal medicine when I first started my journey, all of the delays and setbacks actually routed me here, strengthened me, and prepared me for the destiny that the Lord has for me in medicine. I am immensely grateful and excited for whatever comes next!