Below Average #illumedati #medtwitter

Hey everyone, it’s Medicine Mondays and today I’m going to talk about something relevant to The Match… what to do if you’re “Below Average”.

Below Average
Image by Gerd Altmann from Pixabay

Below Average?


I recently was asked by a friend of a friend about how to approach The Match when you’re “Below Average”.

First of all, let’s define what this person meant by “Below Average”. In a general sense, this probably means to the entire “medical student package” meaning your grades in school, your recommendations, your Step 1 score, your clinical rotation evaluations, etc.

However, what this person really meant was that they were below the average on Step 1. I’ve spoken before about it being The Test That Decides Your Life (But Not Really). Today, we’re going to delve a little bit more into how to approach things when you’re “Below Average” in terms of Step 1 score.

There are plenty of reasons why your Step 1 score isn’t what you want it to be. Perhaps you have difficulty with standardized tests, or something happened that day, or maybe it was just bad luck. Either way, if you think that your score “Below Average” let’s look into what that means.

Let’s break it down a bit…

Do you mean Below “The USMLE Step 1 Average” or do you mean “Below Average” for your specialty of choice. For most people, they probably are more concerned about the latter because context matters. However, in this day in age, there is data for everything, and here is the most current USMLE Step 1 score data for The Match:

Interactive Charting Outcomes for The Match

With this information, it’s pretty easy to see where your score ranks in terms of people who matched into your specialty or not.

For this example, let’s just look at Anesthesiology for 2018. Your chances are as follows:

<200 — 55%
200-209 — 69%
210-219 — 85%
220-229 — 92%
230-239 — 93%
240-249 — 97%
> 250 — 98%

In general, I think a >90% match rate is probably where you want to look for to help you match. So this means if you scored above 220, your chance of matching is pretty good – not assured, but pretty good.

However, if your score is <220 then we need to look into things more carefully. If it’s 219, then you’re probably still doing relatively well in terms of Match outlook. However, if you’re sitting below 200, things become closer to a coin flip.

So then let’s back up a little…

When you say “Below Average”, did you mean in order to match into your specialty? If so, which number are your basing that on? Be very objective with your chances, that’s what the numbers are for that I just demonstrated up there.

If you think “219” is Below Average to match into Anesthesiology… that’s not really correct. However, it is “Below Average” if you want to try to assure you match — which is probably how most medical students will think.

So, in that case, you need to think long and hard about where you are in terms of score and reflect on things. The lower you are toward the “didn’t match” end of the spectrum, the more flexible you need to be with where you want to go. If you absolutely must stay on the West Coast (usually competitive) for residency and your match chance is 55% with your current score, that’s probably not a great plan.

So what do you do?

Also, you’re going to need to be little more proactive in terms of contacting programs and trying to secure interviews. Like it or not, I think most programs will utilize some form of a “Step 1 cutoff” and/or “lack of ties” cutoff. There are simply too many people to applying for limited number of spots. They need to find some way to make the number more manageable. For this reason, you need to be flexible in where you can in order to get the training you need. In addition, the onus is on you to give programs a reason to interview you.

If you are born and raised in California with all your family back in California, even if you went to medical school some where else. You’re going to need to explain why you want to go somewhere else.

Back when I matched wayyyy back in 2007, I called the program and tried my best to speak with the program coordinator. I was polite and just mentioned my specific interest in the program. Also, I mentioned if they could just perhaps put a note on my file that I was interested and let the program director know, that would be much appreciated.

That said, most of the time, it didn’t help. However, a few times it did, and I believe it increased by interview total from 4 to 7 — which was probably the difference in me matching or not.

4 to 7?

Yes, I was trying to match into radiology as a Caribbean Medical School student which was very difficult at that time. Not only that, my Step 1 score was probably only “about Average” for people matched into radiology that were US Medical Students — not International Medical Graduates (IMGs).

I was very proactive because I knew every interview I could get what increase my chances, if only by a little bit. To be quite honest, I was quite ecstatic to get 7. On the other end of the spectrum, I knew other people who had more than 20 interviews and had to cancel them.

Long story short, The Match is kind of like musical chairs. When the music stops, every seat wants a student in it and every student wants a seat.

However, that said, getting the interview levels the playing field somewhat — but not completely. All things being equal at the interview, if someone has better scores before the interview the likelihood is they will still be ranked higher. However, scores matter significantly less once you get to the interview stage. The program has already put some resources (mostly time) into you at this point by clearing out time for the residents/attendings to meet and interview you. Maybe they even bought you your dinner the night before and made a spiffy little notebook with all their info.

Of course I don’t know how I did at my interviews. However, I would like to believe that at my interviews I did a reasonable job at being personable and likable. I think it must have enough to be ranked, since I did manage to match.

What if I don’t match?

If you’re “Below Average” for your specialty, that needs to be a possibility you need to consider. In that case, you may want to also apply to preliminary medicine or preliminary surgery years at your home institution in order to gain some experience and try again.

When I applied for radiology, I was prepared to not match, then reapply the following year as prelim medicine intern. If I didn’t match again, then I would have tried to transition from a prelim medicine year into an internal medicine residency…. but then I would apply for a 3rd time as a 2nd year IM resident. If I didn’t get in the 3rd time, then I probably would have given up. At that time, my resolve was to apply 3 times — 3 strikes and you’re out.

That said, I’ve had friends finish whole residencies and go back and do different ones. I’ve known radiologists who practiced a different specialty for a decade who went back to residency. I’m sure there are similar stories for every specialty.

It may seem like a “waste of time”, but this is the next 30 years of your life. You’ve already committed 7+ years of postgraduate education/training. If you were given the opportunity to do what you really wanted, would you do a few more years?


Define “Below Average”, set your goal.

Be flexible and proactive.

Getting the interview levels the playing field – a little.

Prepare yourself for the possibility of not matching.

Be aware of what you really want and strengthen your resolve.

Medicine Mondays Sensei


Agree? Disagree? Questions, Comments and Suggestions are welcome.

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