What program directors look for: Part II. USMLE scores

* Please post your comments/questions. Keep it short*

USMLE scores are critically important because they are the only uniform measure in the world of student/physician quality.

They compensate for the variability between transcripts and grading systems between schools.

Some places have cutoffs, some don’t and like money, more and higher is better.

1. You CANNOT hide previous attempts at taking the test.

2. If you feeling weak and your Qbank averages are low. it is MUCH better to delay your test.

3. Yes, the later the application, the harder it is to get interview spots, but a failing or low grade is something you will not be able to repair later. That goes for everyone. If you are applying in Ophtho, a delay makes it harder, but a score that is low can eliminate you altogether

4. Good scores are based on what you are applying in.

Average score to get pediatrics is  205 but the average for OB/GYn is 220 and the average for orthopedics is 245.

5. Now is the time to obsess on studying. You are going to live with the resulty for a long time. Do more prep.

the average score on USMLE has been going up more than a point a year.

in 1992 the average score was 200,

in 2008 the average score was 221

Visa holders need higher scores than non visa holders.

If you have a good step 1 score (>90) then apply with JUST the step 1 score and take more time to prep step 2.

IF you have a poor step 1 score (<80) do not apply. YOu may have your application inactivated.

Send in your questions/comments.



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26 Responses to “What program directors look for: Part II. USMLE scores”

  1. pustota Says:

    if one is reapplying, do you advise taking Step 3?

    • Conrad Fischer Says:

      If you need to re-do your application, then you must add something new. Taking step 3 is a great thing to do if you can get a higher grade than step 1 and 2

  2. scores Says:

    How does a program director choose between 2 img’s, one having US clinical exp. with lower usmle grades than the other who does not?
    are scores more important than US clinical experience?

    • Conrad Fischer Says:

      Great question!!
      Scores are UNQUESTIONABLY more important than US experience, because they are MEASURABLE.
      Now, this does NOT count the kind of US clinical experience that an off-shore student gets with a FULL 2 year of real US rotations. THAT type of US clinical experience is real, and better than scores. WHat I mean is, a step 2 score of 95 is a LOT more measurable than simply ‘hanging out’ on a rotation such as an observership for a month or two.

      • optimistic Says:

        thanks, not sure if this will post, but ill try anyway, or ill just have to go back to being scores again, anyway, so a carribean med student with lower scores is more likely to get an interview than an img with out US clinical experience with higher scores?

      • Conrad Fischer Says:

        The Carribean student is more likely to be interviewed with lower scores for two reasons: they do most of their 3rd and 4th year in the US and hence, know the system. Also, there is less likely to be a visa issue. The better carribean schools have standards that are more rigorously checked and known

  3. eekoo Says:

    Dear Fisch,

    I have to disagree with you concerning this statement:

    “If you have a good step 1 score (>90) then apply with JUST the step 1 score and take more time to prep step 2.”

    Last year, I applied sept 1 with a step 1 score of 241/99. I didnt get a single interview, surprised …ya. So then u think there is something wrong with my application: so here is a snapshot: MD 2003 from Russia, PhD from Downstate, 5 publications, 8 conference presentations including the AHA. I mean MD/PhD with a step 1 of 99 and nothing. What is going on in the minds of program directors!!!! Anyways, by december, i had an 88 on the CK and pass on the CS (all 1st attempts).

    So, my point is, for IMG, u’d better have ur application complete before u apply.

    We’ll see how it goes this year. Added this year, 6 months of externship and by december a step 3 score.

    Great posts by the way. Seen u at Downstate a few times but never talked to u.

  4. Lolaz Says:

    Because of the change in score reporting, if someone had a less-than-stellar step 1 score but were ready to murder step 2, would it be better to wait and send out applications when scores are in (October 7th) or send them out early in the hopes that they’re not deactivated?

    • Conrad Fischer Says:

      thanks very much for your comment. I had no idea.
      Is this true?

    • Conrad Fischer Says:

      My Dear Ms O!
      Glad to hear from you!
      If you are a US grad, it is okay to apply. If an American IMG, I think you can still apply with ONLY the step 1 if it is above 80 and you will NOT get de-activated!
      Lower than that, people should wait

  5. mimi Says:

    if I will get 79 on step 1,Ishould forget about residency?

    • Conrad Fischer Says:

      Of course you do NOT have to ;forget about residency’ with a 79 on step 1!!!
      It will just make it more difficult.
      1. Apply in geographically far off places\
      2. Look at places that did NOT fill last year.

      Make VERY careful choices about where to do rotations in the first three months of your fourth year. ONLY rotate inplaces that will have a chance of taking you.

  6. sam reddy Says:

    hi dr fischer…..can you elucidate a little more on the role of a green card as compared to other visa options…………

    • Conrad Fischer Says:

      Green card is JUST as good as citizenship when it comes to the application process. Green card means you do not need a visa and you can show up on July 1st and not be late.
      Happy Hunting

  7. Vincent Says:

    Hello Dr Fischer- so about inactivation, if you send a school ur transcript and the application is complete, but more grades are soon to come in, would schools inactivate applications on the basis of average GPAs and not care for any future relevant clerkships to be updated? Because they’ve already been triaged away? MD 2010, 99 Step 1, average grades in MD school, good extracurriculars…applying to IM top schools.

    • Conrad Fischer Says:

      By ‘Schools’ that you are applying to, I assume you mean ‘training programs’.

      It is UNLIKELY to have an application inactivated simply on the basis of a mediocre transcript. It would be FAR more likely for this to happen on the basis of low scores.
      So, it is POSSIBLE that some very high functioning programs might inactivate on the basis of transcript, this would be far more likely if there were a serious error such as a failure on the transcript.
      So, bottom line: Unless you have a BIG glaring defect on the transcript, it should NOT lead to inactivation

  8. Anna Says:

    Hello! I am from a medical school in Ohio and would like to do a pediatric residency (open to go anywhere). I failed step 1 twice, passing on my third attempt with a 199. I was just wondering how many programs I should apply to?? I applied on Sept 1, 2009 for 29 programs but am thinking of adding up to 90. I will take step 2 ck in late sept and hope to get that score to programs in mid-late oct. Thank you for you time…your dedication to students is admirable Dr. Fischer!

    • Conrad Fischer Says:

      Hi Anna,
      I would DEFINITELY add the extra programs for application. First, it is a VERY SMALL investment, second, if you DON’T need it, just don’t go to the extra interviews.

      Also, I would WAIT for your step 2 grade to do the extra applying. If you apply with the multiple failures on step 1, then you will risk being inactivated, and even if you get a good grade, you will NOT have your grade seen.
      Good Luck!

  9. sumana Says:

    Hello Dr.Fischer,

    Congratulations on your new book and i hope to meet you soon in the bay area! I was wondering though.how important are the step 3 scores? I mean, do PDs look for a pass or is there any optimum range of scores? I have 99 in both step1 & 2, and 85 on step3(considering the ultra-short prep,working as Kaplan MCAT teacher and Clinical skills grader simultaneously). How much of a difference does this score make?Yes,I’m an IMG.

  10. Odunayo Says:

    I am an IMG with 77/78. I have been previously residency trained in my home countryGoing by all I read on your website, I should forget all about residency

    • Conrad Fischer Says:

      I did NOT say to forget about it!!! I just said it would be difficult!!! No laying down inthe dust! Apply to HUNDREDS of programs in far off places and be willing to live any where

  11. jseem Says:

    Dear Dr. Fischer in your webinar on Routine Miracles you advised students preparing for step 1 to keep yourself motivated by searchin for meaning, my level of knowing should go up, i have to teach my fellow docs in residency, no one except me is learnin this info so i must go on ,,but Doc Fischer this gets you of the hiyield stuff n gets you slightly demotivated by realising at the end of the day that this info might not be tested on step 1 plus sometimes it takes alot of time, and the big fear is your hardwork will not be acknowledged and your advised attitude ‘ No one except me is learning ” might not be tested by USMLE, though i do realize that this makes you a chance of doing something(unknown), a chance of changing something(unknown) and keeping up for unknown and believing youself in this regard ,Dont you think that this leads to self deception?

  12. jseem Says:

    Thank you Dr. Fischer , we love you, GOD Bless you

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