Why Failing Step 1 is Unlikely to Ruin Your Career in Medicine

Written by: Dr. Nisha Cooch
Published on: May 27, 2021

Failing Step 1

The decision to go to medical school is a big one, and medical school tends to be a stressful time for students. The idea of failing standardized board exams can be daunting, especially when considering what is often a large financial investment in your medical career and the opportunity costs of spending 4 years in medical school, likely earning little or no money.

Luckily, data show that failing the USMLE Step 1 exam does not mean your medical training thus far has been a waste and that you will never practice medicine. Instead, the numbers show that the majority of those who fail Step 1 get into a residency program. For instance, 72% of those who failed Step 1on their first attempt in 2017 went on to residency.

Though this percentage is lower than that of those who passed Step 1 on their first attempt (94% of whom go on to residency), it also doesn’t account for those who may have chosen to go a different route and not apply for residency, or those who suffered repeated failures. Another reassuring statistic is that more than 99% of those who have graduated from medical school have undergone further graduate medical education. These numbers suggest that many of those who fail Step 1 and do not complete residency have chosen on their own not to pursue this further training.

Medical Students in class

Unsurprisingly, the specialty you are pursuing also affects your likelihood of success in terms of gaining a residency position if you have failed Step 1, as certain specialties are inherently more competitive than others. For example, many more people who have failed Step 1 enter pediatrics residencies than anesthesiology residencies.

Another promising thing to consider if you are worried about a USMLE Step 1 failure is that residency programs appear to be shifting away from what many have deemed an overly heavy emphasis on USMLE scores in their choice of candidates. In recent years, residency programs have been provided with more tools to help them identify the students who would fit best with their programs.

While USMLE scores may provide some insight into how successful a potential candidate might be, there are clearly other, more personal factors that can help determine which among several candidates are most likely to benefit from (and contribute to) a specific residency program. After a USMLE failure, it is therefore important to address the reasons for the failure, take the test again, and make sure that you can present yourself as a well-rounded candidate when applying for residency.