Advice for an Unmatched US-IMG

[kareem1589]

This is going to be a bit of a long post, so I apologize in advance for the length. Basically, as the title says, I need some advice/help as to what to do now and what the heck happened during this match season. Stats wise, I'm a US-IMG that will be graduating in May 2017. I applied on 9/15 of this year. Step 1 208, Step 2 CK 220 (updated on ERAS 9/21), Step 2 CS Pass (updated on ERAS 10/12) (all on first attempt), no research, 3 work experiences, 0 volunteer experiences. All of my rotations were done in the US, and I got one LOR from an anesthesiologist, 2 IM LORs, and 1 FM LOR. Pass in all basic science courses with a couple of them being honors, and Honors in every single rotation that I had completed thus far at the time of my application. No mention of anything that could negatively affect me on my MSPE. I made sure not to use my gas LOR also for any IM/FM programs, and I created separate personal statements for each of the specific specialties.

I knew it was a bit of a long shot, but I was gunning for an Anesthesiology residency. Of course, I knew that an IMG with stats like mine, I still applied broadly to IM & FM. In total, I applied to 109 Anesthesiology programs, 200 IM programs, and 80 FM programs. Surprisingly, I only received 1 interview in Anesthesiology and 0 in IM or FM. Unfortunately, I did not match at the one place that I interviewed at hence why I'm writing this post. Was also unsuccessful during the SOAP, even for Prelim Surgery programs.

I'm going to be starting my last clinical rotation tomorrow, an Anesthesiology elective at a Level I Trauma Hospital with a residency program in that speciality and I of course plan to work my tail off to show that I am dedicated towards Anesthesiology (took forever to schedule it due to factors outside my control, hence why it is my last one). At this point, however, I am not really sure of what to do next in terms of boosting my application for the next year. Unfortunately, my school has not been the most supportive in terms of advice and I keep hearing conflicting thoughts, and so for that I wanted to turn to you guys as to what to do next. Does anyone have any advice and/oor insight as to what to do next? Thank you in advance.

tl;dr: US-IMG w/ Step 1 208, Step 2 CK 220, Step 2 CS Pass, YOG will be 5/2017, didn't match this year (only received 1 IV in Anesthesia) even after applying broadly to Anesthesia, IM, and FM. Horrible support services at school for unmatched, seeking advice here. Thanks!

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[bashwell]

This is going to be a bit of a long post, so I apologize in advance for the length. Basically, as the title says, I need some advice/help as to what to do now and what the heck happened during this match season. Stats wise, I'm a US-IMG that will be graduating in May 2017. I applied on 9/15 of this year. Step 1 208, Step 2 CK 220 (updated on ERAS 9/21), Step 2 CS Pass (updated on ERAS 10/12) (all on first attempt), no research, 3 work experiences, 0 volunteer experiences. All of my rotations were done in the US, and I got one LOR from an anesthesiologist, 2 IM LORs, and 1 FM LOR. Pass in all basic science courses with a couple of them being honors, and Honors in every single rotation that I had completed thus far at the time of my application. No mention of anything that could negatively affect me on my MSPE. I made sure not to use my gas LOR also for any IM/FM programs, and I created separate personal statements for each of the specific specialties.

I knew it was a bit of a long shot, but I was gunning for an Anesthesiology residency. Of course, I knew that an IMG with stats like mine, I still applied broadly to IM & FM. In total, I applied to 109 Anesthesiology programs, 200 IM programs, and 80 FM programs. Surprisingly, I only received 1 interview in Anesthesiology and 0 in IM or FM. Unfortunately, I did not match at the one place that I interviewed at hence why I'm writing this post. Was also unsuccessful during the SOAP, even for Prelim Surgery programs.

I'm going to be starting my last clinical rotation tomorrow, an Anesthesiology elective at a Level I Trauma Hospital with a residency program in that speciality and I of course plan to work my tail off to show that I am dedicated towards Anesthesiology (took forever to schedule it due to factors outside my control, hence why it is my last one). At this point, however, I am not really sure of what to do next in terms of boosting my application for the next year. Unfortunately, my school has not been the most supportive in terms of advice and I keep hearing conflicting thoughts, and so for that I wanted to turn to you guys as to what to do next. Does anyone have any advice and/oor insight as to what to do next? Thank you in advance.

tl;dr: US-IMG w/ Step 1 208, Step 2 CK 220, Step 2 CS Pass, YOG will be 5/2017, didn't match this year (only received 1 IV in Anesthesia) even after applying broadly to Anesthesia, IM, and FM. Horrible support services at school for unmatched, seeking advice here. Thanks!

Sorry to hear it mate. It sounds like you've done a lot of the right things.

1) The Step 1 and 2 scores are on the low side. Unfortunately nothing you can do about that now.

2) Being an IMG hurts, but I'm surprised at getting literally 0 interviews in either IM or FM. Did you go to the Caribbean or elsewhere?

3) Did you apply only to mid-tier or higher anesthesia, IM, or FM programs? You should definitely apply to lower tier programs as well as lower tier community programs too.

4) I think another problem is you split yourself too much between three different specialties. I would think it'd be best to focus on one. Unfortunately anesthesia may be too competitive for you. If you like anesthesia, you could aim for IM, then pulm/cc.

5) Is a prelim (e.g., surgery) year still possible for you? If you can, then you could try to get to know people that way, try to make connections, and if you still insist on anesthesia, you have to do a prelim year anyway. I know it's difficult though.

6) A research year is better than sitting at home. Whatever you do, don't do nothing.

 

[kareem1589]

Sorry to hear it mate. It sounds like you've done a lot of the right things.

1) The Step 1 and 2 scores are on the low side. Unfortunately nothing you can do about that now.

2) Being an IMG hurts, but I'm surprised at getting literally 0 interviews in either IM or FM. Did you go to the Caribbean or elsewhere?

3) Did you apply only to mid-tier or higher anesthesia, IM, or FM programs? You should definitely apply to lower tier programs as well as lower tier community programs too.

4) I think another problem is you split yourself too much between three different specialties. I would think it'd be best to focus on one. Unfortunately anesthesia may be too competitive for you. If you like anesthesia, you could aim for IM, then pulm/cc.

5) Is a prelim (e.g., surgery) year still possible for you? If you can, then you could try to get to know people that way, try to make connections, and if you still insist on anesthesia, you have to do a prelim year anyway. I know it's difficult though.

6) A research year is better than sitting at home. Whatever you do, don't do nothing.

Thanks for that man. Yes I am a Caribbean IMG, and not from the top 4. I applied to every single tier of Anesthesia, IM and FM. And what throws me off is that my one interview was in Anesthesia. I also don't mind to do a preliminary surgery program, but nothing has worked out so far. Still gonna keep trying though just in case!

I definitely want to do research somewhere, and I have already begun emailing programs asking if they have volunteer research positions available but no luck as of yet.

 

[bashwell]

Thanks for that man. Yes I am a Caribbean IMG, and not from the top 4. I applied to every single tier of Anesthesia, IM and FM. And what throws me off is that my one interview was in Anesthesia. I also don't mind to do a preliminary surgery program, but nothing has worked out so far. Still gonna keep trying though just in case!

I definitely want to do research somewhere, and I have already begun emailing programs asking if they have volunteer research positions available but no luck as of yet.

Ya it's tough, I wish I had better advice for you, but hopefully a PD will chime in here. Either way good luck and let us know how it goes. Hopefully something will come up!

 

[IM2GI]

Thanks for that man. Yes I am a Caribbean IMG, and not from the top 4. I applied to every single tier of Anesthesia, IM and FM. And what throws me off is that my one interview was in Anesthesia. I also don't mind to do a preliminary surgery program, but nothing has worked out so far. Still gonna keep trying though just in case!

I definitely want to do research somewhere, and I have already begun emailing programs asking if they have volunteer research positions available but no luck as of yet.

I feel like the default answer for these sorts of posts is "do a research year."

Im not really sure how a research year helps you. First of all, you are only a few months in before the application cycle starts all over again, so it is hard to show anything or be productive that quickly. Second, given your history, you are shooting for whatever community program would have you. I doubt they will really care if you have one abstract/paper in a random journal. The main benefit would be if you can get someone to advocate for you at the place you do a research year.

As more and more US MD schools are graduating students, it puts folks like yourself in an even worse spot. Good luck to you.

 

[kareem1589]

Ya it's tough, I wish I had better advice for you, but hopefully a PD will chime in here. Either way good luck and let us know how it goes. Hopefully something will come up!

Thanks man, and that's what I'm hoping to hear from.

 

[kareem1589]

I feel like the default answer for these sorts of posts is "do a research year."

Im not really sure how a research year helps you. First of all, you are only a few months in before the application cycle starts all over again, so it is hard to show anything or be productive that quickly. Second, given your history, you are shooting for whatever community program would have you. I doubt they will really care if you have one abstract/paper in a random journal. The main benefit would be if you can get someone to advocate for you at the place you do a research year.

As more and more US MD schools are graduating students, it puts folks like yourself in an even worse spot. Good luck to you.

I was sort of thinking the same thing, I'm trying to figure out all of the available options here. At this point I have been looking into doing externships at programs that have IM/FM programs and attain fresh new LORs in them.

 

[IM2GI]

I was sort of thinking the same thing, I'm trying to figure out all of the available options here. At this point I have been looking into doing externships at programs that have IM/FM programs and attain fresh new LORs in them.

The main thing is to figure out, why didn't I match, and what if anything can I do about it.

Unfortunately you are probably getting screened out based on your school and board scores. I don't know much about the Caribbean schools, but it sounds like you could not get into any of the "mainstream" programs, which is a red flag in and of itself.

What is that schools history with matching students into US residency programs?

 

[kareem1589]

The main thing is to figure out, why didn't I match, and what if anything can I do about it.

Unfortunately you are probably getting screened out based on your school and board scores. I don't know much about the Caribbean schools, but it sounds like you could not get into any of the "mainstream" programs, which is a red flag in and of itself.

What is that schools history with matching students into US residency programs?

I think it's because of the lack of strength in my LORs, aside from my scores. That is why I was thinking of doing externships/subinternships at university programs where I can attain stronger LORs. In fact, my final rotation for medical school starting tomorrow is my audition rotation in Anesthesia (due to scheduling conflicts, I was not able to attain this elective until the very end).

I didn't even bother applying to the mainstream programs at the time and rushed my decision years ago to go to the one that I go to now. Although my school is more new, every year my school does have individuals that match successfully into residency, including some friends that matched this cycle.

 

[NotAProgDirector]

It's very hard to tell you what went "wrong". You already know that you're not competitive for anesthesia. And this last rotation is not going to help, except perhaps at that program itself. If they really liked you, and you fall into their "grey zone" of USMLE scores, then perhaps. But otherwise applying next year is not likely to go any better.

The question is why no interviews in IM or FM. And the answer is either 1) they could sense you were really interested in Anesthesia; or 2) There's a problem with one of your letters. You mentioned that you didn't submit your gas letter to your IM/FM programs -- I'd double check that to be sure. It's possible one of your other letters mentioned your interest in anesthesia. Or there's something not great in one of them, or something in your MSPE.

 

[kareem1589]

It's very hard to tell you what went "wrong". You already know that you're not competitive for anesthesia. And this last rotation is not going to help, except perhaps at that program itself. If they really liked you, and you fall into their "grey zone" of USMLE scores, then perhaps. But otherwise applying next year is not likely to go any better.

The question is why no interviews in IM or FM. And the answer is either 1) they could sense you were really interested in Anesthesia; or 2) There's a problem with one of your letters. You mentioned that you didn't submit your gas letter to your IM/FM programs -- I'd double check that to be sure. It's possible one of your other letters mentioned your interest in anesthesia. Or there's something not great in one of them, or something in your MSPE.

I double & triple checked to make sure that my gas LOR didn't go to any IM or FM programs. I had a chance to look at MSPE and there was nothing that could have hindered my application, as I don't have any red flags there (unprofessionalism, failed courses, etc.). There's a possibility that there is something wrong in my LOR, but I made sure to tell my IM/FM writers not to mention any specific specialities. Regardless of what happened, now it's time to look forward, and I was curious as to what you suggest I could do next year to help improve my chances of matching

 

[rokshana]

I double & triple checked to make sure that my gas LOR didn't go to any IM or FM programs. I had a chance to look at MSPE and there was nothing that could have hindered my application, as I don't have any red flags there (unprofessionalism, failed courses, etc.). There's a possibility that there is something wrong in my LOR, but I made sure to tell my IM/FM writers not to mention any specific specialities. Regardless of what happened, now it's time to look forward, and I was curious as to what you suggest I could do next year to help improve my chances of matching

that may have been the issues if they made NO mention of a specialty...frankly i'm surprised at no FM interviews since you dd apply to a decent number of them.

 

[ddjamb]

I haven't applied yet buddy, but if it was me, my TOP priority will be to figure out what went wrong. Same actions lead to same results. What make you think that with research it will be better? When you received rejection letters/emails, did they mention a reason? you applied to enough programs I think (at least way more than what I was shooting for with same stats) but did you chose wisely your programs (IMG-friendly, community vs university), different states etc...

Hope you will figure it out and I wish you best of luck for next match.

 

[NotAProgDirector]

Thoughts about how to proceed:

1. You could try to get feedback on your application from a program that rejected you. This is very difficult to do, usually will only be successful if someone you know has a connection there. Also if you did a rotation at a site, there's more chance they will be honest with you.

2. New LOR writers. I can't tell you if the problem is in one of your letters, but I'd get all new ones if possible -- unless you can somehow confirm their content. At a minimum, have those old LOR's updated so that they say you're applying to FM.

3. You'll have to decide whether you're applying to Anesthesia again. I expect it won't work out, but completely understand if you feel you have to try. If you do, then you'll again need generic letters (or you'll need to get enough letters so that you have FM letters for your FM programs).

4. Get FM experience. Prove that you know what you're getting into, and that you'll really find some enjoyment in it.

 

[ddjamb]

@aProgDirector, what do you think about LoR without specific mention of the speciality?

 

[NotAProgDirector]

For someone whose application suggests one field but is applying into another, it suggests that they are applying to both fields. Programs in the less competitive field may decline to interview the applicant because of this. In general, it's better to have the letters be specialty specific.

 

[Shinken]

Programs in the less competitive field may decline to interview the applicant because of this. In general, it's better to have the letters be specialty specific.

OP, this is good advice.

In our FM program we get a lot of desperate people simply trying to get a residency spot, and it's very obvious they have no interest in family medicine. If the OP's LORs are vague or generic this is a red flag. Being from a Caribbean school "not in the top 4" is a huge red flag too (at least for our admissions committee). I'm guessing both of those are the reason why there were no FM interviews. We're aware some people apply to FM as a backup, but we at least make an effort to only consider applicants who we believe truly want to be family physicians.

 

[ddjamb]

What is/are the real reason(s) IMG are having hard time landing a residency despite good Step scores, strong application, genuine interest? After all, the med schools attended are legit schools and are recognized and further we are held to the same standards as US-graduates, we take the same exams and we pass them, sometimes with better scores. The "big 4 Caribbean schools" students are not smarter or more dedicated than others. I have met students from those schools and believe me I was not impressed, and for some I am still wondering how they made it this far.

So why is it hard for IMG to get a residency spot? I really want to understand.

 

[chicagochildpsych]

What is/are the real reason(s) IMG are having hard time landing a residency despite good Step scores, strong application, genuine interest? After all, the med schools attended are legit schools and are recognized and further we are held to the same standards as US-graduates, we take the same exams and we pass them, sometimes with better scores. The "big 4 Caribbean schools" students are not smarter or more dedicated than others. I have met students from those schools and believe me I was not impressed, and for some I am still wondering how they made it this far.

So why is it hard for IMG to get a residency spot? I really want to understand.

It's not hard to understand. There are more graduates than spots. US AMG's and DO's get first pick, then people from top notch foreign schools and legitimate Carib schools who have high scores get next pick, then the rest fight for the scraps leftover. I'm a Caribbean grad, so are many of my friends. Most people match...the ones that don't tend to have a combination of either visa issues, poor scores, bad lors, immaturity, applying to specialties out of their reach, or failures on boards/classes.


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[ddjamb]

the question was why AMG 's and DO's get first pick? when I say IMG, I have in mind the US-IMGs.
My point is this: if you look at NRMP reports, matched IMGs have higher scores than AMGs for the same speciality. In other terms, being AMG put u at an advantage even with a low score. Why? I was just curious.

 

[chicagochildpsych]

Because people who go to Caribbean schools have a negative stigma attached to them, why is it easy to get into Ross and hard to get into Harvard? Also, prestige and pedigree count in academia. Why take a risk on a IMG when you can get an AMG? I'll let you in on a little secret...in the real world bias and predjudice exist! Also, the world is not always fair.


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[rokshana]

What is/are the real reason(s) IMG are having hard time landing a residency despite good Step scores, strong application, genuine interest? After all, the med schools attended are legit schools and are recognized and further we are held to the same standards as US-graduates, we take the same exams and we pass them, sometimes with better scores. The "big 4 Caribbean schools" students are not smarter or more dedicated than others. I have met students from those schools and believe me I was not impressed, and for some I am still wondering how they made it this far.

So why is it hard for IMG to get a residency spot? I really want to understand.

1st your assumption that the off shore schools all keep to the same standard as US grads is false..many of these schools do their "clerkships" in doctors' offices where there are no residents or fellows, sometimes even with no hospital affiliation...and never have inpatient experience...programs that don't know foreign schools are going to stick with the few names they have at least heard of and those programs that do know foreign schools know which are good and which are bad and stick with those they know are good (lets face it someone who went to AIIMS has a better pedigree than someone who went to Windsor and PD that deal with foreign schools know it...).

the other is that there are more USMD and USDO schools opening and the established schools have increased enrollment so more US seniors, and USDO students give programs a greater number of domestic students to pick from...and even then there are more domestic students that are not matching , when even 5 years ago they would not have had a big issue.

and as for the "big 4 caribbean schools" students being smarted or more dedicated...its the same with USMD and USDO schools...you will meet people who are way smarter than you will ever be and you will meet people who you think...what building on campus did their parents buy to get this person into med school? But, again, even people who know little of foreign school, have heard of them, they have a track record already in place, and the model mirrors the US system,and they are in hospital settings with residents and fellows for their clerkships so they have access to letter writers that are know to other programs.

 

[rokshana]

It's not hard to understand. There are more graduates than spots. US AMG's and DO's get first pick, then people from top notch foreign schools and legitimate Carib schools who have high scores get next pick, then the rest fight for the scraps leftover. I'm a Caribbean grad, so are many of my friends. Most people match...the ones that don't tend to have a combination of either visa issues, poor scores, bad lors, immaturity, applying to specialties out of their reach, or failures on boards/classes.


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actually there are more spots than USMD graduates.

and no there is not pecking order per se...in general a US senior (meaning USMD) will be the preferred candidate in almost any program...but some programs will prefer the DO student if they have experience with them, others will prefer the I/FMG if they have experience with them...the DO student has (at least at the moment) the advantage of their own residencies and if they don't get an allopathic spot they can try to scramble into an unfilled DO spot or try again the next year in the AOA match.

 

[rokshana]

the question was why AMG 's and DO's get first pick? when I say IMG, I have in mind the US-IMGs.
My point is this: if you look at NRMP reports, matched IMGs have higher scores than AMGs for the same speciality. In other terms, being AMG put u at an advantage even with a low score. Why? I was just curious.

it means that to compete with the AMG, an IMG needs to perform better than the AMG to get the same consideration...and US-IMGs (as opposed to the FMG that went to a domiciled medical school) have the advantage of not needing a visa, but some places would rather have the FMG since they were the cream of the crop in their country whereas the off shore student is not.

 

[rokshana]

Because people who go to Caribbean schools have a negative stigma attached to them, why is it easy to get into Ross and hard to get into Harvard? Also, prestige and pedigree count in academia. Why take a risk on a IMG when you can get an AMG? I'll let you in on a little secret...in the real world bias and predjudice exist! Also, the world is not always fair.


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in the real world, no one (hospital credentialing committees, licensing boards, and most importantly patients) cares about where you went to school or trained...they just want a doctor that listens to them and is able to take care of them.

academia may care...but the person who went to podunk med school isn't going to be lumped in with the Harvard grad...they are going to be close to the Ross grad...

 

[Goro]

I am quoting the wise @gyngyn on this:

The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

There was a time when folks whose only flaw was being a late bloomer went Carib, but those days are gone.

the question was why AMG 's and DO's get first pick? when I say IMG, I have in mind the US-IMGs.
My point is this: if you look at NRMP reports, matched IMGs have higher scores than AMGs for the same speciality. In other terms, being AMG put u at an advantage even with a low score. Why? I was just curious.

 

[DH0209]

the question was why AMG 's and DO's get first pick? when I say IMG, I have in mind the US-IMGs.
My point is this: if you look at NRMP reports, matched IMGs have higher scores than AMGs for the same speciality. In other terms, being AMG put u at an advantage even with a low score. Why? I was just curious.

I am currently a 4th year U.S. medical student and had the opportunity to talk to an APD as well as a PD from 2 separate IM programs in California. I was fortunate to be able to round with both of them during my rotations, and so I had the time to ask them questions regarding residency and the qualities of the applicants that they hire. Pretty much both of them admit that IMG Carribean programs focus their curriculum too much on USMLE preparation while neglecting other aspects of medicine, such as patient communication/interaction/presentation. Though it is true that a lot of IMG gets good or even better scores on USMLE than a lot of U.S. grad, the PD/APD know that they lack the other aspects. I personally rotated with a lot of IMG students and I do notice that their patient encounter skills are not well polished despite stellar medical knowledge. The APD that I spoke to told me that many of the IMG students he rounded with had difficulty coming up with appropriate questions to ask/communicate effectively with patients as well providing a concise presentation. My school dedicated heavy hours on OSCE and patient encounters (similar to USMLE CS) and so we are well prepared after 2nd year of medical school. I am not sure if Carribean schools or other non-US IMG have those incorporated into their curriculum.

I am not sure if other programs think the same, but this is what I got from the APD and PD that I worked with for IM residency programs. However, I am sure that if you kill the USMLEs, then none of this really matter. As for OP, his USMLE scores are on the low side and his status as an IMG doesn't really help him with his situation.

 

[Gastrapathy]

I think a "not top 4" Caribbean school may be part of the issue too. I honestly have no idea what that is.

You need to apply broadly to a least competitive specialty with letters that are all about that.

 

[DrElliotReid]

And this my friends is why you should not go to the Caribbean for medical school, especially a "not top 4" one. Did you even do any research about what happens when someone goes to the Caribbean for medical school? Not that it matters now, but I agree with the quoted quote from gyngyn.

I was once a desperate little college grad who wanted to go to med school really badly (not from parental pressure though, it was just self pressure because I really wanted to be a doctor), anyway, desperation makes you do stupid things. I didn't get in to a US MD school and frantically applied to St. George's. I got in. But, after thoroughly researching DO schools vs Caribbean extensively and what to do to strengthen an application for the next round of applications, decided it would be in my best interest to try for DO and MD again - and it worked out. I also came to the conclusion that Caribbean medical schools should not exist; case in point: You, OP.

Good luck to you, but I think you screwed yourself before you even started. The only thing to do would be to try again, and be genuinely interested in the field you decide to apply to, but if you're really doing it as a back up and anesthesia is like your one true desire, well...they're probably see through it. Nobody wants to be someone's sloppy seconds.