An IMG's important concern, please help!

[Dr.FQ]

Good evening everyone. I know that you'll tell me to post this in the IMG's forum, but I'm not sure I could get the same assistance there.

I'm a first year med student, and this issue has been on my mind for the past week. Essentially, it's about matching in residencies, and I know I shouldn't be thinking that far ahead and that I should focus on Step 1 now, but this is basically freaking me out. If what I understand is correct, there's a very big chance that I won't be able to do my residency in the U.S....

I graduate in 2020, and I've heard that by that time, there will be an extremely small number of IMG applicants who match in the US, and almost all of them go into FM, IM, EM, or pediatrics. But I don't want that. I want something like urology, plastics, ortho, or something surgical (but preferably not general surgery). I study in the middle east, and I have an american passport. I'm willing to do everything I can to be matched into one of my preferred, unfortunately more competitive, specialties.

I can get stellar scores on Step 1... I'll get 260 if it helps. Do research and extracurricular activities. Try to stand out in the elective clerkship in the U.S., and try to do that at a prestigious location. But from what I heard, all of this is still not enough to slightly guarantee a spot in any of the specialties I mentioned. From what I understood, the only options that'll be available for IMGs are FM, IM, EM, and pediatrics. Is this true? How can I match in a residency of my choice? Are the odds really against me in the degree that I've heard?

Please be honest and don't just tell me to work hard and stuff. I really wanna know the truth behind this, because apparently my future is at stake, and it might be impossible to fix this situation... So I wanna do everything in my power to turn things around, if at all possible.

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[Erek94]

1) get the 260+ first then again on step 2
2) Youll need multiple publications
3) Even if you are a rockstar with all the above nothing is guaranteed in your position. Sorry. I would really consider looking into anesthesia also since I have seen alot of IMGs while on rotations do anesthesia, with little to none I can think of in surgical specialties.
4) Alot of prestigious locations dont even take IMGs for electives so find out which ones do
5) Nothing is impossible, but definitely be prepared to be let down and have a solid plan.

 

[Pruthvi]

IMG here prepping for step 1....as u have noted above , the specialities you are interested in are the toughest to match for an international grad..no one knows what will happen in 2020 which is five years from now..any day a surgery residency is going to be dead tough for IMG's..

260+ scores in all your steps, multiple publications, USCE, great LOR's is what should be your target..even with all this given the increasing competitiveness of US grads in the match , you might end up without a spot..

be prepared to do a year or two of preliminary surgery if needed...there are no guarantees in this too....remember you can do plastics post general surgery..

don't look too far ahead..put in as much work as you can and you will get what is destined to you ! as of now focus on your step 1..one step at a time !

 

[deygonsan]

Yeah I would focus on getting past the 2nd year first and remember, one's choices keep on changing from time to time. Urology, plastics, ortho are very different from each other so only clinical experience will narrow down your interests. Until then, it's probably best to focus on step 1 and may be shadow/do some research in your field/s of interest.

 

[Dr.FQ]

Thanks guys for all the info.

When you say I need multiple publications, do they have to be in really good journals? I don't know what the state research is in here in Jordan, but I'm sure it's nothing like it is in the US. And honestly, I'm not much of a research guy, but I'm gonna do it to help beef up my app. And when you say publication, do I have to be the, umm, "leader" of the research? Or can I be one of the people who help in collecting results? Because honestly I can't find something to research that hasn't already been done that I can improve upon in any way.

Pruvthi, you mentioned doing a couple of year of preliminary surgery. What's this? Is this general surgery, or something else? I know I can take the general surgery route ---> Surgical specialties, but I've heard that it's almost as difficult, and very rarely do people get into urology/plastics if they start general surgery. I also heard that if I wanted to do that then I'd have to spend 2 years solely on research, and the position still won't be guaranteed. Is this true? Is there a way around this?

Thank you everyone.Just a few questions (I know my posts are kinda long but I'm scared as all hell ). My uncle is an MD in the USA. He's in FM in Omaha, Nebraska. I was wondering if going to stay with him during breaks in med school (my med school is 6 years long) during the clinical years, and trying to gain more USCE and if possible try to get LOR's from this is possible. Do hospitals accept people who want to do that? And is it at all possible to get a specialist's good word from such an experience?

I heard that urology is a small field and a lot of weight is put on getting a good LOR from a good urollgist. What about ortho for example? Does it help a lot if I get a good LOR from a good MD but who's not an orthopod? I'm kind of pretty sure I want to get into a surgical residency, but I'm not sure if I want that to be general surgery.

Thanks in advance everyone, and sorry for the long response!!

 

[Pruthvi]

Preliminary surgery isn't research..it means you enter the residency program as a preliminary intern as a PGY-1..quite a few IMG's go this route.Depending on your performance on ABSITE (exam taken by surgery residents ),the quality of your LOR's, your contacts ,if any spot opens up throughout the US due to attrition or some one else deciding to switch specialities , you may be offered that spot....there is a high chance that even after doing 2 years of preliminary surgery,we might end up with nothing...so this is more or less a hit or miss !!

Urology is a surgical subspeciality by itself and it is 5 years in duration..you cannot do it after General surgery
Plastic surgery is a very competitive post general surgery fellowship along with peds surgery and surgical oncology..

USCE and LOR'S must be from the speciality your interested in a la surgery.. so if your relative is a FM specialist ,your experience with him through USCE /LOR's will be valuable if you want to get into FM..It will have no value for Surgery..

Not sure who told you that urology is a small field bro..its one of the most sought after lifestyle friendly surgical specialities along with ENT..honestly as an IMG, We have close to 0% of matching in ortho,urology, integrated plastics ( straight 6 year programme, that is, not the fellowship after general surgery )..these fields are considered to be AMG's top choices in surgical specialites..

Yes around 3 % of ortho/ plastics positions are obtained by IMG's..but its extremely rare..it isn't realistic for any foreign grad..great step scores, multiple pubs, awards, lots of research experience, great LOR's, and even with all this there is a high chance that we won't match in Ortho,integrated plastics, urology..If you feel you can be among those 3% who match, you can try.. how much money n time you can invest in your future is your choice no one here can tell you that..am just telling you the reality of the competitive surgical specialities..

Our ( i say our because i too want to match general surgery somewhere in the USA and want to be a cardiothoracic surgeon ) best bet is to get great scores, LOR'S, good research and pubs, USCE, a preliminary year or two, and roll the dice hoping that we match general surgery somewhere in the USA..thats what am planning to do..if things dont work out, then have a back up plan.. sorry for my long post..

 

[ketosisevangelist]

Get an old shoebox. Cut a hole it in. Tape a label on shoebox that says "worry on Wednesday"( pick your day )

When you worry, write it down as a note (SOAP NOTE FOR U). Insert the note in box.

Look at your notes every Wednesday. You'll see that all your concerns have resolved.

Don't worry!! Stay the course!!

 

[Dr.FQ]

Pruvthi, thank you for the very informative post. Don't apologize! I actually like longer replies because they explain things better!

So basically, prelim is doing surgery while waiting for the opportunity to actually do surgery in a residency program? So it's like I'm training but waiting to start the actual official training? With nothing guaranteed? Surely there must be a better option out there? I didn't think general surgery is so competitive. If I remember correctly, I think the average accepted AMG's had like 230 on step 1... so wouldn't you think a 250+ IMG (with U.S. citizenship), with other things there to make him a good applicant, gets a good chance? If not, then this is honestly ridiculous.

So basically, I have no chances at any of the surgical specialties. Man, this is honestly so sad. I feel like I'm being raped, and there's nothing I can do about it. I wish I had known this before applying to med school. I would've gone pre-med in the US... I feel so stupid. So basically, my future only has IM, FM, EM, and peds as options. And PERHAPS general surgery. I guess if I don't get accepted into a gen surgery program, I'll do IM-->cardiology, not that it'll work for an IMG either...

This is so annoying, because I keep telling myself that maybe I'll actually match, when I know I realistically have NO CHANCE. This will lead me to work my a** off for the next 6 years, do everything in my power to become a great applicant, all this with the knowledge that it's not gonna be fruitful, and then still be hurt when I find out I didn't match. It's just like a loophole of frustration, lol, and I'm sorry if I'm coming off as extremely pessimistic and annoying (I know I am :/ )

One more thing, if anyone is still here after this rant. I can probably only get 1 or 2 clinical electives in the US, and each will last about a month. So that's like 2 months total of USCE. How much are programs expecting? Because I don't think I can do anymore than that (time doesn't permit, etc).

Thank you so much for your help, and sorry for the bad attitude

 

[Dr.FQ]

kingofmedicine, I like that idea. But unfortunately, my concerns might fade, but the problems are still there! I know I can't do anything to realistically be able to match into urology, but I still can't let go of hope or accept that my future won't be controlled by me. I kinda feel helpless and frustrated, to be honest, and this is 6 years before I even get the match results!

 

[Pruthvi]

Yeah your right about preliminary surgery..if your lucky and a PGY-2 position opens up and your contacts /credentials offer you that spot, you can continue as a PGY-2..or you may have to repeat your PGY-1 if your offered a spot elsewhere..

I beleive that we shouldn't get beyond ourselves in our medical training.. so don't think that all these are impossible for you ,i mean the surgical subspecialities..for any speciality you need a top applicaton these days as an IMG..

do your best in medical school..your specialities of interest might change after you go through clinical rotations..even after your clinical rotations if you feel that you like surgery, then pursue it.. take one step at a time bro.you have to perform well on your boards and be a very good applicant for IM/Surgery as an IMG..

How much USCE are programs expecting is very program independent..Some surgery programs require even a year..
If you listen to me square, i would suggest you to study well and kill the boards..you need good board scores to get good USCE as well..your only 1st year so enjoy med school, do the best you can, kill boards, and keep an open mind with regards to what speciality you will choose..REMEMBER that if you have strong step scores, you can pursue your interests in what ever field you want..including plastics, ortho, or IM..

 

[Dr.FQ]

Pruthvi, I guess you're right. Thank you so much for all the information and the motivation, I think I really should wait until I've had some more exposure. I guess I was just worried and wanted to know which specialties I had a shot at, so I know whether to pursue research in that field, or get particular USCE with someone where I'll get a specific LOR. I guess I'll just do research on whatever topic my professors need help with, or anything like that.

 

[Pruthvi]

yeah stay with an open mind and do well in medical school as well as boards.with that and a bit of luck, you will get where you want to be !!

your welcome

 

[Dr.FQ]

Hey guys. So I was just thinking about this...

I know that for AMGs, clinical years grades, publications and LOR from the hospital/Uni are important. But what about IMGs? How important (if at all) are clinical years grades? I've read somewhere that PDs don't take IMGs' school grades into account, since they have no idea regarding the teaching there or something. Also, what about research? Do they respect IMGs' research (and publication), or do they also brush it off since they have no means of knowing how important/significant it is?

I've heard the only LOR's that matter are ones from the US, and I can understand that. But can someone shed light upon the other things?

 

[Pruthvi]

For IMG's there is something called as MSPE ( medical school performance evalutaion ),previously known as dean's letter , which we have to send to ERAS while applying for interviews..This MSPE will reflect your academic performance in medical school as a whole..Some PD's look into it some don't..It is program dependent..Most of the time, your USMLE scores matter much more and carry much weight than your med school performance..As long as you don't fail, it won't matter..(For some personal self esteem, i had failed a course and had to repeat 6 months due to a major illness and am so worried about how it will affect my residency prospects .. )take it like 80% for usmle scores and 20 % for your medical school performance

Research and publications in american journals carry more weight as a whole..even publications in well reputed international journals are fine..But those in american health journals are much more looked upon..

Hope that helps

 

[Mad Jack]

It's already nearly impossible to match those specialties as a foreign grad unless you attend a first-rate institution abroad. Integrated plastics won't happen. Uro won't happen. Ortho is a small possibility now, but five years from now probably won't happen. If you've got a US passport, you should come back to the US and go to medical school here- a US MD will have an uphill battle for any of those specialties, but they are very doable.

Realistically, given the upcoming crunch and current trends, it is looking like only 1 in 4 foreign grads will match anywhere in 2020. You'll be lucky to get into a low tier IM program, let alone plastics, with a 260.

 

[Dr.FQ]

Pruthvi: Alright thank for the info, I wasn't sure about that. And don't worry; if they don't really care about it, you should be fine (in regards to your exam)!

Is it possible to publish research results in an American Journal if the research is done elsewhere? I guess I'll be happy with an international Journal (if that!).

Mad Jack: This is the ugly truth that I've been dreading. I've kind of come to terms with the fact that all the specialties you (and I) mentioned are impossible. I've started telling myself that I can make it into IM and then Cards/GI, but then I say... what if I don't make Cards/GI? I know I won't be satisfied with IM alone. So I told myself GS might be an option if I'm exceptionally exceptional. But then again, I know that it probably won't happen either. It's left me here miserable.

To be honest, I wish i had known about the differences and downsides of graduating from outside the US. Everyone told me I'd be treated like AMGs because I have a US passport, but apparently they didn't know what they were talking about.

Believe it or not, I've actually considered going to undergrad pre-med in the US. I'm in the 2nd semester of the 1st year of a 6 year Med program here. So after those 6 years, I'll be an MD. But, I don't know if I can go to the US now, since I've already graduated (a year ago, when I apply to US), and I don't think I'll be eligible for a scholarship for undergrad. It was very possible to get a full scholarship for pre-med, but I know med school doesn't offer scholarship. So, can I still get a full scholarship for pre-med programs? I swear I'm actually considering this. Because if that happens, I can't blame anyone but myself if I don't get any of the specialties I want. If going to the US is still as viable an option as it was before, I might do it. Heck, it'll be 9 years instead of 6, I'll get student loans for med school, but I'll be doing what I like to do.

Can anyone get back to me on this please? ^ :O

 

[Pruthvi]

Not to sound harsh , but realistically you should have looked into your speciality considerations prior to commencing med school outside the united states..Anyways, contact your friends /contacts back in the USA and ask them regarding whether you can still get loans if you want to commence your pre- med..6 years vs 9years might not seem a big issue for you now considering your only in your first year of med school, but when you are at in your mid / late twenties, 3 years might become an issue for you depending on your personal life, family commitments, loans, etc..SORRY if i have spoken something wrong..

out of curiosity, how do you know you like ortho/plastics/ urology ? did you shadow someone in the field ? The only thing common is good income for these specialities..I ask this question because not only are they most competitive, but are so variable in the procedures, lifestyle, pathways of training, diversity of cases..

 

[Pruthvi]

Funny enough, through out SDN, where ever people come up with speciality dilemmas prior to commencing clinical rotations, the only reply those people get from the current Attendings, med students, residents, is to wait till third year for clinical rotations to start..Any particular interests in the first year of medical school are highly subjective to change after clinics..Its not the norm, but thats what happens 80% of the time