Desperately looking for externship/observership/rotation in psychiatry

[shoenberg3]

Hello all,

I apologize in advance for having posted a somewhat similar thread around 10 days ago.

Advice requested for a FMG trying to match psychiatry

As mentioned previously in the above post, I am a foreign medical graduate with US citizenship who is hoping to match into psychiatry.

In the last week or so, I have been trying hard to find opportunities for ~ 8 weeks (in perhaps two separate rotations) of hands-on clinical experience in the US, whether in the form of externship/observership/rotation.

There is a program that I am awaiting upon that I hope to spend 4 weeks this summer, but, even if I manage to attend that program (still quite up in the air), I still would want another 4 weeks of rotation. Due to COVID and having graduated already (therefore clerkships not being an option), it has been exceedingly difficult to find and secure an opportunity. I contacted few programs such as UCSD as I understand that they have (used to?) programs, but have yet to receive a response from them. I have also looked into agencies such as AMO but they do not offer any opportunities on sites that are part of universities/residency programs, which Splik kindly noted to be an important consideration when looking into USCE.

As Splik also noted, my best and possibly only option may be to pursue a postdoc and get clinical exposure after establishing connections in the US. However, I am not ready (yet) to make the decision to add another 1-2 years to my already circuitous and lengthy journey thus far.

I do want to give this match cycle a shot, even if my chances might not be greatest. I believe I do have a few things going for me (graduated from US university, citizenship, decent scores, some pubs, somewhat interesting story?) but understand that, as a FMG, my chances are still low and most certainly close to zero if I don't get any meaningful USCEs this summer.

I would appreciate any leads, contacts, or advice. Really, even words of encouragement would be appreciated..

Thank you

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[splik]

Another option as an alternative to a postdoc would be to do an MPH or Masters of Clinical Research etc at a good institution with a psych residency program and work with faculty. You would likely be able to get some USCE during the summer and work with faculty in psychiatry for your research project.

Even if you are able to get some USCE and apply this yr, I would probably not advise it as your chances of matching at a good program are not so good. Even as an IMG, I would not advise you to try to match at any program if you can avoid it. As discussed in these forums, there is pressure in some areas and some kinds of jobs from NPs (which will only get worse), and it will be the psychiatrists coming out of the lower tier programs that will be the ones who will be the canary in the coal mine for this (and in fact already are). Also due to racism, snobbery, ignorance etc, some people regard NPs as preferable to IMGs. It may be tempting to try to avoid spending another year or two building up your application for residency (and could have been avoided with more careful planning during medical school), but I promise you it will likely pay off many fold in terms of job security and opportunities available to you in the future. It is tempting to be short sighted, but I suspect that you could get into a really good program with some extra time and the right experiences and connections. If I thought you had no hope of doing better (which some applicants can't due to failures/poor scores etc, them I would be more likely to advise you apply now).

 

[TexasPhysician]

While it doesn’t hurt to try by calling a ton of programs, I would start prepping to have a valuable 1 year plan like splik has mentioned. In the 3 programs that I’ve been associated with in Texas, I’ve never seen an IMG match PGY-1 without all Steps completed, and rotations for IMG’s that have graduated - seen it once by someone directly related to faculty.

I’d probably call Dartmouth and ask about their 1 year masters in health care delivery science. Much of it can be distance learning on your own time, but the in-person part will have you networking with many physicians. Additionally, some faculty are already part of the medical school. Maybe they could facilitate this after starting the program.

My concern is that some masters programs are so unrelated from psychiatry programs that they won’t help you. I’d start figuring out the best next step now, even if you don’t end up needing it.

 

[shoenberg3]

Another option as an alternative to a postdoc would be to do an MPH or Masters of Clinical Research etc at a good institution with a psych residency program and work with faculty. You would likely be able to get some USCE during the summer and work with faculty in psychiatry for your research project.

Even if you are able to get some USCE and apply this yr, I would probably not advise it as your chances of matching at a good program are not so good. Even as an IMG, I would not advise you to try to match at any program if you can avoid it. As discussed in these forums, there is pressure in some areas and some kinds of jobs from NPs (which will only get worse), and it will be the psychiatrists coming out of the lower tier programs that will be the ones who will be the canary in the coal mine for this (and in fact already are). Also due to racism, snobbery, ignorance etc, some people regard NPs as preferable to IMGs. It may be tempting to try to avoid spending another year or two building up your application for residency (and could have been avoided with more careful planning during medical school), but I promise you it will likely pay off many fold in terms of job security and opportunities available to you in the future. It is tempting to be short sighted, but I suspect that you could get into a really good program with some extra time and the right experiences and connections. If I thought you had no hope of doing better (which some applicants can't due to failures/poor scores etc, them I would be more likely to advise you apply now).

While it doesn’t hurt to try by calling a ton of programs, I would start prepping to have a valuable 1 year plan like splik has mentioned. In the 3 programs that I’ve been associated with in Texas, I’ve never seen an IMG match PGY-1 without all Steps completed, and rotations for IMG’s that have graduated - seen it once by someone directly related to faculty.

I’d probably call Dartmouth and ask about their 1 year masters in health care delivery science. Much of it can be distance learning on your own time, but the in-person part will have you networking with many physicians. Additionally, some faculty are already part of the medical school. Maybe they could facilitate this after starting the program.

My concern is that some masters programs are so unrelated from psychiatry programs that they won’t help you. I’d start figuring out the best next step now, even if you don’t end up needing it.

I genuinely appreciate your honest and heartfelt advice.

I will be honest and say that initially I really did not consider taking extra time as an option. But hearing about these perspectives is slowly changing my thoughts, and I am slowly warming up to that notion.

What is slightly surprising (and bit disheartening) is what Splik mentioned about pressures in some areas/jobs and potential prejudices against IMGs even after residency. Perhaps I have had the optimitic perception that getting my foot in the door into any residency was the end-all, and that afterwards is what I make out of it.

Certainly, I was aware of the increasing trend of midlevel encroachment, but it didn't occur to me that certain groups (eg. those from lower-tier residencies) would be disproprotionately affected. I also had the perception (probably mistaken) that attending a lower-tier residency would only be make things difficult if you were set on an academic career. Finally -- this one is probably the most surprising to me -- I have thought that being an IMG was only really disadvantageous for getting into a residency and didn't really impact your career afterwards.

To think that I once had an opportunity to matriculate into an US allopathic MD program.. Oh well, life choices...

In any case, a lot to think about. I am very grateful for your insights.

 

[shoenberg3]

Hello,

Here's an update -- I did not want to start a new thread. I am looking for some advice.

Thankfully, I was able to secure a month-long rotation at an university program in the East Coast. Very excited to go there for the summer.

I am now looking for 1-2 additional months of USCE.

I've recently got accepted to another program which is a two months long (minimum duration) rotation at an university hospital, which has a pretty well-respected residency program affiliated with it. I've also found another opportunity to rotate for a month at a community clinic/hospital, which is not directly affiliated with a residency program. The preceptor, however, I believe is a professor at a nearby university hospital, which does have a residency program.

Obviously, the conventional wisdom would be to go for the two months long rotation at the university program. But there are two reasons that give me a pause. First, the cost. The aforementioned university program costs over 10000 dollars, not counting housing/COL (some of you can probably guess which program I am referring to, by now). The latter option, in contrast, costs fraction of the former. Second, due to my schedule, the university program would run into mid-October. I could try to get in my LoR before then, but even so, I am not sure if I could put down 2 months of USCE on the ERAS by the time I apply.

Despite that, I still would go to the university program if it would give me a definite advantage over the other option -- and garner me even 2-3 extra interviews. Or if it even gives me a slight increased chance (10 percent?) of matching in the state that it is located in, as unlikely as that is. It is my home state, after all...

As a side note, if I don't do the university program and only do one month of rotation at the latter choice, I would have some extra time before application. I would spend that time to just get "started" on a psych research (cold-emailing some people at the moment). Partially because I would need something to do for a year, if I go unmatched this cycle...

In summary, in addition to a month-long rotation in an East Coast university hospital, I am weighing the benefit of doing a two months of rotations at another university program versus one month at a community hospital + getting started on research.

If the former would give me a definite boost when it comes to matching, I would go for it.

In any case, I am obviously at a much better place now, and I am thankful for it.

Thank you for your help.

 

[ObsequiousAplomb]

That sounds expensive for some USCE. I wonder about the respect an LOR from a program like that might convey. I don't know very many details about it, but I imagine that if a residency program has a low opinion of that type of experience, they might not view it as a positive.

I'm going to DM you some advice for a program I'm affiliated with, but I'm not certain they have started taking externs again yet for the inpatient work. Hopefully if they aren't taking people they can either connect you with people in the know or a program that they would respect that is taking externs.

Ignoring the pragmatic benefits of the options, I would encourage you to do the activity that would be most fulfilling to you in the event you don't match next cycle. While I really hope you do match this cycle, the difficult reality is that it's not statistically as likely you will match as it is for a USMD, and I was a USMD applicant so my knowledge for IMGs and FMGs is limited to my peers and externs I have worked with who were.

 

[Zyprexa100]

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