Help me achieve my dream

[IMG69]

Hi there

Long story short I really want to become an orthopedic surgeon and there are a number of pathways for me to achieve that but I need your opinions.

Firstly i'm from NZ and obtained a bachelors degree there, i'm also a U.S citizen despite the fact that I have never even been to the US. I now currently study medicine in China at a University recognised by WHO.

So i've kept it really short and lets just focus on the options I have;

1. Stay in China and graduate and learn even more Chinese and specialize here.
2. Sit USMLE's and go through the process of applying for a PGY1 position back home although the chances are relatively low due to local grads filling the spots.
3. Same as above except Australia.
4. Do USMLE's and try get my intern year over there and then go through the US system
5. Desperately try find a U.S med school to transfer to before I graduate.

Note; I'll be a FMG not IMG of the U.S

So basically those are all the options I can think of right now.

I would like to add I will have strong references and research on my application for these programs as I currently am working on and actually devising several projects with my Universities department of Anatomy and I hope I can be referred to the Surgical department and do some research with them.

So, thoughts??? Which path do I take? bear in mind I will most likely apply to U.S/NZ/AUS all at the same time because why not..

---

Members don't see this ad.

 

[738177]

If you're insistent on Orthopedic surgery, then stick to Option 1.
Also note that Option 5 is highly improbable/impossible.

 

[Domperidone]

Option 1 - No idea how the Chinese system works.
Agree with poster above, compared to the other options listed, it's most likely the path of least resistance if you graduated from their schools and have done research with their faculty.

Option 3 - look up the medical board pathways to Australia and royal college of surgery with regards to orthopedics.
domestic Australians who graduated from medical school in Australia have a very difficult time getting into surgery in general, never mind orthopedics. you'd also have to sit exams similar to the USMLEs as someone with a non-Australian degree. and your chances are no different to the US, if not worse (definitely not better). if you want to study for board exams for two different countries, i suppose you can try. for either country, you need to do rotations or electives with an ortho team to get letters of recommendation from surgeons local to the region (as in Australian or American, depending one which country you're focussing on) to be taken seriously. it's highly competitive.

Options 2-4 - Not impossible.
But may take years. Not straightforward.
try posting in the surgery forum in SDN with regards to orthopedics in the US if you're not getting many responses in here.
If you're really determined, then try studying for the board exams for one (or both) of these countries and see how you go.
(I would recommend focussing on one country as these exams are not a joke).

Option 5 - Sure, you can try to ask some schools and get their direct opinion on this. But I'd forget this. I'd already responded to your previous post on this too.

Edited: for grammar and spelling.

 

[IMG69]

Thanks for the quick replies guys, I have the same feeling with option 5 however I have found 5~ that may accept transfers however that's dependent on whether they have spots available so basically this option is never going to happen.

The biggest problem with Aus/NZ is not the exams, I have heard the main problem with the exams are peoples lack of English comprehension as patient care/bedside manner is huge in NZ/AUS; the biggest problem is that there are literally no spots for international graduates even if I am an NZ citizen. I actually emailed and asked for the statistics about IMG's in NZ, 60% of people pass the exam but as I stated and have heard from a lot of friends that english is the real problem; E.g I met someone who had failed it 3 times and I couldn't actually have a proper conversation with this guy (like talking to a ~10 year old) The other stat I got was 35 people passed the NZ exam in 2015 and 28 of them have positions now.

In regards to China I would for sure say it's my best bet however it's the least appealing option by far.

In my Intern year i'll be doing the typical rotations and i'm very glad my Uni lets me do that year overseas, so potentially I could spend a year in NZ/AUS/US doing my internship provided a hospital will take me; surely this greatly increases my chance over other FMG's? As you stated I will have contacts in said country and provided I impressed them surely they would want me?

My aim also would be to get a recommendation from my surgery professor as over here we actually do surgeries on live dogs which I believe would never be allowed in the Western world, yes a lot die but regardless hopefully this stands out as an interesting point on my application provided they go well for me.

So basically the consensus so far is China's the best option but give everything else a go but one at a time?

If anyone has any other suggestions or countries or anything please comment and let me know

 

[738177]

It's great that you'll be able to spend a year rotating in the states, but again, you're shooting for a speciality that's INSANELY competitive even for US grads.
Caribbean grads do 2 years of rotations in USA (there are also European and Australian schools that allow it). Check out how many of them make it to Orthopedic surgery.
I can't think of other developed countries that'd benefit you either. Can't apply to Canada without being a Canadian PR/Citizen. Ireland is out because you don't have a EU citizenship. UK is out because you didn't graduate from a UK school.
If your goal is to come to the states, you have to aim for other specialities. Plain and simple. Otherwise, i'd stick to Option 1.

 

[IMG69]

It's great that you'll be able to spend a year rotating in the states, but again, you're shooting for a speciality that's INSANELY competitive even for US grads.
Caribbean grads do 2 years of rotations in USA (there are also European and Australian schools that allow it). Check out how many of them make it to Orthopedic surgery.
I can't think of other developed countries that'd benefit you either. Can't apply to Canada without being a Canadian PR/Citizen. Ireland is out because you don't have a EU citizenship. UK is out because you didn't graduate from a UK school.
If your goal is to come to the states, you have to aim for other specialities. Plain and simple. Otherwise, i'd stick to Option 1.

Yeah i'm fully aware it's literally top 3 most competitive residencies and there's what about a 1% chance of getting it?? but then again i'm also thinking how many applicants will have there name as the main author to research etc. The only other fields I would look into are thoracic surgery, radiology, plastics and possibly EM.

So another vote for China, Thanks a lot for your post

 

[738177]

Yeah i'm fully aware it's literally top 3 most competitive residencies and there's what about a 1% chance of getting it?? but then again i'm also thinking how many applicants will have there name as the main author to research etc. The only other fields I would look into are thoracic surgery, radiology, plastics and possibly EM.

So another vote for China, Thanks a lot for your post

As it stands, you can match into the bolded as a foreign grad given you have a solid app! No idea if it'll stay the same few years down the road.
I'd try to get research experience regardless of the field you're trying for. I mean, i'm sure being a main author wouldn't hurt. I just think statistically/realistically, the numbers aren't in your favor to match Ortho. But if you're open to the bolded specialities, you can probably make it work given you put in the effort.

 

[IMG69]

Alright thanks man, i've got my work cut out for me. P.s what am I looking to score on the USMLE to be competitive for ortho?

 

[gyngyn]

In the last match, 6 US citizens who graduated from an international school matched in ortho. 21 did not.
Of non-US IMG's, 8 matched ortho, 17 did not. Main Residency Match Data - The Match, National Resident Matching Program
When success is measured in single digits, it is safe to say that the odds are long but not impossible.

 

[gyngyn]

Alright thanks man, i've got my work cut out for me. P.s what am I looking to score on the USMLE to be competitive for ortho?

The mean score for a successful ortho applicant in 2016 was 247 (the mean for unsuccessful applicants was 238). The mean number of abstracts, presentations and publications was 8.2, 34.4% were AOA. from Charting Outcomes in the Match.

 

[IMG69]

6/21 got it? I like those odds a lot. Can you explain what you mean by abstracts, presentations and publications?? I don't quite follow? I feel like thats very different to my 'publications' considering we literally work on 1-2 papers for the whole year and I have a huge role in actually devising the experiment etc.

Do you mean they helped out on 8 publications? e.g did some histo staining or something? Because I don't see how they could pump out that many considering the head of our Anatomy department only has like ~20 something publications and has spent his whole life doing research.

 

[Goro]

In the last match, 6 US citizens who graduated from an international school matched in ortho. 21 did not.
Of non-US IMG's, 8 matched ortho, 17 did not. Main Residency Match Data - The Match, National Resident Matching Program
When success is measured in single digits, it is safe to say that the odds are long but not impossible.

Just like winning the Lotto!

 

[gyngyn]

6/21 got it? I like those odds a lot. Can you explain what you mean by abstracts, presentations and publications?? I don't quite follow? I feel like thats very different to my 'publications' considering we literally work on 1-2 papers for the whole year and I have a huge role in actually devising the experiment etc.

Do you mean they helped out on 8 publications? e.g did some histo staining or something? Because I don't see how they could pump out that many considering the head of our Anatomy department only has like ~20 something publications and has spent his whole life doing research.

6 of 27 who made it to the point of having interviews matched.
Publications, abstracts and presentations made during medical school are included in these figures. Some of them did a research year to improve their odds.
You might want to look at the whole Ortho page in Charting the Outcomes.

 

[IMG69]

Please explain a little more what you mean by abstracts and presentations and theres no way you can do 8 publications in one year?? I don't understand what exactly you mean by presentation and abstract?? I don't see what a presentation or abstract has to do with anything? I would happily do a presentation/write an abstract every single day if that meant improving my odds.

Is this an American thing?

Because where I'm from a masters degree publication takes around ~2 years so I have no idea how you Americans are putting out 8 publications while also studying for med school?

 

[Domperidone]

it is a "western thing". It's no different in Australia.
See selection criteria for orthopedics in Australia.
Or faq & contact for iMGs looking at ortho.
Presentations are not random presentations to your class etc. if that's what you're thinking. Presentations and abstracts need to have been accepted by international orthopedic conferences (or in the case of Australia, it could include Australian orthopedic conferences, *but not chinese ones).

I mean you can look into easier fields to get into that don't *share the same mean number of publications, but this is a highly competitive one to go for.

Edited: for grammar/clarity

 

[IMG69]

it is a "western thing". It's no different in Australia.
See selection criteria for orthopedics in Australia.
Or faq & contact for iMGs looking at ortho.
Presentations are not random presentations to your class etc. if that's what you're thinking. Presentations and abstracts need to have been accepted by international orthopedic conferences (or in the case of Australia, it must be Australian orthopedic conferences).

I mean you can look into easier fields to get into that don't *share the same mean number of publications, but this is a highly competitive one to go for.

Edited: for grammar/clarity

Ahh I see what you mean, thanks for clearing that up for me, I actually attend one of these 'meetings' every Tuesday haha, last week a group of students presented information to some Ortho surgeons which was quite cool.

That's cool, as it doesn't seem to be to much work involved in those presentations. Also thanks a lot for linking those Ortho links

 

[Turkishking]

Just like winning the Lotto!

I won 40$ off a 1 dollar ticket once. That was one year ago.

 

[gyngyn]

Ahh I see what you mean, thanks for clearing that up for me, I actually attend one of these 'meetings' every Tuesday haha, last week a group of students presented information to some Ortho surgeons which was quite cool.

That's cool, as it doesn't seem to be to much work involved in those presentations. Also thanks a lot for linking those Ortho links

Those are not the presentations to which we refer.
We are talking about presentations at national meetings (to a group of experts and practicing physicians) to which you are invited because of publications or abstracts.

 

[NotAProgDirector]

Ahh I see what you mean, thanks for clearing that up for me, I actually attend one of these 'meetings' every Tuesday haha, last week a group of students presented information to some Ortho surgeons which was quite cool.

That's cool, as it doesn't seem to be to much work involved in those presentations. Also thanks a lot for linking those Ortho links

From your posts above, I can't tell if you understand what we're trying to tell you.

Abstracts and Presentations are those that are submitted and then competitively reviewed and accepted to national or international meetings. Presentations at your local school don't count for anything. The meeting needs to be one that US docs go to, else it won't be taken seriously.

The publication / abstract counts are over the student's entire career. So might include something from undergraduate, all years of medical school, etc.

Any research you do is only going to "count" for anything if it's published in a major US or European journal. If it's written in Chinese in a Chinese journal no one will take it seriously.

As mentioned, those stats above are include only those people who actually obtained an Ortho interview, else they wouldn't actually be applying to ortho positions in the match. So your chances are ~6/21 if you actually get at least one ortho interview. Looking at ERAS application statistics, it appears that there are about 200 IMG applicants to ortho each year. So, your chances are more like 6/200 = 3%. And I worry that these people who did obtain spots are coming from top European schools, or have amazing connections that allowed them to succeed. Your chance of success coming from a school that many PD's may know nothing about may be much less.

No matter what, you're going to need US experience if you want to do residency in the US. If you're gunning for ortho, then as much of your US experience should be ortho as possible. Problem is, if you do that and then try to apply to another field, programs may see all this ortho experience, realize that you're applying to them as a backup / second choice, and decline to interview you. So if you decide to apply to Ortho you need to give your 100% effort to it, but that may limit your applications to other fields.

 

[bannie22]

You have no chance for USA Ortho unless you either do research or prelim surgery in USA.

Ortho is 4th only to Plastics. Derm/NSG.

I do not know about the other routes, but the best route for USA Ortho is to finish medical school in China with 20 publications.
Apply for prelim surgery in USA. Ace prelim surgery and get ridiculous letter of recs plus another 20 pubs.

Then apply for Ortho residnecy.

 

[IMG69]

Oh I see, in regards to the presentations I guess we just don't do them here then, I mean the presentations we have are exactly as I described, we get specialists come in and ask our professors for further information when they're dealing with a tricky case, E.g when the Ortho surgerons came they had questions about the spinal venous system which were answered in the presentation.

Well there's no way US docs will ever attend these meetings. However I guess it can't hurt to still document and add these to the resume, I mean after all it's still doctors coming to the department (Anatomy) to seek further information on a complicated case.

Any research you do is only going to "count" for anything if it's published in a major US or European journal. If it's written in Chinese in a Chinese journal no one will take it seriously.

Yeah i'm fully aware of this, our last publication is currently pending approval for the Journal of Anatomy, all our submits are in English, to English journals etc. (That's how I got started with this research, they asked me to proof-read and then slowly liked my input on the topics and now let me devise experiments)

As mentioned, those stats above are include only those people who actually obtained an Ortho interview, else they wouldn't actually be applying to ortho positions in the match. So your chances are ~6/21 if you actually get at least one ortho interview. Looking at ERAS application statistics, it appears that there are about 200 IMG applicants to ortho each year. So, your chances are more like 6/200 = 3%. And I worry that these people who did obtain spots are coming from top European schools, or have amazing connections that allowed them to succeed. Your chance of success coming from a school that many PD's may know nothing about may be much less.

I know the odds are heavily stacked against me, i'm aiming for one of the most competitive residencies, if I was really worried about the odds I just wouldn't do it because the odds are heavily stacked against me but I believe I can do it and I will try my dam best.

No matter what, you're going to need US experience if you want to do residency in the US. If you're gunning for ortho, then as much of your US experience should be ortho as possible. Problem is, if you do that and then try to apply to another field, programs may see all this ortho experience, realize that you're applying to them as a backup / second choice, and decline to interview you. So if you decide to apply to Ortho you need to give your 100% effort to it, but that may limit your applications to other fields.

Yup couldn't agree more, come my intern year i'll do my best to spend the whole year in the U.S which will most likely involve jumping from hospital to hospital.

I do not know about the other routes, but the best route for USA Ortho is to finish medical school in China with 20 publications.
Apply for prelim surgery in USA. Ace prelim surgery and get ridiculous letter of recs plus another 20 pubs.

Yeah that's the plan, I realistically want to hit about ~18 publications which is 3 a year.

Anyway thank you all for you're input!

 

[NormanClark]

I would suggest for option 1. Though you can try for option 3 as well, if considered.
and option5 is impossible now.

 

[ThoracicGuy]

Just like winning the Lotto!

 

[IMG69]

Does anyone have/can find the statistics of IMG's match rates from English speaking countries?? I know you all harp on about only ~40% of IMGs getting a successful match but that includes every single IMG, many of which lack what I would say is suitable english to even practice (I know this based on my University, maybe ~15-20% would really struggle with bedside conversation as they have what I would call 'textbook' english, e.g can't vary from those basic sentences and basic replies 'how are you' 'i'm good')

So if these statistics exist or if someone knowledgeable can shed some light on this that would be great

P.s talking about all residencies not just Ortho

 

[gyngyn]

Does anyone have/can find the statistics of IMG's match rates from English speaking countries?? I know you all harp on about only ~40% of IMGs getting a successful match but that includes every single IMG, many of which lack what I would say is suitable english to even practice (I know this based on my University, maybe ~15-20% would really struggle with bedside conversation as they have what I would call 'textbook' english, e.g can't vary from those basic sentences and basic replies 'how are you' 'i'm good')

So if these statistics exist or if someone knowledgeable can shed some light on this that would be great

P.s talking about all residencies not just Ortho

Charting Outcomes in the Match for International Medical Graduates (2nd Edition) Now Available - ECFMG News

 

[the argus]

Does anyone have/can find the statistics of IMG's match rates from English speaking countries?? I know you all harp on about only ~40% of IMGs getting a successful match but that includes every single IMG, many of which lack what I would say is suitable english to even practice (I know this based on my University, maybe ~15-20% would really struggle with bedside conversation as they have what I would call 'textbook' english, e.g can't vary from those basic sentences and basic replies 'how are you' 'i'm good')

So if these statistics exist or if someone knowledgeable can shed some light on this that would be great

P.s talking about all residencies not just Ortho

To match as an IMG, and basically to get an interview at all, you must have already passed the USMLE Step 2 CS which is essentially an english language proficiency exam. I would argue with your assertion that many IMGs don't match because of unsuitable english.

I think you've gotten about as good of advice as your going to get. Your chances of matching in competitive specialties like ortho, CT surgery, or plastics is basically nonexistent unless you have excellent USMLE scores, lots of research, and spend at minimum 3 months of rotations, during medical school, in the US with physicians in those specialties that can write you LORs. And even then you're looking at very slim odds.

I think if you're serious about wanting to come to the US for residency you should get rid of this pipe dream of being an orthopedic surgeon and apply to FM and IM like most other IMGs. It's a plus you're a US citizen for sure, but coming from a Chinese medical school instead of the more established pathways (Caribbean, Ireland, Israel, etc) isn't going to help your case either.

 

[IMG69]

Thanks a lot gyngyn!

Well like all exams they can be studied for, however I was more leaning towards the language difficulties in an interview rather than step 2. Yeah i'm fully aware its a long shot but I haven't mentioned that I have practically learnt all of the USMLE step 1 material in my 1st degree and it's just revision for me now as well as the fact that I have realistically 4 years to study for it but I may sit it sooner. (I'm aiming for at least ~253 on Step 1).

I honestly don't see how it's such a 'pipe dream' I have everything I need to make it happen, I have more then enough time to learn all the USMLE content, I'm already working on my second research paper (so far it's 1 paper every two months) on muscle anatomy (ortho related... ) and if I really need to pump those numbers up I can simply just offer to translate for all the other departments; this involves learning all about the topic and then proof-reading and typing up the final publication netting me another author title. So USMLE and research are sorted. LORs are sorted, 'this guy has been helping us for 5 years blah blah' will all be along those lines. I'll do my whole intern year in the U.S as well.

I'm not worried about statistics and numbers because they are not fixed, they can be worked for and as I said above i've got everything I need so far, so it's just a matter of working for it. The only thing i'm holding onto about my University is that it's WHO recognised.

I can even do a masters or PhD in surgery if I wanted while i'm here too which I am really considering since it's really boring here and I need something to fill the time.

However as you say of course I can apply for IM or FM if things don't work out but where's the fun in that.

Thank you all for your contributions and as you say I think I have got all the advice I need now especially with that last post from gyngyn.

 

[Domperidone]

Erm, what do you mean by 'internship"?
I can't tell if you actually how med school and post-grad training (i.e. residency) is set up in the US. The meaning of internship may be different to the US.

Do you mean that you need internship to finish your degree in China? How many years is your program exactly? or is internship their term for rotations you take as a student in order to graduate? Or is it something that comes after you graduate?

The US has two years of rotations and electives in 3rd and 4th year (of a 4 year degree program).
"internship" comes after grad. Are you referring to getting rotations as a 3rd or 4th year student in the USA?
That's..not a walk in the park to arrange. You may not get the rotations you want even if you apply for them.

Anyway..i kinda give up lol.

From your tone, I can't tell whether you fully grasp the seriousness of what you're facing is and what everyone is trying to tell you - in your best interests, to prevent you from being disillusioned or disappointed. Even if you work as hard as you do, the homegrown AMGs are always going to be preferred. Not to mention, you have yet set foot on American soil, and likely have no idea what the US healthcare system is truly like. Nor will it be the same as New Zealand (where you've grown up) or China (where you're currently at). Even if you manage to get rotations there, it's into the deep end. You'll navigate through different cultural norms and expectations. it's more than about English comprehension. Each country may have their own variations on guidelines/procedures. and there's no way for you to really know how rigorous or demanding the American med schools are. you can assume and hope your school will be at the same level, but should it not, the American students on rotations may outshine you. it may not be easy to catch up.

I mean..given that you've never lived in the US.
What do you think the day-to-day responsibilities and lives are of American students? Or residents? you realize there's 30 hr shifts?

Edit for bad English and other stuff