Need urgent advice: Apply for Ophtho this year or next?!

[ElectricDoc]

Hey guys, I have a huge dilemma and I would gladly appreciate your advice.

I'm a Carib grad(U.S. Citizen) who also completed a dual MBA program, recently graduated with both in May 2013. My plan was to take Step2CK after graduation and apply this year for 2014 IM match(in the 1 year break I had I was going to do clinical research). However, I completely changed my mind and really want to do Ophtho now(for several reasons; the main one being I love it!). I was not given a chance to do any ophtho electives my 4th yr bc none were offered from my school at that time. I am now back in my hometown and got accepted to be a "clinical research fellow" at a prestigious institution here with the Chairman of Ophtho. I am going to be publishing at least 3 projects and presenting at the ARVO and AGS next year. Chairman says every single person(all foreign grads) who have done this one year of research fellowship with him have always matched in to Ophtho the following year(some in the same program).

My dilemma: Do I apply to Pre-lim and Optho this year? Next year? Or apply Pre-lim this year(2014 start) and Ophtho next year(2016 start) after having 1 year of publications, experience, and connections under my belt?

If I do a full year of research fellowship now(from 2013 to 2014) and apply for Prelim for 2015 start year then what will I do during the one year break in between research fellowship and beginning of pre-lim year? I could continue to do research work where I am, but it pays pennies and makes me feel like I'm taking too big of a break from "real medicine". Chairman says it's not a big deal to give up another year of my life to get in to Optho if I want it bad enough(I agree). He said I could apply this year and see what happens, but considering I have no Ophtho electives/letters and no research at this point(and SF apps are currently due) I stand a very glim chance of interviewing this season even if he writes me one letter alone.

An alternative is to apply for Pre-lim IM this year(for 2014 match) and apply Ophtho next season(start 2016) so that I can at least get started with residency by next summer, have an income I can survive off, and not get too much of a break from practicing medicine. However, I will have to try to find a Pre-lim PGY2 position during the year I have off between PrelimPGY1 and Ophtho. I heard they are not everywhere and are scarce, but they do exist and know of some Carib grads who did Prelim PGY2 years and got in to anesthesia and ophtho.

What should I do??? It is disheartening to think I will not be starting residency until 2015, but if I get in to the specialty that I absolutely love then I do feel it's worth it. Other side note, I just turned 28 and I'm getting married next year. I can find random temporary jobs that pay enough for wife and I to survive(and pay off debt), but it may not be as much as I'd get paid in residency and I do not want to financially stress for another 2 years until starting residency. Thanks a bunch.

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[ophthope]

You can't do a "full year of research" now because it's already mid-August and all residency programs start on or a couple of weeks before July 1. Is this research spot guaranteed to just start now? If so, why don't you just do the research fellowship now from now until summer 2014, and apply right now to Prelim IM spots this year (to start in 2014). Would you be able to take that much time away from your research to do enough interviews to match? If so, just do an internal medicine prelim year, apply (and hopefully match) ophtho during that year, and moonlight in some small town ERs or Urgent Care places during the in-between year. You should be able to make enough to live on doing that.

However, one thing to also consider here is that it is going to be very difficult for you to interview for Ophthalmology during your intern year. You may be a US citizen but you're a foreign medical graduate and research or not you're probably going to want to interview at as many places as you can. It will be very difficult to do a lot of interviews during your intern year and whether or not you can even take vacation will be completely dependent on which rotation you're on. I'm a prelim now, and at no time during my 5 wards months or my ICU months can I take vacation. If you could instead just take the year off between your research year and intern year and do something that you could easily take a lot of vacation from at any time, you'd be able to do a lot more interviewing. Also, start saving for interviews yesterday because they're really expensive. Just food for thought.

 

[ElectricDoc]

Thanks for the reply, ophthope!

I already started my research fellowship(July 29th 2013) so I can do what you suggested: apply IM prelim this year, apply ophtho next year and moonlight in the year between. It sounds like I'll be able to still practice medicine and make some money. Yes, my research timings are flexible so I'd have enough time to interview this season for IM-prelim spots. Thank you for the suggestion.

Thanks for pointing out the interview time off issue during intern year, I didn't think about that. If my IM pre-lim program director knows I'm applying for Ophtho and interviewing I'm hoping he/she will cut me some slack to allow me to make it to most interviews since it won't be "vacation" for leisure, but career related time off. It is a gamble though.

Yes, taking that year off in between would give me more time to interview everywhere I want to, but the thought of having a whole year off after research fellowship and not starting residency 'till 2015 is what makes me feel uneasy...

 

[kwel]

wow that research fellowship seems like a good deal. Lots of research + pubs, probably a good LOR, and would significantly improve your chances at the ophtho match. If you applied ophtho this year I think programs might question your true interest in ophtho seeing as you have very little experience in the field. 1 year is such a small price to pay if you're really that interested in ophtho. I don't see any reason to apply prelim IM this year, mainly because as ophthope pointed out you'll have a rough time interviewing for ophtho programs during intern year, and also because you really wouldn't be saving a year (since you'll have to take the year off between PGY1 and ophtho residency). I would say do the fellowship and apply next year for both prelim and ophthalmology. good luck

 

[eyestar]

I disagree with some of the other comments. First of all-yes, it is tough for you given you are not a US med school grad. That being said, there are many top programs in ophtho that do take foreign grads. It all depends on your Step 1 score. Did you ace it? Do you have good letters of recommendation? Can you get one excellent letter from someone in ophtho? (You can get that from doing a month of ophtho elective or research-don't need a whole year).
If all the above is yes-you can actually apply for ophtho this year although I am not sure when the target date for CAS application is? You have to get your applications before the target date to be on the safe side.
If on the other hand, your USMLE step1 score is mediocre and you didn't get honors in medical school or have anything else outstanding (paper published in ophtho) then you have to first take your step2 -ace it, apply with excellent recommendation letters.
So your sequence of what to do when really depends on your credentials -USMLE scores and transcript.
It is not difficult to go for interviews during your intern year. You need to plan it well. Choose an internship that's cush -has lots of elective months and plan your vacation/leave and electives during the interview months if necessary.
Good luck!

 

[wei_c25]

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[linevasel]

The other alternative that you didn't bring up is to simply do two years of research back to back, apply for Prelim and ophtho together like everyone else in your second year of research - start prelim year in 2015, and start ophtho in 2016. There are a few of us on this forum who have done 2 years of research. If your chairman is truly a big wig, and you are a star then the second year will only help further your prospects (might even get you a look at the home program), and could potentially give you a leg up in fellowship. Also if you are a star, I'm sure the chairman will have no problem keeping you on board and paying you for a 2nd year. True, its hard to keep up the drive/determination to be stellar for 24 months but you are a FMG applying ophtho so you obviously have boat loads of testicular fortitude. Lastly, if you do one year of research and your chairman says you'll match, then you'll prob match. But a second year of research will give you interview time, and possibly push you from "matching" into "matching well". I would run all 3 (or is it 4) options by your chairman. I'd frame it like this, I really like project x...... blah blah, would you consider keeping me on a second year if the project continues to go well and the leads that develope are of interest to the Lab etc etc etc.

Also once you are done, you should probably be a good neighbor and let us know which clinical research fellowship has a batting percentage of 1000. None of the ones I've heard of so far are batting 1000. Not Utah, Not Tufts, maybe Bascolm? --- due to selection bias? But your program sounds pretty incredible. I'm sure a lot of people would be interested.

Lastly to be very frank cush prelim years usually go to stellar applicants that didn't need a year of research (don't take this the wrong way). Most likely your prelim program will not be cush... Taking two years off is brutal. I did. I'm in strong University IM program (home institution). I died my first month, but spent 2nd month learning to live on 5 or less hours of sleep or less and read my a__ off. I'm almost back to par. I'm in my situation because I spent 24 months devoted to my research. But it paid off, and I'm glad to sleep 5 hours or less for 3 months since it got me my ophtho spot. You can make a different choice and actually read for medicine during your second research year. You'll be a little slow for the first 3 months, but after that I wager you'll be right with your peers.

Also have a wife and child. My Point: anything you think you can't do, Someone has already done and lived through it. You can too. In fact many people have taken a year off for research taking two years is really nothing. I know people (two) who completed IM residency just to be competitive for ophtho (if you really think about it you'll understand how that could be possilbe). Be encourged and know that many others have walked your path

 

[ElectricDoc]

Wow! I have no doubt I picked the right specialty, because you guys are freaking amazing! Such honest and informative responses...now I know why everyone loves Ophthalmologists. Thanks for all of the feedback guys, I really appreciate it.

Looks like most of you feel I should wait to apply to both prelim + ophtho next year...that way I will have sufficient time to interview next year and do some audition ophtho rotations/more research at current institution. As one of you brought up, I did not ace the Step 1 and being an IMG with no research makes applying for ophtho this year a bad idea. I'm currently studying for Step2 as I continue my research and planning on killing it. I know step1 matters more with Ophtho, but I'm hoping a killer step2 will help my application.

I wish there was a way I could moonlight or use my M.D. to work part-time to earn some money until I start residency in 2015. I'll look in to my options and do my research, but I know without at least one year of residency you are not licensed in most states hence you cannot moonlight even in small ERs or urgent care centers. Others say consulting(McKinsey) or working with pharmaceuticals is a good part-time gig if I'm concerned about income 'till I start residency. I'm going to look in to all of that. Starting residency when I turn 30(2015) was not in my life's plan, but neither was doing Ophtho or a lot of other things. I'm going to stay positive and work hard to pursue my dream.

I will definitely fill SDN in with info about my institution and research if things in Ophtho workout for me. I'd love to benefit and help others in my situation. Thanks again for all the feedback guys and feel free to give me more input if you have any.

 

[ophthope]

You are right, unless you do an intern year first you can't moonlight. Check Practice Link for job opportunities that only require an MD but no residency. You can also try Drop Out Club which is a site for MDs who are looking for jobs outside of medicine.