Now, a cautionary tale...

[Skip Intro]

The nice thing about blogs is that people can share their experience. It is this kind of perpetuity that can help others. And, it's often a nice, longitudinal insight into their experiences.

As I mentioned recently in other threads, some schools will put their "poster children" out there as shining examples of what you can achieve if you matriculate into their program. But, what about a regular (even good) student at one of those programs?

I invite you to read the experience of this student in its entirety. If you don't have the time or the inclination, I think it is fair use to snip some of the more relevant materials of this students seven year - and still ongoing experience - trying to get into residency.

Yes the "BIG 3" as they are called, SGU, AUC, and ROSS have federal student Loans, so Sallie Mae lends to them, I do not know if students can get private loans from them too, the high cost of attending these schools requires most to find private loans too.

So there are over 30 other Medical schools in the Caribbean also, I attend one of them.

http://southerndoccarib.blogspot.com/2007/11/over-30-medical-schools-in-caribbean.html#links

I'll let you figure out which school, if you're so inclined. That's not really the point. The point he was trying to make in this post was that these schools are expensive and require a huge financial investment, not only the one of time, blood, sweat, and - yes - sometimes tears.

You are nothing as a Medical student, you are nothing as a Resident, you are nothing until you Pass the USMLE and get Lic, Are you ready to kiss a lot of behinds? Because if you do not you will never make it.

http://southerndoccarib.blogspot.com/2007/10/ok-bonus-post-premeds-take-look.html#links

I like the fact that he's shown a lot of insight here. These things are true. Going to medical school - anywhere - is a 7+ year journey, which includes getting into residency, getting a permanent license, and achieving board certification. You have to stay focused you have to have stamina. You have to make the correct choices along the way...

Money......... this is the least of our worries, if you look on the internet and google it appears MD's make way less then most think, yeah they want you to believe this, FP make 175 to 225k on the average a year, way more then it says on the net, most will not make less then 200k and I know some while in clinicals that make better then 300k, Stop thinking $$$$ and start thinking Medicine, the money will be there.

http://southerndoccarib.blogspot.com/2007/10/pet-peeve-time.html#links

Well, yes, if you succeed. There's the catch.

I used the same books, I had professors that were from India, USA, UK all with PHDs and MD's I spent 1.5 years on the island and the last 2 years in the US being taught by US Doctors, along side US students........... I will be in a US residency, over 70% of my education is in the USA and 100% is USA resources.

So the answer is hell yes I did the right thing because I was 41 when I started and I'm an RN of 20 years, I have old course work the Caribbean counted.

The school is OK, not great but I could care less, its legit and I'm going to be a MD in 6 months.

http://southerndoccarib.blogspot.com/2009/03/why-did-i-go-to-caribbean.html#links

The above was posted on March 28, 2009.

He continues on...

OK So last week I Graduated. I have my Diploma "Doctor of Medicine"
But
I need to take and Pass Step 2 still
Then try to get a residency.
That is what is Ahead of me.
Its a road, Long road and until I obtain that Residency I do not feel its over or successful.
So Medical School Down and more to go.

http://southerndoccarib.blogspot.com/2011/05/graduation.html#links

I spent the previous 3 years looking for loans until I was in a bad situation with Credit Cards, we ran out of money to pay for them. So I could not find a loan and even if I did my credit score was at the bottom. My mother inlaw and others helped me pay tuition. But there was no extra money. I graduated medical school in April 2011 and plan on being in the up coming residency match.

http://southerndoccarib.blogspot.com/2011/07/caribbean-medical-schools-as-option-in.html#links

This was near the end of a life summary of his experience. This was posted on July 13, 2011 - 6 years into his journey to become a physician and at the age of 47 with massive debt.

He summarizes a lot of what I've been saying on this forum over the past several years, too, in this post.

So.........I did not match.

http://southerndoccarib.blogspot.com/2012/03/after-soap-many-imgfmg-did-not-match.html#links

Continuing forward another year, another update...

I graduated Medical School 2011, I was ECFMG certified last year in 2012. I paid for and applied to over 200 programs in the residency match for 2013 and have not been given one interview. I have no idea what I will do but I will not give in or give up. I will fight and I hope I will still get a residency this year. I'm studying for step 3 and hope to take it and pass this April.

http://southerndoccarib.blogspot.com/2013/02/update-on-my-story.html#links

So, now we have our friend who is not in residency and is going to be expected to start paying back his loans...

I have to choose an option of some kind to decrease the 880 a month payment when I have 1800 a month to live on, pay rent, water, power, gas, buy food and pay other bills.

http://southerndoccarib.blogspot.com/2013/05/wow-depression-and-regrouping.html#links

Above is the depressing reality for many graduates. Here we have a person who has graduated with a degree, has passed all of the Steps, but can't get into residency and therefore get licensed. And, he's in massive debt.

Finally...

OK I'm in the Match again, praying for a residency to finish my training.

This is my third try to get into a residency.

This was posted a month ago. It's 2014. That's 9 years since our friend started his journey.

I'm sharing this with any of you who still think that this process is automatic, especially if you go off the well-trodden track and try to navigate this incredibly difficult process on your own and outside of an established pathway at an established school.

In reading this man's blog, I admire and respect what he went through. He has faced many challenges and stayed determined. But, the fact is that without a residency it means nothing. I know he knows this. I know you all know this. Even if you have that degree and have passed the tests, you do not get to legally call yourself "doctor" until you're licensed.

Do not learn this the hard way. Read blogs, like this gentleman's, and think long and hard before you go this route. Many of us, like myself, have succeeded through good luck, hard work, and good decisions. It only takes a few stumbles and you might end up with a piece of paper and a mountain of debt... and nothing more.

I wish him the best!

-Skip

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[ewax]

Fantastic post. Should be stickied.

 

[NotAProgDirector]

Had some time on my hands, and skimmed through some of his blog. Between the posts complaining about health insurance, the price of breakfast sandwiches at McD's, and Windows 7/8, and his advice to other people about how to get into medical school, a few others are worth sharing:

This one is from 2007, early in his adventure. Much of his blog appears to be answering other people's questions:
Link

WOW I thought I would never be in Medical School at 43 but here I am!
3 kids one in college now, a wife and ex, 19 years as a RN, I have been through a lot, so why do this, take on 180k of debt, sell my house and go around the world to get the MD?

Because I would not be happy with myself ever again if I didn't!
For some its the Corvette, it's the beautiful young wife they want ( my wife is beautiful at any age)
it's the beach house or the hunting cabin and so on, for me it was to be a Doc!

Is it worth it?

I look at it this way...... A house is anywhere between 200 and 1 million dollars in 2007 so if I rack up 180k in student loans thats nothing now, it's cheap! I live in Southern Ga where I can build a house on 5+ acres for 250k or less, so I have this loan and a nice house for much less then most will pay for 1 house and not being a DOC!

the years loss income ect.... Sure I lost income but look at it:

4 year loss income at lets say 55k a year ( I was between 50 and 60k as a RN)

OK so 22ok loss, but after grad residency = 40k plus housing allowance ( another 10k) so about 50k, I'm Back, 3 years then private practice, the Docs I'm doing rotations are making 200 to 300k a year and the Hospital pays the Malpractice for them to have the practice in affiliation with them. ( I know you hear the sad stories about Docs and how much they do not make and on the internet they have lower pay rates, do not believe everything you read or hear) So............. I will make up the money like this

Subtract the 55k a year for the 1st 4 years of Practice and we will use 200k Uh thats 145k left pay back loans subtract out 12k a year thats still 133k a year I would not have made................

Does it pay off I think I made my point.

I will be a MD at age 45

I will practice ( planned) till age 70, thats 25 years, if you take out residency thats 22 years of the 200k or more 200k x 22 years is how much? 4.4 Million,

55k at 22 years? 1.2 million so yea I will win the Life lottery IMO.

If I live Comfortable I can save money for after 65yr and semi retire.



Life can be good real good!

Good Luck

But in 2013, he posted this summary:

My story, Past and up to present.

I graduated Nursing school in 1989 and Passed my Licensing test for RN the first time.

I went on to work as a Trauma Nurse and ER and Cardiac nurse the next few years.

I then wanted to work in Home Health and Home Infusion. Somehow ended up working in Home Hospice.

Then after 9 years of Nursing I told my wife I wanted to go back to school and study to go to medical school. My answer was "No your not!!!!" She had dreams of staying home the rest of her life and not working and wanted me to support her lifestyle. A few years later we are divorced (Surprised? )

I remarried and after a couple years still wanted to go to medical school but I was getting older and at 39 started to look into my options, I cleaned up my credit and a year later was accepted at St. Christophers College of Medicine in Luton England. Great right? Well........ I packed my bags sold my house and took my wife and son to England to live on US student loans (Key Bank). I was accepted into the premed program to "Finish Ochem" and allowed to take some medical school courses, after a year I found out that the school had charter issues with Senegal and I was being tossed around from medical school to premed and back with no clear path. I applied to St. James School of medicine on Bonaire and was accepted as a transfer. Since I had not taken a full 1st semester at St. Chris and getting transcripts from that school was next to impossible I decided to retake the courses I had already passed. Good clean slate right? So I went through basic science and passed all my classes, Sallie Mae was lending the money for study and all was god. I came back to the US after White Coat and rented a house in Georgia to begin Clinicals. Then a life changing event happened, Sallie Mae told me 1 more semester and that was it, no more loans to finish medical school. OMG what to do? I had no idea how I would finish and this was so unfair. No one cared and Congress just ignored my pleas. My mother in law and others helped me to pay for the coming semesters. The first year I studied for step one but with so much on me, trying to pay bills, rent and tuition, I could not study well and I kept having panic attacks. When I tool Step one I did not pass, I struggled for a few more attempts. St. James gave me a problem with Clinicals by the middle of my 4th year, they told me none of the clinicals counted I had done the past 18 weeks counted. I was still in 3rd year and I had better pass step one. I had paid them for the semesters ( 3 in a year) but they refused to count my work despite the good reviews I had. So I left and applied to transfer to All Saints (Now Aureus) School of medicine. It was decided I would do a year with them and with the transcripts from St James, it was decided that I would do Cores that are usually done in 3rd year in my 4th year. (Yes Strange) This made sense since Aureus had a better clinical system. I passed Step One and went on to finish my rotations. I still had no loans and used tax returns and worked some to pay for school. We lived on 50 dollars a week for groceries and I still have no idea where I had money for gas for the car. I then attempted step 2, with all the stress and the panic attacks it took 2 more times for me to get myself under control and pass step 2.

Today: I graduated Medical School 2011, I was ECFMG certified last year in 2012. I paid for and applied to over 200 programs in the residency match for 2013 and have not been given one interview. I have no idea what I will do but I will not give in or give up. I will fight and I hope I will still get a residency this year. I'm studying for step 3 and hope to take it and pass this April.

I hope my story helps other make their decisions. I think my biggest mistake was multiple attempts on step one then step 2 before getting my panic attacks during testing was under better control. You truly cannot think when in panic mode and now take a beta blocker before and during the day's testing.

So, I will not stop, give up or loose faith, I will fight until I succeed

Dr. Bill

And then this:

Many Medical Graduates are asking "Is it time to Sue"

Is it time to SUE?

• I have over 190k in US student loans,
• I passed the USMLE,
• I graduated,
• Residency is not medical school it is a Job and post Medical School training,

Here is the RUB You can pass the licensure test but cannot be licensed with out a US residency.


You are qualified for Residency since you passed the test SO Is the Government, who makes laws for licensure and funds residencies, now responsible to ensure all that can pass the test have an opportunity to practice? Is it legal to underfund a program required by law so that people who have passed the qualification test to practice medicine cannot practice? Is this not a violation of my right to pursue happiness? To work? To provide for my family? To pay back my loans? Hmm I think I may be on to something here. The Government has not been challenged on this before because it was a non issue, now its an issue Law says you must have a residency to be licensed after passing the tests You passed the test So where is the residency?

Required by law but administered by a non regulated system and underfunded by public money


We Ask then, is it time for the Courts to get involved and help us clean up this mess and we move on and practice medicine?

It's sad, really. He had a dream of being a physician. Several Carib schools were happy to sell him that dream. Which has turned into a nightmare.

 

[edgerock24]

Had some time on my hands, and skimmed through some of his blog. Between the posts complaining about health insurance, the price of breakfast sandwiches at McD's, and Windows 7/8, and his advice to other people about how to get into medical school, a few others are worth sharing:

This one is from 2007, early in his adventure. Much of his blog appears to be answering other people's questions:
Link


But in 2013, he posted this summary:



And then this:


It's sad, really. He had a dream of being a physician. Several Carib schools were happy to sell him that dream. Which has turned into a nightmare.

Yeah. Hard to not feel bad for him, even though it is his own fault for bad decision making, etc.

Also, I think it is rather unfair to compare this guy to students who attend one of the reputable Caribbean schools. He was a student at two piece of trash schools. Students from Ross, SGU, AUC, are surely more likely to succeed than someone who went to "St. James" and "All Saints."

 

[AStark]

Last fall on CTU we had a fourth-year elective student from some-or-other Caribbean school. It wasn't one of the "big ones", and this student told us the unfortunate tale of how her school was on the verge of shutting down and that she might be left with no degree at all (!). It sounded like a pretty awful situation, but it really hit home that some of these schools take advantage of people prone to making bad or excessively risky decisions.

To illustrate this point, this student had come to my centre to do an elective in IM. Except that our IM program doesn't really take any IMGs, apart from times it might not fill in the first round (which hasn't happened for several years). So the probability of her elective's being useful in the match was not appreciably greater than zero.

She wasn't a spectacular clerk otherwise, but not terrible either. On the other hand, around the same time we also had an elective student from Saba (I think). She *was* terrible. Poor knowledge, big gaps in clinical skills, and lazy - she didn't complete tasks as requested, and when she did finish them, she was slow and extremely inefficient. Once she was asked to write up a discharge but decided to go to the cafeteria for lunch after just barely starting it.

So when the blogger in question complains about this "process" by mentioning a hypothetical lawsuit, I can't help wondering whether his lack of insight into the risk of his decisions (or the effects of transferring to and from a bunch of third-rate schools *and* failing step 2 twice from the sound of it) belongs in medicine. Those 200 residency programs probably weren't wrong, as unfortunate as that may be for someone who pays out $180k or more for a "degree" that is effectively worth nothing.

 

[Skip Intro]

It's sad, really. He had a dream of being a physician. Several Carib schools were happy to sell him that dream. Which has turned into a nightmare.

I think this is the point right here. Just because you get a degree and pass all the tests doesn't mean you're going to be able to call yourself doctor.

On this other thread, you make some excellent points (that I'm cutting and pasting here).

= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
1. They accept people who cannot get into a US medical school. Whether you see this as "giving deserving people who messed up their GPA / can't do well on the MCAT a second chance" or "leeching tuition off of desperate students who can't get into US medical schools" depends on how you view the situation.

2. Top performers in Carib schools will likely do fine.

3. Middle performers, and especially those at the bottom of their class, may not do fine and find that matching into a residency becomes impossible.

4. Failing a class, or worse failing a step, is often an unrecoverable event. However, students retake, pass, and then think everything will be OK, and it might not be.

5. A reasonable percentage of all carib schools fail out in the first 2 years.

6. If you fail out of med school, or can't match to a residency, you really have no options. A partial MD is of no value. An MD without a residency is also of very limited value.

7. If you fail out of school, or can't find a residency because of poor performance, your loans are non-dischargable. You will have them forever, and paying them off is very difficult.

8. Most IMG's will find it difficult to get more competitive specialties. Best to plan for IM/FM/Peds/Psych/Path etc. If you work really hard, do incredibly well on the USMLE, and get good rotations, you might have a chance at Anesthesia, Surgery, Rads, etc. But I wouldn't count on it.

9. US med schools have increased their class size, while residency spots are remaining relatively flat. It may be that as time goes forward, that IMG's will have further trouble getting even IM and FM spots.

So: Going to a Carib school is an uphill process. You need to work harder and be better than your US colleagues to do well. Carib schools often tout their successes, and ignore the (relatively) large number of students who never make it to graduation, are only able to get a prelim spot, or not match at all. Getting in is not the challenge -- it's getting out with a degree and residency spot.

= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

Thanks for this. Great advice. Looks like "Dr. Bill" is in bad need of some charity right now. I'd reach out to him, but I have nothing to offer. Sadly, honestly.

-Skip

 

[deleted480308]

I view med school without residency and practicing to be like 19.5 years of military service and retirement........close doesn't count

 

[bedevilled ben]

I've seen a couple fellow classmates stubbornly double-down in the face of an irrecoverable setback(s), instead of stopping and realistically reevaluating their chances. It's tough to sit and watch otherwise intelligent and diligent people dig themselves into a hole. It happens even at the well-known Caribbean schools as well, though it's thankfully pretty rare. You can't save people from themselves. For those prospective students reading this, there is great advice in this thread. I'd love to see more posts like this.

 

[Skip Intro]

I view med school without residency and practicing to be like 19.5 years of military service and retirement........close doesn't count

Except you're getting paid during that military service. Of course, the retirement bennies are all the reason to stay in.

This poor fellow... well, he clearly made a lot of mistakes along the way. I think his 10/4/2007 post about "money being the least of our problems" is illuminating. That's one of the ones I highlighted originally.

Money is one of the biggest problems most Carib grads will face. Lower reimbursements in the face of higher school loan burden. It's a lose-lose proposition for many, and that's not even considering the possibility that you will get to the point this blogger did - after 9 years - and still ultimately have nothing to show for it.

-Skip

 

[Skip Intro]

You can't save people from themselves.

I think a bigger point is that "Dr. Bill" is not really a doctor yet, despite the fact that he has a medical degree from some school down there and has taken and passed the Steps. You truly learn how to practice medicine in residency. And, you can't legally call yourself "doctor" until you're licensed in a particular state.

Again, I hope he makes it through this time around because it seems like such a waste of time and money to go through all of this and, in the end, have nothing to show for it.

-Skip

 

[deleted480308]

I think a bigger point is that "Dr. Bill" is not really a doctor yet, despite the fact that he has a medical degree from some school down there and has taken and passed the Steps. You truly learn how to practice medicine in residency. And, you can't legally call yourself "doctor" until you're licensed in a particular state.

Again, I hope he makes it through this time around because it seems like such a waste of time and money to go through all of this and, in the end, have nothing to show for it.

-Skip

Would bill be eligible for (i think missouri) that state program that let's grads act as associate physician under supervision with no residency?

 

[Skip Intro]

Would bill be eligible for (i think missouri) that state program that let's grads act as associate physician under supervision with no residency?

Is that actually official now? And, isn't Missouri one of those states that requires the school to have been chartered for 15 years before you can get a license?

-Skip

 

[deleted480308]

Is that actually official now? And, isn't Missouri one of those states that requires the school to have been chartered for 15 years before you can get a license?

-Skip

I don't have any idea

 

[hallowmann]

This is rough, and regardless of the irresponsible risks he took, I can't help but feel sorry for him in his current situation. He made a ton of mistakes along the way, and I really wonder how many other people are right there alongside him (probably many - those schools do have tons of students). Thank you for posting this. It needs to be clear that going abroad by itself is a huge risk, and the process is not really forgiving when it comes to mistakes.

It looks like this doc has failed both Step 1 and Step 2 multiple times.

When I tool Step one I did not pass, I struggled for a few more attempts...I passed Step One and went on to finish my rotations...I then attempted step 2, with all the stress and the panic attacks it took 2 more times for me to get myself under control and pass step 2.

From the looks of it, he took 6 attempts, at least, to pass the first 2 steps. Some states have a 2 attempt limit per step and others have caps of 5 or 7 for all 3 steps.

I have many friends in the Caribbean or that have finished successfully. I also have many foreign relatives in the middle of the residency app process. The one consistent thing I've heard is how bad its becoming, and I honestly can't imagine what someone from an unknown Carib school has to go through.

I know one person who got interviews at DO schools (waitlisted - decided not to try again a second time), was accepted into a Big 4, and in the end went to a well known (not CA approved) non-Big 4 Carib school. I asked why he didn't reapply or why he didn't go to the Big 4 school. His justification was cost. He had mapped out this plan of how he could only take out X amount of money or pay Y amount from his savings, and when he's Z age, he'll be making $150-$200k. When I read that quote from 2007 about how its a good investment for him, because he'll be an MD by the age of 45, and have 25 years of 6-figure salary (he forgot about residency) ahead of him, it really reminded me of the guy I know.

Everyone needs to know its a risk. You might "win the life lottery" or you might not. First and foremost, anyone wanting to be a doc needs to try at least a few times to get in stateside (MD or DO). If after that, their only options are abroad, they need to only be looking at the big 4, and know its a risk that they won't make it to graduation. If that isn't an option, they need to really reconsider becoming a physician and think about other options (PA, Podiatry, etc.). The idea of going through all of med school only to be applying year after year for the match is just terrible.

 

[Skip Intro]

This is the information (and link) from the Missouri website:

Assistant Physician Licensure
Senate bills 716 and 754 were signed by Governor Nixon and established licensure for Assistant Physicians. These bills will become law effective August 28, 2014. However, before the Board can accept applications, the Board will need to establish rules related to licensure, including submission of applications, renewal, supervision, and other matters necessary to protect the public.

The rule promulgation process is lengthy; therefore, we do not anticipate the licensure of Assistant Physicians to begin until at least the summer or fall of 2015. We will continue to update the website as information becomes available.

http://pr.mo.gov/physiciansandsurgeons.asp

They are currently writing the rules, but the bill was signed into law back in August. It seems like this might be a shot for him, if he doesn't get into residency this go-around. Of course, someone will still have to hire him somewhere.

-Skip

 

[W19]

@Skip Intro Is it difficult to get 1-2 year internship? Why don't carib student try that? I know someone who did that and is working in the prison system and according to his cousin is making over 100k/year... I think this is better than chasing a residency that might never materialize...

 

[Skip Intro]

Not really sure what you're asking. An internship is just the first year of residency. Different states have different requirements about how much training you have to do before you can get an unrestricted license to practice.

Missouri also requires that whatever school you attend has been chartered and enrolling students for at least 15 years before you can get a license. So "Dr. Bill" might still have a problem even if this enacted legislation gets rolled-out in the next year or so.

 

[W19]

Not really sure what you're asking. An internship is just the first year of residency. Different states have different requirements about how much training you have to do before you can get an unrestricted license to practice.

Missouri also requires that whatever school you attend has been chartered and enrolling students for at least 15 years before you can get a license. So "Dr. Bill" might still have a problem even if this enacted legislation gets rolled-out in the next year or so.

I was talking about non accredited ACGME internship... That person I mention on my previous post did 2 year internship in Puerto Rico and subsequently got a general practitioner license in FL .

 

[Skip Intro]

I was talking about non accredited ACGME internship... That person I mention on my previous post did 2 year internship in Puerto Rico and subsequently got a general practitioner license in FL .

I know someone who did something similar. But, it was still a formalized training program that he matched into as a prelim. I'm not sure how someone gets into such a program without going through the Match or SOAP. He ended-up prescribing medical marijuana in a clinic in California. Not exactly my idea of "practicing medicine" but, hey, it paid the bills.

It seems like you are referring to some "non-accredited" yet still ACGME program (?), the type of which I'm not familiar with. Puerto Rico is governed by the same rules as the rest of the U.S. So, again, I'm unfamiliar with exactly what you are referencing.

Perhaps you can include a link to an example of such a program?

You can get a license to practice medicine in some states without having completed a board-eligible NBMS program. It is also damn near impossible to get malpractice coverage, credentials at any hospital, paid for your services by insurance companies, or even patients to agree to come see you. Unless, like you say, you are willing to work on a Native American reservation or in a prison... for a pittance.

-Skip

 

[W19]

You can get a license to practice medicine in some states without having completed a board-eligible NBMS program. It is also damn near impossible to get malpractice coverage, credentials at any hospital, paid for your services by insurance companies, or even patients to agree to come see you. Unless, like you say, you are willing to work on a Native American reservation or in a prison... for a pittance.

-Skip

I would not call 100k-120k a pittance... Of course it not ideal for someone in that circumstance, but is better than not having a license at all. I don't know too much about the PR program. I know a person who did it and another who is doing it right now, and both told me is it not an ACGME accredited program... To be honest, I have no idea what that means...

 

[Skip Intro]

I would not call 100k-120k a pittance...

It's all relative. When you're paying $1,000-$1,200/month back in student loans and your take home pay is less than many of my undergraduate college-educated friends at similar points in their careers who are making the same, if not more, annual salary... just saying. Most CRNAs I know, for example, make FAR more than this.

Also, there are likely severe restrictions on the terms of how you can practice medicine in such circumstances.

Again, future students need to realistically consider the financial ramifications of their decision. Just because you finish the program doesn't mean the money will come. You can see how wrong "Dr. Bill" was about this retrospectively looking at his 2007 post on that very subject.

-Skip

 

[W19]

It's all relative. When you're paying $1,000-$1,200/month back in student loans and your take home pay is less than many of my undergraduate college-educated friends at similar points in their careers who are making the same, if not more, annual salary... just saying. Most CRNAs I know, for example, make FAR more than this.

Also, there are likely severe restrictions on the terms of how you can practice medicine in such circumstances.

Again, future students need to realistically consider the financial ramifications of their decision. Just because you finish the program doesn't mean the money will come. You can see how wrong "Dr. Bill" was about this retrospectively looking at his 2007 post on that very subject.

-Skip

I agree with you that people should consider the financial ramification of going to an offshore school (excluding PR and Hawaii)... I am about to complete my 1st semester at a US low tier MD and I am doing ok so far in my classes, but I am still scared to death that if something goes wrong I might end up having a 25ok student debt and have nothing to show for it... I can't imagine how my mindset would be if I was attending on of these carib schools... From what I have been seeing in SDN, a good majority of people who are going to the BIG 4 could have been accepted to DO school. Some of them could have taken a year extra to strengthen their applications just to be in that more secure pathway, but for some reason , they have decided against it.....

 

[NotAProgDirector]

This is the information (and link) from the Missouri website:



http://pr.mo.gov/physiciansandsurgeons.asp

They are currently writing the rules, but the bill was signed into law back in August. It seems like this might be a shot for him, if he doesn't get into residency this go-around. Of course, someone will still have to hire him somewhere.

-Skip

He doesn't qualify. The law specifically states that you must pass Step 2 within two years of applying for the assistant physician license.

Has successfully completed Step 1 and Step 2 of the United
7 States Medical Licensing Examination or the equivalent of such steps
8 of any other board-approved medical licensing examination within the
9 two-year period immediately preceding application for licensure as an
10 assistant physician, but in no event more than three years after
11 graduation from a medical college or osteopathic medical college;
12 (c) Has not completed an approved postgraduate residency andCCS HCS SS#2 SB 754 21
13 has successfully completed Step 2 of the United States Medical
14 Licensing Examination or the equivalent of such step of any other
15 board-approved medical licensing examination within the immediately
16 preceding two-year period unless when such two-year anniversary
17 occurred he or she was serving as a resident physician in an accredited
18 residency in the United States and continued to do so within thirty
19 days prior to application for licensure as an assistant physician;

 

[wannabie]

I actually attend the school that dude is talking about. I might have even met him. There were two 40 year old white guys at the school and one of them was indeed from the south and was either an EMT or RN--I don't remember.

I really don't have much to say here except that I think the dude committed financial suicide chasing a pipe dream--which is not the best reason to get into medicine. My entire tuition for four years at the school (and food/rent) cost me less than $100,000--which I think is pretty reasonable.

Someone mentioned the school being a "piece of trash". My experiences there were mixed. The basic sciences professors were surprisingly adept, but they inexplicably didn't have professors for the fourth basic science semester. Most of the clinical rotations were superb, but the middlemen the school was affiliated with were sociopaths. Some of that's changed for the better, and last year the school matched 18-20/25 students, which is small, but a decent clip. I've independently verified most of them because I rotated with many of them--but they're mostly located at Harbor Hospital in Baltimore.

I still wouldn't do it again. I've got nine interviews in psychiatry for this year's match, but the stigma attached to being a "****ty IMG" follows me around like herpes. While studying for my steps, I got to know a medical student who went to my state's medical school. He failed three classes, failed step 1, failed CS, applied super late in November for EM and got his first choice. I'd love that coddling treatment because even though I failed nothing and excelled everywhere, I have to go into the crapshoot of the match, which is seldom kind to IMG's. I should have taken a year off and applied to US schools because I still think my poor/okay MCAT of 29 and GPA of 3.7 would have taken me further.

 

[Skip Intro]

He doesn't qualify. The law specifically states that you must pass Step 2 within two years of applying for the assistant physician license.

Thanks for the research.

Again, very cautionary tale. I'm not sure what he's going to do if he can't get into residency this time around.

-Skip

 

[Skip Intro]

I should have taken a year off and applied to US schools because I still think my poor/okay MCAT of 29 and GPA of 3.7 would have taken me further.

Ya think?

Good luck. I hope it works out for you.

-Skip

 

[BestDoctorEver]

I actually attend the school that dude is talking about. I might have even met him. There were two 40 year old white guys at the school and one of them was indeed from the south and was either an EMT or RN--I don't remember.

I really don't have much to say here except that I think the dude committed financial suicide chasing a pipe dream--which is not the best reason to get into medicine. My entire tuition for four years at the school (and food/rent) cost me less than $100,000--which I think is pretty reasonable.

Someone mentioned the school being a "piece of trash". My experiences there were mixed. The basic sciences professors were surprisingly adept, but they inexplicably didn't have professors for the fourth basic science semester. Most of the clinical rotations were superb, but the middlemen the school was affiliated with were sociopaths. Some of that's changed for the better, and last year the school matched 18-20/25 students, which is small, but a decent clip. I've independently verified most of them because I rotated with many of them--but they're mostly located at Harbor Hospital in Baltimore.

I still wouldn't do it again. I've got nine interviews in psychiatry for this year's match, but the stigma attached to being a "****ty IMG" follows me around like herpes. While studying for my steps, I got to know a medical student who went to my state's medical school. He failed three classes, failed step 1, failed CS, applied super late in November for EM and got his first choice. I'd love that coddling treatment because even though I failed nothing and excelled everywhere, I have to go into the crapshoot of the match, which is seldom kind to IMG's. I should have taken a year off and applied to US schools because I still think my poor/okay MCAT of 29 and GPA of 3.7 would have taken me further.

If you match and your total debt is less than 100k, consider yourself as someone who wins the lotto IMO... Most US students will be 250k+ in the red... It was not a good decision to go carib with your stats, but once you match, all these stigma are gone...

 

[tartesos]

@Skip Intro Is it difficult to get 1-2 year internship? Why don't carib student try that? I know someone who did that and is working in the prison system and according to his cousin is making over 100k/year... I think this is better than chasing a residency that might never materialize...

I've heard of those internships( more like er work, a lot of it for free) being done in Puerto Rico to obtain a limited medical license( must be exfmg certified) and with that, you would be able to work in federal( va and Indian health) under served areas.
You would not be board eligible but it's a pretty good living.

 

[tartesos]

If you match and your total debt is less than 100k, consider yourself as someone who wins the lotto IMO... Most US students will be 250k+ in the red... It was not a good decision to go carib with your stats, but once you match, all these stigma are gone...

I agree with that!

 

[AStark]

Last fall on CTU we had a fourth-year elective student from some-or-other Caribbean school. It wasn't one of the "big ones", and this student told us the unfortunate tale of how her school was on the verge of shutting down and that she might be left with no degree at all (!). It sounded like a pretty awful situation, but it really hit home that some of these schools take advantage of people prone to making bad or excessively risky decisions.

To illustrate this point, this student had come to my centre to do an elective in IM. Except that our IM program doesn't really take any IMGs, apart from times it might not fill in the first round (which hasn't happened for several years). So the probability of her elective's being useful in the match was not appreciably greater than zero.

Oddly I was able to determine today that she went to University of Sint Eustatius School of Medicine, which this year became the American University of Integrative Sciences, St Maarten School of Medicine. Not sure what happened with her degree, but Facebook told me she's working as a "medical technologist" in Toronto.

 

[darklabel]

I actually attend the school that dude is talking about. I might have even met him. There were two 40 year old white guys at the school and one of them was indeed from the south and was either an EMT or RN--I don't remember.

I really don't have much to say here except that I think the dude committed financial suicide chasing a pipe dream--which is not the best reason to get into medicine. My entire tuition for four years at the school (and food/rent) cost me less than $100,000--which I think is pretty reasonable.

Someone mentioned the school being a "piece of trash". My experiences there were mixed. The basic sciences professors were surprisingly adept, but they inexplicably didn't have professors for the fourth basic science semester. Most of the clinical rotations were superb, but the middlemen the school was affiliated with were sociopaths. Some of that's changed for the better, and last year the school matched 18-20/25 students, which is small, but a decent clip. I've independently verified most of them because I rotated with many of them--but they're mostly located at Harbor Hospital in Baltimore.

I still wouldn't do it again. I've got nine interviews in psychiatry for this year's match, but the stigma attached to being a "****ty IMG" follows me around like herpes. While studying for my steps, I got to know a medical student who went to my state's medical school. He failed three classes, failed step 1, failed CS, applied super late in November for EM and got his first choice. I'd love that coddling treatment because even though I failed nothing and excelled everywhere, I have to go into the crapshoot of the match, which is seldom kind to IMG's. I should have taken a year off and applied to US schools because I still think my poor/okay MCAT of 29 and GPA of 3.7 would have taken me further.

Wow and you would be someone who had the stats that showed you could succeed in medical school.

Good luck in the match and I hope you get your first choice. Sad thing is, for people of your caliber in Carrib schools, it's only going to get harder.

 

[wannabie]

Wow and you would be someone who had the stats that showed you could succeed in medical school.

Good luck in the match and I hope you get your first choice. Sad thing is, for people of your caliber in Carrib schools, it's only going to get harder.

If you match and your total debt is less than 100k, consider yourself as someone who wins the lotto IMO... Most US students will be 250k+ in the red... It was not a good decision to go carib with your stats, but once you match, all these stigma are gone...

It was an incredibly dumb decision that I regret. But I can't go back in time. I can only go forward..

 

[BestDoctorEver]

It was an incredibly dumb decision that I regret. But I can't go back in time. I can only go forward..

I hope everything works out for you! Since you have had multiple interviews, I guess it will... GL

 

[Skip Intro]

I've heard of those internships( more like er work, a lot of it for free) being done in Puerto Rico to obtain a limited medical license( must be exfmg certified) and with that, you would be able to work in federal( va and Indian health) under served areas.
You would not be board eligible but it's a pretty good living.

I looked into this a little bit online. There is some limited information on such programs.

I found this, from over ten years ago, that explains in part a portion of these programs:

http://www.puertorico-herald.org/issues/2004/vol8n09/CBCodeRed-en.html

In Puerto Rico, the term internship also refers to one-year programs that aren’t accredited by ACGME and are offered by private hospitals. Auxilio Mutuo Hospital and Inter American Hospital of Advanced Medicine (HIMA by its Spanish acronym) offer these programs, known as criollo internships.

(Read the full article, if you're interested.)

As always, caveat emptor. I don't think this is a viable (or desired) pathway for most Caribbean grads, nor is it one that is easily set-up or navigated.

-Skip

 

[W19]

I looked into this a little bit online. There is some limited information on such programs.

I found this, from over ten years ago, that explains in part a portion of these programs:

http://www.puertorico-herald.org/issues/2004/vol8n09/CBCodeRed-en.html



(Read the full article, if you're interested.)

As always, caveat emptor. I don't think this is a viable (or desired) pathway for most Caribbean grads, nor is it one that is easily set-up or navigated.

-Skip

Yeah... It's not a desired option for Caribbean grads... I guess that person I know was lucky then since he was able to get into such program...

 

[Goro]

I don't know about them being the majority, but the bolded is why they're dead meat if they show up on our door step wanting to become DOs after either flunking out of a Carib school, or deciding they really didn't like the place. They had their chance.

From what I have been seeing in SDN, a good majority of people who are going to the BIG 4 could have been accepted to DO school. Some of them could have taken a year extra to strengthen their applications just to be in that more secure pathway, but for some reason , they have decided against it.....

 

[calvnandhobbs68]

I think this guy also made some really bad decisions along the way though. I mean, who told him to apply without having CK and CS scores in? That probably screwed him for the first match and then every match after he was a re-applicant, so even lower on the list every subsequent year out. That was either an example of really bad advising or really bad decision making...even US grads are typically told to have their CK score (and in quite a few specialties a passing CS) in at least before rank lists are set.

Of course he also failed both steps multiple times so it probably wouldnt have made much difference.

 

[W19]

I've heard of those internships( more like er work, a lot of it for free) being done in Puerto Rico to obtain a limited medical license( must be exfmg certified) and with that, you would be able to work in federal( va and Indian health) under served areas.
You would not be board eligible but it's a pretty good living.

I know someone who is in his 2nd year in one of these programs now after failing to match (x2). He already got his PR license. He said he is doing the second year because some states require 2-year internship to have a GP license. In fact, he was telling me about a girl from his program who got her FL license few months ago already got a 130k/year job. That's not bad for someone whose prospect was bleak a couple of years ago...

He told me they give a stipend like $1000/month....

 

[Bryan O’Blivion]

This is a cautionary tale indeed. I've come across it before, and followed it intermittently. It's a good reference for borderline students thinking about their prospects abroad.

I feel for his plight, however, his hubris had no small part to play in this. He chose to attend schools that did not require the MCAT. There really is no good reason to do this. He thought he could take a short cut, and avoid retaking/revisiting courses in undergrad to prepare himself. He failed Step 1 and 2 multiple times, which is an indicator that he really was not well prepared for the material, which he may have been if he had taken the prerequisites seriously enough. There is a reason that we learn foundations first, and have our understanding of them challenged by assessment tests to see if we are ready to assimilate and accommodate the information we will learn in medical school.

He many times scorned the idea of becoming nurse practitioner, which he could have completed by 2010 or 2011, and been gainfully employed.

Also, it looks like he spent a lot of time blogging and posting when he should have been studying.

Why on earth did he graduate and then apply to ERAS without step2 CK, CS? Clearly he has received little guidance from his medical schools, but he is repeating the same sort of behavior as before, and trying to skip steps.

It may seem like I am kicking a guy while he's down. I'm not. I sincerely hope that he can find some why to turn it all around. But at some point he needs to get a grip. This man was as much a victim of his own vainglorious nature as he was of predatory for profit education.

I wish him the best. I think that a possible good use of the resources and experience that he has as an RN and on this personal odyssey would be to get a job in an ICU, and pursue training as a CRNA. Just an idea. I am not a guidance counselor, merely a Googler.

Shalom. May he fare well, his fortunes improve, and may others take warning.

 

[Skip Intro]

[sic]He thought he could take a short cut, and avoid retaking/revisiting courses in undergrad to prepare himself.

[sic]...experience that he has as an RN and on this personal odyssey...

I found that the people with some form of medical training or nursing background always had a distinct advantage over the fresh-out-of-undergrad learning the stuff "cold". That's what's doubly baffling to me about this case. And, he is quite mature being in his late 30's (now late 40's) when he started this "odyssey".

Just not clear where the malfunction occurred in this case. Dunning-Kruger effect? Maybe. It seems to be on multiple levels, though, and I agree with your assessment on the whole, Brick Majors.

-Skip

 

[Bryan O’Blivion]

It's hard to say. His case is tragic, and raises a lot of questions.

I would think that people with previous training in related fields would be particularly at an advantage during clinical years. He does not report much difficulty in that area. Unfortunately, it may have contributed to his underestimating the basic science aspect of medicine.

From his blog, it appears that he was kind of dismissive about prerequisites, and the MCAT, as I stated before. His age was a disadvantage, as he was a father and husband, with responsibilities other than studying, which can be hard with an ordinary job, more so in the all consuming effort that medical school can be. I don't think he fully appreciated this, or many of the other difficulties, or how they could combine to reduce his chances of success.

Certainly, he was a poor estimator of his own ability throughout the process, so yes, definitely an element of D-K.

Then, there is also the fact that his focus was scattered. Between his blog and his postings in the sites linked to his blog, he has written the Anna Karenina of the Carib med school experience. Not the most judicious use of time.

I still think that if he hadn't been so dismissive of a few prerequisites and the MCAT, taken a year or two to study, things would have gone better for him. This is a theme I see repeated, when he doesn't seem to care about the validation of knowledge demonstrated by the Steps, to him his multiple attempts and finally passing with a low score mean that he has finally gotten some silly hurdle out of the way, checked a box of on his list of doctor ingredients. To me, multiple fails and one low pass indicate that his knowledge is marginal, around the cut off, and the odds worked out for him one time.

To fair, I have worked with people who were poor test takers, but very good clinicians. Maybe he is one of them.

In any case, I am not sure how much value there is in my dissecting the decisions of this man. It's pretty easy to critique it as a spectator. I his position, though, it is easy to see how his choices would have been appealing under the circumstances. I hope he finds something that works for him.

 

[Skip Intro]

Very cogent and thoughtful analysis, Brick. Thanks for posting.

This is a theme I see repeated, when he doesn't seem to care about the validation of knowledge demonstrated by the Steps, to him his multiple attempts and finally passing with a low score mean that he has finally gotten some silly hurdle out of the way, checked a box of on his list of doctor ingredients.

To everyone else reading this, I cannot underscore how much Brick hit the nail on the head here.

You absolutely have to take this test seriously, pass it on the first try, and do the absolute best you can. If you struggle with standardized tests, you need to seriously and earnestly think about going to the Caribbean to become a doctor, because you have to get past this test and do well on it or you're doomed. It's not just a "silly hurdle" to somehow clear.

-Skip

 

[Mad Jack]

I actually attend the school that dude is talking about. I might have even met him. There were two 40 year old white guys at the school and one of them was indeed from the south and was either an EMT or RN--I don't remember.

I really don't have much to say here except that I think the dude committed financial suicide chasing a pipe dream--which is not the best reason to get into medicine. My entire tuition for four years at the school (and food/rent) cost me less than $100,000--which I think is pretty reasonable.

Someone mentioned the school being a "piece of trash". My experiences there were mixed. The basic sciences professors were surprisingly adept, but they inexplicably didn't have professors for the fourth basic science semester. Most of the clinical rotations were superb, but the middlemen the school was affiliated with were sociopaths. Some of that's changed for the better, and last year the school matched 18-20/25 students, which is small, but a decent clip. I've independently verified most of them because I rotated with many of them--but they're mostly located at Harbor Hospital in Baltimore.

I still wouldn't do it again. I've got nine interviews in psychiatry for this year's match, but the stigma attached to being a "****ty IMG" follows me around like herpes. While studying for my steps, I got to know a medical student who went to my state's medical school. He failed three classes, failed step 1, failed CS, applied super late in November for EM and got his first choice. I'd love that coddling treatment because even though I failed nothing and excelled everywhere, I have to go into the crapshoot of the match, which is seldom kind to IMG's. I should have taken a year off and applied to US schools because I still think my poor/okay MCAT of 29 and GPA of 3.7 would have taken me further.

Dude, you totally should have gone DO. You probably could have gotten into MSU, PCOM, or any of the other big-name schools with those stats.

 

[Spirit of the Student Doc]

I've heard almost everyone who fails step one doesn't get a residency... even in the U.S.

 

[W19]

I've heard almost everyone who fails step one doesn't get a residency... even in the U.S.

Not sure that is true! I was told you still can match in the less competitive specialties (FM/IM/psych etc...) as a US grad even if you fail step1 once...

 

[Spirit of the Student Doc]

Not sure that is true! I was told you still can match in the less competitive specialties (FM/IM/psych etc...) as a US grad even if you fail step1 once...

Can, but will you? Also, requires passing at some point.

I think the best thing to do is not to fail

 

[W19]

Can, but will you? Also, requires passing at some point.

I think the best thing to do is not to fail

Definitely... There was a popular thread in the DO forum about a student that was dismissed from DO school after failing step1 multiple times, somehow got back and now is doing a residency in FM... It's best to pass your boards 1st attempt, but if you don't, it's not like game over as if you were a carib student... Maybe @Skip Intro can chime on that..

 

[Mad Jack]

Can, but will you? Also, requires passing at some point.

I think the best thing to do is not to fail

It's totally possible to match after not paying Step 1 and retaking it. Something like 2% of MD students don't pass each year, and roughly 10% of DO students fail to pass COMLEX 1 on their first attempt, but the vast majority of these students end up matching eventually.

 

[Spirit of the Student Doc]

It's totally possible to match after not paying Step 1 and retaking it. Something like 2% of MD students don't pass each year, and roughly 10% of DO students fail to pass COMLEX 1 on their first attempt, but the vast majority of these students end up matching eventually.

Eventually? I'm not trying to be rude or anything.... but it must be one hell of a road. Still if step one is mostly undergrad material, makes you wonder what's on it.

 

[Mad Jack]

Eventually? I'm not trying to be rude or anything.... but it must be one hell of a road. Still if step one is mostly undergrad material, makes you wonder what's on it.

By eventually, I mean most match their first year. At my school 9 people failed the COMLEX 1 in 2009, for instance, but all of them matched except one. Failing isn't even close to a death sentence if you're a US grad, it just limits your specialty choices.