Being a Foreign Medical Graduate in US Balwant S Nagra, MD Assistant ProfessorChild and Adolescent Psychiatry/Adult Psychiatry University at Buffalo New York, USA Contact Info: email@example.com
Myth• If you ask any foreign medical graduate who just landed on the airport in US about what field he or she wants to go for residency. The answer will be ? Guess ?
• -Internal Medicine• Or• Next best answer will be• -Surgery• Nothing wrong with that
• Keep your options open• There are so many other interesting fields you might like working in your life.• Every field will provide different life style, job opportunities, and different income.• For example; myself wanted to be surgeon back in India but started liking Psychiatry in US but ended up matching in Internal Medicine.
• After a year in Internal Medicine I changed to Psychiatry and also did fellowship in Child Psychiatry.• I am very happy in my field. I love my job and the life style with excellent income.• Some people keep on changing their fields.• Some people don’t want to stop doing residencies and fellowships.
• Being a foreign medical graduate it is hard to get in to residency program.• You will be competing with American medical students (my 4th year medical students) and the students from India (who come to US with their scores in USMLE step 1 and 2 in 99th percentile (I don’t know how they get it).• Now you can imagine how many hoops you have to jump to compete with these people.
• Match results in 2012• Total applicants in match=48,507• Positions offered=24,034• American graduates in match=24,369• American graduates matched=15,712 (65.4%)• You can see how many foreign medical graduates apply each year and how many get into residency.
• It is very competitive.• So you have to work hard.• There are so many things you have to work on.• First and most important thing is to get very good scores in USMLE step 1 and 2 and pass CS.• Avoid any attempt that will go against you.
• There should be no unexplained gap in your training or gap between graduation and time of application.• For foreign medical graduates USMLE step 3 is must.• Most of the residency programs have a filter to the applications. They don’t even open the application which does not have certain high score in Step 1 and 2 in the first attempt.
• Most of the programs also look if candidate has research experience including the name in some publication in related field.• Also some clinical experience including observership or externship.• Certain specialties don’t entertain foreign medical graduates.
• Psychiatry is becoming very competitive.• In 2012 match, total 1,118 positions were offered. 680 American graduates applied and matched to 616 positions out of 1,118.• Psychiatry itself is specialty. It’s very much in demand.• These days most of people started going to 2 year fellowship in Child Psychiatry.• If a Child is referred by his Pediatrician. It takes to see a Child Psychiatrist 6-9 months. There is big shortage.
• For USMLE step 1 and 2 the book First Aid is must. It’s written and updated by the people who recently took the exam and scored well. Also read the other books recommended in the list by this university and attend the course offered by this program.• For CS Kaplan has good course.• Before I passed CS I took one day course in NJ offered by an actor patient of Kaplan.• It was pretty good and I passed.
• USMLE step 3 is pain in the neck.• Some people started their residency before passing step 3.• Now when you are in 3rd or 4th year of residency in certain specialty (eg. Psychiatry) you don’t have time to study Internal Medicine, Obe/Gyn, Surgery, Ortho etc.• Some program kick out their residents after 2nd year and don’t give them contract for 3rd year. No one wants to be in that position.
• You can not get a state license to practice without step 3.• Every state has different time limits and limits of attempts.• For example: Delaware, Florida, New York, Pennsylvania and Virginia has no limits.• Other states has different rules.• Pass step 3 ASAP. It will help for residency
• I recommend highly following material on your tips. I guaranteed you will pass step 3.• 1. Master the boards step 3 written by Conrad Fischer, a well known instructor in Kaplan and Program Director In Internal Medicine.• 2. Premier Review course. Excellent course. They have live lectures and also home study material available on MP3 and lecture notes.• 3. Flash cards for step 2 and 3 by Conrad Fisher.• 4. Some dermatology pictures from any dermatology book to correlate with above dermatology section
• Before applying for residency choose a mentor who has been to the residency program in US.• Get professional help to prepare CV and Personal statement.• Get good recommendation letters. It matters who has written it. If it is written by someone famous, well known in that field, its great.• It also depends on the wording in the letter.• When I give letter to my students. They come back after the interview and tell me that my letter was mentioned during the interview and most of them get their first choice.
• Get help to prepare for residency interview.• Before putting the rank order list in the match only rank highly the place you really want to be. Otherwise it will be painful to survive.
• Next and last thing is “How to survive in a residency program”.• You are under microscope all the time until you graduate.• Always respect the authority. It does not matter it can be anyone, your senior resident, attending or administrator.• Don’t make blunders. If you don’t know ask before you act.• Any disciplinary action will stay in your file for your whole life and will be reported to FCVS when applying for a license in any state.
• So work hard. You will do it.• After you graduate and have your license to practice, by then it will be a piece of cake.• GOOD LUCK !• Most of the information to apply for USMLE steps is on line.