Sunday, September 27, 2015

Another Caribbean med school graduate needs advice

I did not attend St. George's, Ross, or Saba. I chose my school because it has a premed program which leads to an MD program. My USMLE Scores on Step 1 and Step 2 CK are above 230.

I did not apply for the 2015 match because I did not have my step 2 CK results until November. It would have been too late. I could have rushed my step 2 but I wanted to get a good score and be a solid applicant. Also I would not have been able to complete my surgical electives in time to get letters of recommendation. At some point, I will be doing research at [a very well-known medical school]. I felt that for these reasons this would make me a better applicant the next year.

Since graduating I have been trying to find a medical related job (scribe) but have had no success. I have reached out to many institutions regarding research opportunities but have come up dry. I may be able to secure a volunteer research position by next month. Do you have any suggestions for me? I knew I would hate being out of the medical field for this long but this was my best bet. Does this gap hurt my chances?

I am concerned that despite your excellent USMLE scores, taking a year off from clinical medicine may cause your application to be rejected immediately. I do not know if a 9 week research elective, even at a premier med school, would be enough to offset your lack of clinical experience over the entire year. Acting as a scribe would not be considered clinical experience.

Another issue is what is the record of your school regarding matching graduates into surgical programs? Since you didn’t tell me your school’s name, I cannot give you any insight into that situation. Even if I did know the school’s name, it may not have published its match results.

To answer your specific questions:

How many gen surg programs should I apply to? I was thinking ~100. That seems reasonable. You should be able to gauge your chances better after you see if you receive any offers for interviews from the 100 programs.

During a gen surg interview, should I be open about my backup specialty? I would advise you to say that you would take a preliminary spot in general surgery if you didn’t match in a categorical position. Admitting that you would do internal medicine is often seen as a lack of commitment to surgery.

Most hospitals I am looking to apply are IMG friendly. Which means the surgery and medicine programs are both IMG friendly. Would it be a bad idea to apply to different specialties at the same hospital? I think it would be a bad idea. I suggest you wait and see if you get interviews from the general surgery programs. If you don’t, then there would be no problem applying to internal medicine at the same place. I doubt very much that the two services would talk about any specific applicants. Most surgery programs get hundreds of applications and those applicants who are not offered interviews are not remembered.

Some readers may have other opinions. I hope they will comment.


Anonymous said...

Why are the schools not attended specified? That would leave AUA/AUC/MUA?

Skeptical Scalpel said...

Not really. There are at least 20 other med schools in the Caribbean.

Anonymous said...

This drmuchogusto, twitter. My advice to this student, you have your usmle exams complete, outside of step 3. Obtaining a categorial spot with your CK results arriving in November is out of question. My suggestion dont take a year off, dont be a scribe, dont do any of those things. As soon as you get that CK score in november, apply to 50 prelim spots. You might hear from someone. I believe a lot of prelim spots are not filled, but from my understanding just because there is an unfilled position, does not mean a chairman will welcome you. Its a tough process. Maybe Skeptical Scalpel can discuss this further in regards to prelim. Also, your personal statement you MUST discuss why you are applying for prelim surg, how it will help you, in your case you want a cat gen surg spot. I seen people make this mistake, your score comes in november, no guarantee of what your score is. You mention 230 plus both exams, but you have not RECEIVED your score yet, you later mention November for score arrival. You got to apply, there are no rules from keeping you from applying in Nov. Most programs have a deadline of december. Last, say you apply in november with your "230 plus" score on ck, then say you dont hear from anyone. This makes you eligible for SOAP. The chances of matching in SOAP also slim, but it gives you a chance at least. Look you have until februrary! Dont waste time, start email programs as soon as you get your score. Whats the worst that could happen they say sorry no thanks. But if it results in one or 2 interviews. Also, what are you doing right now! You are waiting for your score now, get back in the hospital, keep learning, keep networking.

Anonymous said...

This is drmuchogusto. Also, since you had it in your mind to take a year off, Im assuming you dont have your application put together. Dont have your personal statement done, did not request your letters, have all your transcripts, and all the paper work this requires submitted. You need to do this now!! Say you did not get letters requested, now you need to give your attending 2-4 weeks to put something together. Feel free to PM me on twitter. I really push students, but mean well. I'm quite surprised. Another thing you need to think about do you have a surgical mentor. You really need to have one to bounce ideas. Like me and skeptical scalpel are far away and this is just online. Someone you can speak with in person. Your surgical attending might have to make a phone call for you too for a prelim spot. This point you need good letters, since your score for ck does not arrive for another month, this gives you a month to have those letters in, quality is most important.

Skeptical Scalpel said...

Mucho, thanks for the comments. He already has his CK score. He was referring to November of 2014 and the 2015 match that occurred in march of 2015.

A few surgeons have commented on Twitter about this post. They all favor a prelim year over any of the other options. I agree the writer should enter the current match so he can try for a SOAP position if necessary.

Anonymous said...

Thanks SS for clarifying the student's situation. I apologize for the confusion. Question for you SS, if you look at the NRMP/Soap data it seems yr after yr prelim surg spots go unfilled or it seems PD's do not want to fill the spot with just anyone. What is the reasoning for having so many pre-lim spots available and then not filled? I never understood.

Skeptical Scalpel said...

Why are there so many prelim spots?

Hospitals need bodies to do the work. The RRC once made some noise about eliminating most or all of the non-designated prelim positions (meaning those slot where progression to a urology, ENT or other subspecialty was not going to occur), but it never happened.

I think nearly all prelim slots are filled after SOAP by those who did not match through SOAP.

Anonymous said...

This is Drmuchogusto, thanks. Do you think the SOAP positions for prelim surg are taken majority by USA students who did not match in Optho, ortho, ent, and other competitive programs? Im asking so students can plan accordingly. I tried to research last yr how many spots were open for prelim surg, I could not find anything official. Just rumors btwn students in forums who did not match and I read 113. Assuming if this is true, I have a feeling at least half for sure goes to USA unmatched surgical candidates, if not more. Then 40-60 spots to IMG/FMG students. It seems the soap is not in favor of the IMG/FMG student, I get a feeling, not sure. I have no background or experience in this. I just did research so I can advice students. If anyone knows the official data for SOAP prelim/cat surg positions please post. All the best to those in this situation and plan your future accordingly. Good luck!

Skeptical Scalpel said...

According to the NRMP Match data (, 435 of 446 open prelim slots were filled during the SOAP process. But only 126 of the > 250 programs participated in SOAP.

US seniors filled the majority of all open positions in SOAP, but there's no breakdown of how many US seniors filled the prelim positions in SOAP. (See pages 46 and 47.)

Erik Pearson said...

Hi "another Caribbean grad" and Skeptical Scalpel...looks like an interesting discussion, as a foreign medical grad I remember reading similar discussions on etc in the run up to the general surgery match so I thought I would chime in to the conversation.

Basically, if you're expecting to match as a FMG you've got to be as prepared or more prepared then your American counterparts, any less and you fulfill the stereotype placed on you...that you simply were not strong enough to go to a US school...that's the attributional error, like it or not, it's up to you to make it an error and not the truth. You have all of medical school to battle this stereotype and unfortunately from your story it looks like you are behind the 8 ball. A couple of things I would say or advice I would give.

1.) Decide you want to do general surgery, from your comments I'm not convinced.

2.) I agree with MuchoGusto - I would take categorical off the table and save the money on your application fees, apply prelim and 50 is a good number to shoot can apply to as many as you like.

3.) Find a general surgery mentor, someone who will pick up the phone for you...definitely a requirement for you at this stage.

4.) Forget the research, it doesn't matter if it's at Harvard, Penn, fact if it's at one of those places you may be worse off as the labs are like a Lion's Den and you may be eaten alive. If you do decide that you've got to do research to help beef up your CV then you should pick a lab that is highly productive, not necessarily famous and a place where you can churn out some papers...not a place where you're charged with designing another mouse model of disease x. Remember, it doesn't have to be basic science, clinical medicine, outcomes, value research, etc would be good places to start. And forget the scribe stuff, you went to medical school, you have to find someplace to be a doctor.

5.) Agree with Skeptical Scalpel, I would not entertain the idea of telling a bunch of surgeons that if you don't match you're going to do internal medicine, they are opposite ends of the spectrum, practically and literally.

Bottom line, from your post it sounds like you're all over the place with your this point you need a cheerleader, laser like focus, and a clear set of goals. Good luck

Skeptical Scalpel said...

Erik, thanks for your thoughtful comments. I think they will be helpful to our applicant.

Anonymous said...

Hi Dr. SS, its drmuchoguesto. Quick question, a USA MS who has borderline scores for ortho only has 2 interviews this yr. I recommended to him to do prelim yr and try to match next yr if it does not work out. He asked me if he applied last minute now to categorical spots for GS, can he switch after a yr or two doing GS? I said I don't really know, ill find out. Have you seen this happen before? Im assuming GS chairman would not be so thrilled to have a resident applying to another specialty yr after after, unless it was a prelim. Your thoughts are appreciated, Im pretty sure you have answered a similar question in the past. If you have a link, ill send it the MS. Thanks for your time.

Skeptical Scalpel said...

I don't recall answering a question like this before. Of course he can switch, and of course it will annoy the general surgery chair and program director.

What makes you and him think that marginal USMLE scores will be looked upon more favorably by gen surgery programs?

I don't know enough about the situation in ortho these days, but since it is still quite competitive, I'm not sure how doing a year or two of gen surgery will 1) improve his USMLE scores or 2) somehow make him more attractive to ortho programs.

I see no harm in trying. The worst case scenario is that he will end up in a gen surg prelim spot either via the match or after.

Anonymous said...

Its, drmuchogusto. I understand, makes sense. I did mention that to him that applying late for cat GS with marginal scores would look suspicious. I agree with you. Thanks for your feedback.

Post a Comment

Note: Only a member of this blog may post a comment.