Thursday, April 14, 2016

FAQs from IMGs about applying for surgery training

Here are some of my responses to common questions from international medical graduates (IMGs) looking to match in categorical general surgery residency programs.

1. Which programs should I apply to?

You should apply to a number of second and third tier programs, especially if you USMLE Step 1 scores are not outstanding.

2. What would you consider second and third tier academic programs?

There is no short answer to this question. I suggest you go to Doximity’s residency navigator and look at their list of surgery programs. You should start at the bottom and work your way up. Doximity’s list is not perfect, but it is better than any other one I have looked at.

3. How much of a level playing field is the interview process?

I’m not sure what you mean by this question. The object is to get some interviews. Most programs will not waste their time interviewing people they have no interest in. If you are offered an interview, you should obviously make the best impression you can.

4. What about observerships?

My understanding is that residency programs require IMGs to have "hands-on" experience in American hospitals. Observerships do not offer hands-on experience and therefore would not be acceptable. Clinical experience rotations can be expensive. I am not aware of any data showing what the success rate is for IMG applicants who have done US clinical experience rotations, but you probably will not be interviewed if you have not done at least one such rotation.

5. Should I apply for a preliminary surgery position through the match?

You should make a list of at least 30 or 40 [some IMGs tell me they have applied to more than 100] categorical programs to apply for as soon as the application process starts. If you get 12-15 interviews, you probably have a decent chance of matching. If you only get a few interviews, you should have a backup list of programs to apply to so that you can get that number of interviews up to the minimum of 12-15.

You might consider applying for a prelim position if you apply to a number of categorical residency programs and don’t get many interviews.

There were about 450 unfilled surgery preliminary positions in the 2016 match. Google "NRMP advance data tables 2016" and look at table 7.

You really don't need to apply to one of these positions through the match. However, if you are worried that you won't match to a categorical spot, you may want to apply to match for a prelim one to be sure you have something.

Most program directors will interview just about anyone who applies for an undesignated [meaning not already matched or planning to be matched to a subspecialty program such as orthopedics, ENT, or urology].

Remember, obtaining a preliminary position is not necessarily going to lead to a categorical spot.

6. What about applying for categorical and prelim spots at the same institution?

Think twice about applying to categorical and prelim spots at the same time and the same institution. That is perceived by some as a lack of confidence.

You may want to apply only for categorical positions at first. If you get very few interviews, then you can apply for prelim spots which are much easier to obtain than categorical ones. You need not be so eager to get a prelim position until you see how the categorical programs respond to you applications.

7. Should I apply to internal medicine programs as a backup?

Applying to medicine is an option, but once you start an internal medicine residency you are not likely to be able to switch to general surgery. In other words, doing a medicine residency does not enhance your application to categorical surgery the next year or even if you do a full 3 years of IM.

However if during the application process you don't seem to be getting many interviews for categorical positions and you are reluctant to take a chance on a preliminary position, you may want to apply to internal medicine or family medicine programs and abandon the idea of becoming a general surgeon.


Anonymous said...

This is DrMuchoGusto, twitter.

I would like to add few points based on what Ive observed over the yrs. For an IMG seeking residency here in USA, I strongly recommend you come here and do research and an observership. I feel very strongly your ticket into a categorical spot is NOT the fact you did research/observership. The point of doing both are to find a mentor! A mentor who can see your work ethic, listen to your clinical judgement, and just see what kind of person you are to work with. This relationship with a mentor is extremely important and if this person can vouch for you, I feel strongly you can find a spot. Other than that, I have seen people with strong scores and you won't believe some have completed a residency in their home country. Sometimes though your accomplishments are not seen or heard about simply because I hate to say it..but maybe your application will be looked at last. So go some where that gives opportunities to IMGs, work your butt off. Last, they want new graduates or people who recently did training in their country with all usmle's done! If you are out of this game for 10 yrs, its a tough road, but I never say never to anyone. Last, I find a lot students skip steps. A lot of IMGs will do an observership or research without having completed step 1 and step 2. This is no, no. Pls finish your steps, do well, then find opportunities. How can someone help you, if you have not completed your boards. In addition, if you are Caribbean, sometimes students do rotations in hospitals no one has ever heard of. Find an elective in a nice academic program, work hard, get a nice letter. You be surprised who knows each other, but if you are rotating in a non-academic hosp w no res program, then who will know your attending. Wishing everyone all the best!

Skeptical Scalpel said...

Good points as usual from my loyal reader Dr. Much Gusto. I had not thought about research and the value of a mentor. That strategy might work for a few. The problem is that there aren't enough research jobs and mentors for the thousands of IMGs looking for residency positions.

Anonymous said...

This is DrMuchoGusto, twitter.

That's true Dr SS. It's definitely a challenge to find research work or a mentor. How bad you want it, thats what it comes down too. You might have to work for free and work part time somewhere else. At univ of miami there are quite a few jobs in various depts (med, peds, surg), but they all want someone with a molecular biology background (Southern blots, elisa). Unfortunately, I do not see any advantage to doing an observership. I know people say they want students with some USA experience, but a letter from someone saying you just watched for a month is not going to get the foot in the door. Plus, the expense of doing an observership, most places charge couple thousand dollars. So I really believe students have to make extra effort and make sure someone gets to know them somehow. Who has the time for that, so thats why I say if you can research and an observership in the same place, you have better chance of someone getting to know you. That's how hard it is, this path. Otherwise, the other option is to pursue a PHD, get to know people, take all your usmle exams, then apply. This road is quite long and if you have a family or kids, Im not sure if it is wise. There are better options in my opinion if you have a family, pursuing PA school, nursing, etc. The time it takes to prove yourself and then actually complete training, its too long. I found something..I have no affiliation with this program, but look at the cost for an observership at mass general: 20 working days = 7,200!

Skeptical Scalpel said...

Thanks for your follow-up comments and the interesting info about The MGH. $7200 for 20 working days. That's $360 per day. [Well after all, it is The MGH.]

I think I'll start an observership here at the Skeptical Scalpel Institute.

Anonymous said...

SS, did you ever have IMG's under your supervision? If so, what was the experience like?

Skeptical Scalpel said...

Good question. I've trained many IMGs. Like graduates of US med schools, some IMGs were excellent, some were dreadful, and some were in between. Selecting residents is a crapshoot. All you can do is try to guess which applicants have what it takes and hope you get lucky in the match.

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