I posted this under different forum as well but this looks like more relevent forum. I've few questions including changing speciality:

My wife recently passed her Step 2 ck. She got 99 in both step 1 and step 2 and scheduled to have her CS in few weeks. She does not have US clinical experience but have sufficient number letters of recommendation from her previous work as Ob/gyn and school abroad.

She now wants to pursue internal medicine as it seems most appealing to her under present circumstances as career choice.

We live in Washington DC area and would like very much to stay in this area so basically are looking for residency program here. So far 3 institutes stand out as the choice: George Washington Univ, Georgetown, Washington Univ Hospital. Howard and Providence are later on the list if nothing else works.

If she gets residency somewhere else then I'd have to quit my job and we'd have to sell our condo and move--obviously least desired situation--specially since we've an 8 months old baby and I will have to cut-down my working hours when my wife starts residency and DC area seem like pretty good area to offer more flexibility in those terms in my field.

My questions are these:

1. She is going to switch from being an Ob/gyn to IM resident. Is that going to be a problem? Is this something considered totally NO NO or under certain circumstances it's ok?

2. What do you think, in your opinion, are her chances at GWU, Georgetown, WUH? I read around here somewhere that there are very few IMGs at these institutions.

3. How about Howard and Providence? How would you rate them?

4. If we have to move out and I've to quit my job and find somewhere else (I'm a software engineer) then John Hopkins is our next choice. What success factors count there?

Thanks in advance for any opinions, guidance, comments, suggestions.

Pple say Step Scores aren't everything. SO many factors come in. For somebody who wants to limit herself to a geographical location then US Clinical Experience is a must. Maybe an observership can get her some American Letters of Recommendations.
Though she may have great Letters from her xtry...from what I understand this foreign letters don't help much. And I am in doubt if an Intl Figure in OG from the foreign xtry will do magic for Internal medicine.
What about research?
What I have learned on this board is that no matter what there is a chance but in reality the more u limit yourself then it becomes more difficult. For example don't forget that Hopkins for instance a lot of Americans with diuble 99 are also applying and those being chosen are those with great research and pub, great letters from American Doctors, strong clinical grades, and with no gap in their med education. So avoid being picky Howard vrs GW.

anyway I am no authority on this issue. But this is what I learnt over the years from different forums

Thanks Robinho. Makes sense.

Johns Hopkins - very unlikely she could get in as an IMG. It is very, very hard to get in to even for US grads. Also, it's a pretty brutal residency from what I've heard, and I don't think I'd personally want to go through that residency with a small child, unless she has some compelling reason for wanting to go there. also, very specialist driven. It's in a rough/dangerous neighborhood as well. There are a lot of smart people there.

GWU and Georgetown - I interviewed at both about 5 years ago. My impression was that Georgetown was a little academically stronger in terms of the residents, but that the hospital was pretty old and run down, and there seemed to be some malignancy and morale problems (may be better now, though). They did have at least one British IMG that I recall meeting. Would think that one might do slightly better in the fellowship/specialty match later by going to Georgetown vs. GWU, but I don't have absolute proof of that. Traditionally, years ago, Georgetown was a hospital with a pretty good academic reputation, and a famous cardiology department, but fell on hard times in recent years (particularly financially). Not sure what the current situation is.

GWU was a small hospital, but new with great technology. They were giving all the residents PDA's to us. The residents seemed happy, though not overly passionate about being doctors, in my opinion. They did seem laid back, which could be a good thing given you and your wife have a young child and she may not want to get herself ground in to the ground as an "intern", particularly as it sounds like she's already BEEN an intern of some kind in the past, in OB/Gyn. GWU apparently sees quite a few international type patients, plus travelers. As I remember several years ago they did have several IMG's, including somebody from one of the Caribbean medical schools that people from the US often attend if they can't find a spot in a US med school. I do remember them saying at the interview that they do take IMG's, so that might be a good bet for her. The hospital is right by the subway and is easy to get to from anywhere in the DC area.

I don't think that switching from OB/Gyn to internal medicine per se will be a problem. The big wild card is being an IMG. You don't tell us what country IMG your wife is, or how much clinical experience she had in her home country. If she's a British IMG with an internship-type experience under her belt, that may be looked upon more favorably than a Caribbean grad US citizen, though I have no proof of that. The higher test scores should be helpful.

If I were your wife I'd go ahead and throw out some applications this year (still plenty of time...just get them in around beginning of November or so), even without the US clinical experience. It doesn't really cost that much to apply. I doubt most of the US med students and residents on here could tell you how much the US clinical experience is critical vs. not for her application. A medicine program director might be able to. It would probably be OK to send a short email and/or phone message to the program directors at Georgetown and GWU for internal medicine, just to ask them whether they will consider an application from an IMG with 99 USMLE scores, from medical school X in country X. The worst they can do is be noncommittal.

As a foreign medical graduate, you have to take what you can get. University programs in Internal Medicine are competitive. There's tons of FMG's out there with 99/99 board scores who fail to get anything better than Family Medicine at a community program. The fact that your wife did OB/GYN before will not adversely affect her; this is very common. Anyway, you need to be realistic and apply to a broad range of Internal Medicine program all over the country, including a number of community of programs. Focus on ones that actually take FMG's.

If I were your wife I'd go ahead and throw out some applications this year (still plenty of time...just get them in around beginning of November or so), even without the US clinical experience. It doesn't really cost that much to apply. I doubt most of the US med students and residents on here could tell you how much the US clinical experience is critical vs. not for her application. A medicine program director might be able to. It would probably be OK to send a short email and/or phone message to the program directors at Georgetown and GWU for internal medicine, just to ask them whether they will consider an application from an IMG with 99 USMLE scores, from medical school X in country X. The worst they can do is be noncommittal.

I wouldn't go "throwing out" applications. When you apply, make sure you apply right, with 100% effort. Because re-applicants aren't looked upon all that favorably. I saw several chumps this year making their 3rd or 4th rounds of the interview circuit for Internal Medicine. Your best chance of matching is going to be on your first time around, so make sure you get it right. Take Step 3, do your externships or whatever, get your letters, and then apply.

I switched from Psych to IM as an IMG (i was still in psych rsidency when I applied to IM). I did interview with GW at the time and saw many IMGs. I don't if I would have matched there cause I matched somewhere I ranked higher than them. The Sinai Hospital of Baltimore has a lot of IMGs as well.

Thanks all! Very useful information and comments. I appreciate a lot your time and effort in responding. :thumbup:

What I've sensed so far from various places on the net including this one is that one must not narrow down his/her choice of programs to apply. Always apply broadly. Even NRMP site suggests that. We do intend to apply broadly it's just that our first choice is definitely going to be DC area, be it a community hospital or any other.

My wife graduated from Pakistan and has worked as OB/Gyn couple of years post-residency/clerkship in her country before she migrated to US after marriage. I also DO THINK that changing specialty should not be a problem--I think it depends on how you pitch it. If you look like your commitment to IM specialty is circumstances-driven or you are not too serious and might have applied to other specialties then no program director is going to consider you.

Which brings me to the next question: How do you pitch it if you are changing from Ob/gyn to IM specialy? Any cues or ideas will be greatly appreciated.

My wife since the start of this thread got an externership in a healthcenter so that should help to some level.

It sounds like your wife should have a good chance to get in somewhere.
I would just pitch it as liking the "problem solving" and patient managment aspects of patient care. I would mention having worked as a physician in her home country (helps separate her from some applicants who have only done med school and don't really have clinical experience). She'll probably get asked in the interview why she decided to ditch OB and do IM instead, but I don't think it's such a big deal. The big deal is to make her application look good enough on paper, and send enough applications that she will get enough interviews to get in. I would think that getting at least 1, preferably 2, excellent letters of recommendation from US doctors would be very helpful. After that, just don't act weird at interviews and show that she speaks English well. The not acting weird part isn't hard if you are a reasonable person. Internal med they are looking for several interns each year so it isn't like derm or urology where they are looking for reasons to throw your application away, even if you get to the interview.

Thanks! 'appreciate your time and help!