Weird situation/Step 3 eligibility question

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Ok guys, I have a weird situation that I'll explain (briefly) below, and then I have a question about when I can take Step 3:

I started at a US allopathic school in 2005 and I successfully completed my first two years and passed Step 1. I got two core rotations done (Surgery and FM) when I had a serious personal/family issue come up that required me to take an extended leave of absence, and eventually withdraw. (In addition, I was having what I now call my "early-life crisis" where I wasn't sure that practicing medicine was what I wanted to do with my life after all.) I spent a few years in the wilderness working odd jobs and contemplating law school, and eventually I decided that returning to med school was what I wanted to do. I looked for (and found) the most cost-effective Caribbean school that could facilitate me completing my degree in the city where I lived. I started back up with rotations in March of this year, and I will barely make the 2013 Match. I'll have 6 weeks to take off for Step 2 studying (which I'm taking at the end of July) and then doing rotations back to back will see me graduate on June 14th, 2013. Just in time to start a residency two weeks later. ;-)

Now, my question is this: I took Step 1 a long time ago, on June 15th, 2007. I know that most states require you to take and pass all three steps within 7 years, meaning that I must take/pass Step 3 by June 15, 2014. However, I also see that most states, including the ones where I would really like to do residency, require you to have completed at least one year in an ACGMC-approved residency before you can take Step 3. For me, that math won't work out... I'll be completing my first year of residency around the end of June 2014, but I need to take Step 3 by June 15th, 2014. So, my three-pronged question is:

1) Am I limited to doing residency only in a state that lets me take Step 3 before I've completed 12 months in residency?

2) Would there be any way to get permission to take Step 3 earlier? Would that be something that a state medical board would have to approve, and if so, would they be likely to do it?

3) I have read in a few forum posts that you can take Step 3 (or at least register for it) in whatever state you want, even if you don't live there and are doing your residency elsewhere. So, if I were doing my residency in a state with strict Step 3 eligibility rules, could I take it in a state with no rules at all, thus allowing me to pass it within my 7 year window? Would there be any problems with doing it that way?

I know that's a lot to put in one post, but thanks for reading it and I'd appreciate any insight you may have!

http://www.fsmb.org/usmle_requirementschart.html

For the COMLEX, you just have to had graduated. Most people I know took it during, not after, their intern year. I would assume it is the same for USMLE. You can't get a full license until an intern year is completed.

That is what I thought too, but as you can see from the link I posted above, some states have very strict rules. For example, in Missouri if you are a foreign medical grad, this is the requirement:

Three (3) years ACGME approved program, completed or in the process of completing the 3rd year before applying.

Bump.

You can register for step 3 in any state you want, doesn't have to be the one you do residency in. I took mine in California and I'm doing residency in Illinois.

Originally Posted by arielred

You can register for step 3 in any state you want, doesn't have to be the one you do residency in. I took mine in California and I'm doing residency in Illinois.

Exactly. Even if you meet the stricter requirements you might as well register in a state with less because there is less paperwork. You don't have to go to the state you register in.

Originally Posted by yoda32

Ok guys, I have a weird situation that I'll explain (briefly) below, and then I have a question about when I can take Step 3:

I started at a US allopathic school in 2005 and I successfully completed my first two years and passed Step 1. I got two core rotations done (Surgery and FM) when I had a serious personal/family issue come up that required me to take an extended leave of absence, and eventually withdraw. (In addition, I was having what I now call my "early-life crisis" where I wasn't sure that practicing medicine was what I wanted to do with my life after all.) I spent a few years in the wilderness working odd jobs and contemplating law school, and eventually I decided that returning to med school was what I wanted to do. I looked for (and found) the most cost-effective Caribbean school that could facilitate me completing my degree in the city where I lived. I started back up with rotations in March of this year, and I will barely make the 2013 Match. I'll have 6 weeks to take off for Step 2 studying (which I'm taking at the end of July) and then doing rotations back to back will see me graduate on June 14th, 2013. Just in time to start a residency two weeks later. ;-)

Now, my question is this: I took Step 1 a long time ago, on June 15th, 2007. I know that most states require you to take and pass all three steps within 7 years, meaning that I must take/pass Step 3 by June 15, 2014. However, I also see that most states, including the ones where I would really like to do residency, require you to have completed at least one year in an ACGMC-approved residency before you can take Step 3. For me, that math won't work out... I'll be completing my first year of residency around the end of June 2014, but I need to take Step 3 by June 15th, 2014. So, my three-pronged question is:

1) Am I limited to doing residency only in a state that lets me take Step 3 before I've completed 12 months in residency?

2) Would there be any way to get permission to take Step 3 earlier? Would that be something that a state medical board would have to approve, and if so, would they be likely to do it?

3) I have read in a few forum posts that you can take Step 3 (or at least register for it) in whatever state you want, even if you don't live there and are doing your residency elsewhere. So, if I were doing my residency in a state with strict Step 3 eligibility rules, could I take it in a state with no rules at all, thus allowing me to pass it within my 7 year window? Would there be any problems with doing it that way?

I know that's a lot to put in one post, but thanks for reading it and I'd appreciate any insight you may have!

http://www.fsmb.org/usmle_requirementschart.html

A few points:

1. You can register for the Step 3 in any state that you want, and you can take it wherever you want despite whatever state you registered in. Go ahead and register in Connecticut. I registered there and took Step 3 in Louisiana. It takes about a month of so from start to finish. You can only register for Step 3 after completing medical school.

2. I doubt you will start residency in July 2013. You will be graduating as a FMG. It takes time to get your training permit granted, etc. I just got my training permit granted, and it took at least 2 months of paperwork. In our state, FMGs have to make a "personal appearance", etc, to even get the training permit.

3. You need to be realistic too. Please don't be offended by this, but a reality check may be needed, as well as a backup plan. It's going to be harder than you think to get interviews and get a residency position, considering that you have such a massive gap, and that "in between" you had no medical exposure whatsoever. It's almost like you didn't goto medical school, and only finished up some rotations in a hospital. Every year it's harder for FMGs to get interviews and residency spots. When you are stacked up against other FMGs who did not have a 5-6 year gap, who stayed at one school, etc, you will simply be less competitive than them. And with your schedule requirements (ie, 2 weeks between graduating and wanting to start residency), you're going to ask a residency program to take an uncompetitive applicant and then make a special exception for them to start later than everyone else. The most unwanted thing in a residency program is an off-cycle resident.

4. It would benefit your application greatly if you could pass Step 3 before applying to residency positions, but with your time line it is not possible to do that.

5. In all honesty, again, starting residency July 2013 just seems impossible for you. Just be prepared for this. When you graduate, even if you don't start residency, you could at least take your Step 3 ASAP and get that out of the way so that you have all your boards passed within that 7 year window.

6. Start looking for any and every connection you have. You may need to pull strings to get interviews.

7. Be fully aware that a Caribbean MD will barely get you any job in the real world. You could maybe be a teacher at a small college if you have connections, or possibly some type of research, etc, but there is almost nothing out there. So honestly if you can, try to be looking out for alternate careers while you are doing your rotations.

8. Will your school actually "graduate" you on June 16th? Our school only did graduations once or twice a year. For your timeline, honestly, it'd be better if you filled in that 6 week gap that you have off to study for Step 2, and finished your rotations at the end of April 2013.

9. I hope this didn't offend, I really just wanted to share this with you because I know all of this to be true, because I was in a somewhat similar situation (2 years off after finishing med school - I applied to like 200 programs, granted 2 interviews, got in my top choice. As for as your Carib MD and non-doctor jobs, I applied for over 500 other jobs and got 1 interview only because I pulled strings. I have a VERY LONG LIST of people who are going to be begging me to buy their product that I'm going to kindly let them know to **** off. )

10. Good luck. Just don't bank it all on a belief that you're easily going to slip into a residency program once you graduate. Don't go broke, don't pass up any good job opportunities, etc. There are much more competitive people sitting unmatched each year than you.

2. I doubt you will start residency in July 2013. You will be graduating as a FMG. It takes time to get your training permit granted, etc. I just got my training permit granted, and it took at least 2 months of paperwork. In our state, FMGs have to make a "personal appearance", etc, to even get the training permit.

Can you, or anyone else for that matter, expand on this comment? I've explained my timeline to my school and they seem to think it is doable. What is a "training permit"? Is it different in every state?

Re: finding a residency spot, I am well aware that I face an uphill battle. However, I am only shooting for Family Medicine, and I would be willing to move anywhere in the country if necessary. Don't you think I would be able to find SOMETHING, SOMEWHERE? It's my understanding that the FM fill rate is around 90% to 95% each year... Doesn't this mean that there are unfilled residency positions each year? And if so, doesn't that mean that if FM is your desired specialty, and you're willing to move, you can find a spot?

Originally Posted by yoda32

2. I doubt you will start residency in July 2013. You will be graduating as a FMG. It takes time to get your training permit granted, etc. I just got my training permit granted, and it took at least 2 months of paperwork. In our state, FMGs have to make a "personal appearance", etc, to even get the training permit.

Can you, or anyone else for that matter, expand on this comment? I've explained my timeline to my school and they seem to think it is doable. What is a "training permit"? Is it different in every state?

Re: finding a residency spot, I am well aware that I face an uphill battle. However, I am only shooting for Family Medicine, and I would be willing to move anywhere in the country if necessary. Don't you think I would be able to find SOMETHING, SOMEWHERE? It's my understanding that the FM fill rate is around 90% to 95% each year... Doesn't this mean that there are unfilled residency positions each year? And if so, doesn't that mean that if FM is your desired specialty, and you're willing to move, you can find a spot?

re: training permit - in our state, for a (at least FMG/IMG) resident to start, they have to undergo a criminal background check, get fingerprints, fill out tons of paperwork, and bring original copies of your diploma and ECFMG certificate to be evaluated by a specific designated doctor in your area. Most of the paperwork is done by civil servants so there is nothing done expediently. Mine was finished as a week or so ago, and it started very soon after match date, in mid-March. None of it is optional, and it all has to be completed before you start. Sometimes some exceptions could be made, perhaps if the background check was taking too long (mine took over 2 months), they could possibly excuse it and give a temporary approval pending the background check clearance. My medical school played very little role in any of this, they only had to send one certified form somewhere. I was lucky at my resident program to have a fantastic HR person help all of this go as smoothly as possible.

I imagine the process is different in most states, but I can't imagine that it's much faster. There is a lot of paperwork that needs to be done before you start cutting on patients and writing prescriptions and all of that.

Have you given any thought to giving up that six weeks of Step 2 study time in order to do rotations so you can finish 6 weeks earlier? You could schedule an easy rotation during that time period.

re: unfilled spots - yes, many spots go unfilled, but they get filled. Fast. I think almost every FM program in our state had openings at the end of the match, but they all filled up almost instantly. Our unfilled spot when to a US grad who didn't match into a more competitive residency. I followed the SOAP (used to be "scramble") threads closely this year because I was concerned that I'd have to participate. Apparently the process is brutal for FMGs. It almost seemed like the post-match SOAP process was all for US grads (which is perfectly fine - our programs should fill preferentially with US students.)

The difficulty with saying "I'll move anywhere" is that you have to apply everywhere. I'm talking over $10,000 in application fees and you still won't blanket the US in apps. But keep in mind that getting an interview isn't an odds thing in the sense of "If I pick a number between 1 and 100, after 99 tries I'll get it no matter what." For interviews, each residency program is a new set of odds, so if you're not competitive at one, that doesn't make you more competitive at another. It just makes you not as competitive at another.

I suppose that it's possible that some FP programs simply don't fill, and perhaps they don't grant visas so foreign IMGs can't go there, and that would be a good option because you don't need a visa. There is a service called residencyswap.com that you can sign up for that will alert you to open residency positions. They also maintain a list of unfilled residency positions. I signed up for it after I had completed all my steps and was waiting for match date, because just in case I didn't match I'd have something.

PM me and I can tell you the name of a good university-associated FP program that seems to get uncompetitive applicants, and has matched someone from a USA school who was 5+ years out of school doing real estate and otherwise matches primarily FMGs. The program is just fine, it's just in a crummy city that most people would rather not live in.

Again I am not trying to be a Negative Nancy. I just wanted to give you an absolutely real answer.

Originally Posted by yoda32

Can you, or anyone else for that matter, expand on this comment? I've explained my timeline to my school and they seem to think it is doable.

Regardless of that, you NEED to be ECFMG certified before starting residency. This takes between 4-8 weeks. There is no way you can start a residency if you graduate 2 weeks beforehand.

Is ECFMG certification different from ECFMG verification? The guy posting in this thread seems to think so:

http://www.valuemd.com/residency-mat...ification.html

However, based on other forum posts I've read, I don't think he is correct... Also, it looks like some people report being able to get thier certification in 1-2 weeks:

http://www.valuemd.com/residency-mat...tion-help.html

That thread also indicates that some programs are willing to work with you if you are waiting on your certificate (i.e., by taking your vacation time up front while you wait). I hope that is true... In any event, I intend to try and make something work. It is too late for me to rethink taking 6 weeks off to study for Step 2 CK, as I'm already doing it (exam date is July 30th). And anyway, I'm hoping that a good score on CK will help make up for some of my application's other shortcomings. Based on what I've read, there seems to definitely be programs that won't rank you if you don't have your ECFMG certificate in your hand, and obviously these programs would be unattainable for me. However, it also seems like there are programs that are more flexible, so I'm hoping I can make something work with one of them.

Thanks for the info LD, I'll PM you about that program you were talking about.

Originally Posted by yoda32

Is ECFMG certification different from ECFMG verification? The guy posting in this thread seems to think so:

http://www.valuemd.com/residency-mat...ification.html

However, based on other forum posts I've read, I don't think he is correct... Also, it looks like some people report being able to get thier certification in 1-2 weeks:

http://www.valuemd.com/residency-mat...tion-help.html

That thread also indicates that some programs are willing to work with you if you are waiting on your certificate (i.e., by taking your vacation time up front while you wait). I hope that is true... In any event, I intend to try and make something work. It is too late for me to rethink taking 6 weeks off to study for Step 2 CK, as I'm already doing it (exam date is July 30th). And anyway, I'm hoping that a good score on CK will help make up for some of my application's other shortcomings. Based on what I've read, there seems to definitely be programs that won't rank you if you don't have your ECFMG certificate in your hand, and obviously these programs would be unattainable for me. However, it also seems like there are programs that are more flexible, so I'm hoping I can make something work with one of them.

Thanks for the info LD, I'll PM you about that program you were talking about.

The poster is correct that there is a difference between ECFMG verified and certified.

You cannot be ECFMG *certified* until you graduate. You get your certificate after passing Step 1, and Step 2 CK & CS, and graduating from school. So traditional (people without time gaps) FMG students are not ECFMG certified at the time of applying for interviews, or at the time of matching.

What most programs are talking about for applying for interviews and matching is ECFMG verification (even if they say certified, they mean verified - if a program wanted a certified FMG then they would only be inviting FMGs who graduated the year prior, which obviously are not ideal candidates.) Verification means that you have passed Step 1, and Step 2 CK& CS, but have not yet graduated. Programs do not know your verification status. They only see your Step scores. Verification comes into play during the match. If you apply to programs, get interviews, etc, if you are not ECFMG verified, then you are removed from the match. There's a little bit of text that pops up on the Rank List screen that says "ECFMG verified" or "Not ECFMG verified." So even if a program wants you, and ranks you 1st on their list, if you haven't passed your Step 1 and 2 CK CS then you are automatically removed from the list.

Bottom line:

ECFMG verified = Passed Step 1, Step 2 CK CS
ECFMG certified = Passed Step 1, Step 2 CK CS + Graduated

I think my ECFMG certification only took a couple of weeks. But still - that is only 1 small part of the puzzle. There is so much other paperwork that takes weeks or months to complete. I hope you can figure out someway to make this all work for you.

In the event that I can't make it work out, and therefore don't match, what are my options then? Could I do an externship? Are those paid? (I have a wife with a kid on the way, and I REALLY need to do something next year that will bring in some income...)
Thoughts?

Originally Posted by yoda32

In the event that I can't make it work out, and therefore don't match, what are my options then? Could I do an externship? Are those paid? (I have a wife with a kid on the way, and I REALLY need to do something next year that will bring in some income...)
Thoughts?

No, I do not believe externships are paid. In fact, you have to pay to go on some externships/observerships. I'm sure many are free, but they are most likely not going to pay you, because you technically don't have any qualifications (legally - you know what I mean.)

You could try teaching. Ie, as a lab instructor at your local small college or trade school, or as an instructor at a massage therapy, etc, type school. Sometimes they have job offers on this forum for research positions, which wouldn't be bad. Or you can do menial work at a doctor's office and get to observe some stuff in the interim.

The job market is rough as hell.

This forum also has a place where they post available PGY-1 positions, and the residentswap.com, and also if you google "find a resident" I think the NRMP or whomever runs a service to help find PGY1 positions. Also, since some PGY1 availabilities aren't advertised, residentswap.com has a service that will email basically every program in the country and ask them about open positions. It's expensive as hell, but, hey, who knows.

Originally Posted by yoda32

Ok guys, I have a weird situation that I'll explain (briefly) below, and then I have a question about when I can take Step 3:

I started at a US allopathic school in 2005 and I successfully completed my first two years and passed Step 1. I got two core rotations done (Surgery and FM) when I had a serious personal/family issue come up that required me to take an extended leave of absence, and eventually withdraw. (In addition, I was having what I now call my "early-life crisis" where I wasn't sure that practicing medicine was what I wanted to do with my life after all.) I spent a few years in the wilderness working odd jobs and contemplating law school, and eventually I decided that returning to med school was what I wanted to do. I looked for (and found) the most cost-effective Caribbean school that could facilitate me completing my degree in the city where I lived. I started back up with rotations in March of this year, and I will barely make the 2013 Match. I'll have 6 weeks to take off for Step 2 studying (which I'm taking at the end of July) and then doing rotations back to back will see me graduate on June 14th, 2013. Just in time to start a residency two weeks later. ;-)

Now, my question is this: I took Step 1 a long time ago, on June 15th, 2007. I know that most states require you to take and pass all three steps within 7 years, meaning that I must take/pass Step 3 by June 15, 2014. However, I also see that most states, including the ones where I would really like to do residency, require you to have completed at least one year in an ACGMC-approved residency before you can take Step 3. For me, that math won't work out... I'll be completing my first year of residency around the end of June 2014, but I need to take Step 3 by June 15th, 2014. So, my three-pronged question is:

1) Am I limited to doing residency only in a state that lets me take Step 3 before I've completed 12 months in residency?

2) Would there be any way to get permission to take Step 3 earlier? Would that be something that a state medical board would have to approve, and if so, would they be likely to do it?

3) I have read in a few forum posts that you can take Step 3 (or at least register for it) in whatever state you want, even if you don't live there and are doing your residency elsewhere. So, if I were doing my residency in a state with strict Step 3 eligibility rules, could I take it in a state with no rules at all, thus allowing me to pass it within my 7 year window? Would there be any problems with doing it that way?

I know that's a lot to put in one post, but thanks for reading it and I'd appreciate any insight you may have!

http://www.fsmb.org/usmle_requirementschart.html

Originally Posted by yoda32

In the event that I can't make it work out, and therefore don't match, what are my options then? Could I do an externship? Are those paid? (I have a wife with a kid on the way, and I REALLY need to do something next year that will bring in some income...)
Thoughts?

http://www.fsmb.org/usmle_eliinitial.html

A potential wrinkle is that you may be limited to applying for residency only to states that have a longer than seven year limit on completing all steps, as even if you were to register in a state that does not have a time limit, where your residency is located will have a bearing as to whether you can even be licensed in that state that you are training in.

If you can't be licensed in your training state, there's little chance of moonlighting, much less practicing, there. Doesn't look promising.

I'll be able to get Step 3 done within the 7 year window, as long as I don't have to wait until after my intern year to take it. That was the point of this post... I was asking if I can register in a state without eligibility rules (i.e. Connecticut) so I could take Step 3 in the middle of my intern year, rather than having to wait until it was over to take it. My date to have Step 3 passed is June 15th, 2014. So, if my intern year had to be completed before I could sit for the exam, I wouldn't make it. However, if I can take the exam in the middle of my intern year, say around December or January, then I'll make the deadline. Right? I'm not missing something am I?

Originally Posted by yoda32

I'll be able to get Step 3 done within the 7 year window, as long as I don't have to wait until after my intern year to take it. That was the point of this post... I was asking if I can register in a state without eligibility rules (i.e. Connecticut) so I could take Step 3 in the middle of my intern year, rather than having to wait until it was over to take it. My date to have Step 3 passed is June 15th, 2014. So, if my intern year had to be completed before I could sit for the exam, I wouldn't make it. However, if I can take the exam in the middle of my intern year, say around December or January, then I'll make the deadline. Right? I'm not missing something am I?

No, you are not missing anything. You can register for the exam as soon as you finish med school. Just have it completed and passed before that 7 year window.