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FAQs for IMGs wanting to match into top psychiatry programs

Discussion in 'Psychiatry' started by splik, 03.16.12.

  1. splik

    splik

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    We get so many threads asking the same questions, usually answered by people who don’t really know what they’re talking about that I thought I would answer some of these questions from the perspective of an FMG who was applying to academic programs. This thread is more useful for those applying to the major academic centers (as that is what my experience is of) but may be useful for others. It is not aimed at Caribbean students (which is a whole different ball game, or FMGs who are many years out of medical school). Please do not PM me unless you have a private question that cannot be answered here or I will delete it.
  2. splik

    splik

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    Your Step 1 USMLE score is the most important part of your application. It will not make up for other deficiencies, but Step 1 scores are more important for IMGs than they are for US students. For many programs the vast majority of applicants are IMGs and a good way of filtering down the numbers is to have an arbitrary cut off. Do not expect to get (m)any interviews with a Step 1 Score less than 200. There are many IMGs who are scoring >240 and a fair few scoring >250 for psychiatry so an average score will not necessarily cut it at the top programs.

    It is usually mid-tier places that care about score more than the top programs, although at places like MGH, Columbia, Cornell you really do need to have scored >240 unless you have connections and a significant publication record.

    However all is not lost. I scored below average for psychiatry applicants on Step 1 and still managed to get interviews at top places. However, I was also filtered out of places that I should have otherwise got interviews from.

    Different programs have different criteria. Some programs such as WPIC will place more emphasis on Step 2 score for IMGs. Others will look at all your scores and choose the best one. Try and have step 3 at the time of applying, however don’t worry too much about this, but it is important to get it in before rank lists are due if possible. A pass is all that matters for Step 3.

    Passing step 2 CS first time is very important. It is a big red flag if you don’t but again the willingness to overlook failure varies from program to program.

    I strongly advise all IMGs to take step 1, 2 ck, and 2cs and have results back before Sep 15th (i.e. take all exams no later than June of the year of application). However if you are still waiting for results do not wait to submit your application. Do NOT wait for ECFMG certification to apply.
  3. splik

    splik

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    After board scores, clinical experience is very important. The best type of clinical experience are electives at US medical schools taken as a student. You will significantly limit the number of interviews you get without this. It is important to get strong letters of recommendation from attendings on these elective rotations. Appear keen and diligent, do extra reading, look for opportunities to publish case reports, enquire about possibilities of co-authoring review articles or getting involved with research. Keep in touch with the attendings as they will be able to help you get interviews later on.

    Observerships or externships are completed after medical school and essentially involve shadowing attendings/residents and learning about the US system. These are not nearly as helpful as they do not allow you to show your clinical skills though if this all that is available to you, then you must make the most of it by interviewing patients, presenting your findings, reading up on cases, offering to do presentations, and try and get involved in research/writing papers if possible.

    Actual clinical working experience, as a medical student or doctor in the UK, Canada, Australia, or Israel is sometimes viewed as equivalent to US experience. This varies from place to place.
  4. splik

    splik

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    You should have at least one, and preferably 2 letters of recommendation from US psychiatrists. US letters tend to be written in the most embellished language ‘Dr x was the best student I ever had and will no doubt become the leading psychiatrist of his generation’ – so be careful. You should have 1 letter from Internal Medicine, and it is fine to have letters from your home country or other countries as long as they are written in good English, and again go in to detail about how you are the best thing since sliced bread. In US terms good=bad, very good = satisfactory, excellent = good, outstanding = very good, exceptional = excellent. So it will come across negatively if your letter reads ‘Dr x is a good clinician, whose attendance and punctuality were satisfactory. I have no concerns about his professional behavior’ etc. Even though that may be standard in the rest of the world.

    Ask between 4-5 people for letters (you need 3) as it is frustrating trying to get letters from busy people so if you find someone does not do it, you should still have enough.
  5. splik

    splik

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    A bad personal statement will lead to a rejection, but a great personal statement will not necessarily lead to acceptance. Keep it short (500-600 words no more) and simple. Boring isn’t necessarily bad. Just explain why you are interested in a career in psychiatry, why you have come to the US, what you hope to achieve, what you are looking for in a residency program, and what a program can expect from you. Come across as motivated, passionate, and committed to becoming a psychiatrist and training in the US.

    Get someone to look over it, especially if your English is not very good. Poor spelling, grammar, punctuation, syntax, or bizarre idioms will look bad. For IMGs the personal statement is one marker of your communication skills.
    kagman likes this.
  6. splik

    splik

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    This is an essential component of your application. It usually does not matter for IMGs as most international schools do not do one following the AAMC guidelines and thus it is useless. The Dean’s Letter should contain a brief narrative statement of your educational, professional, and extracurricular achievements at medical school, and summarize your clinical rotations which must include internal medicine, general surgery, paediatrics, psychiatry (of course), obstetrics and gynecology, neurology, and family medicine. If you had grades for your clerkships these should be on here, including what proportion got As Bs Cs etc. It should mention any prizes or awards, and your class ranking. If your class ranking is poor then do not put this on! If your class ranking is good make sure you are listed as being in the top 10% or whatever.

    If you were an excellent medical student use the Dean’s Letter to highlight your accomplishments. If you were not, do not let your medical school put anything that makes you look bad on!
  7. splik

    splik

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    Not really. Obviously, all being equal, a program would prefer someone who is a US citizen or has GC/PR but needing a visa has not been an issue for myself or the other IMGs I know who have applied for psychiatry. Getting a J1 visa is straightforward and is sponsored by the ECFMG not the program. Getting an H1b visa is more complicated. University programs can apply for as many as they want, but community programs are subject to a national cap on H1B visas, meaning an application from a non-university affiliated community program is more likely to fail. Programs also are required to pay the costs of the visa and legal fees which may be offputting for some. But if they like you they will go out of your way to sponsor it. Psychiatry whilst becoming more competitive still requires IMGs (there are about 1100 positions and only 700 US allopathic applicants)

    If you are not getting interviews it is not because you need a visa, it is because you are not a good enough applicant for those programs.
  8. splik

    splik

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    Having connections is really helpful. If you have some people who know those at places you have applied it would be worth asking them to put a word in. Even if they don’t, it can still be helpful for them to get in touch and see what happens.

    Having people vouch for you, getting to know people who are important or influential etc is very important. It could be someone in your own country, or, more likely someone in the US. It may be key to getting interviews, and later on getting matched into a residency program.

    This may be something you have no control over. However electives are one way of make connections as are doing research fellowships, observerships and externships. Attending conferences (especially if you are presenting is another way). The Association of Academic Psychiatry conference will usually be attending by people in medical education including program directors and chairs and networking here could be a way to get yourself some interviews (if you make a good impression).
    kagman likes this.
  9. splik

    splik

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    You should only do an additional degree in the US (or anywhere) if you are actually interested in gaining that qualification, and not because you think it will improve your chances.

    Additional qualifications do not increase your chances of getting into residency. This is especially true if it is not a qualification at a top institution or is not clearly related to your career goals.

    Having something different and interesting in your application can be a useful talking point and distinguish you at interview – but that relies on you making the most of the opportunities. For example, doing an MPH could allow you to do some public mental health research, gain skills in biostatistics and epidemiology, and prepare you for an academic career. Alternatively you may gain skills in administration, policy, program planning and evaluation, advocacy which may be useful for community mental health. It is not the degree itself which is helpful, it is how you show that it is valuable to your career.
    kagman likes this.
  10. splik

    splik

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    A PhD or an extended period of time doing research in psychiatry or neuroscience at a major academic institution in the US (or Canada, UK, other European Countries, possibly even in Asia) can be helpful in getting a residency spot at a top academic institution. For example MGH, Columbia, UCSF, and Emory have IMGs who have PhDs or significant research experience which helped them secure their spot. Doing the PhD or research at the institution where you are most set on doing your residency is helpful. It depends also on what your research is on, how many publications you get, whether your PI is a big name in the field and likes you enough to write a strong letter and make calls on your behalf.

    However doing a PhD is hard and requires dedication and motivation and is far removed from clinical psychiatry. If you are not interested in an academic career do not even think of embarking down this long road.

    Research can also be harmful – it means more time away from clinical medicine, disuse atrophy of clinical skills, and you will face many questions about why you want to do a psychiatry residency. Some programs will worry about your ability to rejoin clinics. Thus having high USMLE scores and strong clinical skills and good communications skills are essential. A PhD will not usually compensate for these things. It is more likely to be harmful than helpful and only some academic centers will salivate over you.

    Also if you are on a visa you will not be able to apply for a T32 so some academic institutions will not be interested in training you in their research track.
  11. splik

    splik

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    There is no such a thing as an IMG Friendly program. Programs either have predominantly US students or they do not. This has nothing to do with how ‘friendly’ they are to IMGs. IMG friendly could mean many things anyway- the PD is an IMG, they sponsor H1 visas, they have many IMGs in the program, they actively recruit IMGs etc. The reality is most top programs want the best residents, they don’t care whether they are US allopathic students or FMGs. US students simply have a home advantage – knowing the system, trained to prepare for USMLEs, more opportunities available, more chances to do away rotations, have more people supporting their application, recognized training etc.

    There are some programs that have a higher proportion of IMGs such as Duke and Yale. This is not, despite what they might tell you, simply because they like having lots of IMGs. It is because they worry they will not fill if they do not. But clearly they do not have an issue with IMGs and reject US students for IMGs for interview each year.

    Apply everywhere you are interested, but be realistic. You are not going to match at MGH/McLean if you do not have any connections there. The two IMG residents at this program did research there beforehand. Same goes for Columbia etc.
  12. splik

    splik

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    Many programs will extend interviews for US seniors in the first instance. IMG interviews are offered later in the season. There are a number of exceptions to this, Duke being a prime example. Be patient.

    If you are still not hearing from places by the end of October/Beginning of November, it is time to start worrying. You can do a number of things:

    1. Have someone (ideally a well known or influential psychiatrist, but any psychiatrist will do) contact programs (either the PD or Chair) or your behalf. Perhaps the attendings you did your electives with know someone at the programs you applied? Even if it is not the PD they know, it can be helpful for them to contact that person and they may get in touch with the PD. Do not be shy to ask everyone you know to think if they know anyone they could contact on your behalf. You may be surprised.
    2. If you do not know anyone then it will not hurt to contact the programs yourself. This is less likely to be effective. Choose the programs you are most interested and write a brief email (no more than 150 words) stating why this program is a good fit for you and why you are a competitive applicant. If you don’t think you’re a competitive applicant (real or imagined) then you’re not helping yourself.
  13. splik

    splik

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    There’s not much you can do except try the tactics mentioned above – have someone contact on your behalf, or contact the PD and explain why you are a good fit. I got rejected from a program I was really interested and wrote an email to the PD and got an invite to interview and subsequently matched there! At interview it was clear it was not just a sympathy invite as they went to great lengths to woo me... sometimes IMGs get filtered out, or applications get missed.. you never know. Sometimes programs think you won’t be interested so no point in interviewing you (makes no sense – you applied but there you go) and an expression of interest can help.
  14. splik

    splik

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    Interviews are usually one-to-one and you will have between 3-8 interviews which can include the PD, associate PD, chair, various faculty, and residents. It can be exhausting.

    It should go without saying you should be polite, professional, well-groomed, and wear a suit (grey, charcoal, blue, or black) and a shirt (no patterns – white, light blue, pink), men should wear a tie (can be patterned, nothing humorous and please don’t be the idiot who wears a bowtie it’s not cute), and a decent pair of shoes that at comfortable. It is best to assume everyone is interviewing you – from the janitor to the chair – be pleasant and enthusiastic with everyone which you will of course be doing anyway because you are good person.

    Re-review your application and be prepared to answer any questions from you app.

    General questions will be:

    • · Do you have any questions for me? (prepare lots: this is the most common and a good way for them to see what you are interested in, how much you already know about the program, what you might bring to the program, what you are looking for etc)
    • · What can I say to make you want to come here?
    • · Do you have any questions about living in this area?
    • · How did you hear about our program?
    • · How did you get interested in psychiatry?
    • · Why come to the US?
    • · Are there any particular fields of psychiatry you are interested in?
    • · Tell me about x research project?
    • · Tell me about x hobbies and interest?
    • · Interviewer just talks at you and doesn’t let you say a word... (smile and nod)

    Have a list of about 50 questions to ask and do not worry about asking the same questions again – you may get different answers! Ask residents questions like “what’s call like here?”, “how much does it cost to rent/buy here?”, “what are the didactics like”. Avoid asking about call schedule, vacation etc – wait until some resident is drunk at the dinner or someone else asks! Ask faculty “what is unique about this program?”, “what is the psychotherapy training like?”, “what sort of things do residents go on to do after?”, “what is the ABPN exam pass rates?”. Also try and use questions to highlight your strengths – e.g. “I am really interested in proteomics research. For example I recently published a paper in Nature on this. I understand Professor X is doing similar research. Will it be possible to work with him during residency?”, or “I am really interested in homeless mental health. I have volunteered with homeless shelters in the past and found in rewarding. Are there opportunities to work with the homeless mentally ill? Is there a free clinic for them? If not, is it possible to set something like this up?”

    You may also get asked specific questions related to your app. Some places that are more psychodynamically inclined could ask personal questions including about your childhood, family, love life, sexual orientation, whether you have ever been in psychotherapy etc. – some of this could veer on the illegal. Prepare to answer difficult questions. If you have a history of mental illness yourself do not mention this if you are asked and never say ‘I do not feel comfortable answering that’. As an IMG this is even more difficult as you may feel even more powerless to report unprofessional behavior. It is rare, usually not with malicious intent. However if you experience hostility especially racial or regarding being an IMG – run! Do not look back, and do not go there! Report it on SDN and name and shame!
  15. splik

    splik

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    H1 visas last up to 3 years, can renewed for a further 3 years, and can have dual intent – which means you can apply for permanent residency/green card whilst on them. It is also possible to transfer onto other visas like a J1 if necessary. They are employer sponsored so your GME office of the program you match will do all the paperwork and pay most/all of the fees. If you are interested in academics at all, get this one. You need to have completed Step 3 to get H1 often before the rank lists are due (varies) Your spouse would get a H4 – they would not be able to work on this. They could of course apply for an H1 or whatever themselves.

    J1 visas last 1 year, and can be renewed for up 7 years. You cannot apply for PR/GC whilst on them – it is not dual intent. You need to go back to the consulate/embassy in your home country every year to get it renewed. They are NOT sponsored by programs (programs who say we ‘sponsor J1 visas’ are misleading- they do not) – they are sponsored by the ECFMG. You will have to pay the fees associated with them and need a statement of need from your country (or the country you last resided in) ministry of health. You must go back to this country for 2 years after the visa expires before you can reapply for a visa and work in the US. For psychiatrists there are many opportunies to work in underserved areas (rural and urban) and get a J1 waiver – to get this you return to your home country for a few days/weeks and pick up a H1 visa which is contingent on you working in this job which could be at a VA or community mental health clinic, or an Indian Reservation for 2 years. You could then apply for PR/GC. No need for step 3 before residency for J1. Spouses get a J2 visa on which they can work.

    On the plus side you don’t pay taxes for medicare/social security if on a J1 for the first ?5 years, whereas you do on an H1. That said, you do not get a tax free amount on your income on a J1 which you do on a H1 so it almost cancels out.

    F1 visa - you cannot complete residency on an F1 as you are not a student. Thus programs that claim residents are students and that is an excuse to treat them badly and pay them poorly are lying and should be avoided! If you are an international at a US medical school you can apply for an OPT (optional practical training) for 1 year to do internship and then transfer onto a H1. Highly recommended. It is not usually possible for internationals doing MPHs or other degrees to do internship on an OPT but if your programs GME office doesn’t know better and your university’s international office is willing to go along with it you can.
  16. splik

    splik

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    It is not usually programs who decide whether to sponsor a visa, it is the GME office. However as the program usually has to pay, this can vary. If the GME or International Office says they sponsor H1, but the program says J1 it might be negotiable. Discuss at interview. If they say no visas then that means they don’t. Michigan does not sponsor visas, neither does NYP (Columbia and Cornell).

    In my experience programs will usually bring up the visa situation at interview. If they do not, ask the PD at the end of the interview.

    In general you can negotiate this with university programs. There is some flexibility as they have no limit to how many visas they can sponsor (community programs do have a cap – almost impossible due to the visa cycle starting in October). If they really likely you they can unless the hospital has a flat out policy. Personally I think it is ridiculous for top academic programs to not sponsor visas but there you go. I do think J1 visas are good in general as they provide doctors for underserved communities which justify having IMGs coming to work in the US in the first place. The argument for not simply expanding US medical school places is – it will not increase the number of academic leaders in the field compared with having international graduates, and it will do nothing to help with the shortage of physicians in underserved areas compared with having international graduates. But I digress!
  17. splik

    splik

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    From 2013 receiving a pre-match means three things for an IMG. Either:


    • 1. You are from a rich arab country who is funding you residency
    • 2. This is a program that does not usually fill through the match and/or is an underserved area
    • 3. The program is violating the match

    Do not be suckered into any back room deals, and do not withdraw from the match without clarifying. Since this is about getting into a top program, none of this should apply! None of them will offer you pre-matches.
  18. splik

    splik

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    You should make your rank list in order of preference. Rank in order of which programs you like the most (for whatever reason). If location matter most go with that, if research go with that, if prestige go with that, if hours/pay/vacation go with that – but mostly go with gut feeling. Did you feel like you would be happy there. The other issue is if you want an H1 – consider – do you really want to rank programs with J1? Will that be too much of a headache? Would you want to work for 2 years in an underserved area? Would you be happy to go home every year to get your visa renewed? Could you go and work in your home country for 2 years afterwards? If not, think hard about it. I decided to rank 1 place that would not sponsor a visa for me and I regretted it. (and thankfully did not match there but was sh**ting myself)

    Do not rank any place you would not be happy to go.

    Do not rank based on how interested programs seem to be in you.

    If you do not match at your first choice, you are just as likely (or not) to get your second, third or fourth, as if you ranked them first.
  19. splik

    splik

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    IMGs have next to zero chance of getting into a top psychiatry program in the SOAP. You may get offered a very undesirable one and you must ask yourself whether you want to.

    You need to decide whether you apply for prelim medicine positions. If you have low USMLE scores you have very little chance of getting a prelim medicine position. You will probably need some back-up IM letters sent to ECFMG to upload to ERAS in preparation.
  20. splik

    splik

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    There are many excellent/very good academic programs that are not very competitive because they are not in New York, Boston or California. They include: Duke, Wash U, MUSC, Emory, Cincinatti, Indiana, Iowa, Medical College of Wisconsin, Cleveland Clinic, Mayo clinic and a few others. If you are not too fussy about location give them a look – unfortunately many are J1 only! (Check the GME website of these institutions to find out, or FREIDA)
  21. whopper

    whopper Former jolly good fellow

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    I'm at U. of Cincinnati. While I can certainly say there's plenty of good things about the program, I didn't graduate from the general residency program and can't phenomenologically give a good description of what it's like to be in it, especially since I'm not an attending that is directly involved with the residents much.

    What I can tell you is the program is respectable in research with several doctors here being highly published and being known to have advanced the state of the art in several fields. I've always stated that simply being a top doctor in terms of publication or fame does not make one a good teacher and I stand by that because so many doctors can't teach or are narcissistic. That said, I can tell you that I've sat in sessions with several top doctors here who were very approachable. Henry Nasrallah, for example, has several teaching sessions with residents, and is very cordial with them.

    In terms of clinical exposure there's an emergency psychiatric center, transplant psychiatry, very good C&L (part of a nationally ranked mega-sized medical hospital), a geriatric unit (where I'm currently working), rotations at the VA, voluntary and involuntary units, a partnership with a state forensic psychiatric facility, ECT, several fellowships: child-psychiatry (with a child fellowship, and a triple board pediatrics, psychiatry and child psychiatry fellowship), addiction, geriatric, and forensic, a combined FP and psychiatry program, a very strong psychotherapy curriculum with several professors specializing in the field, and opportunities to do research with notable professors.

    The university merged with the Lindner Center, a private psychiatric center where there is an eating disorder unit, transmagnetic cranial stimulation (and research in that field), specialized therapists in DBT, sensory stimulation rooms, among a few other interesting things. I don't know, however, how much involvement residents will have at this location.

    Some features I've respected about this program that I didn't get where I did my training was having psychologists on-board for psychological testing (e.g. malingering, MMPIs, neuropsychological, etc), being able to have a top researcher in the field available for consults/second opinions on particularly difficult cases.

    Again, I haven't been in the actual program and my own work within the department doesn't give me enough to give a real rub of what's going on. That is do the residents feel overworked, are they being treated fairly, is the pay fair, etc. I came to the area for forensic fellowship and was impressed with it but that's not what this thread is about. I have no reason to believe they are being treated unfairly, but at the same time it's not like I would know. I do know that some of my colleagues are instructors and they are good people who do care about the residents and graduated from the program.

    Some drawbacks I can think of are some people might not want to do residency in a big hospital, and while Cincinnati has a fair share of great city culture (e.g. restaurants, opera, theater) it's certainly no NYC (though I actually like it better because I found NYC too big for my tastes). The weather here isn't terrible like in places such as Syracuse or Buffalo NY, but it can be like Seattle at times with lots of rain during the fall and winter months. The cost of living is relatively low, and if you really want to be cheap, you could live in Kentucky that is right across the river, has a lower cost of living vs. Ohio, and still work in Cincinnati.

    I can tell you there's decent moonlighting opportunities within the dept, the local VA, and with local mental health agencies. During fellowship I was able to moonlight to the point where I was making what an attending made. If you want to practice in an area where there are hardly any psychiatrists and make a name for yourself for being one of the only ones available, merely drive 25 miles north or south (into KY) and it's no-man's land with a big opportunity for anyone to start a practice that'll fill up quickly. A buddy of mine is raking in about 250K per year only working 40 hours a week doing this.
    Last edited: 03.16.12
  22. Jorje286

    Jorje286 Member

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    Hi splik,

    From my understanding, you would need to take a year off so you are able to do Step 3 and apply for H1 visa. You can't do Step 3 if you did not graduate. Is there any possibility that you could take step 3 after match and after you graduate, and still in time to be sponsored H1? Thanks a lot! Great thread.
  23. splik

    splik

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    To be most competitive, you should have step 3 by the time rank lists are due. Some programs (including the one I matched at) have to petition GME if they want to sponsor H-1 visas for anyone they are ranking and in order to do this you would ordinarily need to have step 3, but this can vary from program to program.

    This year there has been a delay in step 3 reporting which some of my friends have been caught up in - some programs will allow you to start late (i.e. august or september) if your visa will not come on time. However, not everywhere is so flexible. Also if you start off-cycle you will also graduate from residency late and will not be able to sit the ABPN Part I exam the year you graduate (which may or may not be relevant).

    You may wish to consider spending a year working in your own country or doing a research fellowship in the US after medical school and taking Step 3 then.

    It may be possible to do Step 3 after you match if you graduate in March but you would be cutting it fine (and you would have to negotiate with the program). If you graduate after March the answer is almost certainly no.
  24. shan564

    shan564 Below the fray

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    Hi splik,

    Thanks for taking the time to write such a thorough FAQ. You definitely helped to answer a lot of questions that I had.

    Here's another one - with regard to finishing Step 3 before starting residency, is that mostly a question of visa sponsorship? Or is just as important for those of us who don't need a visa?
  25. splik

    splik

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    You only need to have step 3 before matching if you want an H-1B visa. Those going for J1s, US citizens or those with PR do not need it before residency. In fact it is ill-advised to do it before intern year as it is not the sort of exam you can learn from by reading first aid or master the boards. The only exception would be failure in previous exams and barely passing the retake. In that case, pass on Step 3 could be helpful. Also, no one cares how you do on Step 3 only that you pass.
  26. Jorje286

    Jorje286 Member

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    Splik,

    A couple more questions, not necessarily related to the match per se. Do IMG's have a decent chance of establishing basic/translational science academic careers during or after their residencies, and are there programs out there open for recruiting IMGs into research track residencies? My interests in particular are in neural circuits/computational neuroscience. Also, you mention J1 waivers. Is there a good chance of landing those if you don't want to live in no man's land?

    Thanks!
  27. shan564

    shan564 Below the fray

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    :thumbup: Great question - I've been wondering about that too.
  28. splik

    splik

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    Although establishing oneself as a physician scientist is incredibly difficult, there are many many opportunities during or after residency to get further research experience to be able to get a tenure track position. In recent years many programs have had research-track positions that have gone unfilled. There are very few people wanting to establish academic careers in psychiatry, fewer still doing basic science research and this is one of the areas where IMGs are particularly well-positioned as there is definitely a need. My advice is you must get an H-1B visa if you want to get a tenure-track position, a J-1 visa is no good though there are many j-1 waiver jobs that are not in the middle of nowhere they are all clinical. There are some programs such as UIC that predominantly recruit IMGs into their research track but do not sponsor visas and thus should be avoided. Yale, Duke, WPIC, and Mt Sinai are probably the major research centers that are most open to having IMGs and will make time for you to do basic science research even if they do not have a research-track per se.

    As I mentioned above, the one snag is that you must be a US citizen or have PR in order to apply for a T32 or K-award* thus you need to go to a program that would be willing to sponsor your permanent residency application. However anyone with a pulse can get a research fellowship after residency (although if it is a T32 it will not be open to those on visas)

    *T32 is an NIH-funded research training grant. a K-award is a research career development award from the NIH
  29. shan564

    shan564 Below the fray

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    Hey, one more question - hope you're still checking this thread. How important is it for me to have Step 2CK results back before sending out my ERAS application? If my Step 1 scores are good enough (taking the test in 10 days, but I'm expecting to be in the 240-250 range), would I be significantly hurting my application if I delay Step 2 until after my ERAS application goes out (assuming I can still get my scores back before my interviews)? Or would it be better to get a somewhat lower score but still have it before the September 15 ERAS deadline?
  30. splik

    splik

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    In your case, you will need to have all these exams done to be ECFMG verified (ie passed the exams but not graduated yet). Don't expect (m)any interviews without having done CK and CS before applying. As long as you comfortably pass (i.e. >200) and you have a good score on one of these exams, you will be fine. It doesn't matter if you score lower, but you would be in the minority, the average ck score is 10 points higher than step 1, for me it was >30 points. but then my step 1 score was sh*t
  31. aphenomenon

    aphenomenon

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    The new president of the APA is an IMG, no?
  32. SmallBird

    SmallBird

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    This is not correct. ECFMG has a detailed explanation on their website about the difference between "visa status" and a "visa". The J1 visa issued by the consulate is only valid for one year. However, you can stay in the US after the visa has expired, for up to 7 years, as long as you maintain "visa status", which simply requires submitting a form to the ECFMG. If you want to travel outside the USA, however, you will need an actual, unexpired visa, which will then require you to go back to your home country in most cases.
  33. splik

    splik

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    Your program should handle this and handle all the costs. They should apply for expedited processing of your application which takes less than 15 days to get an answer. They should complete the paperwork etc, and you should supply any immigration documents, copy of your passport, if applicable I-94, copy of your ECFMG certificate and your medical diploma. If you are in the US on an F1 visa etc then you do not need the visa to start work, just paperwork stating your have changed your status, but when you leave you would need to go back to your home country US consulate and get the visa stamped.

    If you not in the US with valid visa status, you must take schedule an appointment at the embassy, taking your I-797A form etc with you and have an interview. You cannot enter the US until 10 days before the visa starts, which should be the first day of work.
  34. splik

    splik

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    Whilst it is true there is a difference between visa status and 'visa' (you can work on your visa status without a visa, as I am), in reality how many IMGs are going to to stay in the US all the time. The vast majority will leave the US and thus they will have to go back. Conversely, the H1b visa can be renewed in any country, although you must return to your home country to get the initial visa (assuming you weren't in the US). This is a snag for me, I'm on H1b visa status, not planning on returning to the UK this year, but I'm supposed to be heading to Australia in January for an elective! Doesn't look like it will happen unless I return to blighty flrst :(
  35. splik

    splik

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    p.s. hi smallbird hope you've arrived in one piece and looking forward to starting! I might not be able to start on time because of various woes which hopefully will be sorted out! and feel free to add any Q and As here!
  36. aa1984

    aa1984

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    This is the most informative thread I've come across in months. Thank you so very much.
  37. MariaMaria3

    MariaMaria3

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    Hey splik I was wondering how long does the ECFMG Certification takes? If I have the results of step I and II (CK and CS) in early may and try to apply inmediatly in the ECFMG web page, more or less when would the certification be ready so I can take step 3??? Would I still be able to apply in september and get a H1 visa???
  38. MariaMaria3

    MariaMaria3

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    hey Splik, first of all thanx for a very useful post...

    I'm a 3th year med student from a southamerican country. I've got 6 months in my last year where I can take electives at US medical schools, I was wondering if I should take the hole period in psych or if it would be better to take a month or so in peds or internal medicine in order to get LoR of specialties different than psychiatry... Want do you think?
    Would it be ok if I use LoR from other specialties from my country and use the time in the states to get to know as many psychiatrist as I can?
  39. splik

    splik

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    ECFMG certification takes a few days after you have completed your USMLEs. If you have yet to graduate, then you would be ECFMG verified which is just as good for application purposes. This assumes you have graduated medical school.
  40. splik

    splik

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    I would suggest getting 1 LoR from your final year of medical school or internship in medicine. And then spending the 6 months of medical doing psychiatry. I would suggest, if you are interested doing some research doing that time. In particular Mt Sinai in New York often has many foreign elective students. Also you don't have to pay to do electives (up to 9 weeks) at UCLA. Many other places charge a lot of money. It may be ok to do electives in other specialties in the US the problem I could see is if they thought that psych was a back up and you really wanted to do peds/internal medicine because of that letter.
  41. splik

    splik

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    Question posted anonymously:

    With the exception of Duke there really aren't any good med/psych programs. Many of them are v. uncompetitive, have trouble filling and you are bound to get one, but the quality of the psychiatry training would be highly questionable, you would probably be in the middle of nowhere, there is no time for research, no time to learn psychotherapy, no provision for electives in psychiatry, and unless you are interested in primary care (which you're not otherwise you would be applying to IM/FM and med/psych not psych + med/psych) there is no good reason to do a med/psych residency, and lots of reasons not to.

    I can tell you that you have next to no chance of getting into the med/psych residency at Duke the residents are stellar (compared with their psych residents who are mostly mediocre). They have a strong medicine program and if you dont have a chance of getting into the IM residency you don't have much chance of the med/psych (though of course it is less competitive).

    I suspect you want to do med/psych under the misapprehension you will be a 'proper doctor'. It is completely understandable that you would be reluctant to turn your back on your medical training to be a psychiatrist. But if that is what you want to do, you will need to make your peace with it. The concern is that many people think that those who do med/psych have a negative perception of psychiatry or are scared of not being a 'real doctor'.

    Well you know even in psychiatry we do the odd bit of 'real doctoring' - I draw labs, start IVs, to ABGs, physical exams, order investigations. This past week I have requested an MRI, EEG, CBC, Chem-10, HIV, syphilis, ANA, ANCA, ENA, antineuronal antibodies, skin punch biopsy, and genetic testing for a patient I don't know what's wrong with her (diff dx psychotic depression, CADASIL, metachromatic leukodystrophy, Wegener's granulomatosis, neurobehcet's, paraneoplastic limbic encephalitis, progressive multifocal leukoencephalopathy etc..)

    Psychiatry is psychiatry because much of the time neurobiology doesn't help us understand what is wrong with our patients, because the act of listening intently is the examination, because the experience of being listened to is the therapy, because of the level of explanation we use to formulate the case may not be a biomedical one but psychodynamic, cognitive, behavioral, systemic, sociocultural, or social constructivist and having a pluralistic approach frees us from the dogmatism that may prevent us from understanding the patient in front of us, who hasn't read the DSM and doesn't know she's supposed to present in this way or that way..

    The challenge and fun of medicine is the diagnosis; the challenge and fun of psychiatry is the formulation. How do we make sense of the patient in front of us, her symptoms, her problems, her presentation, and how do we use that understanding to help her? Learning this well is why psychiatry residency is 4 years.. you can learn the DSM and psychopharmacology in 2.5 years doing med/psych. You cannot learn psychotherapy and case formulation well in such a short time, and you and you patients will be all the poorer for it.

    I would strongly discourage you from applying to med/psych, but if you are going to I would apply to psych programs at those institutions as well anyway as although it may disadvantage you in getting into the psychiatry program, it will not disadvantage you getting into med/psych as at the competitive places you are unlikely to get an interview, and at the non-competitive (i.e. most) places they are so desperate that it wont make a difference.

    N.B. Duke for a decent IMG would not be a reach for categorical psychiatry, it would be for med/psych.
  42. SmallBird

    SmallBird

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    Splik, I wonder if you have heard anything about Emory's Med/Psych residency? I agree with everything you say in the above post, but wondered about whether Duke is really the only competitive Med/Psych program.
  43. splik

    splik

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    yeah i would agree emory med/psych is up there (though not like duke) and would probably out of the scope for most IMGs. I think it would be a hard sell at these sorts of programs for most IMGs to make a convincing case they want to work the the rural or urban underserved making a pittance, and I suspect the person who posted the original question was not aware this was the purpose of med/psych residencies.

    I will reiterate that one can do as much medicine as you (and your attending) feel comfortable with. I have stocked our psych units with equipment for IVs and blood gas syringes, and regularly treat metabolic syndrome, UTIs, exacerbations of asthma/COPD basic metabolic abnormalities (e.g. hypokalemia), vitamin deficiencies, simple Hashimoto's etc. The great this is not having to treat manky cellulitis and other horrible smelly conditions that never get better! That is why we do psychiatry! As mentioned above, occasionally I do extensive workups for complex patients who we don't know what is wrong with them but can proffer ridiculous diagnoses...
  44. splik

    splik

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    Yes it's been two weeks! Chill! Take a deep breath, interviews continue to be offered until November. Then people cancel and there may be further offers extended. You cannot expect to (At many places) get interview offers as soon as US medical students.

    Also if you don't have a complete application (are all your LORs in, have you done step 1, step 2 CK, and CS?, is your transcript in) then many places/most places will not review your application so you should not be expecting invites anyway! Not everyone is so stringent about completing all the USMLEs prior to applying, but some places are...
  45. shan564

    shan564 Below the fray

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    FWIW, I haven't taken Step 2CS yet, and I've gotten interviews from...

    EDIT: Ended up getting invitations from many of my top choices despite not having a Step 2CS score yet.
    Last edited: 01.20.13
  46. psychattending

    psychattending Program Director

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    Though we are all still learning about the new All-In Policy, I believe this is incorrect. For a July 1 start, no program may give an out-of-Match slot if any of their slots are being filled in the Match. Thus, only a program that is not going through the Match can give out-of-Match slots. Since all current US graduates most go through the Match, a program not going through the Match would only be filled with IMGs, or AMGs who did not graduate this year. Even if Kuwait was paying for a resident 100%, for that resident to be trained in the program he/she would have to go through the Match.
  47. SmallBird

    SmallBird

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    I agree, this was my understanding too.
  48. splik

    splik

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    I have just looked into this and it appears the information I posted was correct in March 2012, that specific exceptions were being considered but now everything is all in except rural scholars programs and family medicine accelerated programs (neither of which are relevant to psychiatry or to IMGs). Now if an IMG is receiving a prematch offer it only means the program is violating the match. Programs are allowed to offer off-cycle appts starting after Feb 1st outside the match, otherwise there are no exceptions.
  49. psy80

    psy80

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    Hi, I am an fmg working in non uni based research under H1 visa for a yr long, this is my 3rd time applying for psy programs but in vain, not even got a single IVs, wondering if i would be able to switch to any university based research programs. Would like to get help how to approach such programs? Suggestion and advice would be highly appreciated and of gr8 help.
  50. Jorje286

    Jorje286 Member

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    Splik, I have a quick question about the timeline for electives. Of course it's preferable to have everything done by September 15, but now I am considering doing my electives in the US in August and September, so I will have my second letter of recommendation at the end of September. Do you think that jeapardizes my application in any way? Can I actually still submit my application on Sep 15 and later submit my second letter of recommendation?

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