Getting into residency programmes in the US from the UK

[jane2]

Hi,

I'm going to be starting medical school as a mature student (I'll be 22 when I start) in September. After I graduate (either 4 / 5 yrs down the line, depending on which course I end up on) I'd like to move to the states and practice there. I understand that there are a lot of certificates and things which I need, and I also u nderstand that I need to gain entry to a residenc programme. What I'm wondering is whether anything which I do at this point (which med school I go to, etc) will make a major difference to my chances of being accepted on a residency programme - a good one.

Is there anything I can do to make myself a better candidate?

Is there, indeed, any advantage to me starting to think about it this early, when I'm not going to be going for at least 4 years?!

Realistically, what are the chances of getting onto a good residency programme? I understand this varies with speciality... I've not yet been able to find statistics on which specialities are easier / harder. I see myself (probably) going into something like neurology/neurosurgery, or maybe psychiatry.

It sounds to me lke the application process is fairly complicated and probably fairly expensive - is this true?

Last but not least - is it especially easier / harder to transfer to Canada compared to the US?

It'd be great to hear from anyone in the UK who is currently going through the process of applying, or who has been through it.

Thanks,

Jane

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[f_w]

> Is there anything I can do to make myself a better candidate?

-- Try to get into some research projects early on in your medical school career. The 'fallout' in terms of your name on publications sometimes takes a year or two to materialize. Having your name on some pubs definitely helps in the residency selection process. Ideally, if you have a general idea what specialty you are interested in, it is helpful to do the work in that area, but everything helps.

-- Ace the USMLE's , particularly step1. This is the single most important number in your search for a residency position in the US. Folks here are a bit simple minded in that regard and believe in the value of standardized testing above many of the other variables (GPA, honors etc.) When you apply through the 'Electronic Residency Application System', the programs have a choice to only download applications above a certain USMLE score. If, like in many competitive specialties, a program receives 500 applications for 3 slots, this is an often used feature to reduce the # of resumes to read to something manageable.

-- If your medical school has some sort of cooperation or contacts with a US medical school, try to do some elective or research time in the states. Letters of recommendation play a pivotal role in the decision about who of the qualified candidates will be invited for an interview. For some reason, more weight is put on LOR's from US faculty.

-- Play the 'green-card' lottery every year (offical name 'diversity visa lottery'). Unless of course you already have a green-card or are a US citizen, this is the easiest way to get one. Having a GC gives you an edge over other 'foreign' medical graduates. The US goverment subsidizes every residency slot with $80.000 to $140.000. Many people here feel that people who will stay in the US and take care of patients here should receive preference over people who by the nature of their visa have to return. If you have a research background, there are other ways for you to obtain a GC. A US immigration attorney would be able to inform you about these options.

> Is there, indeed, any advantage to me starting to think about it this
> early, when I'm not going to be going for at least 4 years?!

Yes. Start doing the 'groundwork' early in medschool. Do your USMLE step1 sometime during medschool while you are studying for the comparable exams in your own country. Remembering the Krebs cycle is just so much easier if you are still in school than 2 years after graduation (don't do step1 too early, in many states a maximum of 7 years is allowed between step1 and step3)

> Realistically, what are the chances of getting onto a good
> residency programme?

Psychiatry 100%
Internal medicine (crappy program) 100%
Internal medicine (decent program) 80%
Internal medicine (top program) ?
Pediatrics (crappy program) 100%
Pediatrics (decent program) 80%
...
...
...
ENT (any program) slim to none

> I've not yet been able to find statistics on which specialities are
> easier / harder. I see myself (probably) going into something
> like neurology/neurosurgery, or maybe psychiatry.

There is a table of the %age of foreign grads somewher within the flame war next door titled 'How are UK graduates viewed...' A low proportion of FMG's is a bit of a measure (albeit a flawed one) of the competitiveness of a field.

Of your choices, neurosurg is probably the hardes to get into. Without the use of nepotism or a strong research background, chances are probably slim.
Psychiatry is wide open, with good scores you would have a choice of programs.
Neurology is somewhere in the middle. It is realistic for foreign grads to make it into neuro, particularly if your CV has something to offer.

> It sounds to me lke the application process is fairly complicated
> and probably fairly expensive - is this true?

Complicated: No
Expensive: Yes

For the application itself (depending on the specialty), you commonly go through teh ERAS system. Everything said and done, you spend a couple of $100 to enter your application, it goes by the number of programs you want to send it to, the more programs, the more $$$.

You register for the 'match' or NRMP, it is something like $140 for the the first 15 programs on your list. After that there is some penalty if you want to list more.

The biggest factor are interview trips. A couple of $1000 are easily spent, particularly if you have to go back and forth to the US two or three times.

> Last but not least - is it especially easier / harder to transfer to
> Canada compared to the US?

My understanding is that it is significantly harder. The US residency match is open for everyone who has the credentials (ECFMG certificate or US medical graduate).
The canadian match otoh goes through two rounds. In the first round only canadian medical school graduates are allowed to compete. The foreign grads have to compete for the crumbs, usually family practice slots in rural areas. If canada is your final target, you might be better off transferring into one of their medical schools during the later years of your training. That way you are considered a canadian graduate (this however will cost you serious $$$).

 

[Miklos]

> Last but not least - is it especially easier / harder to transfer to
> Canada compared to the US?

My understanding is that it is significantly harder. The US residency match is open for everyone who has the credentials (ECFMG certificate or US medical graduate).
The canadian match otoh goes through two rounds. In the first round only canadian medical school graduates are allowed to compete. The foreign grads have to compete for the crumbs, usually family practice slots in rural areas. If canada is your final target, you might be better off transferring into one of their medical schools during the later years of your training. That way you are considered a canadian graduate (this however will cost you serious $$$).

IMO, unless Canada drastically changes its present policy towards IMGs I would simply strike it off my list. For true IMGs (e.g. those without Canadian citizenship or landed immigrant status), the door at present is virtually closed, despite an acute physician shortage. In addition to the outright discrimination inherent in the two iteration Canadian match (see statistics for IMGs at http://www.carms.ca/jsp/main.jsp?path=../content/statistics/statistics/st_2004#imgs2nd ), IMGs must meet provincial requirements as well (see http://www.carms.ca/jsp/main.jsp?path=../content/applying/eligibility and http://www.carms.ca/jsp/main.jsp?path=../content/program/restriction ). These very often include 1 year of physical residency in the given province or alternatively years of service in the province after completing residency.

As a result of these factors, a significant number of Canadian IMGs come to the US for post-graduate training, especially if they would like to specialize (as opposed to doing FP). See the Canadian IMG forum for more info.

Regarding transferring to a Canadian school, I'm under the impression that it is near impossible to transfer from a non-LCME school.

Miklos

 

[jane2]

Thank you both for the very helpful replies.

Just a quick thing - I thought UK nationals weren't eligible for the green card lottery? How can I get a green card besides this way? sorry for my ignorance!

 

[siddesh]

you are right. certain countries cant that already have high immigrant rates to the US such as the UK.

alternatives = marry an American(!) quickest route. or you can go through the employment sponsporship route which is what most docs do i guess. takes longer but commoner.

Thank you both for the very helpful replies.

Just a quick thing - I thought UK nationals weren't eligible for the green card lottery? How can I get a green card besides this way? sorry for my ignorance!

 

[john182]

Thank you both for the very helpful replies.

Just a quick thing - I thought UK nationals weren't eligible for the green card lottery? How can I get a green card besides this way? sorry for my ignorance!

Best option is do the exams and so on. Also do Step 3 of USMLE (only certain states allow this to be done without you already working in that state, NYC is one for example).

ECFMG and Step 3 allow H1B visa. This is an employer-sponsored visa and as such many programs will sponsor one, and many won't - it depends on how much they want you and how much they want hassle for extra forms and legal obligations.

Once you have a H1B, you can apply through your employer for a green card - these are on 5 catgeories I think, the otp one being say, STephen Hawking, reknowned PhDs and so on, the second category is doctors (it's on a professional requirement level).

Do not apply for a J1 as it is non-transferable to anything (any other type of visa - it is issued by agreement with your own government). J1s can only get a green card by applying under teh US Department of Agriculture for a post-residency attending post in a federally-designated under-served area. I.e., do you residency on J1 in NYC and prepare to move to New Mexico to stay after it.

 

[f_w]

Visa/immigration options for physicians in training (from most desireable to least desirable, but allso sorted from least to easiest attainable...)

'green card' (often actually pink)
- through lottery (UK citizens except Ulster Co are excluded, but not everyone studying in the UK is a UK citizen)
- family based through marriage to a US citizen
- derivative citizenship through a US citizen grandparent (complex)
- employment based (labor certification) big hassle, takes typically years, depending on where the job is
- research based (extraordinary ability). If you are in the top 2% of your research field, you can give it a shot
- research based (national interest waiver). If you work on a research project deemed to be national in scope.

O-1 visa (extraordinary ability in the arts and sciences) similar to the research based GC limited to hard core researchers. No 'foreign residency requirement', No time limit (issued for one year at a time, but does get extended without problems).

H1b visa (skilled worker) Desireable nonimmigrant visa for residency as it doesn't exclude you from immigration like the more common J1. BUT Many, if not most hospitals don't sponsor this for residents because it costs them $$$ and exposes them to certain labor law related liabilities.

J1 visa (exchange visitor) You are considered a student. You need a 'letter of need' from the UK department of health to be eligible. BIG CATCH: You have to return to your 'last country of habitual residence' after your finish a maximum of 7 years on this visa. The only exemptions from this dreaded 'foreign residency requirement' (HRR) are:
- Practice in a medically underserved area for 3 years after you graduate (30% of the US are numerically underserved) Limits your job choices considerably.
- work for the veterans administration. (federal hospital system for ex career soldiers and war veterans). Little money to be made here.
- Excel in an area of research (HHS waiver) Only 50% success chance.
- proove hardship to a US citizen if you have to leave (your mentally ******ed kids which would be a liability to the state here). Very Very hard to get. <50% chance of success.
- proove political persecution in your home country. Difficult point to make in the UK.