Have I Redeemed Myself Enough For PDs to Consider me?

[Dr.BeardFacé]

Hi all,

I know everyone hates 'what are my chances' threads but I haven't seen anything banning these threads in this sub-forum (apologies if I've missed it).

I had a really rocky start to medical school, but I hope I have clawed my way back since.

I'm a non-US IMG born in and educated in England (Not Oxford/Cambridge) who would need a visa
In my first semester I took a leave of absence for 2 years to care for a sick relative.
When I returned I failed first year by 6 marks.
Since then I haven't failed a single exam and have scored at least in the top 30% of my cohort in every exam since.
Passed Step 1 on first attempt
Passed Step 2 CK on first attempt with a score of: 263
Hoping to take Step 3 before applying
2 publications (not first author)
2 months USCE with strong LORs in Psych and IM
0 YOG
Tons of volunteer experience and extracurriculars demonstrating interest in Psych.

I plan to apply to every Psych residency that I am eligible for.

Do you think I've done enough to redeem myself in the eyes of a Psych PD or am I still very unlikely to match? I know that no one can say for sure, but I'm curious about what others think.

---

Members don't see this ad.

 

[TexasPhysician]

Every year is a different round of applicants. Like they say in football “on any given Sunday”.

Are you likely to match? No. Those are massive red flags that will likely have you screened out by over 50% of programs.

Pass step 3. Try to do multiple rotations at programs with multiple international IMG’s.

I’d apply to other fields as a back-up and prelim programs. If you maintain your upward trajectory, you could be a much better PGY-2 transfer candidate than your current position.

 

[Merovinge]

I think England generally has a pretty good reputation for medical training so you are in a better spot than most IMGs. I presume you are not coming from Cambridge/Oxford or you would have included it in the post (if you are then you are in good shape). The 2 years leave puts you right at the same age cohort as US MDs since you have such a short overall med school compared to our undergrad + grad setup. The first year fail is a big hurdle and if you are getting interviews will need to be able to address it thoughtfully when it comes up. Crushing step 3 will help, apply broadly, and I think you have a decent shot. People really like British accents in the US.

 

[Dr.BeardFacé]

Every year is a different round of applicants. Like they say in football “on any given Sunday”.

Are you likely to match? No. Those are massive red flags that will likely have you screened out by over 50% of programs.

Pass step 3. Try to do multiple rotations at programs with multiple international IMG’s.

I’d apply to other fields as a back-up and prelim programs. If you maintain your upward trajectory, you could be a much better PGY-2 transfer candidate than your current position.

Thank you for responding. I have a few follow-up questions if you don't mind.
How much better are my chances with IM and FM?
Do you think the LOA or the failed year is hurting me most?
I'm not too familiar with prelim years as I was never looking at specialties that required them. Could you explain how a prelim year would help?

 

[erys]

Agree with TexasPhysician. Unfortunately, those are massive red flags that will get you screened out by most programs, especially as an IMG. Best thing you can do is do multiple rotations at programs (in places that accept IMGs)--programs will then get to know your work ethic, clinical skill, and interpersonal skills that may set you apart from your application. If you have any geographical ties, that is a plus (i.e. esp for a underserved area who is looking for psychiatrist that want to stay in the area). Best also apply to FM/IM just in case and then apply as a 2nd year resident to 2nd year psychiatry spots (often times these spots are less competitive than matching the first time around). FM and IM are less competitive than psychiatry so your shot is better. Prelim year is an option, but you'll be in the same uncertain position at the end of the year in trying to match again WITHOUT the reassurance that a FM/IM spot would give you (i.e. being on your way to becoming a board certified physician and paying back your loans). As, I said, you can always continue to apply to psych your 2nd year of FM/IM. In response to you other question, I would think that the failed year is worse than LOA.

 

[Stagg737]

Thank you for responding. I have a few follow-up questions if you don't mind.
How much better are my chances with IM and FM?
Do you think the LOA or the failed year is hurting me most?
I'm not too familiar with prelim years as I was never looking at specialties that required them. Could you explain how a prelim year would help?

Your chances in IM and FM would likely be much better simply due to numbers.

The failed year hurts far, far more. Leaving school to take care of family for an extended time and coming back and crushing it isn't even a red flag imo. Failing a year definitely is, and it's a big one.

Pre-lim years and TRIs (traditional rotating internships) are basically an intern year before entering another field. Some fields still require their residents to do a traditional internship year in medicine before starting their desires area of residency (radiology and some surgical fields require this, psychiatry does not). The positive of doing this would be to show you can function at the level of a resident and hopefully get Step 3 passed to show psych (or any) programs you're not at risk of failing out. The program I'm associated with accepted a PGY-2 after they completed an internship year here because the PGY-4 class had a large number of people leave for child psych fellowships. So it can be a viable alternative for those who go unmatched.

 

[Dr.BeardFacé]

Agree with TexasPhysician. Unfortunately, those are massive red flags that will get you screened out by most programs, especially as an IMG. Best thing you can do is do multiple rotations at programs (in places that accept IMGs)--programs will then get to know your work ethic, clinical skill, and interpersonal skills that may set you apart from your application. If you have any geographical ties, that is a plus (i.e. esp for a underserved area who is looking for psychiatrist that want to stay in the area). Best also apply to FM/IM just in case and then apply as a 2nd year resident to 2nd year psychiatry spots (often times these spots are less competitive than matching the first time around). FM and IM are less competitive than psychiatry so your shot is better. Prelim year is an option, but you'll be in the same uncertain position at the end of the year in trying to match again WITHOUT the reassurance that a FM/IM spot would give you (i.e. being on your way to becoming a board certified physician and paying back your loans). As, I said, you can always continue to apply to psych your 2nd year of FM/IM. In response to you other question, I would think that the failed year is worse than LOA.

Thank you. Considering my situation I was planning on seeing if I can do a rotation at a HCA Hospital with a residency program that has a ~100% non-US IMG intake. Is this the kind of program you're suggesting I look into? Mount Sinai Morningside seem to have a non-US IMG heavy program in IM and are open to sub-Is from internationals. Do you think that this program is out of reach and therefore a waste of time that could be spent at a lower tier institution?

 

[FlowRate]

I'm a non-US IMG born in and educated in England (Not Oxford/Cambridge) who would need a visa

You obviously don't have to answer this but why do you want to come to the US/train in the US? I'm pretty sure you could train in the UK and move to Canada if you're not so picky as to which North American English-speaking country to move to. Psychiatrists get paid really well in Canada, too.

 

[gyngyn]

How much better are my chances with IM and FM?

Last year, psych had only 21 unfilled positions (out of 2164)
In contrast, EM had 555 (of 3011).
FM had 589/5100.
IM had 545/11,911.

 

[erys]

Thank you. Considering my situation I was planning on seeing if I can do a rotation at a HCA Hospital with a residency program that has a ~100% non-US IMG intake. Is this the kind of program you're suggesting I look into? Mount Sinai Morningside seem to have a non-US IMG heavy program in IM and are open to sub-Is from internationals. Do you think that this program is out of reach and therefore a waste of time that could be spent at a lower tier institution?

I'm not familiar with those programs and their culture, so it's hard for me to give you advice. Ideally, one that not only accepts IMGs, but the rotation where you will be working at be with attendings who actually have a say in who gets a interview/matches there. Rotations where you work with PDs are the best. If you're going in blind, maybe you can email the program directors to get the email/number of the current chief resident and they can give you more advice.

 

[TexasPhysician]

Thank you for responding. I have a few follow-up questions if you don't mind.
How much better are my chances with IM and FM?
Do you think the LOA or the failed year is hurting me most?
I'm not too familiar with prelim years as I was never looking at specialties that required them. Could you explain how a prelim year would help?

It is hard for me to quantify odds of matching in other fields, but FM and EM aren’t popular right now. Job markets are not optimistic in either.

The failed year is a bigger red flag, but you have multiple. The programs which I have been associated with are above average but not top 25 places. The IMG Visa issue, loa, and failed year would each have screened you out individually pre-interview.

Right now, I’d aim for programs typically thought of as bottom 25%.

Prelim programs are 1 year programs. They are easier to get. They dont get you anywhere by themselves, but they would get you in the door. Once you are in the door, you can develop relationships, and PD’s will look at your prelim year info more than your medical school info.

There are good psych programs that purposefully accept PGY-2 transfers every year. I don’t keep an updated list. I’ve seen poor medical school applicants get good transfer positions after a prelim year, because there isn’t as much competition. There is more uncertainty with this path, but you have the potential to land at a better program than you do right now.

 

[nexus73]

It's not unheard of to complete a full 3-year residency in FM or IM (even Emergency med which is low competitiveness right now) then apply for psychiatry entering as a PGY-2. This is a longer road (six years total instead of four years), but you will be dual boarded and extremely competent in general medicine and psychiatry. Completing for example an FM program and performing well, maybe being chief resident, would almost certainly open doors to potentially more prestigious psych residencies. If you were able to match at a hospital with both FM and psych, or at FM in the same city as a psych residency, having the connections of doctors who may know each and writing letters of recommendation for you would be beneficial.

 

[whopper]

Maybe it's just me but I wouldn't hold it against a person who took time off. The failures by "6 marks?" (I don't know what that means, "6 marks") would be a red-flag assuming you failed some classes.

Passing USMLE Step 1 and 2 on first tries wouldn't erase the red flags, but helps.

8 years ago I'd say you'd have no problem, but I've been out of academia for about that many years. IF there were only 21 unfilled spots last year then I'd say things are definitely much more competitive.

 

[Dantes]

I'm not involved in residency apps, but you knocked Step 2 out of the park. My perspective is that should be reassuring that you would pass boards, and is a more recent snapshot of your academic ability than who you were first year, especially being in the top third of your class since. Plus showing specialty interest definitely helps.

All that being said, as an IMG, apply broadly and network.

 

[Dr.BeardFacé]

You obviously don't have to answer this but why do you want to come to the US/train in the US? I'm pretty sure you could train in the UK and move to Canada if you're not so picky as to which North American English-speaking country to move to. Psychiatrists get paid really well in Canada, too.

There are 3 main reasons:
1) US residency programs are shorter than UK programs. For example Psychiatry is 4 years in the US and it is 8 years in the UK
2) UK residency programs prioritize service provision over teaching in a way that I don't believe US residency programs typically do due to the nature of our healthcare systems. However, given my red flags this may no longer be accurate if I can only match into malignant, scutwork-heavy US programs.
3) My long-term girlfriend is American and hates living in England. She wants to move back ASAP. I quite like the states so it made sense to try to move there for residency. Happy spouse, happy house.

There are other reasons but those 3 are probably the main ones

 

[Dr.BeardFacé]

I'm not involved in residency apps, but you knocked Step 2 out of the park. My perspective is that should be reassuring that you would pass boards, and is a more recent snapshot of your academic ability than who you were first year, especially being in the top third of your class since. Plus showing specialty interest definitely helps.

All that being said, as an IMG, apply broadly and network.

Thank you. This might make me a sound a bit clueless but how exactly do I network in a way that will help me get an interview outside of clerkships. I tried talking to a US Psych PD that was a keynote speaker at the annual Psychiatrist convention in England once, but I don't see why that would make him want to interview me for his program, unless I begin showing off my psych skills by doing mental state exams on the other attendees around us.

 

[Splenda88]

I think chances are very good for IM and FM. I think you will be ok for psych.

 

[shoenberg3]

I am basing my statements on the outcome of last year's match for IMGs that I personally know, and also the composition of the intern class of my program in a somewhat undesirable location.

If I had to make a guess, you would have had a decent shot to match to a half-decent psychiatry program perhaps 5-10 years ago.
Nowadays, though, I would say you might have a somewhat of a shot in malignant programs in NYC, but somewhat unlikely in other programs. Psych is not the new derm, no. Regardless, there has been a significant increase in difficulty of matching to psychiatry, especially as an IMG.

As other posters here suggested, you still have options to end up in psychiatry in the US. But whether a potentially more arduous path would be worthwhile is your decision.

 

[splik]

There are 3 main reasons:
1) US residency programs are shorter than UK programs. For example Psychiatry is 4 years in the US and it is 8 years in the UK
2) UK residency programs prioritize service provision over teaching in a way that I don't believe US residency programs typically do due to the nature of our healthcare systems. However, given my red flags this may no longer be accurate if I can only match into malignant, scutwork-heavy US programs.
3) My long-term girlfriend is American and hates living in England. She wants to move back ASAP. I quite like the states so it made sense to try to move there for residency. Happy spouse, happy house.

There are other reasons but those 3 are probably the main ones

Marry your GF and get a green card and move to the US. You will become much more competitive.

FYI: A lot of residency programs in the US provide much worse training than you would be able to get in the UK. And much of the US is grim. If you did some electives in the US and got strong LoRs I do think you should be able to match somewhere.
Also the systems are not really interchangeable. psych training in the UK is 6 yrs and split in 2. core training is 3 years and more equivalent to the 4 yr psychiatry residency. Higher training is another 3 yrs and equivalent to doing mandatory fellowships in the US. That’s a crude comparison but more accurate.

 

[docksan]

I might be the only one here who thinks you have a decent shot.

 

[Celexa]

I might be the only one here who thinks you have a decent shot.

Make that two of us who don't think this is hopeless? Depending on how you look at this application, it could be seen as ONE big red flag and not multiple. There's a section on ERAS now that is specifically meant for students to have space to explain something like this education taking a massive hit due to caring for a sick relative. Unless I'm missing something, all the deficits in the OPs application can be explained in that context.

I agree getting screened out is the biggest issue, and the way around that is usually away rotations and close networking. This is even the type of situation where it is probably worth picking out a handful of programs you are really interested in and can make a pitch for in terms of ties, and actually writing a longish email saying both why and up front explaining your challenges and sending it to the programs. It's a hail mary but humility and insight can go a long way.

 

[shoenberg3]

Well, I speak as someone who went through the same process last year as an IMG. I quickly understood that being an IMG in itself -- being from UK or not -- is already a significant "red flag." The OP has another obvious red flag on top of that.

For another data point, there is just one more IMG besides me at my program in a less desired location. But he has green card, has no red flags, and graduated from a non-Caribbean school with direct connections with US clinical sites (think Oschner and similar). He also has both Step 1/2 scores slightly higher than the OP's impressive score! I know many others with great scores and no red flags who ended up with only 2-3 interviews and did not match.

That being said, OP still has a chance in my opinion, especially if he's willing to go to less desirable (potentially malignant) programs. Or perhaps, play the long game and spend 2-3 years in the US doing research and making connections. PM me and I will try my best to provide further advice.

 

[KnightofBaldMt]

I participated in all of our resident interviews last admission cycle. We definitely interviewed a small number of IMG candidates, we definitely interviewed people that had at least one failure during their journey. Importantly, the failure was early and you've shown quite a lot of resolve and proven an upward trajectory. I think passing Step 3 would be another reassuring marker on your application. Especially in the current market, you will need to play up "Why Psych?" for you and the geographic location of where you're applying. I wouldn't advise applying all psych, but perhaps also apply a backup specialty. Our chair is from the UK, could attempt to look for similar connections that would make people screen you in.

 

[Celexa]

Well, I speak as someone who went through the same process last year as an IMG. I quickly understood that being an IMG in itself -- being from UK or not -- is already a significant "red flag." The OP has another obvious red flag on top of that.

For another data point, there is just one more IMG besides me at my program in a less desired location. But he has green card, has no red flags, and graduated from a non-Caribbean school with direct connections with US clinical sites (think Oschner and similar). He also has both Step 1/2 scores slightly higher than the OP's impressive score! I know many others with great scores and no red flags who ended up with only 2-3 interviews and did not match.

That being said, OP still has a chance in my opinion, especially if he's willing to go to less desirable (potentially malignant) programs. Or perhaps, play the long game and spend 2-3 years in the US doing research and making connections. PM me and I will try my best to provide further advice.

To a certain degree we are arguing over terminology, but as someone who advises medical students at a residency that accepts people from a wide range of backgrounds, I don't think being an IMG is by itself a red flag. I think of red flags as being aspects of an application that make you doubt whether someone can successfully complete residency, if accepted. Red flags have to be specifically addressed and mitigated in the application itself. Just being an IMG isn't one of those. Instead I would say it's a disadvantage--which influences where you should apply and what your chances are, but which you don't have to explain away in your application.

It is true though that there is a LOT of nuance to who gets accepted for interviews and what mitigates that disadvantage. There are too many medical schools in the USA for us to be familiar with all of them, much less international. If you can find programs where other graduates of your school have gone and done well, that can go a long way. Once a program has had a good experience with a graduate of a particular medical school, they begin to feel like other graduated from that place are a more known quantity. This is where that question of networking and away rotations can become key.

 

[Stagg737]

To a certain degree we are arguing over terminology, but as someone who advises medical students at a residency that accepts people from a wide range of backgrounds, I don't think being an IMG is by itself a red flag. I think of red flags as being aspects of an application that make you doubt whether someone can successfully complete residency, if accepted. Red flags have to be specifically addressed and mitigated in the application itself. Just being an IMG isn't one of those. Instead I would say it's a disadvantage--which influences where you should apply and what your chances are, but which you don't have to explain away in your application.

It is true though that there is a LOT of nuance to who gets accepted for interviews and what mitigates that disadvantage. There are too many medical schools in the USA for us to be familiar with all of them, much less international. If you can find programs where other graduates of your school have gone and done well, that can go a long way. Once a program has had a good experience with a graduate of a particular medical school, they begin to feel like other graduated from that place are a more known quantity. This is where that question of networking and away rotations can become key.

It may be semantics, but I do think being IMG as SDN defines it is a red flag. Ie, US citizen who didn't go to a US med school and is now trying to match. The issue there being why couldn't they get into a US med school and did their training at what are often notoriously predatory schools (Caribbean) set them up to succeed in residency?

OP sounds more like an FMG as SDN would call it (ie, non-US citizen IMG), which is far more variable. Some FMGs are better candidates than most US grads. Some are definitely not. While there may be no academic concerns if they're one of the great candidates, there's still the citizenship concern and whether their visa/green card status will stay valid as well as if they'll even stay after residency since plenty of programs want to train docs that will stick around the area.

1) US residency programs are shorter than UK programs. For example Psychiatry is 4 years in the US and it is 8 years in the UK

This is fair but not something you should be telling people during the process as it makes it sound like you just want to take a short cut. I know just enough about the UK's educational system to make potentially bad assumptions. Ie, in the UK you may not have any undergrad education before entering medical school and may be applying to US residencies as a 23 or 24 yo and may have deficits in other educational areas than someone who did a UG degree then went to medical school. That may be bias, but I've met many docs who feel that way. That combined with failing a year of medical school would be very problematic imo.

2) UK residency programs prioritize service provision over teaching in a way that I don't believe US residency programs typically do due to the nature of our healthcare systems. However, given my red flags this may no longer be accurate if I can only match into malignant, scutwork-heavy US programs.

You'll encounter this to some extent even at the most educationally focused programs, and to a certain extent it's necessary for you to be prepared to actually deal with that stuff when you actually start practicing as an attending. Idk what the extent of scutwork and non-educational activities in residency in the UK is, but unless you talk to someone very familiar with multiple programs in both countries I'd be cautious about that comparison.

3) My long-term girlfriend is American and hates living in England. She wants to move back ASAP. I quite like the states so it made sense to try to move there for residency. Happy spouse, happy house.

This is probably your strongest argument of the 3 and very legitimate imo. If you're planning on coming to the US to be with her at some point anyway, then doing so before residency is likely the best timing for that. If there are certain locations that you/she want to move to long-term then apply heavily in those geographic areas. Keep in mind, the UK is geographically tiny compared to the US, so there's a massive difference between east coast vs west coast vs no coast (pics below in spoiler for idea of scale). I would absolutely discuss this in your application and agree with Splik to put a ring on that if you see her being your partner for life.

Spoiler: The UK is small...

 

[whopper]

IMHO the international medical education system is inferior, not as a whole, but at the just graduated with an MD level vs the US system. Why? Other countries take medstudents right after high school, while in the US the MD system is intense post-graduate schooling. Several in medschool in other countries do work hard but it's usually not on the order of US medical students. Also several non-US programs do not have clinical rotations by the time the student graduates with the MD.

Add to that, the non-US systems require residency training that's longer than the US system. Hence in the end I'd say they're about the same, but right at the point of graduating with the MD, the US students are actually ahead. And of course I haven't seen any studies really putting US fresh MD graduates vs non-US MD graduates, but this is what I've seen in-person, as someone who is an IMG, did a semester in the UK, and saw IMGs start residency in America. To the IMGs credit, while I saw most of them behind, they'd usually catch up within a few weeks to months of being put in the grind of being a PGY-1.

The only other problem with IMGs is the language and cultural barriers. Not speaking the native language of the patient can be a serious problem and this isn't about speaking English or not. It's a great boon for a physician to speak the language of the patient no matter their language. That includes Spanish in some areas, or even other languages. But getting to the point and I don't mean this politically, there has to be a common language in a hospital so the staff could speak to each other. PC is getting nonsense when this cannot be addressed in a honest manner. Of course a treatment team isn't going to function as well if they don't speak the same language. Anyone wanting to (dishonestly) argue if we have to have providers who don't speak the same language in a hospital and if we don't do such we're culturally ignorant-I'm not going to waste my time on this.

Now all that this has been written and moving beyond, IMHO so long as the applicant had great USMLE scores I almost wouldn't care about their grades especially if someone had a real issue going on such as a family tragedy or personal health problem. The problem, however, is such an applicant is going against other applicants who didn't have this problem, and when competition ramps up, the arbitrator has to start picking anything, even if unfair to parse things out.

To give an example, several elite colleges get too many applicants with too many excellent grades. The admissions committee then has to start culling applicants based on standards that have no evidenced-based merit cause they really have nothing else to go on.

 

[docksan]

Yep to all of that

 

[Merovinge]

IMHO the international medical education system is inferior, not as a whole, but at the just graduated with an MD level vs the US system. Why? Other countries take medstudents right after high school, while in the US the MD system is intense post-graduate schooling. Several in medschool in other countries do work hard but it's usually not on the order of US medical students. Also several non-US programs do not have clinical rotations by the time the student graduates with the MD.

Add to that, the non-US systems require residency training that's longer than the US system. Hence in the end I'd say they're about the same, but right at the point of graduating with the MD, the US students are actually ahead. And of course I haven't seen any studies really putting US fresh MD graduates vs non-US MD graduates, but this is what I've seen in-person, as someone who is an IMG, did a semester in the UK, and saw IMGs start residency in America. To the IMGs credit, while I saw most of them behind, they'd usually catch up within a few weeks to months of being put in the grind of being a PGY-1.

The only other problem with IMGs is the language and cultural barriers. Not speaking the native language of the patient can be a serious problem and this isn't about speaking English or not. It's a great boon for a physician to speak the language of the patient no matter their language. That includes Spanish in some areas, or even other languages. But getting to the point and I don't mean this politically, there has to be a common language in a hospital so the staff could speak to each other. PC is getting nonsense when this cannot be addressed in a honest manner. Of course a treatment team isn't going to function as well if they don't speak the same language. Anyone wanting to (dishonestly) argue if we have to have providers who don't speak the same language in a hospital and if we don't do such we're culturally ignorant-I'm not going to waste my time on this.

Now all that this has been written and moving beyond, IMHO so long as the applicant had great USMLE scores I almost wouldn't care about their grades especially if someone had a real issue going on such as a family tragedy or personal health problem. The problem, however, is such an applicant is going against other applicants who didn't have this problem, and when competition ramps up, the arbitrator has to start picking anything, even if unfair to parse things out.

To give an example, several elite colleges get too many applicants with too many excellent grades. The admissions committee then has to start culling applicants based on standards that have no evidenced-based merit cause they really have nothing else to go on.

Being non-fluent in the language you practice in is the biggest problem in psychiatry of all fields of medicine. Yes that means foreigners from English speaking countries have a leg up, and yes that means the affluent that had English based international/high end schools have a leg up. I have seen patients hospitalized (unfortunately on more than one occasion) because an outpatient psychiatrist did not understand what was being said to them and reported them as psychotic. In CAP it's even more painful when this leads to misdiagnosis. Nothing about xenophobia, I just don't see equivalent outcomes for non-fluent English speakers practicing psychiatry in the US.

 

[whopper]

Patient comes in with black lipstick, purple hair, long black fingernails and a "my parents don't understand me cause they won't get me a sports car for my birthday," comments. Diagnosis? Me-Cluster B, IMG-Bipolar Disorder or Schizophrenia.

 

[shoenberg3]

Admittedly, I am mostly familiar with IMGs who started residency within last two years, but I have not witnessed such egregious deficiencies from those I've met personally. They were - I suppose I am including myself here - not only perfectly fluent in English but also usually well acculuturated to the US.

But perhaps, that is one positive thing to come out of the recent increase in competition for psychiatry. As I understand, only those who are highly motivated, well qualified (presumably at least), and highly acculuturated manage to match to a psychiatry program nowadays.

 

[whopper]

Seeing competition go up is great because I see so many bad psychiatrists out there. The only problem is for guys like me who haven't gotten in who love the field and our love shows in our work, but don't test well. I was lucky and applied during an era where there was a significant lack of applications.

 

[FlowRate]

The only other problem with IMGs is the language and cultural barriers. Not speaking the native language of the patient can be a serious problem. Of course a treatment team isn't going to function as well if they don't speak the same language.

Some of my PGY-1 was spent at a hospital where the categorial IM residents were largely from south asian countries. There was a pretty wide variation of English proficiency among them. I was rounding together with my senior one morning and the senior asks the patient "what color was your stool?" The patient says, clear as day, "brown." My senior didn't ask any further questions about stool or GIB workup which was, to me, totally appropriate given that's a normal finding. We get back to the workroom and my senior instructs me to go perform a DRE/FOBT on this woman because somehow my senior heard "black" and wouldn't take my word for it.

Thankfully the senior left early that day, I explained the situation to the covering senior who understood how poor her English was and we ultimately did not DRE the patient...

 

[Stagg737]

I don't think the idea is xenophobic at all, just an unfortunate aspect of our field because so much of what we do is dependent on verbal communications. Where I live has a lot of immigrants from various areas of SE Asia and Africa who speak dialects that translation services don't even understand. I've had more than one patient where we did our best but only figured out what was going on after 2-3 ER/hospital visits when other family finally showed up to translate or once had videos of bizarre behaviors at home. I can't imagine how much more difficult or even how it would be possible if the psychiatrists and staff weren't fluent in English and we were trying to translate through 3 or even 4 languages/dialects.

On the opposite end, in med school we were seeing a patient who was brought in by family overnight but then we couldn't get a hold of family to get collateral for several days. We thought she was psychotic because the translator(s) kept telling us she she was "hearing her ancestors talking about her from above" or something along those lines, but was definitely "hearing her ancestors" and said she'd see them in her apartment too. We thought maybe it was a cultural psychosis for days and had started antipsychotics. Nope. Turns out her grandparents lived in the apartment above her and she could hear them talking about her through the ceiling and their cultural dialect had similar words for grandparents and any other "ancestors". Family was just concerned about her being depressed but said she was otherwise normal.

Even with translators, things can still be easily misinterpreted, so I completely understand why there would be an ongoing (and warranted) bias against FMGs/IMGs without very high levels of language proficiency being accepted into US psych residency programs.

 

[whopper]

I don't think the idea is xenophobic at all, just an unfortunate aspect of our field because so much of what we do is dependent on verbal communications.

We live in an era where there's a demographic of people too sensitive and too easily offended, and another demographic more than willing to piss these other people off.

 

[docksan]

Psych is unique in that other than language proficiency you need to be able to dive under the superficial and have skepticism and yet time and time again what I see happening is "ah I remember DIG FAST it just be bipolar" before you come in and go ah yes it's actually just PTSD.

 

[squeakyclean]

I would consider addressing the reason(s) you failed your first year in your application; that shouldn't be the focus, but should be addressed in a straight-forward manner that helps the reviewer understand why this happened and the steps you took to ensure it would not recur. I also wonder if any of your UK mentors have strong enough collegial relationships with US faculty that they might help explore or create opportunities for you. Finally, I would imagine your "chances" in any year depend on the quality of your co-applicants. I interview fellowship applicants, not residency. For what it's worth, I would not rule you out if you were otherwise competitive and had a compelling explanation for your failure. Some of our faculty might, but others would share my stance.