How to work as a dermatologist in the US? HELP ME PLEEEEEEEASE!

[Becky.derm]

Good evening everyone,

I am so very desperate right now, I need serious advice from you, rs.. I am a 26 year old medical student, going to graduate by the end of this year. To be a dermatologist is what I've been dreaming of in the last few years..Getting into medical school here in Brazil is not easy - you've got to pass a really, really competitive exam. Fortunatelly, I'm proud to say that I'm graduating from one of Brazil's best medical schools. Also, in order to be a dermatologist here, you need to pass another very difficult exam. So, this year, I'm studying to get trought it and be able to start my dermatology residency next year. The thing is, I am an american citizen and I am desperate to go back to the US! But I've lived in Brazil for most part of my life (as you can probably see, not even my english is that good anymore) and I didn't take the USMLE steps yet. What I want to know is..

1) Do I REALLY need to take all the USMLE steps in order to work as a dermatologist in the US?
2) If I pass the USMLE and get me certification, do I still need to do all my residency in the US in order to work there as a derm? Or will my brazilian residency be enough?
3) How possible is it, really?

Any advices?? Please, it would help me sooo much..

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[Mad Jack]

You need to complete the USMLE and an ACGME derm residency to practice derm in the US. You might be able to get a residency in the US, but you will certainly not get a derm residency, as it is currently one of the most competitive residencies in the match.

 

[Becky.derm]

Thank you for your advice Mad Jack! Imagining how hard it would be to get into derm in the US I decided to change my plans..At first I was studying for the USMLE steps, but the time came when I needed to decide wether I would focus on my brazilian residency exam or on the USMLE steps..Because it would be impossible to get them both in the same year! But as I still wish to go to the US, I'm now studying all possibilities there are for me..
I wouldnt say that I am certainly not getting into a derm residency in the US, since I'm graduating from an excellent medical school here, which is not only very hard to get in but also is very respected worldwide. Actually, I wouldn't go anywhere looking for a better medical school/hospital than I already have, but I wish to go back to the US because of many other aspects regarding quallity of life. Also, I wouldnt accept to do any other residency that not derm just to go back to the US..
I know about many collegues that went to the US because of a fellowship program or something like that and got real invitations to stay (because the staff apreciated them), and some of them didn't even take the steps! I know that is not the best way to do it, but maybe a possible way?
What I'm thinking now is that I'm doing my residency here, taking the USMLE steps during this time and than applying for a residency in the US..What do you think about that? Do you think that would give me some advantages on the match or wouldnt it make a difference?
Thanks again!

 

[Mad Jack]

Out of 12,683 IMG and USIMG applicants, 8 matched in dermatology last year, taking 8 of the just over 400 dermatology positions available. Those aren't impossible odds, but less than 1 in 1,000 foreign grads lands a derm spot. It isn't about how good your school is- out of applicants from the best schools the world over, only 8 got derm spots, and my bet is that half of those (if not more) were already board-certified dermatologists in their home country that were taken on by the US residencies due to a past history of ground-breaking research that will make these derm departments look good.

If you want to be a physician in the US, it is going to be a tough road. Only about 40% of foreign grads, regardless of school quality or US citizenship, manage to get into the US to practice as physicians. Study hard for the USMLE when you decide to take it, and don't screw it up- an IMG with a single failure on the Steps is basically done for. Once you have that sorted out, apply very broadly in the Match (100-200 programs or more, mostly spread out among the less competitive fields), interview well, and pray. Also do it as quickly as possible, as the number of US grads relative to residency spots is exploding and there soon won't be a whole lot of residencies left over for IMGs.

 

[Medstart108]

Out of 12,683 IMG and USIMG applicants, 8 matched in dermatology last year, taking 8 of the just over 400 dermatology positions available. Those aren't impossible odds, but less than 1 in 1,000 foreign grads lands a derm spot. It isn't about how good your school is- out of applicants from the best schools the world over, only 8 got derm spots, and my bet is that half of those (if not more) were already board-certified dermatologists in their home country that were taken on by the US residencies due to a past history of ground-breaking research that will make these derm departments look good.

If you want to be a physician in the US, it is going to be a tough road. Only about 40% of foreign grads, regardless of school quality or US citizenship, manage to get into the US to practice as physicians. Study hard for the USMLE when you decide to take it, and don't screw it up- an IMG with a single failure on the Steps is basically done for. Once you have that sorted out, apply very broadly in the Match (100-200 programs or more, mostly spread out among the less competitive fields), interview well, and pray. Also do it as quickly as possible, as the number of US grads relative to residency spots is exploding and there soon won't be a whole lot of residencies left over for IMGs.

Yeah, and also remember that if you pass your USMLE you can't retake it ever again so its very important that you do well especially for derm the first time. Honestly since you have a backup in Brazil its not too big of a deal. In the 2014 match the match rate was 49% for true IMGs, aka non- US citizen grads, and since you have US citizenship it should be slightly easier.

If you really are "the best out of the best" in brazil and you study really hard it should show on your application and there is a small chance you will have an interview. You would have to have fluent English though because PDs want the best with the least hassle period. If things are equal, they'll always take the US grad, so yes it will be very tough for derm. Good luck if you decide to pursue this route.

 

[Becky.derm]

Thanks for the advice guys..Medstart, did you mean 49% of all IMGs who applied for any US residency matched? Do you know the percentage of IMG who applied for derm that got in? Well, I'm not the top student of my class, but I'd say I'm a good student in the best med school..Dont have an impressive curriculum, but I've got publications and good grades..By the way, do you know if they care at all about sports participation during college? And I will for sure take some english classes during this time, rs! Thanks!

 

[Medstart108]

Thanks for the advice guys..Medstart, did you mean 49% of all IMGs who applied for any US residency matched? Do you know the percentage of IMG who applied for derm that got in? Well, I'm not the top student of my class, but I'd say I'm a good student in the best med school..Dont have an impressive curriculum, but I've got publications and good grades..By the way, do you know if they care at all about sports participation during college? And I will for sure take some english classes during this time, rs! Thanks!

Yeah 49% of all non-US citizen IMGs who applied for any US residency (this includes all the specialities) matched. Since you are a US citizen, your chances are better but because you are going for dermatology your chances will be a lot worse.

Most important is you need to get electives in the US in dermatology. I'm assuming your school gives you some time off in your final year to do rotations in other places, you need to set up an elective during that time in the US in derm. You can't do this after you graduate because you need to be in medical school to get an elective, it has something to do with malpractice insurance. The other thing is you will need a lot of vaccines and forms so start the process early, preferably 8 months before you are scheduled to do your elective.

If you don't get electives in the US in derm, your chances will be much diminished because the whole point of electives is to "show off your skills". If you are good, then you can get US letters of recommendation which you will need to apply for residency. Brazilian letters of recommendation are a lot less effective. What they want to see is that you can perform in the US clinical setting.

The thing is since you are in your final year already I think you may have missed the boat slightly. If you can try and delay graduation take the time to do electives in the US. Basically you just need to still be a medical student and have time off, once you graduate you won't be able to get electives. If electives aren't possible, try observerships which are where you can only observe. Its definitely not as good as an elective you are given your own patients to take care of, in an observership you can only watch. Without proof that you can function in the US well as a resident, most programs won't even look at your application.

Anyways, good luck, i don't anticipate you will apply for a few years but the one thing you need to get done before you graduate is a derm elective in the US because you won't be able to do it so easily after you graduate.

 

[Winged Scapula]

You've gotten good and accurate advice here. While I won't say that you won't be able to obtain a US dermatology position, it is exceedingly unlikely.

In regards to to the perceived doctor shortage, there is argument whether this is, in reality, a distribution shortage. Regardless of which side of the argument you fall, the reality is that training positions have been frozen for 20 years and there is no plan to increase the number of residency positions in the future. Therefore the US government has no interest in bringing here and foreign physicians to solve any perceived shortage at this time outside of the already available number of positions.

With US trained medical students offering to pay for a dermatology residency the chances for someone who is foreign trained, even if the US citizen, are very slim.