IMG interested in Emergency Medicine

[mjp0288]

Hi I am currently a third year student at Ross University and was interested in EM. I recently received my STEP 1 score and got a 235. I was wondering if EM is still an option for me and if so, what more should I do be a competitive applicant? Any suggestions on what electives to take and where to take them? How should I begin preparing for my rotations? I will be at Atlanta Medical Center for my core rotations but will be able to complete my electives anywhere. Any help would be greatly appreciated!

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[DocEspana]

Just continue to be the best candidate you can be and apply very broadly. Seems like General advice, but the "img bias" is very variable institution to institution. But the ones that don't have a lot of bias will have A LOT of exceptionally high scoring candidates to select from and the ones that do show bias are many and they will want you to really outscored the American applicants. You really won't significantly outscore most applicants with that score (it's quite average, which wouldn't be an issue if biases weren't quite so common).

But if you're consistently the best candidate you can be, your score is not a terrible starting place and a broad application should serve you well.

 

[BoardingDoc]

Yeah, need to echo what DocEspana said. I ran into a couple of people from Ross and St. George on the interview trail and both of them kept saying how surprised they were with how few interview offers they got. I didn't pry too much, but it sounded like they had decent applications so I would definitely agree that there is a significant IMG bias. Translation: apply to craptons of programs.

 

[DocEspana]

Yeah, need to echo what DocEspana said. I ran into a couple of people from Ross and St. George on the interview trail and both of them kept saying how surprised they were with how few interview offers they got. I didn't pry too much, but it sounded like they had decent applications so I would definitely agree that there is a significant IMG bias. Translation: apply to craptons of programs.

Yea. I was trying to keep too much of my anecdotes interacting with Ross, SGU and AUC students out of this.... but they have given some real doom and gloom scenarios about the process for EM interviews. Now I know plenty that match fine... BUT... im under the impression the people with this success were packing some good scores (250+) and the ones more in normal applicant range (230-245) have significantly fewer interviews than youd expect. does it stop them from matching? Only if they dont seriously hedge their bets and apply very broadly (and to small programs and middle america) or so I'm told. Not that small programs and middle america are the only choices, but you really can't *not* take that insurance. I was lucky enough to be able to apply only northeast, but I knew I had some really compelling things in my CV and Im a US student, and I matched well. My islander friends who tried the same thing had an unusually high number of "did not match at alls".

 

[Apollyon]

Yeah, need to echo what DocEspana said. I ran into a couple of people from Ross and St. George on the interview trail and both of them kept saying how surprised they were with how few interview offers they got. I didn't pry too much, but it sounded like they had decent applications so I would definitely agree that there is a significant IMG bias. Translation: apply to craptons of programs.

I went to SGU, graduated 12 years ago, and any students that are surprised by how FEW interviews they got are talking directly out of their recta. Period. Every invite should be viewed as a gift, not an entitlement.

The first year Georgies took the NBME part I (precursor to the USMLE, and this was 1978 or 79), a guy hit 792/800 questions right. That's 99%. His name is Jeff something. What was the first statement? That he worked his ass off? No, that the guy, somehow, cheated. (He didn't.)

So, the FMG bias WAS worse, but now it's just more civil/absent actions - just reject your app without comment.

 

[Apollyon]

but I knew I had some really compelling things in my CV and Im a US student, and I matched well.

Aren't you DO? If you are so high-powered/connected/blessed/whatever, why did you choose DO? (Not a dig on DOs, being an FMG myself, but I used to think that it was about 50% "true believers", and 50% "didn't get in MD", but, out of about 10 DOs I know (and, yes, this is anecdote), none did it for ideology, and none practice it today.) As one guy said, the first thing he did after getting his degree was sell his OMT table. Now, this is not to say that some don't keep up their AOA stuff, but none are using anything but allopathy in their work.

 

[DocEspana]

Aren't you DO? If you are so high-powered/connected/blessed/whatever, why did you choose DO? (Not a dig on DOs, being an FMG myself, but I used to think that it was about 50% "true believers", and 50% "didn't get in MD", but, out of about 10 DOs I know (and, yes, this is anecdote), none did it for ideology, and none practice it today.) As one guy said, the first thing he did after getting his degree was sell his OMT table. Now, this is not to say that some don't keep up their AOA stuff, but none are using anything but allopathy in their work.

Wasn't connected until med school.

I had family reasons to stay in NYC area. It's hard to get into med school there as I was probably an average candidate. So I could move hours (or time zones) away and get MD or stay with family and get DO. Degree never meant anything to me, so it was a no brainer. It's not a decision I regret, but I wonder what opportunities might be different if I went to Ohio or Kentucky.

And it goes both ways bevcause I used my Dean at my med school to get me into prestigious positions within the AMA, something I doubt I'd be doing if I went to any other school and is the feather in my cap now, having written actual health policy in my state and in Washington.

 

[Groove]

Search the forum, dude. This one has been done so many times over the years. Do some legwork and sift through the data on NRMP "Charting Outcomes in the Match". All your data is there. Mean accepted board scores on steps 1 and 2. Mean "programs ranked" needed for successful matching. They've even got a new one specifically for IMGs.

 

[BoardingDoc]

Search the forum, dude. This one has been done so many times over the years. Do some legwork and sift through the data on NRMP "Charting Outcomes in the Match". All your data is there. Mean accepted board scores on steps 1 and 2. Mean "programs ranked" needed for successful matching. They've even got a new one specifically for IMGs.

Jesus. I just checked out that doc for IMGs.

US-IMGs (e.g. Caribbean) had a seriously rough year with applying to EM. Overall match rate: 27.8%
Match statistics by Step 1 score

 

[RustedFox]

SGU grad here. Matched in 2009.

Buckle up.

Apply widely. W - I - D - E - L - Y. Hit up the IMG friendly markets of NYC/NJ/Detroit. Be prepared to go rural. It ain't like it used to be. At all.

 

[Apollyon]

It ain't like it used to be. At all.

It never was. There aren't any "good old days", at least for EM. The FMG anesthesiologists from the end of the 90's and beginning of the 21st century got in right at the right time. Then, with these past 10 years to earn their money, they got it just right in the sweet spot. Then, the "ROAD" days hit, and gas was muy popular with the AMGs again, just in time to get the income slashed.

 

[DocEspana]

SGU grad here. Matched in 2009.

Buckle up.

Apply widely. W - I - D - E - L - Y. Hit up the IMG friendly markets of NYC/NJ/Detroit. Be prepared to go rural. It ain't like it used to be. At all.

Sorry. I may have had something to do with that in my own tiny way.

But I honestly wish nothing but the absolute best for any IMG student applicant (my wishes for the schools and their admin is different). But even the NYC/NJ (cant speak on detroit) markets are drying up comparatively. A lot of the local schools have begun getting program directors on the schools payroll and thus in the schools mindset. And the mindset has been that "we cant compete with them at the clerkship level, so we won't even try, but we can choke them off at the residency point", which works really well if you have program directors echoing that sentiment.... unless you're the 'them' in that sentence.

Now with that said, NYC still has programs like the City Scholars (free tuition for SGU students if you agree to go to a residency in a NYC public hospital. a widely criticized program which appears to cut deals outside of the match system for hospitals that are supposed to be 100% NRMP match) so its not all gloom and doom.

 

[exsanguination]

Say an IMG candidate gets into a US ACGME EM residency, does well, graduates without issue, and has stellar in house reds. Is there a similar bias when it comes to jobs and finding work in more desirable location? How about earnings over a lifetime?

RustedFox and Apollyon, I'd be very interested in hearing your opinions and experiences.

 

[DocEspana]

Say an IMG candidate gets into a US ACGME EM residency, does well, graduates without issue, and has stellar in house reds. Is there a similar bias when it comes to jobs and finding work in more desirable location? How about earnings over a lifetime?

RustedFox and Apollyon, I'd be very interested in hearing your opinions and experiences.

Probably a very small amount of bias out there at that point, but it's probably not statistically significant. Always been told your last level of training takes precedent over everything before it 9 times out of 10.

 

[RustedFox]

Say an IMG candidate gets into a US ACGME EM residency, does well, graduates without issue, and has stellar in house reds. Is there a similar bias when it comes to jobs and finding work in more desirable location? How about earnings over a lifetime?

RustedFox and Apollyon, I'd be very interested in hearing your opinions and experiences.

No.

 

[Apollyon]

Nope. No one cares where you went to med school. If you are licensed and residency-trained and boarded/eligible, you're good.

And, truth be told, I'd accept what the people with experience say.

 

[mjp0288]

I appreciate the honest opinion of everyone who posted. Is it safe to assume everyone who posted is in EM?
How can I be a better applicant because it seems like my STEP 1 score (235) is not going to get me too far...

 

[GTP]

I appreciate the honest opinion of everyone who posted. Is it safe to assume everyone who posted is in EM?
How can I be a better applicant because it seems like my STEP 1 score (235) is not going to get me too far...

I think it's pretty clear. I'll repeat what everyone has said. Bust your ass for step 2 (>255) since people are easily getting 240's these days (so I've read on SDN). Apply EVERYWHERE. Bust ass on your rotations and get good SLOEs. Apply "smart" ie try to make sure SLOEs are uploaded well before programs are done handing out interviews. Interview well. That's all you can do at this point. Good luck. I'm applying this cycle as well.

 

[gro2001]

I appreciate the honest opinion of everyone who posted. Is it safe to assume everyone who posted is in EM?
How can I be a better applicant because it seems like my STEP 1 score (235) is not going to get me too far...

I am an FMG that matched into EM 3 year ago. Agree with everything said above. Here are some specifics:

1) I applied to 113 programs and got 4 interviews. So when they say apply broadly, apply REALLY BROADLY. In fact, I would say apply to ALL the programs (with possible exception of ones in California).

2) Crush step II and do it early enough for the score to ship with your application. By no means does it absolve your step I score, especially since many people end up doing better on step II, but doing worse is not an option for you. Ideally you would do at least 15-20 points better on step II.

3) Have your application complete as early as possible. Ideally, day 1.

4) Do as many away Sub-Is as you can at places that would consider you as an applicant. Also, be awesome while you are there.

5) Hustle. Make follow up phone calls to all the programs you are at all interested. Tell them you are really interested, why you are particularly interested in them and that you will be in country during interview season so are happy to accept last minute invitations.

Good luck! Being an FMG is an uphill battle, but it's not impossible.

 

[MSmentor018]

I am a DO that completed a MD residency, now doing a MD fellowship so I hear ya. it's going to be some work and a lot of patience on your part but definitely doable. we match at least 1-3 islander and/or DO every yr. ross and sgu has been the 2 names I recognize the most. sub I, shadowing, the more face time the better esp at places that have taken IMG before. talk to your school and use the alumni list if you have one to get assistance/advice exactly like what you're doing here. bring your A game. you're fighting an uphill battle and for a very limited number of slots. good luck

 

[mjp0288]

thank you so much for all the advice! I have my work cut out for me.

 

[EMIM2011]

Gro2001, are you a US-IMG or a "true" FMG?

 

[triguy358]

Hi I am currently a third year student at Ross University and was interested in EM. I recently received my STEP 1 score and got a 235. I was wondering if EM is still an option for me and if so, what more should I do be a competitive applicant? Any suggestions on what electives to take and where to take them? How should I begin preparing for my rotations? I will be at Atlanta Medical Center for my core rotations but will be able to complete my electives anywhere. Any help would be greatly appreciated!

Hey there.
I’m SGU, just matched to a small program. I got 7 interviews. My board scores were 243 and 241 on step 1 and 2, respectively. Word around SGU was that kids with scores 260+ all had 15+ interviews, and 255+ had about 11+ interviews, but I knew plenty of people who had 230+ and got around 4-8 interviews depending on their auditions. You want about 10 to be safe they say, but as an IMG I think it is very different. I would recommend quality over quantity. Do as many auditions as possible. schedule them starting in JULY. this is not too early for an IMG. Look at SGU, Ross, and AUC’s match lists and write the program admins to see about scheduling auditions at those places. I did 4. Loved two of those programs, they also really liked me. I ended up at the one I ranked first. If you’re likable and a hard worker, you’ll be fine. If you just have scores and no one knows you, its unlikely a program will take a chance on you, regardless of interviews. An other great thing about doing a ton of auditions is that you can really see which program you gel with. I cannot stress this enough. I met so many people who would go anywhere just to match ED, but they were forcing a fit which just wasn’t there. Another advantage is that you get all that experience! I learned a ton, and if you really like ED its so awesome to be a fourth year in the ED. You just see patients, do cool stuff, hone your differentials, histories, suturing, may even do spinals or intubations if you’re lucky! No orders, paperwork, crap that residents hate. Its beautiful. I wish I could do one right now to get ready for intern year...
I have probably 4 friends I know who matched with step one scores like yours this year. At SGU, we were very worried coming into this season after hearing the horror stories from those matching before us. Nevertheless, we had our best year ever. We matched 34 Em, and 2 EM-peds (U. of Maryland and U. of Arizona). Some of the students with lower end scores were exceptional in the ED and it did not go unnoticed on their rotations. I had the pleasure of rotating along side them and can say without doubt that there isn’t necessarily a difference in a 227 kid v. 255 kid. It seems to me that the more you love the ED and the more auditions you do, the better off your chances of matching.

 

[gro2001]

Gro2001, are you a US-IMG or a "true" FMG?

I am as FMG as they come. Foreign born, went to school abroad, here on a visa.

 

[EMIM2011]

Which country or region of the world are you coming from? Did EM exist in your home country?

 

[gro2001]

Which country or region of the world are you coming from? Did EM exist in your home country?

I am originally from Russia (where EM does not exist) but went to medical school in the Middle East (EM exists in some countries but is super new in all of them, and the specialty there hasn't quite figured itself out yet).