swedish medstudent: inquiry about US surgery residency

[medsweden]

Hi everybody,

I've been very impressed by the amount of information that ive recieved about US residencies from reading everybody's posts, and so i actually wanted to hear your opinions about my choice to seek general surgery residency in the US.

I'm a fifth year med student (of a total 5.5yrs) studying at the Karolinska Institute in Stockholm, Sweden.

I've had an interest for surgery since day one and now that im closing in on graduation ive started thinking about how to reach my goal. The surgical eduation in Sweden is good but it is in fact not as profound as the American one; for example in Sweden a surgical resident will perform 300-400surgeries during his whole residency while in the us that number is closer to 1000. Im also in general very interested in us life and would like to move abroad and try a new world.

I recently took the Step 1 exam (passing on first try, 233/97) and i plan to do step 2 ck + cs by the end of the year. Im also planning to participate in an exchange programme to do 2-3months of clinical clerkship at Vanderbilt in my last semester of studies. In terms of research, the Karolinska Institute has a strong background in that area which has helped me engage in a few research projects within pediatric surgery and ped neurology but nothing published, so i do admit that my experience is limited.

Im simply asking anyone to comment on my competitiveness for a gen surgery residency? do european students have an advantage towards other fmg in your opinion, and also, is the Karolinska institute known in the states for its education (or just that it awards the nobel prize in medicine to an american every yearhehe)?
my intention is not to apply to top tier programs so im very broad-minded in that sense, even though i would prefer a program in a medium-big city on the atlantic side..

looking forward to your replies.

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[Miami_med]

I am not an expert, but I do go to a school that deals with a LOT of IMGs and FMGs due to location. I can tell you what I've surmised from speaking with them, though you can take everything with a grain of salt.

It is very hard (though not impossible) to get a categorical general surgery position in the US as an IMG. The vast majority of spots are taken by Americans. Your experience at Vanderbilt will be extremely helpful, as US clinical experience is almost a must, but that doesn't mean that you will get a spot.

Do you have a legal way to emigrate here, and if you do, what type of work VISA will you be using? Many residencies don't sponsor some types of VISAs. While being European may be helpful in securing a VISA, I am unsure as to whether it is an extreme advantage in terms of getting a spot.

Your Step I is good, but frankly may not be good enough to secure a categorical from Sweden. There are literally hundreds of Indian and Latin American students chasing these spots with 250+ and even 260+ on the steps. You may want to consider applying for prelim spots as well. If you do well there, you can chase a categorical from inside the system. I would also put any sort of geographic restriction out of mind. The majority of programs that might take you as a categorical are going to be the types of programs that are not urban and on the east coast for the most part. Being an urban east coast program almost by definition pushes a surgery program beyond where most IMGs have a chance at the categorical spots.

You will see this at Vanderbilt, but work hours in the US are VERY different than they are in most of Europe. I am very unfamiliar with the Swedish system, but there is no 48 hour work mandate in the US. Our first work restrictions ever were to an average of 80. That was only 7 years ago or so, and some places still take it as a suggestion. This may be changing, but it is unlikely that we will be as restrictive as they are in most of Europe. US residents must get atleast 750 and sometimes will get as high as 1200 or 1300 cases, but this is because they spend a LOT of time in the hospital.

I don't know if that helped. Anyone may feel free to correct me.

 

[Winged Scapula]

I agree with most of the above except that if any FMG has a chance, a graduate from the Karolinska Institute with a good Step 1 score and USCE has it. There are other students with higher USMLE scores, but many of them do not have USCE or do not speak English fluently.

The Karolinska Institute is very highly regarded and it is well known in the US by medical faculty. IMHO You have a better chance than many US citizens educated in the Caribbean and elsewhere abroad, all else being equal.

That said, categorical general surgery is increasingly competitive in the US. Not all programs are open to foreign citizens. Interestingly enough, some of the bigger names are (as opposed to the conventional wisdom that foreign nationals only have a chance at small FMG loaded community hospitals). The Karolinska Institute is regarded highly enough that this alone may polish your application nicely.

In the end, its all a gamble. No one can tell you if you will be successful, but every year there are FMGs who are successful in getting a categorical US position. Most come from well known medical schools (like yours), have no Visa issues, have decent to excellent USMLE scores, and USCE. If you can get your ECFMG certification before application, that will increase your chances of getting interviews.

 

[Pilot Doc]

My impression has always been that there are IMG's and then there are IMG's. Some are more equal than others. Your country, your medical school and your medical system are all well regarded in the US. I don't think you'll encounter any prejudice, and if you do I think it will work in your favor because people will find you interesting and unusual.

My biggest concern for you would be where you would eventually practice. You need to find out if
1) your US training would allow you to practice in Sweden
2) if you have any ability to become a US citizen or permanent resident. Your best chance of that would be marrying a US citizen, but you need to talk to an immigration attorney.

 

[Habeed]

And you know, staying in Sweden can't be that bad. Sure, you get less cases during residency...but I bet you get a lot more sleep and time off, as well. Honestly, I kind of wish I could do your residency. Also, as an attending surgeon, surely you'll have a chance to 'catch up' in cases.

 

[medsweden]

Hi

Thank you for all the quick replies. Yes Habeed there is more off time here in Sweden but extensive hours on the other hand wont scare me away; yes i am not oblivious to the fact that it will take its toll on other parts of my life, but yeah, a dream is a dream i guess..and actually, swedish surgeons are increasingly forced to take rotations abroad, e.g. south africa or us, to acquire sufficient experience, so why not just make that process short for myself and seek that knowledge directlyas ive also said, another incentive for me is that i would like to move to the us and try a new life, and that is not because im discontented with life here in sweden (actually rather content

also a us residency is regarded highly here in sweden so there are certainly many possibilities for me to return to sweden after residency if i believe there was too much hardship to my us experience. (and with the usual J1 visa for residency there is anyway a requirement to return country of origin for a minimum of 2yrs)

thanks winged scapula for those encouraging comments, ive also heard from fellow swedish students who have enrolled in a us program that the karolinska title was very helpful; admittedly theyve only applied to internal medicine which is supposedly easier to match to. Yes i will be ECFMG certified and i am also intending to take the step 3 to make myself eligible for an h1b visa which is sponsored by some hospitals; most of these hospitals are actually on the east coast, e.g. NY FL PA, which is why i mentioned that i might be more interested in them (thought it could be a sign of a more fmg friendly attitude, but of course, i would be applying nationwide)..

yes ive recieved the advice about preliminary spots from other students, but im just worried if thats not too risky, being completely new to a country it would be nice to enroll as a categorical (just feels more secure and mind settling)..

i welcome any further ideas or comments

 

[Habeed]

I agree about categorical. If you can't match categorical, it's stupid to risk a preliminary spot.

Consider this - if you take a prelim spot and don't secure a categorical spot at that institution, then you've wasted a year.

If you had just stayed in Sweden, you might be a year 'behind' where a U.S. resident would be after 3-5 years of a swedish residency due to the lower caseload.

Finally, I have to ask, why do you want to move to the United States? From what I have read, Sweden is a nicer country than America in a lot of ways. The only advantage to the U.S. that I know of is that the lower taxes and higher pay mean that it is possible to accumulate a lot more money.

But what does all the money mean if you have to treat a terribly unhealthy population of overweight slobs? Where 95% of your nurse coworkers are also overweight and a bit dumpy?

What does the money mean if you can't enjoy it due to having to work 80 hours/week?

 

[Miami_med]

I agree about categorical. If you can't match categorical, it's stupid to risk a preliminary spot.

Consider this - if you take a prelim spot and don't secure a categorical spot at that institution, then you've wasted a year.

If you had just stayed in Sweden, you might be a year 'behind' where a U.S. resident would be after 3-5 years of a swedish residency due to the lower caseload.

Finally, I have to ask, why do you want to move to the United States? From what I have read, Sweden is a nicer country than America in a lot of ways. The only advantage to the U.S. that I know of is that the lower taxes and higher pay mean that it is possible to accumulate a lot more money.

But what does all the money mean if you have to treat a terribly unhealthy population of overweight slobs? Where 95% of your nurse coworkers are also overweight and a bit dumpy?

What does the money mean if you can't enjoy it due to having to work 80 hours/week?

There are plenty of problems in both the US and Sweden. The pay is not a little bit different. It is a lot different. There are surgeons in the US still making salaries an order of magnitude higher than their Swedish counterparts. Taxes are also not a little different. They are a lot different. Is it Sweden that still has an 80% marginal tax rate? I also believe that Stockholm is actually one of the most expensive cities on earth, easily rivaling our NYCs and San Francisco. American's like to idealize Europe. It comes with its own problems, as do we.

To the OP, it's all about priorities. If you have no VISA issues, then take a shot. If you want it badly enough, try for the prelims as backup. If you don't, I'm sure that you'd do well in Sweden. As an applicant this year who has applied to both some powerhouses and a LOT of small community programs, I have seen ONE program that has taken an IMG with no prelim year as a categorical in the last 2 years. I know that there are a few more, but the odds are definitely stacked against you in that regard.

 

[medsweden]

Yes i do think preliminary is a bit risky, so im glad i have you on my side on that point.

Well habeed, sweden does have a good reputation and probably is nicer than america in some ways, but at the same time its not a utopia here either you should know..there are many issues in healthcare here that many are disappointed about, recently there was a nationwide strike amongst nurses cause they are considerably underpaid and overworked, referrals of patients to specialists takes dangerously long time (often pointed out by the media) because of shortages here n there..there are of course positives but what i mean is that we also have issues here just as in the states, btw believe me obesity is an issue here too, swedes arent all slim blondes anymore

so in short, im gonna try to make an effort to do my residency in the us because i believe there is a superior surgical education there, that would be 5 tough years of my life i know..as a lighthearted last comment we europeans are quite fascinated by american life (both the negatives and positives) and that fascination lures some of us over, and vice versa i think because weve lured over 2 american EM doctors to our hospital.

 

[Celiac Plexus]

On the plus side for Sweden...

It is a nation populated by beautiful, 6 foot tall, Nordic ice goddesses.

On the plus side for America...

Denny's is open 24 hours a day.

 

[medsweden]

funny that we expressed at about the same time that sweden and us have their own problems, so you cant really compare the countries in that sense..yes 80% for those making good money (in sweden that would be above 10,000dollars/month here)

yes miami_med thanks for giving me a realistic look on things, is florida also empty of IMGs?just asking cause you might know more about that state.

 

[Habeed]

Yeah, that's kind of how I see it...

I don't see how having more money in your pocket that you don't really need is going to make living in America more enjoyable than Sweden.

Many upper middle class americans, at least the ones I grew up around, tend to be obese, work long hours in offices with long commutes, and to spend their money on stuff that doesn't really improve their life much. It's quite common, at least where I grew up, for everyone to blow their funds on vastly oversized houses (5000 square foot was common on the street I lived on), money pit SUVs, and maintainence on the swimming pool.

Yet the oversized house would just eat energy to heat/cool it, and half the rooms aren't really used. The SUV can't be all that much fun for an hour a day commuting in traffic, and they tend to burn money fast.

And fast food for dinner...

I'd rather have a 1 bedroom apartment and spend my time dating swedish blondes...

Basically, the Americans I knew, 'living the dream' (this was a suburb in Texas) didn't seem to be getting much value out of all the money they had. (most residents of the suburb worked for the oil industry or related and household income was almost always six figures)

 

[Habeed]

Sure, in Sweden, you might have less dollars/euros in your pocket, but you would have more time to sleep and do other things like date those Swedish blondes. I'm sure surgeons in Sweden are not at the bottom of the totem pole, even if they don't enjoy quite the same relative status as surgeons in America.

Sweden might have a growing obesity problem, but I don't see how you wouldn't have access to the dwindling pool of hot six foot tall goddesses as a lowly surgeon...

And you might live in a small house and drive a more fuel efficient european compact sedan, rather than a monster SUV. And you'd have plenty of time for exercise and bike rides...

Still not seeing the downside....

Money is not an end in itself, it is merely the means. While happiness differs for each and every person, there are quite a few commonalities. Most men greatly enjoy the company of attractive women. Most of us like recreational activities that offer a challenge and a chance to go somewhere, but aren't too painful or dangerous. And other generalities.

Yeah, the best scenario is to spend an American salary in a nicer country. But you have to come back to live here...

 

[medsweden]

haha im glad you have such a wonderful picture of sweden, and probably as a tourist, that picture would come true if you ever visited!

on a more serious note, i do think there is a misunderstanding if you think that im out for a higher salary, because in that regard i do believe sweden isnt that much worse, in the sense that that pay in comparison still gives you a more "luxurious" life than the average citizen..so money isnt a major issue.

but anyways, it wasnt really my intention with this post for us to argue about who has the prettier girls and such (and yes okay sweden wins), but rather asking of peoples' opinions on the possibility of a swedish/european graduate obtaining GS residency in the US, and i do appreciate the posts that have been written about that so far.

 

[Marsupilami]

Haha, this thread is hilarious . Habeed, I concur with everything you say...I'd chose the opportunity to date attractive Swedish girls over high US salaries, monster SUV's and oversized houses any time.

 

[Miami_med]

funny that we expressed at about the same time that sweden and us have their own problems, so you cant really compare the countries in that sense..yes 80% for those making good money (in sweden that would be above 10,000dollars/month here)

yes miami_med thanks for giving me a realistic look on things, is florida also empty of IMGs?just asking cause you might know more about that state.

We've got a LOT of IMGs. Miami has a huge number in most of its clinical programs. They tend to be Latin American, but that's because we are frankly the number one attractive spot in the world for a large cohort of Latin America. You can speak Spanish on the street, and most latin cultures are well represented.

That being said, we have non-Latin IMGs as well. The majority at my hospital seem to be British or former commonwealth (especially Indian), but not exclusively. The thing is, that in the surgery program, all of the IMGs did prelims first. We have a third year categorical that started as a prelim. We had a chief who was an IMG graduate last year and successfully match into Peds Surg (about as competitive as you can get in the US), but he didn't start as a categorical in the program. We have a lot of Prelims who are IMGs trying to get categorical spots, and many will scattered throughout the US.

To Habeed, I'm already married to a hot Miami woman and have kids, so the tall Swedish blondes just don't hold the same allure for me that they might for you. I need the big house to hold all of my kids' crap

 

[Habeed]

Yeah, that's the thing. All my neighbors in Texas somehow bought enough stuff to more than fill every room of their oversized houses. Some families would have a 'junk' room where they would fill it to the ceiling with possessions that had not been used in years, but that they wanted to keep anyway.

 

[Simppu]

Hi everybody,

I've had an interest for surgery since day one and now that im closing in on graduation ive started thinking about how to reach my goal. The surgical eduation in Sweden is good but it is in fact not as profound as the American one; for example in Sweden a surgical resident will perform 300-400surgeries during his whole residency while in the us that number is closer to 1000.

You could also take a look at other nordic surgical programs, we get to do about 200 cases/year + about the same amount of assisted operations during the first half of our residency. I don't know how many during the second half, because I just started on that one.

J

 

[medsweden]

which nordic country is that?

 

[BlondeDocteur]

Simppu sounds very Finnish to me.

And medsweden, I echo what others have said-- perhaps surprisingly, I think you would have a better shot at an academic program versus a community one. Academic university chairs and PDs go to conferences, follow specific corners of the literature closely, and perhaps have fantasies of being invited to the Karolinska Institute for reasons you already mentioned. I would expect them to be more conversant with the reputations of certain international medical schools over community PDs.

Above all, come over here to research/do clerkships. You have to establish your American bona fides to have a shot.

 

[Simppu]

Simppu sounds very Finnish to me.

Correct. But actually our west coast is very swedish speaking and there are at least two larger hospitals in that area, Vasa and Karleby. So you ,might try one of those.

J

 

[psychforme]

This thread is worthless without pics from sweden

 

[medsweden]

Thanks for the advice, i think you actually have a point about academic PDs versus community PDs. im planning to maybe send some emails to a couple of PDs asking a litte about their program, and we'll see how many bother to answer

psychforme haha excellent picture of our girls!i guess habeed will be happy to see that sweden still has its share of slim n blonde

 

[Habeed]

Bluntly put : do you have a woman similar to one in the picture as your girlfriend or fiance? Because, trust me, if you come to America and leave her there, you aren't going to be able to easily replace her with a comparable model here...

 

[Winged Scapula]

As lovely as the women in the picture above are, do you really think they represent the AVERAGE Swedish female?

I've been there, I have close friends who live in Stockholm. The average Swedish woman is no more or less attractive than the average US female. They don't tend to have as many morbidly obese as we do, but please don't fool yourself into thinking that women as attractive as those in the picture above are filling the streets and cafes.

If I showed you a picture of some Playboy models, do you really think they would represent the average American female?

 

[BlondeDocteur]

Actually all of those women were in the BlondeDocteur impersonation contest.

 

[Winged Scapula]

Actually all of those women were in the BlondeDocteur impersonation contest.

But none of them came close to your beauty, right?

 

[BlondeDocteur]

Of course not. But I gave them all a trophy anyway, since that's how we do things in America.

 

[medsweden]

interesting twist this thread has taken..but okay

 

[Habeed]

You still haven't told us how your actual girlfriend/fiance stacks up against the images above. I'll freely admit that mine does not resemble anyone in the playboy catalog.

 

[Miami_med]

Again, maybe its being in Miami, but my hospital is like 3 miles to south beach, where all of the world's most beautiful people come to hang out. All you need is a corporate expense account, $2 million condo, and a private jet and one of them might be yours .

Also unlike Sweden, there are places in the US where it is warm for more than 2 months of the year, so everyone doesn't look like a trench coat or parka.

 

[Habeed]

Again, maybe its being in Miami, but my hospital is like 3 miles to south beach, where all of the world's most beautiful people come to hang out. All you need is a corporate expense account, $2 million condo, and a private jet and one of them might be yours

That's kind of my whole point. Slim, pretty girls are much rarer in the U.S. relative to the total population than they are in Sweden. So, here, they can demand things like that, and sometimes get them. I'm guessing, though I could be wrong, that a "mere" surgeon in training would be enough to interest women equally as attractive over there in Sweden.

But if he came to Miami? How's he going to compete against all the beach bums with trust funds and the retired millionaires? "Surgical resident" making less than a physician's assistant won't buy a high maintenance girl many shoes...

 

[medsweden]

well i didnt answer about my girlfriend because i didnt really think that was the issue of this thread, but yes, she is a very pretty swedish girlthats all youre getting out of me my friend..btw you cant really flaunt with your money like you seem to describe you can do in the states, youll have to be a bit more subtle about it here (naturally, there are exceptions to every rule)..anyhow..

i was going to ask you all if you thought that the First Aid series for the various steps is really the best review out there; i used the one for step 1 and was actually quite satisfied but just wondering if anybody knew of anything better? thanks.

 

[BlondeDocteur]

That's kind of my whole point. Slim, pretty girls are much rarer in the U.S. relative to the total population than they are in Sweden.

Dude, Habeed, have you been to the South?! That's all girls do, is preen and primp and go to the gym. At my undergrad women got up every day at 6:30 to get ready for a 11 AM class. Have you walked around a Southern campus, or been to an SEC football game? Don't judge the US by Pacific Northwest fleece-clad crunchy women, or the no makeup/shapeless clothes/hair in a ponytail Northeasterner.

 

[Habeed]

Dude, Habeed, have you been to the South?!

Yes, I grew up there. I said as a proportion of the population : I know beautiful women exist even in this nation of fast food and McDonalds.

 

[Miami_med]

This thread is so off topic

 

[medsweden]

This thread is so off topic

tell me about it, its been highjacked..but i do thank for the relevant answers thus far

 

[Habeed]

Well it can be simplified to the following :

"medsweden" wants to know if he can receive more opportunity in the American system to become a better surgeon and to make more money. The reply has been "yes to both, but it's an uphill battle, as the categorical surgery seats go almost entirely to American grads."

And some of us have injected in : "why would you want to fight this uphill battle that you might lose? The only long term benefit is more money, and what would you do with that money?"

 

[medsweden]

Hi

Is there anybody who is doing residency or medical school at vanderbilt who could reply and tell me a little about it? Im gonna be there for a 2 (maybe 3) month exchange in the spring of next year and was wondering which electives were worthwhile (especially in terms of surgical electives). I would be very appreciative of your replies. thanks

(naturally i will also look around at vanderbilts own website for some answers)

 

[MossPoh]

As lovely as the women in the picture above are, do you really think they represent the AVERAGE Swedish female?

I've been there, I have close friends who live in Stockholm. The average Swedish woman is no more or less attractive than the average US female. They don't tend to have as many morbidly obese as we do, but please don't fool yourself into thinking that women as attractive as those in the picture above are filling the streets and cafes.

If I showed you a picture of some Playboy models, do you really think they would represent the average American female?

Oddly enough, during the world cup in germany, all of the swedish women except maybe two did look like that. It was so perfectly stereotypical.

I obviously can't offer advice, but just wanted to comment on something. Medsweden has better English skills than about 95% of the people on this website. If the whole surgery thing falls through, you can tutor some of the people in the pre-allo/pre-osteo forums. It'd be much appreciated.

 

[medsweden]

Oddly enough, during the world cup in germany, all of the swedish women except maybe two did look like that. It was so perfectly stereotypical.

I obviously can't offer advice, but just wanted to comment on something. Medsweden has better English skills than about 95% of the people on this website. If the whole surgery thing falls through, you can tutor some of the people in the pre-allo/pre-osteo forums. It'd be much appreciated.

thank you mosspoh, i do admit though that my primary and secondary school education has been at an english-speaking school here in stockholm, so its not all american tv-shows (even though we have plenty of that here too; and its not dubbed like in germany! so people have a chance to actually learn english here)...well i do love teaching, so if surgery does fall through i will definitely be on the next lot of med students to maybe advance their knowledge

well well im anyway very excited about going to vanderbilt next year, and hopefully ill see a lot of the trauma that never shows up here (i do understand that it maybe is a bit sinister to hope for great trauma, so i do apologize if anybody is offended)

 

[Llenroc]

I've never heard of your medical school no offense. That said your Step 1 score is decent. Also, American program directors will always take a blonde white Swedish guy over an Indian or African FMG applicant, which is a reality more cold and more harsh than Sweden's winter.

 

[Bill_Brasky]

This thread is worthless without pics from sweden

wait why aren't we talking about this picture anymore? lets get back on track here

good luck medsweden come to america and bring all your female friends

 

[BlondeDocteur]

Vanderbilt is an excellent medical center with a very good surgical department. Any elective you take will be fine-- though hopefully you're not expected a short, relaxing Swedish work week. Pediatric surgery is well regarded there, and as Vanderbilt is basically the only show in town (in a catchment area of well over a million people) the trauma experience will be good too. Americans have lots of road accidents.

 

[medsweden]

Vanderbilt is an excellent medical center with a very good surgical department. Any elective you take will be fine-- though hopefully you're not expected a short, relaxing Swedish work week. Pediatric surgery is well regarded there, and as Vanderbilt is basically the only show in town (in a catchment area of well over a million people) the trauma experience will be good too. Americans have lots of road accidents.

thanks a lot blondedocteur!..great that pediatric surgery is so good there since im extra interested in that area.

 

[psychforme]

Oddly enough, during the world cup in germany, all of the swedish women except maybe two did look like that. It was so perfectly stereotypical.

It's actually a very representative image of the Swedish female, a fact everyone who have been to Sweden know. The myth that "they don't really look like that" is perpetrated by jealous females all over the world and of course by the swedish males who do not want any international competition.

 

[medsweden]

btw, good luck to all of you who are participating in the match!

 

[Winged Scapula]

It's actually a very representative image of the Swedish female, a fact everyone who have been to Sweden know. The myth that "they don't really look like that" is perpetrated by jealous females all over the world and of course by the swedish males who do not want any international competition.

Having been to Sweden and not having any reason to be jealous, I think the comment above was that not ALL Swedish women look like that.

There are certainly a large number of beautiful women in Sweden, but the picture above does not show you the average Swedish woman anymore than photos from the Playboy mansion show the average American woman.

 

[medsweden]

just got my step 2 results back and it was soo poor 220/91..that sure is disheartening, the hill just got considerably steeper...im gonna go feel sorry for myself for a couple of days nowand take new strides towards the cs i suppose..

 

[medsweden]

wohoo! just got notice that i was accepted for a research year in trauma surgery in the states..looking better now