Well I Matched to a Transitional year, but did not match to an Advanced position...What now?

[CriticalTico]

Hi Guys!

IMG here, 229/240/236 CS first pass. Internist and critical care fellow from home country. I matched to a transitional program but did not match to an advanced anesthesiology position. My plan is to go into anesthesiology and then into neurocritical care. What are the odds...? Which is the best way to go? Any words of wisdom?

Thanks.

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[wickedskillz]

depends on how committed you are to anesthesia. Rock you intern year, look for open spots by emailing program coordinators and keeping an eye out on different websites. If nothing works out by the end of the intern year, try to get some facetime with anesthesia fculty that can recommend you in front of a residency selection committee. You can do this by taking observorships, doing research, etc.

 

[CriticalTico]

Thank you so much!

 

[deleted171991]

I would also think about an alternative specialty as a backup plan, and would try to tailor the transitional year to qualify as the intern year for that specialty (speak to your PD).

 

[VanDiemen]

In your post you say you are an internist and critical care fellow and that your goal is ultimately neurocritical care. I am a little confused why you want to do an anesthesiology residency. Do you want to also practice anesthesiology, or just staff a neuro ICU? Why not apply to internal medicine or neurology residency? There are many different paths you can take if you only want to take care of patients in a Neuro ICU.

 

[deleted171991]

Because he's a smart guy, and wants to fill the holes in his cheese? Because he knows that anesthesiologists make the best intensivists?

But you are right, and he should have a backup plan involving neurology and internal medicine. To satisfy a PGY-1 year for both, I think he needs 9 months of various internal medicine rotations (his PD should know the details).

Also, getting into neurology might be easier than getting into anesthesia. Those scores suck with that CV, especially for an IMG, but some people might be impressed by the diplomas (I am not). I am probably not the only one thinking like that, hence the no match. I am curious what the home country is.

 

[CriticalTico]

Yes actually for me it would be very hard going again through internal medicine, now being getting used to the all the action in the ICU, I thought the specialty that involves a more familiar environment would be anesthesiology. Also getting used to difficult airways, different sedations, and complex OR cases and trans OP echo is a big plus. And yes I know my scores are not great but I had to take them during my first year in the Critical Care Fellowship, so It was impossible for me devoting as much time as I wanted. Actually It had never occurred to me to try the neuro pathway, It surely sounds interesting!

 

[bashwell]

Yes actually for me it would be very hard going again through internal medicine, now being getting used to the all the action in the ICU, I thought the specialty that involves a more familiar environment would be anesthesiology. Also getting used to difficult airways, different sedations, and complex OR cases and trans OP echo is a big plus. And yes I know my scores are not great but I had to take them during my first year in the Critical Care Fellowship, so It was impossible for me devoting as much time as I wanted. Actually It had never occurred to me to try the neuro pathway, It surely sounds interesting!

But I don't think your scores are by any means bad though! I'd say right around average or maybe just slightly under, and most people including IMGs haven't even taken Step 3 before applying. Not to mention you're an attending in your own country, which can't hurt especially if it's a developed country like the UK or some European nations. If you're open to going anywhere for anesthesia, then I think your chances may be better than you think. Of course don't take my or anyone else's word for it, check out NRMP, talk to PDs, etc.

 

[deleted171991]

@bashwell, seriously?

IMGs need much higher scores for the same positions as AMGs.

Also, as I said: the low scores hurt the perceived quality of the IM/CC background. The good anesthesia CCM guys I know tend to be high scorers on all their written exams. It comes with the territory. Plus USMLE is 40+% internal medicine, so it should have been a home game for OP.

I am not saying that anesthesia is 100% out, just that s/he should think about why s/he didn't match. That speaks volumes.

 

[bashwell]

@bashwell, seriously?

IMGs need much higher scores for the same positions as AMGs.

Also, as I said: the low scores hurt the perceived quality of the IM/CC background. The good anesthesia CCM guys I know tend to be high scorers on all their written exams. It comes with the territory. Plus USMLE is 40+% internal medicine, so it should have been a home game for OP.

I am not saying that anesthesia is 100% out, just that s/he should think about why s/he didn't match. That speaks volumes.

Please don't get me wrong, I definitely agree with everything you said you here @FFP! I agree that for the same positions IMGs do need higher scores than AMGs, I agree it's a big question mark as to why OP didn't match the first time around, and I definitely agree we need solid foundations to be a good if not great doctor (especially in CCM).

Sorry I was probably being unclear. But what I mean is, getting into any anesthesia program. Just getting in somewhere, anywhere.

OP's scores are "229/240/236 CS first pass". These scores seem to be around average or maybe slightly under average, at least based on NRMP's Charting Outcomes for IMGs 2014 (though of course average scores have likely become higher since 2014, but at least as far as I'm aware this is the latest NRMP we have). According to NRMP Charting Outcomes for IMGs (2014), the average matched Step 1 score for "Non-U.S. IMGs" was just under 230 (page 9) and the average matched Step 2 CK score for "Non-U.S. IMGs" was just under 240 (page 13). Or see page 25 for a summary.

So I'm just saying, if OP wants to be an anesthesiologist and is willing to go to any program anywhere in the US, then it doesn't seem like his scores are bad enough to rule him out from somewhere. Of course, OP could be ruled out for other reasons (e.g., visa issues).

 

[vector2]

He also didn't say how many programs he applied to. Most IMG's apply to 60-80 and hope to get 8-12 interviews.

 

[Doctor4Life1769]

@bashwell, seriously?

IMGs need much higher scores for the same positions as AMGs.

Also, as I said: the low scores hurt the perceived quality of the IM/CC background. The good anesthesia CCM guys I know tend to be high scorers on all their written exams. It comes with the territory. Plus USMLE is 40+% internal medicine, so it should have been a home game for OP.

I am not saying that anesthesia is 100% out, just that s/he should think about why s/he didn't match. That speaks volumes.

Agree
But there are variables, including the English language, if he comes from a country where English isn't the top language. The other variables being tons of OBGYN, Peds, etc. it's not just an IM test.

 

[deleted171991]

Please don't get me wrong, I definitely agree with everything you said you here @FFP! I agree that for the same positions IMGs do need higher scores than AMGs, I agree it's a big question mark as to why OP didn't match the first time around, and I definitely agree we need solid foundations to be a good if not great doctor (especially in CCM).

Sorry I was probably being unclear. But what I mean is, getting into any anesthesia program. Just getting in somewhere, anywhere.

OP's scores are "229/240/236 CS first pass". These scores seem to be around average or maybe slightly under average, at least based on NRMP's Charting Outcomes for IMGs 2014 (though of course average scores have likely become higher since 2014, but at least as far as I'm aware this is the latest NRMP we have). According to NRMP Charting Outcomes for IMGs (2014), the average matched Step 1 score for "Non-U.S. IMGs" was just under 230 (page 9) and the average matched Step 2 CK score for "Non-U.S. IMGs" was just under 240 (page 13). Or see page 25 for a summary.

So I'm just saying, if OP wants to be an anesthesiologist and is willing to go to any program anywhere in the US, then it doesn't seem like his scores are bad enough to rule him out from somewhere. Of course, OP could be ruled out for other reasons (e.g., visa issues).

bashwell, there are tons of foreign docs who want to train in the US. Tons. So to impress a PD to the level that he would rather take an IMG and not an AMG, in a decent program, one needs solid scores. As a foreigner, there may be all kinds of negatives the candidate does not realize: lack of medical system knowledge, cultural differences, unpleasant accent, xenophobia, racism, visa bureaucracy, foreign recommendation letters, foreign research and publications etc. This is why the USMLE can sink the ship. Of course, as I have alluded to earlier, one can get into anesthesia with even marginal scores, but those are the chosen ones, usually charming people.

The fact that s/he got into a transitional program suggests that either it's a weak one, or that s/he was able to seriously impress, which means that s/he would have chances trying for an IM PGY-2 opening. Honestly, I don't really buy the "I did not want to redo my training" story. It's more like "I would not be able to get into a good academic internal medicine program, so I am trying anesthesia, where it's way easier to get into a fellowship, especially CCM". S/he also needs to be very careful how s/he structures the transitional year, before that goes to waste. While a TY may satisfy the requirements for a PGY-1 year, nobody stays in line to hire a TY grad as a categorical IM PGY-2, so s/he will have better chances with advanced programs such as neuro or anesthesia. The TY does not have the same image as a solid prelim internship.

The OP's scores are decent, just not impressive, especially given the background. S/he needs a good story to put people at ease about the discordance, and why s/he's not going the IM or neuro route. Right now those scores dilute any value of the previous training. There must be also more than just scores at play here.

I think you are right, bashwell, when you suggest that the OP should cast a very wide net.