your valuable opinion and guidance needed please.

[EVOLVED9]

Hello current and future doctors,i'll appreciate it a lot if anybody can take a few moments to respond.I'm an FMG who's a very passionate ophthalmology residency aspirant.My step scores: step1:269 step 2:286 cs: pass on 1st atempt.I plan to apply for electives soon,but i've been told repeatedly that it's close to impossible for an img to match into ophthalmology.I have no research to my name.I need to know my chances at matching into ophthalmology,i plan to give it 1 year approximately,beginning now doing electives and what ever possible research till i apply for the 2016-17 match.Very greatful for anybody's guidance.

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[DrZeke]

Your step scores are beyond strong. I'm not sure research matters as much as the relationships forged during these 1-3 year research stints that FMGs perform.

I'm not sure the point of your post since you did not specifically ask a question. I do think at least a year of research is important to get good letters and a few publications. At this rate you would be doing less than 1 year of research. If you can form good relationships with strong faculty who are willing to call/email for you in under 1 year then I recommend applying.

Some considerations:

1) Your application will be much different if you are a permanent resident of the us (green card holder)

2) clinical research is best - it has higher outcomes than basic science

3) do your research at a top institute.

4) expect to be unpaid.

 

[EVOLVED9]

Your step scores are beyond strong. I'm not sure research matters as much as the relationships forged during these 1-3 year research stints that FMGs perform.

I'm not sure the point of your post since you did not specifically ask a question. I do think at least a year of research is important to get good letters and a few publications. At this rate you would be doing less than 1 year of research. If you can form good relationships with strong faculty who are willing to call/email for you in under 1 year then I recommend applying.

Some considerations:

1) Your application will be much different if you are a permanent resident of the us (green card holder)

2) clinical research is best - it has higher outcomes than basic science

3) do your research at a top institute.

4) expect to be unpaid.

Thanks a lot! for willing to help.I'l try to be more crystal about my query and my approach.I am not very familiar with how the system of getting recommended by superiors to program directors and authorities concerned with residency works in the U.S. In my country there's simply a single competitive entrance test for 3 hours,by which one gets ranked according to the scores,higher the rank more are the choices in more institutes(i just want to get it out there about the system i'm used to).This is why the thought of research never occurs to any of us before post graduation.
Now i've been wanting to persue residency in the U.S. For quite sometime,hence i worked very! hard on steps for a year and secured those scores.Initially i was told step scores and clerkship in good institutes would get me my desired speciality.When i flew to the U.S. to take my CS exam i was told by people that ophthalmology is off bounds to us FMGs. My plan is to serve in how many ever clinical electives i can serve in at the best possible institutes untill i apply for residency by august 2016 and indulge in whatever research.I've gathered that to get a research paper published in a journal takes time and so my research profile will be quite weak.
-I want to know that will approx 8 months of clerkships at different institutes suffice for me to have a chance at ophthalmology residency?
-Also i have quite a bit of knowledge and skill in ophthalmology(the chief of opthalmology at my med school is quite well known in the opthal community worldwide and was kind enough to teach me a lot in person).
-If i'm able to show my competance is it possible for senior opthalmologists at the institutes i do clerkships in to recommend me?
-Do FMGs match into opthalmology in such ways or does it neccessarily need years of research?
-I've heard sometimes FMGs are promised residency in future and keep working for years together,ultimately in vain to be denied residency.Most of such people i've heard about didnot have very good scores though.Will my scores give me an edge and make up for the lack of research in my CV?
-Do FMGs with good scores and only clerkships get recommended for residency or is it biased only in favour of american citizens?(please pardon the ignorance and list of questions).

 

[OphthoApp]

The problem is there are tons of US grads with good board scores. If you want to match in US I suggest you go to one institution you know is accepting to foreign grads, stay there, do research, and publish. If you go to various institutions in your eight months no one will get to know you well, you won't be able to publish, and likely won't be able to match. As Dr. Zeke mentioned most foreign grads come to US for years to do research.

 

[OphthoApp]

Also do you plan to return to your country after residency? It is very hard to stay in US as a FMG. While a FMG can do residency with a J1 visa they cannot do fellowship with a J1 or work on a J1. To stay you would have to get a more permanent visa that would allow you to bill. I would investigate this more because I don't know any details of how that works but I know people who have failed at getting these and had to go back. Sometimes it can cost $50,000-$100,000 in lawyer fees as well depending on where you are from. The US does not make it easy for foreign doctors to stay and work here unless you pick a underserved specialty, of which ophthalmology is not one of them.

 

[DrZeke]

Though you may have skill in ophthalmology most people will value other qualities over that. For example a good command of the English language and understanding and blending in with American mannerisms and style of learning is very important. Your posts suggest English is your second language. Though I'm sure you speak it well...You know little about the American system. It would be unwise to attend a clerkship or elective in the United states without a bit of coaching from others who have done this before you. I have a friend who matched successfully after 3 years of research and when he first arrived in the us from Egypt he had trouble on his first rotation. His style and approach were Totally acceptable in his home program and home country but here he upset his attendings... He conveyed this story to me himself. So, no disrespect but getting accustomed to certain things in America and how to write an application in America that is to be polished, diplomatic, well worded and Plays to your strengths are challenges in the themselves. Most people attend schools all over the world where the system is just as you describe - you pass competency tests and exams to weed out the weak. This is hardly so in the USA. Very different approach to education. I recommend you spend serious time studying us and learning how to fit in with this system before rushing into this application.

 

[EVOLVED9]

Also do you plan to return to your country after residency? It is very hard to stay in US as a FMG. While a FMG can do residency with a J1 visa they cannot do fellowship with a J1 or work on a J1. To stay you would have to get a more permanent visa that would allow you to bill. I would investigate this more because I don't know any details of how that works but I know people who have failed at getting these and had to go back. Sometimes it can cost $50,000-$100,000 in lawyer fees as well depending on where you are from. The US does not make it easy for foreign doctors to stay and work here unless you pick a underserved specialty, of which ophthalmology is not one of them.

The 1st concern i had before i made up my mind to persue post grad in the U.S. is whether it would be possible to get board certified and practice in the U.S. as a citizen.Not only does the U.S. not allow a physician to work with a J1 visa,my country mandates a bond to be signed promising to return back to our country after finishing post grad,but there is a loophole to this.If i give my step 3 before i apply for residency and am able to secure an H1b visa,there's no hinderence then.From what i've learnt there are quite a lot of institutes that offer H1b visa,infact i have friends who have secured one and are in residency presently,have found their soulmate and have also settled down.HOWEVER none of them are opthal residents and that last sentence of yours got me thinking that opthal being one of the "ROAD" subjects and the market being saturated too,will i be allowed to get an H1b visa.I better look into this.Thankyou for bringing up that realisation.

 

[EVOLVED9]

Though you may have skill in ophthalmology most people will value other qualities over that. For example a good command of the English language and understanding and blending in with American mannerisms and style of learning is very important. Your posts suggest English is your second language. Though I'm sure you speak it well...You know little about the American system. It would be unwise to attend a clerkship or elective in the United states without a bit of coaching from others who have done this before you. I have a friend who matched successfully after 3 years of research and when he first arrived in the us from Egypt he had trouble on his first rotation. His style and approach were Totally acceptable in his home program and home country but here he upset his attendings... He conveyed this story to me himself. So, no disrespect but getting accustomed to certain things in America and how to write an application in America that is to be polished, diplomatic, well worded and Plays to your strengths are challenges in the themselves. Most people attend schools all over the world where the system is just as you describe - you pass competency tests and exams to weed out the weak. This is hardly so in the USA. Very different approach to education. I recommend you spend serious time studying us and learning how to fit in with this system before rushing into this application.

I absolutely agree with you,and get your drift completely.I'd like to tell you now that i'm from india,a country where the literate are totally english bred.Those of us who are well educated and belong to elite backgrounds not only understand american ways and culture,but believe it or not,i'm not exaggerating:we actually follow it(and that's why we feel out of place and move to the U.S.)I've been to the united states quite a few times for different reasons,my mum is a citizen of the U.S. and i've been surrounded by NRIs(non-resident indians in america) ALL my life.That,and thanks to a lot of american television,every bit of which is watched by us on our cable(american t.v. Is my life from comedy central to nat geo ) it almost feels like i'm communicating with americans all the time.So speaking american and being american(in the unpretentious,non-cliche way) is not at all a problem for me.I know you meant to guide me genuinely in that matter .My main concern is TIME which i'm pretty uptight about.If like you and ophthoapp say i'l need to spend years doing research to get into ophthal,i think i'l have to consider my 2nd passion:neurology.If clerkship and minimal amount of research within this period of 8 months will be enough to look good on my CV then i'l go all out for opthalmology,which is why i need to know to what extent is this general notion that ophthal is off limits to FMG valid,and How much does a senior ophthalmologist's word lend to a program directors ear? or is a long term research with a pile of publications the norm?Will convincing one by good skill,fluent american-english,a diplomatic and adjustable attitude,good personality(dont mean to brag) be enough to get him/her to do that big a favour for me?Does that happen in the real world?.Thankyou once again.

 

[Fascia Lata]

I second every Word Dr. Zeke said. A MINIMUM of a year of research fellowship in one of the large departments is indispensable for IMGs who want to match in ophthalmology, not to publish as much as to form strong connections with one or two faculty members who can support your application. The mentor should be someone with enough political power to support your application at his/her home institution or a strong national reputation for his/her calls to PDs at other institutions to be valuable and of benefit. You have an excellent start (stellar board scores). Your next step will be to to secure a pre-residency research fellowship (or an ophthalmic pathology fellowship - those are extremely competitive). There is no one (even a PD) who can ever promise anyone a residency position (even a stellar US grad). This violates the SF match rules and can have dire consequences and legal ramifications that I am sure no US faculty would put him/herself through. Many IMGs, with enough persistence, are able to match after 2-3 years of such research tenures at big US institutions. In my opinion one year is too little of a time for a US faculty member to know you well enough and be willing to support your application with full strength and no reservations. This is not to say that this has not been done.

 

[Fascia Lata]

And by the way, home country experience, no matter how impressive, matters very little when applying for US ophthalmology residency, if at all.

 

[elementals]

286, jesus. i didn't even know that score existed.

 

[EVOLVED9]

Not uncommon to come across that score in india.You see we take our own sweet time to give the mles after we graduate,unlike the U.S. where a med student takes the steps during med school.how it works here is: internship is done soon after medschool(not during PGY1) to obtain a primary care general physician's degree,so we get the Dr. Title soon after med school.

 

[EVOLVED9]

Thankyou Fascia Lata.That pretty much sums it up.