Non-US IMG's dilemma - get a PhD or apply for residency asap?

Zli · Feb 19, 2009

Hi, everyone!

Serbian MG here, interested in hem/onco. I graduated last June in top 1% of class (2nd out of 450, to be more specific... not that it matters that much, the school being in Serbia and all). In the past four years I did a few international rotations; unfortunately, none of them were in the US (one clinical - radiology in Finland, and three research ones - physiology in Portugal, immuno-genetics in Thailand and immunohistology in Germany, a month each). All I have to show for it is quite a bit of lab experience and a paper published in the no.1 journal for microscopy (and 84th in cell biology 😀), as the 3rd author, plus some presentations at international students' conferences (got the Best overall in Ankara, Turkey... yeah). I'll also be getting an MS in citology, immunohistochemistry & embriology, hopefully by the end of summer. The only clinical experience I had since graduating is the Serbian "internship" - 6 months of clinical rotations needed prior to getting a license.

I've been studying for the usmle for two whole months now, and the plan was as follows - step 1 in April, step 2 CK in May, go to the US for step 2 CS in June (maybe try again in July), do some observing from July 'till September and try to get as many LoRs as possible (with which I can wipe my *ss, I know, but it's the best I can do), apply to decent internal medicine programs ('decent' meaning ones that could get me into a hem/onco fellowship later on) and a couple of backups in pathology, interview, pray (to the FSM).

Now, I've been lurking here since my 2nd year of med school and I know that what-are-my-odds questions usually don't get answered, so this isn't one of those. I'm pretty sure it's a decent plan that could've been better had I spent a couple of months of my final year getting USCE instead of dicking around in Phuket (in retrospect, I think it was totally worth it). The thing is, today I learned that I wouldn't have to jump through regular bureaucratic hoops to get into a histology PhD program in Belgrade and would quite easily be able to finish it in a couple of years, working as a TA/LA in the meantime. It's immunohistology, most of the groundwork is already done, and I'd be doing some of the stuff in Germany, which is nice...

On one hand, PhD>MS, and it would be in a basic since pretty relevant to the field I'll be going for. On the other, I dunno if it's enough to compensate for a 3 year break from clinic. I may fit some Serbian/German clinical experience into it, but I'm pretty sure it'll be mostly mice and rats. Now, even if I did accept, I'd go for ECFMG certification this year; I'm not gonna let 2 months' worth of studying go to waste. But should I just forget about it, go for it, or maybe wait for my step 1 scores and do it if they're not that good (220+? looking at people's scores here you'd think 240 wasn't good enough).

Your thoughts on this would be really appreciated 🙂

(Oh, and 1st post. Yay!)

NotAProgDirector · Feb 23, 2009

Zli said:
I've been studying for the usmle for two whole months now, and the plan was as follows - step 1 in April, step 2 CK in May, go to the US for step 2 CS in June (maybe try again in July), do some observing from July 'till September and try to get as many LoRs as possible (with which I can wipe my *ss, I know, but it's the best I can do), apply to decent internal medicine programs ('decent' meaning ones that could get me into a hem/onco fellowship later on) and a couple of backups in pathology, interview

That's a pretty reasonable plan.

, pray (to the FSM).

Can't hurt😀

...a decent plan that could've been better had I spent a couple of months of my final year getting USCE instead of dicking around in Phuket

Yep. Too late.

The thing is, today I learned that I wouldn't have to jump through regular bureaucratic hoops to get into a histology PhD program in Belgrade and would quite easily be able to finish it in a couple of years, working as a TA/LA in the meantime. It's immunohistology, most of the groundwork is already done, and I'd be doing some of the stuff in Germany, which is nice...

On one hand, PhD>MS, and it would be in a basic since pretty relevant to the field I'll be going for. On the other, I dunno if it's enough to compensate for a 3 year break from clinic. I may fit some Serbian/German clinical experience into it, but I'm pretty sure it'll be mostly mice and rats. Now, even if I did accept, I'd go for ECFMG certification this year; I'm not gonna let 2 months' worth of studying go to waste. But should I just forget about it, go for it, or maybe wait for my step 1 scores and do it if they're not that good (220+? looking at people's scores here you'd think 240 wasn't good enough).

Your thoughts on this would be really appreciated 🙂

IM residencies will likely not care about your PhD. Your lack of clinical experience will be a big problem. Perhaps a PhD will help when you apply for H/O, but probably not much. Better to try to get into a residency now. If not successful, PhD is secondary plan.

Path might like your PhD. Then again, path isn't very competitive now, and you might get in without it.

Zli · Feb 25, 2009

aProgDirector said:
IM residencies will likely not care about your PhD. Your lack of clinical experience will be a big problem. Perhaps a PhD will help when you apply for H/O, but probably not much. Better to try to get into a residency now. If not successful, PhD is secondary plan.

Path might like your PhD. Then again, path isn't very competitive now, and you might get in without it.

Thanks for the input! 🙂 It might seem like a no-brainer to some, but at this point every bit of info helps, and exploring all the options rarely hurt...

I'm lucky enough to have mentors who are completely understanding, so I shouldn't have much trouble starting the program in November/December if the interviews turn out to be few or non-existant.

Sigh... I'm at once looking forward to and dreading this fall... It's senior year of high-school all over again 😀

dragonfly99 · Feb 25, 2009

Hi. I'm an internal medicine trained doc...cardiology fellow. My advice won't be as good as the program director's, but I'll give you my 2 cents anyway.

I think your plan sounds good, except I agree with the above comment that you should ditch the idea of a PhD unless you want a career in research rather than clinical medicine in the U.S. I don't think the PhD will do much for your chances of getting an IM residency, although the research you've already done won't hurt, and probably will help your application a little.

From what you have written, you seem to have great command of English (even slang...LOL!) and that will help you a ton if you do residency here in the U.S.

My only concern is with your trying to take all those USMLE steps in such a short number of months, but I know you might not have a choice. I'm kind of worried about you not having enough time to study for the Step II CK, but maybe that's just me. You have to do what you have to do...better cram hard!

Hem/onc is a fairly competitive fellowship, but it's not as bad/hard as GI, cardiology or allergy/immuno. I would think you could get a hem/onc spot somewhere if you can do well on the USMLE and get yourself into a decent IM residency somewhere...I mean you're not going to do hem/onc at Sloan Kettering but that doesn't matter...there are lots of places that would give you good training. You should just give it a shot (without going for a PhD first) if you want to do residency here. Just go for it and see what happens.

Zli · Mar 3, 2009

dragonfly99 said:
I think your plan sounds good, except I agree with the above comment that you should ditch the idea of a PhD unless you want a career in research rather than clinical medicine in the U.S. I don't think the PhD will do much for your chances of getting an IM residency, although the research you've already done won't hurt, and probably will help your application a little.

Ditched, for now 🙂 The thing is, I still plan on working in Serbia once I'm done, and having a PhD used to go a long way here. Getting into a program was something "good" students just did by default. Granted, in seven years' time the (communist?) fascination with titles will probably fade away. Hell, if history is any guide, in seven years it most likely won't even be the same country 🙄

From what you have written, you seem to have great command of English (even slang...LOL!) and that will help you a ton if you do residency here in the U.S.

Thanks 🙂 Won't do me much good if I don't get any interviews, but I guess it's one less thing to worry about.

My only concern is with your trying to take all those USMLE steps in such a short number of months, but I know you might not have a choice. I'm kind of worried about you not having enough time to study for the Step II CK, but maybe that's just me. You have to do what you have to do...better cram hard!

Yeah... I'll see how Step 1 goes and adjust the plan accordingly. If I do well I'll take the CK in late May, so I'll have at least 6 weeks of prep time. Now, if I'm not happy with my uworld scores for Step 2, and the CS is as easy as everyone says (i.e. people skills being more important than clinical stuff... I should have enough of those 🙂 ) I might push it to late June/early July and take the CK mid-June. But I'm just thinking out loud now, so I'll stop 🙂

I mean you're not going to do hem/onc at Sloan Kettering but that doesn't matter...there are lots of places that would give you good training. You should just give it a shot (without going for a PhD first) if you want to do residency here. Just go for it and see what happens.

Oh, I have no illusions about that. The way I see it, a mid-of-the-line program over there is probably on par with the best ones here, with an added advantage of actually getting some money for all the work. So, getting into one of those would be great 🙂

Zli · May 20, 2010

After more than a year, an update for anyone who finds this thread through a search.

The short story is - the plan worked! I matched into my 1st choice, a uni-affiliated east coast IM program (one of the few that's been mentioned on sdn in a positive light) and I'm moving to the states on a J1 next week.

It didn't all go that smoothly, though. Because of a paperwork mix-up I was only able to schedule Step 1 in late May, and then go for 2 CK within 3 weeks of taking the first one, with the CS in early July so I could get the scores on time. In all, I took all three parts within a month and a half of each other, but I think I still managed to get respectable scores (246 and 255). Applied to 30 programs (east coast + Chicago), interviewed at 6 (only 1 uni), and matched at my no. 1. Considering I didn't have any USCE, not even an observership, I guess I did as well as I could have hoped for.

Many thanks to aPD and dragonfly! It might have only been a couple of paragraphs from you, but they really pushed me towards going forward with everything. Of course, I don't think I could've done as well as I did if it weren't for this forum, especially Taurus' study guide and all the different USMLE-related topics, so a huge thanks to anyone who's ever started one of those.

As for the PhD, it's been put on hold for the next 3-6 years. Can't have everything, I guess...

shreypete · May 20, 2010

Wow I truly commend your effort. You must be one of those rare, super-smart IMGs with an excellent command of English and an in-depth knowledge of medical stuff.

Great job again! How did you exactly go about preparing for Step 1 (apart from following the Taurus' study guide)? What resources did you use? (did you self-study or take some sort of a coaching program?)

Zli · May 21, 2010

Heh, don't know 'bout super-smart, but thanks 😳

It was self-study all the way, didn't even have a study partner. I had a pretty good basis from my regular studies, so when I prepared for the tests I just tried to reconfigure all the knowledge and get accustomed to the usmle-style questions. Most ppl, especially older FMGs, go too broadly and want to re-learn everything they ever did in med-school, when instead you should have a laser focus.

The only two things I did differently than what Taurus recommended were that I didn't do many more questions aside from what was in UWorld (you should take all the UWorld explanations as a text book of its own, btw, especially for 2CK); and instead of going through First Aid/Goljan/whatever else ad infinitum, I used supermemo. My own version was on an old Palm Tungsten, but they now have them for all the newfangled iphones and android phones. I ended up with thousands of simple questions, but it was pretty helpful for the stuff you could only know through rote memorization (especially abundant in biochem and microbiology, if I remember correctly). In those couple of months that I was studying for the steps, I tried to have as little down time as possible. When commuting, waiting in lines or whatever, I either listened to Goljan's lectures or went through the Supermemo stuff.

It's all simple*, really--have a decent plan that gives you some flexibility, and stick to it. Also works pretty well for other things in life 🙂

*not to be confused with 'easy'

shreypete said:
Wow I truly commend your effort. You must be one of those rare, super-smart IMGs with an excellent command of English and an in-depth knowledge of medical stuff.

Great job again! How did you exactly go about preparing for Step 1 (apart from following the Taurus' study guide)? What resources did you use? (did you self-study or take some sort of a coaching program?)

shreypete · May 22, 2010

Thanks again. I'll try and follow your strategy when I start preparing for the MLEs. God job again and have a great year!

Winged Scapula · May 23, 2010

That's great news Zli. 🙂

thrombin · May 24, 2010

how does it look if you go for a PhD after completing med school abroad, I know that in the USA the two are integrated in a MD/PhD program. Most PhD programs extend to like 5 year but since the some of the courses for the PhD program are taken during med school can the PhD be cut down to perhaps 3-4 years?

I know that it will look bad that you've been away from clinical practice for these years but can't a PhD look good for some specialties ie the more competitive ones?

DrJosephKim · May 27, 2010

In some ways, you may have a better chance by going into residency and giving up an additional year to do research in your area of interest. I know some residents who were willing to commit to a year of research to ensure a spot in a fellowship program.

svg789 · Jun 30, 2010

svg789 · Jun 30, 2010

Zli said:
Heh, don't know 'bout super-smart, but thanks 😳

Hiii,
You are Right inspiration for me at the right time.
Im an IMG from India and completed graduation in 2004. My interest is in radiology/paed.
I pursued Indian civil services(one of toughest examinations in this earth) and reached the interview stage .
.
Now I am having following options with me...
1. Pursue post graduation in MD Radiology in Poland, apply for doctoral progs in USA and then write usmle steps. I have heard that u dont need usmle for practising radiology (need more details about these no patient contact programs)
2. Write the steps directly.

I need laser guidance from you Zli regarding the best material for step 1, step 2.step 3.
What to study and how to study. As I am starting from ABC, Pls tell me in detail about the materials and the actual study styles required for passing with good scores.

Pls rem , my first step starts with your first advice...
Energetically awating for your reply..pls mail me [email protected] and be my freind and mentor
Thanks

thrombin · Jul 22, 2010

how does a master after graduating form med-school look to be competitive in a field such as surgery, it isn't as long a a PhD but is another post-grad degree and if done in a field related to surgery could it turn out to be good thing on one's resume/CV??

Non-US IMG's dilemma - get a PhD or apply for residency asap?

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