A cautionary tale to IMGs

[BetrayedRO]

Long time lurker, first time poster on this forum.

I have a cautionary tale for international medical graduates seeing as I am one. First of all, in the strictest terms an international medical graduate in the US is someone who did their medical school outside of the US. For the purpose of this thread IMG is going to mean someone who is a non-US citizen/non-green card holder and went to a medical school outside of the US. I am actually unaware of a single person who did medical school in the US without being a citizen.

I did medical school in Europe. I entered radiation oncology residency in my home country. Despite coming from a well developed country with a high income the prospects for all specialties was dismal. So, I decided to try my prospects in the US instead of continuing residency at home. I did a research fellowship in a very reputable center in the US. All of my research was with a radiation oncology mentor.

I matched into a radiation oncology residency program. Not a hellpit and not one of the premiere institutes.

Throughout residency I had no issues, never got in trouble. Passed all my exams. Yes including the clinicals. Turns out I still have to wait until next year for the orals! What a joke.

I applied for jobs, I even applied for a fellowship. For the jobs the first question by the bean counter from HR would be whether I have a green card or US passport. I do not. IMGs cannot secure either of those during training because of the visa rules. And then I would be placed on " a list" and never hear back from them even if I pestered them. For fellowships there are so many US applicants this year and in big places like one of the big 3 there's always some research fellows who've been trying for years to get into a clinical fellowship position. Therefore you're actually in a tier 3 list behind US applicants and these research fellows.

Anyways, I had no job offer. No fellowship offer. I had to go back home because my visa was about to expire. I am back home without a certificate even (board eligibility is not a thing anywhere except the US). So I cannot even get an attending post. So I'm doing a research fellowship (again!). I'll be doing my oral boards next year. Maybe once I get my certificate I can get a job back home, I'll try the US again. Maybe being board certified will make a difference?

I am beyond angry. It feels like everything was for nothing. None of my mentors had anything useful to say. I feel like some tried to help but I don't know if they ever went the extra mile or not.

To all the IMGs who got into the US because Rad Onc is shambolic I sincerely wish you the best of luck. I got in when things were good. I still ended up back home. And at least home is stable, comfy and has a high quality of life. I am sure many IMGs cannot say the same.

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[medgator]

Going to get really ugly in a few years if stories like these are happening now.

Sorry to hear about your situation

 

[Neuronix]

I'm sorry for your situation. There are so many difficult stories out there because of the job shortages in rad onc. I'm glad that you came to share with us because there are too many "leaders" in denial of reality trying to sit back and direct medical students off a cliff.

IMGs are considering this specialty because there are many open residency positions. They should read this post and take pause. There is a serious shortage of jobs in rad onc, and as a foreigner without a green card or citizenship, an IMG will be the last considered for the few jobs available.

Rad onc training only sets you up for a job as a rad onc and virtually nothing else. If there is also no job in your home country, you will run the serious risk of being jobless after residency. Also, you will not become eligible to be board certified for a year after you finish your residency. If that is a requirement for jobs in your home country, you can end up in the same situation as BetrayedRO and have to wait a year.

 

[elementaryschooleconomics]

From a practical standpoint, I imagine the WORST job applicant who's a US Citizen will be looked upon more favorably than the BEST job applicant who needs to go through the green card process 95%+ of the time.

This post just serves to increase my concern over the eagerness by which programs are matching/SOAPing FMGs in this market. It's easy to handwave stats and numbers regarding RadOnc economics and forget that these are actual people, with families and lives, that are negatively affected by what's happening.

But yeah, greedy departments, keep filling your ranks with whoever you can find to pad your revenues. Nothing immoral about that!

 

[Mandelin Rain]

I kind of hate to add this but... from the syntax of the opening post, this person likely speaks nearly flawless Americanized English. If you don't, you're even further down the line than this person.

 

[fiji128]

The reality is jobs in the specialty are incredibly tight. There are plenty of BC docs that or mid or later career that are under or unemployed because of this. Many fresh grads struggle to find a single reasonable job offer after years of training. It used to be about five years ago you would see super rural rad onc jobs (ie 3 hours from an airport) that said they would sponsor visa/green cards. Can't recall seeing that recently. Its important that any FMGs thinking about matching into one of these "we will take anyone" training programs fully realize what likely awaits them after they complete training.

 

[TheWallnerus]

OP is either lying or truthful. There's a chance he's truthful. Which means rad onc can't be a rational specialty choice by a med student. It's like a variation on Pascal's wager: believe in every other specialty because believing in rad onc carries a risk of eternal damnation... and why risk that? Name me another specialty where someone with a pedigree like this CAN'T GET A JOB.

I'll wait.

 

[thecarbonionangle]

The breadlines are here folks. This x100 very soon. Anybody applying to this field at this point, hellpit or not, deserves no sympathy when they end up like this later.

 

[Beerus]

This seems odd to me tbh. Why would U.S Rad Onc programs open 200+ residency slots per year if the job market is already saturated??
hmmm, something really weird like why are they shooting themselves in the foot?
In my country they only accept 6 residents per year in RadOnc and as you can imagine, the competition is ruthless but they do that to control the job market and to insure they don't lose "leverage" because once the MBAs know that they can replace you..... it's over.

 

[Mandelin Rain]

once the MBAs know that they can replace you..... it's over.

So you're saying it's over?

 

[Neuronix]

This seems odd to me tbh. Why would U.S Rad Onc programs open 200+ residency slots per year if the job market is already saturated??
hmmm, something really weird like why are they shooting themselves in the foot?
In my country they only accept 6 residents per year in RadOnc and as you can imagine, the competition is ruthless but they do that to control the job market and to insure they don't lose "leverage" because once the MBAs know that they can replace you..... it's over.

The people making these decisions are the well established senior people. They don't care what the residents or junior faculty think.

These chairs and other "leadership" care about their department's or institution's bottom line. Their bonuses and positions depend on making more profit year on year and continuing to expand.

Residents are cheap labor. Institutions even get subsidies for having training programs. Having too many residents helps institutions in the long run because they get cheaper faculty. It will never be a problem for the chairs causing these issues, they're just going to retire someday.

The program directors use program expansion, or at least having and maintaining a program, as a way to get promoted within academics, so you won't hear complaints from them typically either. They're the ones PMing me on SDN or whispering my name at ASTRO asking for my head on a platter. These are the ones playing the academic pyramid scheme trying to get to the top.

The only way to end this cycle is to let medical students know what is going on. A pyramid scheme relies on new people at the bottom...

 

[Mandelin Rain]

whispering my name at ASTRO asking for my head on a platter.

You got to go buck.

 

[OTN]

This seems odd to me tbh. Why would U.S Rad Onc programs open 200+ residency slots per year if the job market is already saturated??
hmmm, something really weird like why are they shooting themselves in the foot?
In my country they only accept 6 residents per year in RadOnc and as you can imagine, the competition is ruthless but they do that to control the job market and to insure they don't lose "leverage" because once the MBAs know that they can replace you..... it's over.

Here are some facts:

According to Dr. Dennis Hallahan, the chair of the Washington University Department of Radiation Oncology, residency spots were opened with the specific intent of decreasing radonc salaries, so his department could improve their bottom line.

This department, the Washington University Department of Radiation Oncology, is affiliated with Washington University in St. Louis, which has the 12th largest endowment among US institutions, currently worth $8.5 billion.

Endowment Facts | Investment Management Company (WUIMC) | Washington University in St. Louis

$11.5B Endowmentmarket value at 6/30/23 $12.5B MEP*market value at 6/30/23 *Managed Endowment Pool (MEP): A pool of capital managed ...

endowment.wustl.edu

Replicate this across each academic institution, and it's pretty easy to double the residency compliment in a mere decade.

 

[BetrayedRO]

I appreciate everyone's response to this thread. I've left the US early July and didn't want to post anything. I fell into a deep depression. But thanks to family and friends I started feeling better and today I shared my story.

I do not have student loans. Many US medical students cannot say the same. I have never needed to take out any loans to come to the US for my training or do any of the exams or pay the Match fees but I know a lot of IMGs from third world countries do that! And I mean no disrespect using the term third world. It just means you are not paid enough in currency to be able to jump through the necessary US hoops.

And yes, my spoken English is with an American accent or rather the "no accent" American accent. I am a Caucasian male with an "interesting" sounding European name. It shocks me that I've met some people who immediately assumed that somehow belonging to this phenotype would magically bestow upon me US citizenship even if I was born outside of the US to non US citizens. I guess implicit biases do exist.

At my institution we had a physician (non-rad onc) who originally came from Colombia (the Latin American country) for residency training. He went into a specialty that was saturated at the time but is no longer saturated. He had to return home following his training. A few years later he managed to return to the US. Those few years he spent between Colombia and him coming back to the US were years spent living under the constant threat of Pablo Escobar running amok in the country!

So I urge IMGs especially those coming from countries that are de-stabilized (lots of Middle Eastern ones come to mind): think very carefully! You could be returning to a horrible situation. I am counting my blessings and I don't know what I would do if I were in that situation.

 

[RickyScott]

OP is either lying or truthful. There's a chance he's truthful. Which means rad onc can't be a rational specialty choice by a med student. It's like a variation on Pascal's wager: believe in every other specialty because believing in rad onc carries a risk of eternal damnation... and why risk that? Name me another specialty where someone with a pedigree like this CAN'T GET A JOB.

I'll wait.

This is why I have such a low opinion of anyone who goes into the specialty. What normal medstudent would weigh the risks and benefits and then select radonc.

 

[Mandelin Rain]

So I urge IMGs especially those coming from countries that are de-stabilized (lots of Middle Eastern ones come to mind): think very carefully! You could be returning to a horrible situation. I am counting my blessings and I don't know what I would do if I were in that situation.

Yes. Internal medicine is probably best bet. After three years you can...
1. PCP
2. Hospitalist
3. Urgent Care
4 Fellowship in like a dozen specialties

Heck, even after your intern year, you can jump to Rads, Rad Onc, Derm, Anesthesia, etc... if that's something you REALLY want to do.

Whatever. So many options if your first choice doesn't work out.

 

[TheWallnerus]

I've left the US early July and didn't want to post anything. I fell into a deep depression. But thanks to family and friends I started feeling better and today I shared my story.

THIS.

I have said many times: the desire and willingness is very low to come and openly profess and talk about what feels like a life failure. Be grateful that this human wanted to talk about it.

The incidence of the bad things is much higher than the incidence of talking openly about the bad things.

 

[taserlaser]

Really sorry to hear that. As a non-US citizen but board eligible, I can also attest that when I was looking at US positions, it was like pulling teeth. I would say like 75% of the positions I would hear back from are the usual ‘burn n churn’ type places that were talked about here.

I’m doing orals this fall and debating on whether it’s even worth my time to study (read: cram). Nice to have the certificate, but I’m board certified in Canada, and I like my current job and location. It’s really to hedge if things go south here economically/politically, but finding an equivalent/suitable rad onc job in the US i suspect would be difficult. I’m ok with staying up north, but really I also don’t think the US is a viable early-career option for most canadian trainees, or already have citizenship or a green-card.

 

[CurbYourExpectations]

If things are this bad due to job over supply I don't know why more people don't talk about it nonanonymously. Wouldn't it hurt most of the field if there end up being people unemployed willing to do the job for much less than what the median is now?

 

[Chartreuse Wombat]

If things are this bad due to job over supply I don't know why more people don't talk about it nonanonymously. Wouldn't it hurt most of the field if there end up being people unemployed willing to do the job for much less than what the median is now?

That is the plan to drive down salaries so the employers (training programs and hospitals) can benefit. Many in academics are fearful to say this out loud (with few exceptions).

 

[OTN]

If things are this bad due to job over supply I don't know why more people don't talk about it nonanonymously. Wouldn't it hurt most of the field if there end up being people unemployed willing to do the job for much less than what the median is now?

It hurts junior faculty and mid-career physicians, but improvement in departmental profitability helps department chairs. Ideally the "leaders" in a field would care about the futures of the doctors in said field, but that has demonstrably not been the case with radonc.

 

[Neuronix]

I talk to a lot of people and have seen a lot.

There are a lot of underemployed rad oncs out there who straight up blame themselves. Posting about it and being plain hurts their egos (if only I had done X or been better I wouldn't he in this position)... Plenty of blaming the victim IRL as well leads people to get quiet about it.

Or there are those who would never come on SDN because they're too scared someone will find out they said something negative publicly and that it will hurt them in the future.

I'm a bit surprised too more people aren't on here sharing their stories. There are lots more out there.

 

[elementaryschooleconomics]

If things are this bad due to job over supply I don't know why more people don't talk about it nonanonymously. Wouldn't it hurt most of the field if there end up being people unemployed willing to do the job for much less than what the median is now?

The field is small; those in power are vindictive. It's human nature. If we non-anonymously/openly move to keep students away, we hurt the revenue - and prestige - of academic departments with residents. Anyone doing so with any degree of success would be blacklisted. Simul is a notable exception - but he's board certified and in private practice.

For example, even though I'm in private practice now, I still have to face our most subjective of exams, oral boards. I still don't speak openly because I'm afraid I could upset one (or more) examiners and cause problems for myself with passing. Also, if my practice ever goes under and I need to look for a new job, I can't afford to make widespread enemies. If I was closer to the end of my career, things would be different. I'm sure many of my colleagues feel the same.

 

[SubserviantToABR]

The field is small; those in power are vindictive. It's human nature. If we non-anonymously/openly move to keep students away, we hurt the revenue - and prestige - of academic departments with residents. Anyone doing so with any degree of success would be blacklisted. Simul is a notable exception - but he's board certified and in private practice.

For example, even though I'm in private practice now, I still have to face our most subjective of exams, oral boards. I still don't speak openly because I'm afraid I could upset one (or more) examiners and cause problems for myself with passing. Also, if my practice ever goes under and I need to look for a new job, I can't afford to make widespread enemies. If I was closer to the end of my career, things would be different. I'm sure many of my colleagues feel the same.

This. This is exactly why I don't say anything non-anonymously. I'm starting my third year post-residency. While I feel fortunate to have a job now in this messed up job climate, I do not know what the future entails and don't want to risk it, in case I have to leave my current position for whatever reason. In the end, I can only worry about myself. I have a job now, and I hope to have a job, any job, long enough until retirement or death.

 

[CurbYourExpectations]

short sighted to both oversupply and to not show concern about it, don't see how it benefits anyone if true. wish more people would openly talk about it if it is evident to them, but understand early career people might be worried due to tight market as a baseline

 

[Chartreuse Wombat]

short sighted to both oversupply and to not show concern about it, don't see how it benefits anyone if true. wish more people would openly talk about it if it is evident to them, but understand early career people might be worried due to tight market as a baseline

Again it does benefit the employers. Always winners and losers.

 

[fiji128]

The field is small; those in power are vindictive. It's human nature. If we non-anonymously/openly move to keep students away, we hurt the revenue - and prestige - of academic departments with residents. Anyone doing so with any degree of success would be blacklisted. Simul is a notable exception - but he's board certified and in private practice.

For example, even though I'm in private practice now, I still have to face our most subjective of exams, oral boards. I still don't speak openly because I'm afraid I could upset one (or more) examiners and cause problems for myself with passing. Also, if my practice ever goes under and I need to look for a new job, I can't afford to make widespread enemies. If I was closer to the end of my career, things would be different. I'm sure many of my colleagues feel the same.

“prestige - of academic departments”

Pretty sure rad onc is now considered one of the least prestigious of all medical specialities these days.

 

[elementaryschooleconomics]

“prestige - of academic departments”

Pretty sure rad onc is now considered one of the least prestigious of all medical specialities these days.

Totally agree - it's another reason why I think the entrenched leadership, as well as the rank-and-file, have been slow and will continue to be slow to do anything (or even acknowledge) the issue. To do so would be a tacit acknowledgement that they no longer hold the prestige they once did, and for many people who have built their entire identity around being a "doctor in an elite specialty", that's extraordinarily damaging to the ego.

Now I, on the other hand, recognize my place in the Dumpster of Life, and thrive in the moist darkness.

 

[StIGMA]

Are we overtraining residents? 1 photo should make it obvious (and put a knot in the stomach):

Chairs don't care, PDs don't care. There's too many programs to make any substantive impact individually.

 

[fiji128]

Are we overtraining residents? 1 photo should make it obvious (and put a knot in the stomach):
View attachment 342588

Chairs don't care, PDs don't care. There's too many programs to make any substantive impact individually.

The speciality may be describe as a hopeless dumpster fire but at least we are in full compliance with imagined anti trust laws.

 

[thecarbonionangle]

Are we overtraining residents? 1 photo should make it obvious (and put a knot in the stomach):
View attachment 342588

Chairs don't care, PDs don't care. There's too many programs to make any substantive impact individually.

So many hellpits, probably only like 30 of those places should exist

 

[RickyScott]

So many hellpits, probably only like 30 of those places should exist

Hellpit thread should be sticky. It’s a public service. Truly no chance of a job once you emerge from those places.

 

[seper]

I’m sorry to hear about your situation. You need an employer to sponsor a visa, and there is just no demand for that in US RadOnc

 

[medgator]

I’m sorry to hear about your situation. You need an employer to sponsor a visa, and there is just no demand for that in US RadOnc

There used to be a few years ago now those desolate locations no longer sponsor visas. No need to.

 

[Mandelin Rain]

Perhaps truly excellent IMG candidates will get a second look in the future, if their cohort of graduating American medical grads is of relatively poor quality (which, by posts here seems to be the current short-term trend).

But for the time being, having to sponsor the visa is a tough hurdle to clear when essentially everyone is still a very good candidate.

 

[seper]

It is interesting that things have changed so quickly. I’ve got colleagues from France, Bahrein and India who got GC and eventually citizenship directly via RadOnc

 

[medgator]

It is interesting that things have changed so quickly. I’ve got colleagues from France, Bahrein and India who got GC and eventually citizenship directly via RadOnc

Job market was relatively great 2000-2015 imo

 

[BetrayedRO]

It is interesting that things have changed so quickly. I’ve got colleagues from France, Bahrein and India who got GC and eventually citizenship directly via RadOnc

I have met one person from India who has done this. It's not impossible. You just need one job with an employer that will go through the process and keep you around long enough till you get your citizenship.

I think the double whammy of COVID and poor radiation oncology job market did me in. And yes, maybe IMGs will fare better in the future vs poorly selected American rad onc grads but that's a big if.

I think fellowships will take off. It'll be like Radiology and Pathology. Fellowships everywhere.

I wish I had applied for more fellowship positions. I only applied to one place and it was one of the big 3. I did not get in. None of my attendings supported the idea of doing a fellowship, they found it insulting. They all said I had great training and the program never had issues placing someone for "a job". I think one to two fellowships will be the reality for everyone in 3-4 years.

The situation will not change. Radiation Oncology will become the new pathology. We will not re-invent ourselves. We won't fold it into radiology like what nuclear medicine did. I don't think our leaders could ever stomach losing their clout in the cancer center.

 

[thecarbonionangle]

classic head up the arse mentality. We have never had a problem placing someone “anywhere” so its not our problem. These people suck.

 

[RaptorA]

I have to say this is not at all that surprising given the current state of affairs, and the situation is likely to worsen in the upcoming years. Of course, you could not have predicted how rapidly the prospects would decline when you were applying for residency in the US.

What can't you practice as attending in your home country or elsewhere in Europe? From what I've heard, the residency should be at least partially recognized and in some countries the salary is on par with the US.

 

[BetrayedRO]

I have to say this is not at all that surprising given the current state of affairs, and the situation is likely to worsen in the upcoming years. Of course, you could not have predicted how rapidly the prospects would decline when you were applying for residency in the US.

What can't you practice as attending in your home country or elsewhere in Europe? From what I've heard, the residency should be at least partially recognized and in some countries the salary is on par with the US.

The training is recognized but I have to have a certificate that is considered equivalent to my home country's certificate. I'm not certified by the ABR yet.

I'm fresh out of residency. I passed all my written exams. I even took the clinical one that was offered off cycle thinking it would enable me to sit the oral exams sooner. No such luck.

It'll have to in May next year. I could've done the Canadian exams and be certified. Oh well.

 

[fiji128]

The training is recognized but I have to have a certificate that is considered equivalent to my home country's certificate. I'm not certified by the ABR yet.

I'm fresh out of residency. I passed all my written exams. I even took the clinical one that was offered off cycle thinking it would enable me to sit the oral exams sooner. No such luck.

It'll have to in May next year. I could've done the Canadian exams and be certified. Oh well.

This is just a heads up if you'll be practicing out of the country, but when I took the oral boards several years ago part of being eligible to take the exam was having a current/active state or provincial (whatever that means) medical license.

ABR

Prerequisites and Registration Last verified on December 15, 2023 On this page Prerequisites Registration Prerequisites Pass all three parts of the computer-based Qualifying Exam Complete 60 months of approved training (PGY 1 plus 48 months of radiation oncology residency) Document in myABR a...

www.theabr.org