Advice requested for a FMG trying to match psychiatry

[shoenberg3]

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Hello all,

I am aware that it has become rather difficult as a foreign medical graduate to match into a US psychiatry program. As I am pretty anxious about my chances, I am seeking advice on how to best spend the next few months before participating in the 2023 Match.

For some background, I am an US citizen who graduated from US university but graduated from a foreign medical school (in Asia, wanted to spend a few years in the motherland..).

I have recently received my Step 1 score (245+) but haven't taken the Step 2 CK yet. I also do not have any USCE/observership, nor do I have any psychiatry research under my belt.

This concerns me, as I only have around 7 months left.

/As an aside, I do have neuroscience/neurosurgery research experience (with one pub) and also gastroenterology research experience, largely during my undergraduate years. In addition, I also did some volunteering in clinics, also during undergraduate years. Not sure how relevant/helpful they would be for the match/

With approximately 7 months left, I realize that I cannot do everything and need to prioritize. Here are the questions that come to mind:

1) How critical would be USCE/observership for matching into psychiatry? Previously, I had believed that USCE/observership is almost a requirement for matching. But I have recently heard an opinion that in psychiatry, unlike in IM/FM, such experience is of less importance and it would be a better use of my time to pursue research in psychiatry with a US professor.
Of course, in an ideal world, I would have both -- as in, for example, an arrangement in which I can observe some patients while conducting research. But, I realize that such an opportunity is hard to come by.

2) What of the importance of Step scores in matching psychiatry? Looking at the match data, I have been led to believe that the scores are quite important and, hence, I was planning on committing at least 4 months full-time to Step 2 CK, followed by 2-3 months of research and/or USCE. Recently, however, I heard an opinion that scores only need to be somewhat decent and that I should spend that extra time instead doing psychiatry research and building relationships in the US.

3) I was originally interested in pursuing research in the area of transcultural psychiatry, as I found the topic quite interesting. I was told by a US-trained psychiatrist, however, that this topic would be considered too left-field and even be met with bit of skepticism/cynicism from the professors and PDs during match cycle. I was advised to find a more mainstream area of research. For instance, in my case, tying in my previous experience with neuroscience research to pursue neuroimaging/neuropsychiatry research (which I do find interesting, but not quite as much as cultural psychiatry).

4) Finally, I had the idea of conducting simple, self-directed research project based on the FDA database. For instance, I could run some statistics on the FAERS data on a specific drug to be published into a short case study or something similar. Obviously, this wouldn't be a high-impact research, nor would I be able to make build relationships with US professors. It would be a way to demonstrate that I did perform some type of psychiatry research, particularly if I had difficulty finding research opportunities in the US or if I decided instead to do observership in lieu of a full-on research experience. Wondering if such publication would be helpful for my application?

Thanks for reading this long-winded post. I would sincerely appreciate any insight or suggestions on this matter.

 

[TexasPhysician]

My information may be outdated, but the few institutions that I was associated with required IMG/FMG’s to complete not only step 2’s but also Step 3 to be granted an interview. No exceptions were made. Scores matter but so does having these items completed. If now outdated, I apologize.

 

[splik]

You are getting terrible advice. You need USCE ideally 8 weeks of electives at US medical schools with a residency program doing inpatient, C-L or emergency psychiatry to be as competitive. This ideally would be while you are still a medical student. You need at least 2 LoRs from this to be most competitive. It is a bit too late to be thinking about research at this point and is of lesser importance unless you want to be a researcher in which case you want to do a post doc at a US institution once you have graduated and then apply for residency and will need 1-2 years of research under your belt with publications and presentations. If you don’t want to be a researcher then I wouldn’t bother but being an impressive researcher is one of the few ways that IMGs match at top programs.

Cultural psychiatry would be a perfectly legitimate area of study. Do what you are interested in, not what you think others are interested in.

You do not need to do step 3 to match or get interviews and if you are a US citizen don’t need it until you’re in residency. However those needing a H1B visa need it and it can make applicants more attractive especially if their other board scores are lower.

 

[ObsequiousAplomb]

I agree with Splik.

Splik's definitely someone who you should listen more to than my opinion on this subject, but I'll expound a little based on my experiences.

Your scores will decide whether they look closely at your application, your application meeting their criteria will determine whether you get an interview. Your interview determines where they rank you.

Programs are more likely to interview known good candidates, candidates who come well recommended, and candidates who fit their mission.

If you want to be a researcher then show that you do research. You've already done some research. If you want to do more in cultural psychiatry, most programs will at least think that's neat. It will ingratiate you more with programs that have a mission statement regarding whatever topic you research. If a program isn't interested in you because of your passion, would you want to work with them?

If you want to be a clinician show that you have been exposed to the clinical population in question. Clinical experience in the US is the most important factor, after that it's clinical experience with the population the program specializes in. For example, clinical experience with primarily affluent, white, suburban patients will probably be slightly less important to programs at HBCUs in inner cities.

Letters of recommendation from the people you have worked with in the US are very important, whether you are FMG, IMG, or USMD. Programs want to know why they should rank you above the graduates from familiar programs who completed one or two M4 electives with them.

 

[Celexa]

I agree you seem to be getting bad advice. Transcultural psychiatry is a very legitimate interest and potentially very appealing to a program that, say, serves a large immigrant population, particularly if you are fluent enough to conduct psychiatric evals in a second language. There might also be programs that would be turned off by it but... If you'd be miserable there because they don't share your values, is that really a loss?

I'll leave much better informed people to speak to more of the FMG application aspects.

 

[shoenberg3]

I sincerely thank you all for your advice.

You are getting terrible advice. You need USCE ideally 8 weeks of electives at US medical schools with a residency program doing inpatient, C-L or emergency psychiatry to be as competitive. This ideally would be while you are still a medical student. You need at least 2 LoRs from this to be most competitive. It is a bit too late to be thinking about research at this point and is of lesser importance unless you want to be a researcher in which case you want to do a post doc at a US institution once you have graduated and then apply for residency and will need 1-2 years of research under your belt with publications and presentations. If you don’t want to be a researcher then I wouldn’t bother but being an impressive researcher is one of the few ways that IMGs match at top programs.

Cultural psychiatry would be a perfectly legitimate area of study. Do what you are interested in, not what you think others are interested in.

You do not need to do step 3 to match or get interviews and if you are a US citizen don’t need it until you’re in residency. However those needing a H1B visa need it and it can make applicants more attractive especially if their other board scores are lower.

I agree with Splik.

Splik's definitely someone who you should listen more to than my opinion on this subject, but I'll expound a little based on my experiences.

Your scores will decide whether they look closely at your application, your application meeting their criteria will determine whether you get an interview. Your interview determines where they rank you.

Programs are more likely to interview known good candidates, candidates who come well recommended, and candidates who fit their mission.

If you want to be a researcher then show that you do research. You've already done some research. If you want to do more in cultural psychiatry, most programs will at least think that's neat. It will ingratiate you more with programs that have a mission statement regarding whatever topic you research. If a program isn't interested in you because of your passion, would you want to work with them?

If you want to be a clinician show that you have been exposed to the clinical population in question. Clinical experience in the US is the most important factor, after that it's clinical experience with the population the program specializes in. For example, clinical experience with primarily affluent, white, suburban patients will probably be slightly less important to programs at HBCUs in inner cities.

Letters of recommendation from the people you have worked with in the US are very important, whether you are FMG, IMG, or USMD. Programs want to know why they should rank you above the graduates from familiar programs who completed one or two M4 electives with them.

If I understood correctly, I can choose to devote 1-2 years to research if I wanted to pursue a career in research and apply mostly to academic programs. But otherwise (especially if I wanted to match in 2023), my priority should be on gaining clinical experience in psychiatry and come out with few LoRs.

Therein lies the problem, however. I have already graduated and along with COVID situation, it has become quite difficult to find USCE in psychiatry. Obviously, an observership would not be as good as doing an elective/clerkship (which I cannot do as a graduate), but if I do find such an observership with some hands-on experience with LORs to show for it, would that help with obtaining at least few interviews? (provided that my Step 2 scores turn out decent).

With the difficulty in finding such opportunities, I might have to pay large fees to agencies such as this one: Graduate Rotations | USCEs that Prepare You for the Match. I do wonder if I would be able to obtain meaningful experience from these programs…



In regards to cultural psychiatry research, I am beginning to understand that with such limited time it would be of less importance to my application, especially when compared to obtaining USCE. Would you say getting my feet wet (without publication) just to be able to say I did some psychiatry research (beyond neurosurgery/gastroenterology research that I did in undergraduate) be helpful at all? Obviously, I am pretty interested in the subject..

On a side note, how useful would be a LoR from the professor (endocrinologist) with whom I performed clinical research during my undergraduate be? Also, in regards to clinical volunteering that I did during undergraduate, should I even bother mentioning it in the application?


Thank you for your advice; it is providing me with some much-needed clarity and will certainly influence how I will plan out the next few months.

 

[splik]

I sincerely thank you all for your advice.

With the difficulty in finding such opportunities, I might have to pay large fees to agencies such as this one: Graduate Rotations | USCEs that Prepare You for the Match. I do wonder if I would be able to obtain meaningful experience from these programs…

Please do not use these agencies. It is completely unethical for someone to be paid by you to do one of these electives, and they obviously are expected to write you a positive LoR. As such these letters are worthless (and from what I have seen are usually very poorly written). As mentioned above, UCSE really needs to be done at a medical center affiliated with a residency program, not someone's random office who has no idea about contemporary expectations of psychiatry residents. I strongly recommend you seek out a postdoc at a US medical school psychiatry department w/ a residency program, and during that time your PI should support you in getting some USCE. This is usually how I have IMGs rotate with me these days as visiting scholars. It is very competitive now for IMGs to match into psych (though many still do), and this is the best route, along with getting high USMLE scores.

 

[Vasanervo]

You would likely need your Step 2CK score to get USCE.

 

[shoenberg3]

Please do not use these agencies. It is completely unethical for someone to be paid by you to do one of these electives, and they obviously are expected to write you a positive LoR. As such these letters are worthless (and from what I have seen are usually very poorly written). As mentioned above, UCSE really needs to be done at a medical center affiliated with a residency program, not someone's random office who has no idea about contemporary expectations of psychiatry residents. I strongly recommend you seek out a postdoc at a US medical school psychiatry department w/ a residency program, and during that time your PI should support you in getting some USCE. This is usually how I have IMGs rotate with me these days as visiting scholars. It is very competitive now for IMGs to match into psych (though many still do), and this is the best route, along with getting high USMLE scores.

Really thankful for your insight on this matter.

I appreciate your recommendation about a doing postdoc, which would allow me to pursue both research and USCE. However, unless absolutely necessary, I would like to avoid adding another 1-2 years to the application process, as I've already had a long and circuitous journey.

As difficult as it may be, my plan now is to find an USCE opportunity in an institution affiliated with a residency program, as you've recommended. I am looking into programs like this: 4B Observership | Psychiatry | SUNY Upstate Medical University.

If I am able to find such an opportunity and receive good LoRs from it, I wonder if I would have a shot of garnering few interviews in the upcoming cycle? Provided that, of course, I follow up my 245+ Step 1 with a 250+ on Step 2, and given that I am a US citizen who graduated from US university (a HYPS school, if that helps at all) with some non-psych publications under his belt.

If things are becoming so competitive that even with 1-2 months of decent USCE my chances aren't looking good, I will then definitely have to more seriously consider putting aside an extra year or two to a postdoc program or MPH.

Once again, I am truly grateful for your help.

 

[Vasanervo]

Really thankful for your insight on this matter.

I appreciate your recommendation about a doing postdoc, which would allow me to pursue both research and USCE. However, unless absolutely necessary, I would like to avoid adding another 1-2 years to the application process, as I've already had a long and circuitous journey.

As difficult as it may be, my plan now is to find an USCE opportunity in an institution affiliated with a residency program, as you've recommended. I am looking into programs like this: 4B Observership | Psychiatry | SUNY Upstate Medical University.

If I am able to find such an opportunity and receive good LoRs from it, I wonder if I would have a shot of garnering few interviews in the upcoming cycle? Provided that, of course, I follow up my 245+ Step 1 with a 250+ on Step 2, and given that I am a US citizen who graduated from US university (a HYPS school, if that helps at all) with some non-psych publications under his belt.

If things are becoming so competitive that even with 1-2 months of decent USCE my chances aren't looking good, I will then definitely have to more seriously consider putting aside an extra year or two to a postdoc program or MPH.

Once again, I am truly grateful for your help.

You could PM me.

 

[shoenberg3]

You could PM me.

I appreciate your response.

When I click on your profile to send you a PM, it reads: "This member limits who may view their full profile."

I would be grateful if you could contact me on [email protected].
Alternately, please let me know if there is any other way to reach you.

Thank you