Applying for Medical Residency in America

[billybadass]

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I want to be an orthopedic surgeon and practice in America. I currently live in Pakistan and am a Pakistani citizen. I did most of high school in the States (9th-11th grade). I had to move back here because my family decided to. I am going to finish up high school here, and then go to the best Med school here because the chances of an international student getting into an American school on scholarship are little to none. I'm fluent in English, have an almost perfect American accent, and took all Honors/AP classes in high school in the states. Also, I made a 93 in Biology in high school. I have taken the SAT once and got a 1600/2400 without studying. I also have a whole summer's worth of volunteering hours at a Veterans Hospital in the States under my belt. I would like to know what are the chances of me successfully securing a residency in the states and later on becoming a successful surgeon there. My dad is also a doctor (pediatrician, but doesn't practice anymore), has plenty of doctor/surgeon friends in the states and got his doctorate in the states on scholarship (the main reason I was in the states for 3 years. He is a PhD in Public Health, one of the very first in my country). Just saying that in case it improves my chances. A detailed answer would be much appreciated.

edit: i'm going to med school straight out of high school because there is no such thing as pre-med school here. i'll have a MBBS. a lot of people have done this before, i just want to know where i stand and what are my chances.

 

[EMDO2018]

I think an IMG getting an American orthopedic surgery residency is very, very, very slim unfortunately. That is a very competitive specialty for even American MDs to match.

 

[QofQuimica]

I think an IMG getting an American orthopedic surgery residency is very, very, very slim unfortunately. That is a very competitive specialty for even American MDs to match.

Agree.

OP, what is your citizenship/residency status? If you are an American citizen or permanent resident, I would suggest moving back to the US after HS, going to college and medical school here, and then applying for US ortho residency programs as an AMG. That is the pathway that will most likely result in you successfully becoming a US orthopedic surgeon.

However, if you are a Pakistani citizen and do not have a US green card, it will be very difficult for you to ever work as an orthopedic surgeon in this country. In that case, you will likely have to make a difficult decision: would you rather try to be an orthopedist in Pakistan, or a PCP here in the US? None of us can advise you on this without knowing how strongly you want to be an orthopedist versus how much you want to practice in the US. But unfortunately, without US citizenship/permanent residency status, the odds of you being able to do both are extremely low.

 

[billybadass]

Is it really that hard to do both? I mean, the people my dad graduated med school with back in like 1990 are now cardio surgeons living in New York that only travel via private jets... The practicing is limited by visa and green card. I wanna know what my chances at securing an American residency as an IMG are. From what I know, most people in Pakistan give USMLE part 1 & 2 in Pakistan, secure a residency in the States, then goto the States and give USMLE part 3 and finish up their residency on J-1 visa status. Of course, they have to spend 2 years in Pakistan after the residency but can return after that. My aunt's a US citizen that could probably help out with the green card situation, and my parents are applying for immigration to Canada currently if that means anything.

@QofQuimica to answer your questions, I am a Pakistani citizen, and I want to be an orthopedic surgeon in America. That's basically my dream. I love the place.

Also, couldn't I be a surgeon and practice in the States on work visa? My dad's friend is a PCP and did that. Then he married an American citizen and became an American citizen.

 

[theseeker4]

Is it really that hard to do both? I mean, the people my dad graduated med school with back in like 1990 are now cardio surgeons living in New York that only travel via private jets... The practicing is limited by visa and green card. I wanna know what my chances at securing an American residency as an IMG are. From what I know, most people in Pakistan give USMLE part 1 & 2 in Pakistan, secure a residency in the States, then goto the States and give USMLE part 3 and finish up their residency on J-1 visa status. Of course, they have to spend 2 years in Pakistan after the residency but can return after that. My aunt's a US citizen that could probably help out with the green card situation, and my parents are applying for immigration to Canada currently if that means anything.

@QofQuimica to answer your questions, I am a Pakistani citizen, and I want to be an orthopedic surgeon in America. That's basically my dream. I love the place.

Also, couldn't I be a surgeon and practice in the States on work visa? My dad's friend is a PCP and did that. Then he married an American citizen and became an American citizen.

The environment is a lot different now than it was in 1990. It is much, much more difficult to get into orthopedic surgery for anyone, and it is much more difficult to get a US residency as a IMG or FMG than it used to be.

What Q told you is the best way to be a physician in any competitive specialty here. You have to complete a US residency to practice here, and you face very steep odds of matching to any competitive specialty without a degree from a US MD or DO school. Ortho is one of the most competitive specialties out there right now.

If your dream is to practice here, the best method would be to try to get permanent residency status here, go to school here, get a residency here, and then you can practice here. They have tightened up the requirements to practice here, whereas before you didn't need to complete a full residency to practice in the US, now you have to. If there are exceptions to this, they are uncommon and not something to count on. Good luck!

 

[billybadass]

Well damn. Are there any ways for international students to get student loans?

 

[Law2Doc]

Odds of coming from a Pakistani med school to a US ortho residency these days are about 0.001%. you should probably buy lottery tickets instead.

 

[billybadass]

@Law2Doc What do I have to do to be that 0.001%? My dad works with Johns Hopkins, WHO, and a couple of other international health organizations so we have plenty of contacts. He doesn't work for WHO. If he did I could just do my pre-med and med school in the States all for free lol. Life is so competitive. So again, what do I have to do to be that 0.001? What do the people that control these residency programs look for in IMGs?

 

[Law2Doc]

@Law2Doc ... What do the people that control these residency programs look for in IMGs?

I think my point is they really don't look for IMGs at all. This specialty is among the more competitive right now, and so fills easily with top students from US allo programs. The couple of IMGs I've met in ortho (and there haven't been many) were European educated with absurdly high step scores and extensive research, and I suspect they used a lot of connections to boot.

Coming from a foreign country and landing "a" categorical US residency in any specialty is actually a big accomplishment these days. Landing one in one of the most competitive specialties is just not being realistic. Lots of accomplished US grads don't get ortho and have to settle for other specialties.

 

[QofQuimica]

@Law2Doc What do I have to do to be that 0.001%? My dad works with Johns Hopkins, WHO, and a couple of other international health organizations so we have plenty of contacts. He doesn't work for WHO. If he did I could just do my pre-med and med school in the States all for free lol. Life is so competitive. So again, what do I have to do to be that 0.001? What do the people that control these residency programs look for in IMGs?

If you really do have "connections," use them to expedite getting a green card, and come to the US for your college and medical training.

 

[theseeker4]

If you really do have "connections," use them to expedite getting a green card, and come to the US for your college and medical training.

This. OP, this is the only realistic chance to obtain what you are trying to achieve.

 

[billybadass]

Yeah well, I don't really have those kind of connections lol. I would need to know senators and people in such powerful positions for that to happen. This is getting a bit confusing for me now.
If I do pre-med and med school in the States as an international student do I still not have chances of getting an orthopedic US residency just because I'm not a resident? I think I can get about 50% waived off at Johns Hopkins.

If I can't fulfill my dream of being an orthopedic surgeon in the states, I'd still like to at least be some other surgeon there nonetheless. So, what are my options? Cardiac surgeon? Brain surgeon?

Also, I read on other forums that you can still get matched for an ortho US residency as an IMG if you get 260s on USMLE, do prelims, lots of electives in med school, publish research papers, and get good LORs. The downside: You don't get a residency straight out of med school. Is this true? I don't mind spending two years researching and publishing papers after med school seeing how I'll be a med school graduate at the age of 24!

 

[Goro]

It's getting harder and harder for IMGs to get these, and even when they do, they're not good programs. Focus on what you can do, instead on what you are fantasizing about. You've received some very good advice on this thread. Heed it.

Also, I read on other forums that you can still get matched for an ortho US residency as an IMG if you get 260s on USMLE, do prelims, lots of electives in med school, publish research papers, and get good LORs. The downside: You don't get a residency straight out of med school. Is this true? I don't mind spending two years researching and publishing papers after med school seeing how I'll be a med school graduate at the age of 24![/QUOTE]

 

[AlbinoHawk DO]

Yeah well, I don't really have those kind of connections lol. I would need to know senators and people in such powerful positions for that to happen. This is getting a bit confusing for me now.
If I do pre-med and med school in the States as an international student do I still not have chances of getting an orthopedic US residency just because I'm not a resident? I think I can get about 50% waived off at Johns Hopkins.

If I can't fulfill my dream of being an orthopedic surgeon in the states, I'd still like to at least be some other surgeon there nonetheless. So, what are my options? Cardiac surgeon? Brain surgeon?

Also, I read on other forums that you can still get matched for an ortho US residency as an IMG if you get 260s on USMLE, do prelims, lots of electives in med school, publish research papers, and get good LORs. The downside: You don't get a residency straight out of med school. Is this true? I don't mind spending two years researching and publishing papers after med school seeing how I'll be a med school graduate at the age of 24!

If your dad is really rich as you say, there are ways to get citizenship here. Talk to an immigration attorney. Dreaming about a 260 is one thing. Doing it is another.

 

[billybadass]

@AlbinoHawk DO
Citizenship isn't an option, my parents wouldn't let me do that nor help me do it. I'm still gonna try and get it once I'm independent anyways. But for now, it isn't an option. I'm willing to do anything it takes education-wise. I plan on burying my head under books for the next 8 years of my life. And I never said my dad was that rich man, I'm not an only child either haha.

Also, the thing about citizenship is that it isn't easy to get. Too many villagers apply for immigration here. They make up 90% of the immigration applicants. They go there, work at gas stations, and give a bad impression of Pakistanis (not Pakistan, it is definitely a ****ty place). So anyways, yeah, if I were to apply for immigration today the United States embassy would probably get back to me about it in about 11 years.

I don't think you guys quite understand how seriously I'm taking this. I plan on making my life revolve around this goal.

Could someone please tell me what exactly are the requirements for getting matched into an ortho (or any other surgical) residency? If I came out on top of everyone else wouldn't they have to take me in? We all know that IMGs get matched into surgical residencies every year even though its only a handful of them. Now I don't wanna know about the odds of me getting in, I wanna know what those handful of IMGs did to get accepted. Please help me with that.

 

[AlbinoHawk DO]

@AlbinoHawk DO
Citizenship isn't an option, my parents wouldn't let me do that nor help me do it. I'm still gonna try and get it once I'm independent anyways. But for now, it isn't an option. I'm willing to do anything it takes education-wise. I plan on burying my head under books for the next 8 years of my life. And I never said my dad was that rich man, I'm not an only child either haha.

Also, the thing about citizenship is that it isn't easy to get. Too many villagers apply for immigration here. They make up 90% of the immigration applicants. They go there, work at gas stations, and give a bad impression of Pakistanis (not Pakistan, it is definitely a ****ty place). So anyways, yeah, if I were to apply for immigration today the United States embassy would probably get back to me about it in about 11 years.

I don't think you guys quite understand how seriously I'm taking this. I plan on making my life revolve around this goal.

Could someone please tell me what exactly are the requirements for getting matched into an ortho (or any other surgical) residency? If I came out on top of everyone else wouldn't they have to take me in? We all know that IMGs get matched into surgical residencies every year even though its only a handful of them. Now I don't wanna know about the odds of me getting in, I wanna know what those handful of IMGs did to get accepted. Please help me with that.

That's the thing. There is no straight guideline to follow that guarantees a result. You could get a 270 on Step 1 and have 10 first author papers in Nature and Science and still get rejected. Aside from the general "get the best grades possible and publish in the best journals you can," there's really nothing more to say. If I were you, I'd use my connections to meet people that may help you get in by virtue of being in your network rather than earning it. In 8 years your chances are going to be that much worse with the many new MD and DO colleges opening up and graduating more US people. I've even heard of having a 2 tier system after the merger where US MD and DO get to match first. Then whatever is leftover from the match, the IMG/FMG can pick up. If this happens, your chances are effectively zero even with perfect grades as Ortho is not a field where you should expect spots to be left open.

 

[billybadass]

So, let's move aside from the ortho then. What other surgical options do I have then? And I understand, a couple of my dad's friends are chiefs of surgery at their respective hospitals. Possibly that could help? Also, seeing how I won't be doing pre-med I'm guessing I can't do something like transfer my credits to the States after two years of med school here. Or can I?
Is residency enrollment based on merit? How do you even apply for a residency? Does a bad (probably not the best word) residency program affect your career? I mean, once you're done with the program and become a board certified surgeon it doesn't really matter if the residency program wasn't the most prestigious program ever does it?

 

[Law2Doc]

No way to transfer from a Pakhistani med school to a US one -- totally different systems. And residency is based on merit, but to a large extent merit in US rotations, which you won't have. If you put up great numbers and have chiefs of surgery pulling for you, maybe you can end up in a general surgery program at some community hospital someplace. It's a long shot. You realistically won't get ortho, or neurosurgery. Unless you have the kind of connections that can bypass the normal rules, which it's really not sounding like you do, I think most of what you want isn't in the cards. At least not in the US. Why cant you become a Pakhistani orthopedist? Or another country that might actually value your schooling?

 

[Why Not MD?]

Yes, it is true that citizenship is hard to get, so I'm quite confused how you are saying that you'll try and get American citizenship once you're independent. Unless you have a work visa or an immigrant visa with an immediate family member sponsoring you, it will be tough.

I'm not sure what kind of visa those immigrants you discussed have, but either they're here on a tourist visa and working under the table or they came under sponsorship of an immediate family member.

I want to commend you on being so brave, but this comes with a reality check as everyone has done.



Here's what you want to hear:
How to get in: Be the best. That's pretty much it. There's no weaving around it. You know what you need to do actually. You need to be exceptional.
Do not have any unexplained breaks from med school. Research, leadership, etc. whatever. Your records have to be absolutely clean. You have to be almost superhuman to even be CONSIDERED. But if you are, then take a chance. It's slim, but you never know.

We have to keep this in mind though:
NRMP has implemented an all-in policy. This means that any program participating in the match has to attempt to fill all positions offered through the match. They either open ALL the positions for the match or NONE.
What it means? Most ortho residencies are only available through the match. (I don't know if there are any ortho programs that don't participate)
Previously, several IMGs got residency positions OUT of the match. This is the reason that Caribbean medical schools offer clinical rotations in the US, and why several IMGs do internship rotations in the US. After getting themselves known through the program, they apply out of match into the residency programs. 4,626 IMGs were able to get residency positions through the Match in 2011, while 6,754 IMGs entered residency programs that same year.

Here's what you don't want to hear (the stats):
Non-US IMGs in 2014: 7,334
Matched PGY-1 in 2014: 49.5%
US IMGs in 2014: 5,133
Matched PGY-1 in 2014: 53%

US allopathic seniors in 2014: 17,374
US seniors matched: 94.4%

Total applicants: 34,270


Orthopedic residency positions offered in 2014: 695
Orthopedic residency positions filled by US seniors: 649
Orthopedic residency positions filled by others*: 44
(Others: previous US grads, DO grads, US citizens from Canadian schools, US IMGs, non US IMGs)

You're thinking: Wow! 46 spots unfilled by US seniors!
Why? It doesn't mean there weren't enough applicants. I think it's the algorithm. Spots left open because they were outranked by programs or applicants. Those unfortunate guys probably didn't rank in the right order to get their residency.

2013 NRMP Matches for non-US IMGs in Orthopedic Surgery
Alabama: 1
California: 1
Illinois: 1
Maryland: 1
Pennsylvania: 2
All other states: 0.

Total: 6

Unfortunately, I can't find data on those non US IMGs who matched in Ortho. In other specialties, there is some data if you'd like to check it out. http://www.ecfmg.org/resources/NRMP...atch-International-Medical-Graduates-2014.pdf

So your chances are pretty slim. Too slim.

Consider your options rather than keeping your mind set on that goal. If you want to go to the US, you have to adjust. Or do orthopedic surgery where you are able to do it, either there or in another country. But the U.S. institutions would prefer hiring U.S. medical school grads because they want to give U.S.-trained U.S. citizens those jobs.

Start paving your path, but when you're in medicine, you'll really be influenced as to what you want to do.
I went into medicine with the hopes of becoming a surgeon. I went through surgery and ended up hating it. I did well in pediatrics, obstetrics, and gynecology though, which were subjects I never thought I'd do well on.

If you are just about to finish high school, then I remember the position I was in at your age. I went to another country to do my undergrad and medical school (US Citizen though) but had no idea how hard it would be to go back here and apply for residency. I remember thinking things were easy and that I could do everything. The teenage years sort of impart that kind of thinking. But now here are the facts. Use them well.

 

[Law2Doc]

Yes, it is true that citizenship is hard to get, so I'm quite confused how you are saying that you'll try and get American citizenship once you're independent. Unless you have a work visa or an immigrant visa with an immediate family member sponsoring you, it will be tough.

I'm not sure what kind of visa those immigrants you discussed have, but either they're here on a tourist visa and working under the table or they came under sponsorship of an immediate family member.

I want to commend you on being so brave, but this comes with a reality check as everyone has done.



Here's what you want to hear:
How to get in: Be the best. That's pretty much it. There's no weaving around it. You know what you need to do actually. You need to be exceptional.
Do not have any unexplained breaks from med school. Research, leadership, etc. whatever. Your records have to be absolutely clean. You have to be almost superhuman to even be CONSIDERED. But if you are, then take a chance. It's slim, but you never know.

We have to keep this in mind though:
NRMP has implemented an all-in policy. This means that any program participating in the match has to attempt to fill all positions offered through the match. They either open ALL the positions for the match or NONE.
What it means? Most ortho residencies are only available through the match. (I don't know if there are any ortho programs that don't participate)
Previously, several IMGs got residency positions OUT of the match. This is the reason that Caribbean medical schools offer clinical rotations in the US, and why several IMGs do internship rotations in the US. After getting themselves known through the program, they apply out of match into the residency programs. 4,626 IMGs were able to get residency positions through the Match in 2011, while 6,754 IMGs entered residency programs that same year.

Here's what you don't want to hear (the stats):
Non-US IMGs in 2014: 7,334
Matched PGY-1 in 2014: 49.5%
US IMGs in 2014: 5,133
Matched PGY-1 in 2014: 53%

US allopathic seniors in 2014: 17,374
US seniors matched: 94.4%

Total applicants: 34,270


Orthopedic residency positions offered in 2014: 695
Orthopedic residency positions filled by US seniors: 649
Orthopedic residency positions filled by others*: 44
(Others: previous US grads, DO grads, US citizens from Canadian schools, US IMGs, non US IMGs)

You're thinking: Wow! 46 spots unfilled by US seniors!
Why? It doesn't mean there weren't enough applicants. I think it's the algorithm. Spots left open because they were outranked by programs or applicants. Those unfortunate guys probably didn't rank in the right order to get their residency.

2013 NRMP Matches for non-US IMGs in Orthopedic Surgery
Alabama: 1
California: 1
Illinois: 1
Maryland: 1
Pennsylvania: 2
All other states: 0.

Total: 6

Unfortunately, I can't find data on those non US IMGs who matched in Ortho. In other specialties, there is some data if you'd like to check it out. http://www.ecfmg.org/resources/NRMP...atch-International-Medical-Graduates-2014.pdf

So your chances are pretty slim. Too slim.

Consider your options rather than keeping your mind set on that goal. If you want to go to the US, you have to adjust. Or do orthopedic surgery where you are able to do it, either there or in another country. But the U.S. institutions would prefer hiring U.S. medical school grads because they want to give U.S.-trained U.S. citizens those jobs.

Start paving your path, but when you're in medicine, you'll really be influenced as to what you want to do.
I went into medicine with the hopes of becoming a surgeon. I went through surgery and ended up hating it. I did well in pediatrics, obstetrics, and gynecology though, which were subjects I never thought I'd do well on.

If you are just about to finish high school, then I remember the position I was in at your age. I went to another country to do my undergrad and medical school (US Citizen though) but had no idea how hard it would be to go back here and apply for residency. I remember thinking things were easy and that I could do everything. The teenage years sort of impart that kind of thinking. But now here are the facts. Use them well.

Good post, but it's even bleaker than described. Many of the PGY-1 spots IMGs get are dead end prelim spots. And as US enrollment increases each year, the percentage of IMGs who match is anticipated to be worse each year for at least the foreseeable future.

 

[billybadass]

@Why Not MD? Thank you for your thoroughly detailed answer. It is probably the best one yet.
If I understand correctly, the already extremely slim chances I have can be increased a tad bit if I complete and internship program after med school?

I completely understand that the chances of me getting a US residency are really slim. But hey, its not supposed to be easy. The way I see it, working my ass off is worth it. Why do I not wanna be an orthopedic surgeon in Pakistan? Well, the answer to that is simple: this country is going to ****. Doctors get shot up all in the open for nothing but their religious beliefs. (read: http://edition.cnn.com/2014/05/27/world/asia/pakistan-american-doctor-killed). I love America, and I love medicine. I really, really, really want to do it. Being realistic, I know the odds are stacked up against me. And they are supposed to be. People trust surgeons with their lives, and I completely understand why going underneath the knife of a foreign doctor seems so scary. It is scary. But I'm willing to prove otherwise.

So what exactly is the process? How does it work? Do med-school grads just get a residency straight up out of med school? Are internships required? Can someone guide me through the process step by step? Knowing all the steps and different levels would make it easier for me to be on top of my game.

What if I actually am the 0.001% and we just don't know it yet. Let that sink in. It is unlikely, but its still possible haha.

 

[Law2Doc]

So what exactly is the process? How does it work? Do med-school grads just get a residency straight up out of med school? Are internships required? Can someone guide me through the process step by step? Knowing all the steps and different levels would make it easier for me to be on top of my game.

What if I actually am the 0.001% and we just don't know it yet. Let that sink in. It is unlikely, but its still possible haha.

Most don't spend years of their life working hard to get to the point where they have a 99.999% chance of failure, but do what you'd like. I personally would put the idea of ortho out of your head, you really can't get there from here. Even generl surgery will be tough. Try to become "a" doctor if you can find other specialties palatable.

Intern year is what we call the first year of residency. It IS residency and you have to go through the same match process. In the US you start to apply for residencies in early summer of your final year of med school, interview with programs from September to January, and find out whether you got a spot in march. people sometimes take preliminary positions -- one year intern spots in either medicine or surgery, and try to prove themselves so they can get to categorical (full residency) spots. Most of the time for IMGs this is a dead end because it's tough to start in July and prove you are a superstar by the time you are interviewing in October. If you do prove yourself and somehow land a categorical spot, you sometimes have to redo intern year at the new place. And again, the spots you are proving (auditioning) yourself for will be IM (mostly) or GS (rarely), not ortho. And you are competing with US grads who have an edge every step of the way. And odds will be even worse in a few years than they are now because US med school enrollment is increasing a lot faster than residency slots. It's a moving target.

I hope you get to where you want, but in good conscience unless you were saying you are shooting for the least desirable primary care spot in an underserved area in the US just to be able to be a doctor, I wouldnt give you much encouragement -- i don't think you have a great shot to come close to your goals. Many very good foreign educated people don't get to be doctors here at all, let alone surgeons.

 

[QofQuimica]

Agree with L2D. I'm all I'm favor of people having lofty goals. Working your a** off is worth it if you have a worthwhile goal. But a goal without a plan for achieving it is just a pipedream. There is no plan in existence that is likely to allow you to achieve your dream as things currently stand. Again, the reason why no one here can tell you how to make what you want happen, is because you can't. So, you either need to change how things stand (figure out how to arrange to be able to train in the US from college onward), or pick a goal that, while not your ideal, is still something that would make you happy and is actually achievable.

FWIW, doctors get "shot up for their religious beliefs" in this country, too. Here's one that happened in my home state when I was about your age: http://en.m.wikipedia.org/wiki/Murder_of_David_Gunn

 

[billybadass]

Thank you all for your detailed responses. I really appreciate them. If I really don't get into an American residency its not going to be a complete failure. There are still other countries in the world that wouldn't mind hiring an IMG with high scores, although I'd rather it be America. But hey, we can't always get everything we want. But we can always try our best to accomplish what we want no matter how impossible it may seem so even if we do fail we can tell ourselves that we gave it our 100% at the end of the day. Every shot we don't take is a guaranteed miss, right? That's just how I think.

 

[Law2Doc]

Thank you all for your detailed responses. I really appreciate them. If I really don't get into an American residency its not going to be a complete failure. There are still other countries in the world that wouldn't mind hiring an IMG with high scores, although I'd rather it be America. But hey, we can't always get everything we want. But we can always try our best to accomplish what we want no matter how impossible it may seem so even if we do fail we can tell ourselves that we gave it our 100% at the end of the day. Every shot we don't take is a guaranteed miss, right? That's just how I think.

Nothing wrong with taking a shot, but you have to at least do it with your eyes open.

 

[Why Not MD?]

You can still be a doctor here in the U.S. As Law2Dock suggested, pick a less-desired residency in areas no one really wants to go to. You're pretty much a shoe-in. There are way too many foreign M.D.s in the US who cannot get a residency position and end up not working as a physician or taking nursing to become a nurse here.

 

[billybadass]

I would have absolutely no problem working in underserved areas for a few years if it helps me achieve my goals in the long term.

 

[Law2Doc]

You can still be a doctor here in the U.S. As Law2Dock suggested, pick a less-desired residency in areas no one really wants to go to. You're pretty much a shoe-in. There are way too many foreign M.D.s in the US who cannot get a residency position and end up not working as a physician or taking nursing to become a nurse here.

Um, he isn't "pretty much a shoo in". Its still a long shot. As noted above only about half of all foreign grads who want to come here get spots and that's a percentage only expected to get worse in the coming years. I'm just saying that's not as absurd a goal as wanting ortho.

 

[Why Not MD?]

It would help you get a residency position----just not in orthopedic surgery. 🙂

 

[Law2Doc]

I would have absolutely no problem working in underserved areas for a few years if it helps me achieve my goals in the long term.

Again I don't think this "helps achieve your goals in the long term". It's not a few years. It kind of needs to be the goal. That's it -- you get to be a doctor in the US -- that's the prize most in your situation won't get. If you get a noncompetitive spot at a community hospital in an underserved area, you get to be "a" doctor; you are really no closer to ortho or even surgery than you are today. Maybe you can relocate to a better geographic location. But you have to wrap your mind around whether you'd enjoy being "a" doctor and not ever achieve additional specialty goals because again that's not a likely end result here.

 

[billybadass]

What if I specialize in Europe and then came to the States for residency?

 

[QofQuimica]

What if I specialize in Europe and then came to the States for residency?

Well, I suppose there is an odd chance that the EU might vote to become part of the United States, thus placing their medical schools under the oversight of our LCME so that their grads will no longer be considered as IMGs by our residencies. But the odds of that happening are even lower than the odds of anything else you've suggested thus far.

 

[billybadass]

Ha ha ha. That was actually my dad's suggestion and I just wanted to know if it would work or not.

 

[AMEHigh]

Is it really that hard to do both? I mean, the people my dad graduated med school with back in like 1990 are now cardio surgeons living in New York that only travel via private jets... The practicing is limited by visa and green card. I wanna know what my chances at securing an American residency as an IMG are. From what I know, most people in Pakistan give USMLE part 1 & 2 in Pakistan, secure a residency in the States, then goto the States and give USMLE part 3 and finish up their residency on J-1 visa status. Of course, they have to spend 2 years in Pakistan after the residency but can return after that. My aunt's a US citizen that could probably help out with the green card situation, and my parents are applying for immigration to Canada currently if that means anything.

@QofQuimica to answer your questions, I am a Pakistani citizen, and I want to be an orthopedic surgeon in America. That's basically my dream. I love the place.

Also, couldn't I be a surgeon and practice in the States on work visa? My dad's friend is a PCP and did that. Then he married an American citizen and became an American citizen.

Yes it's hard, but not impossible. The statistic from last year's match was that 49% of non-U.S. citizen IMGs matched. I don't think there is a break down by specialty. So the odds are definitely against you, but obviously it's not impossible.

Here is the link:
http://www.nrmp.org/wp-content/uplo...Residency-Match-Advance-Data-Tables-FINAL.pdf

 

[AMEHigh]

What if I specialize in Europe and then came to the States for residency?

You will still have to start over and do a residency here and it will still be more difficult than a US graduate to match.

 

[AMEHigh]

@AlbinoHawk DO


Could someone please tell me what exactly are the requirements for getting matched into an ortho (or any other surgical) residency? If I came out on top of everyone else wouldn't they have to take me in? We all know that IMGs get matched into surgical residencies every year even though its only a handful of them. Now I don't wanna know about the odds of me getting in, I wanna know what those handful of IMGs did to get accepted. Please help me with that.

Unfortunately, no, they wouldn't have to take you in. Getting in to med school and residency can be such a crap shoot. Even students with high scores and research and LoRs don't match. So I would obviously do well over the next few years of school, but you also have to be realistic about your options and be open to other plans as well.

 

[billybadass]

The odds are stacked up against me. There's no doubt about that. Every post in this forum so far has made sure to point that out. I get it. But can we move on from that now? I'm not ******ed. I know that as long as I'm not a US citizen and a US med school grad the chances of me getting a US residency are extremely low. Its supposed to be that way. What I meant by "What if I specialize in Europe and then came to the States for residency?" was that will doing so increase my chances of getting an ortho US residency as compared to applying for one straight out of a Pakistani med school? Obviously my chances are going to be nowhere near the chances of a US medschool grad, but will doing so be better than just applying straight after med-school? What is the process for applying anyways?

What are the different positions you have to go through before you become a "real" surgeon? Is this order correct: Med school -> Residency -> Resident -> Attending/surgeon? I'm 99% sure I didn't even get all the names right yet alone the order.

 

[billybadass]

Also how does the whole specialization/fellowship work? What's the correct order of the whole process?

 

[Why Not MD?]

Doing specialization in Europe and going to the US will lead you to do this ---> Applying for a residency spot in the U.S. the same way as you would straight out from a Pakistani school.

IM NOT SURE HERE, but I think the main difference would be if you were stellar in the program and did great stuff. I know many doctors who were specialists in other countries but weren't able to get residency spots in the U.S. But they were run of the mill physicians in Asia. Probably didn't do much research. I heard a lecture for IMGs that said research was important.

The process of applying:
(can someone confirm these or correct if they're wrong, this is all from reading, lectures, and anecdotes as I haven't been through these myself!)
You have to be certified by the ECFMG (education commission for foreign medical graduates) which requires passing the USMLE Step 1, Step 2 CK, and Step 2 CS.

Most residency programs use the ERAS (electronic residency application program), so register with that and list the programs you wish to enter. This is the service that residency programs use to download your application and all documents pertinent to your application.

Register for the NRMP (national residency matching program) which begins in September. Interviews through October-January. Rank the programs sometime in January and February. Find out if you matched sometime in March. If you don't match, programs will release a list of unfilled programs, which you may apply to. A few days after that, the match results are released.

The NRMP uses an algorithm that matches an applicant's rank order list with a program's rank order list.
You list programs based on preference, #1 to however many you want. If you don't get into #1, NRMP will try to match you into #2, and so on.
Programs will also rank their applicants #1 to however many applicants. If they have X positions, they will rank the top X applicants. If an applicant matched to another program that they ranked higher, they are taken out of the rank, and the next best candidate comes in.
You only match into one program (if you are a lucky IMG).

I think there are some residency programs out of the match. Some caribbean or other IMGs either get their residencies through non-match programs (i don't know how many there are) or PREVIOUSLY from pre-match contracts, which are not available anymore due to the NRMP's all-in policy.

the timeline goes like this:
Med school --> Residency --> Attending
OR
Med school --> Residency --> Fellowship --> Attending

note that some people or some programs have an internship year as PGY-1 (post graduate year 1) before beginning residency.

Again if I'm wrong or anything, hopefully someone can correct these mistakes so the OP and other readers (and myself) can be enlightened. 🙂

 

[Law2Doc]

The odds are stacked up against me. There's no doubt about that. Every post in this forum so far has made sure to point that out. I get it. But can we move on from that now? I'm not ******ed. I know that as long as I'm not a US citizen and a US med school grad the chances of me getting a US residency are extremely low. Its supposed to be that way. What I meant by "What if I specialize in Europe and then came to the States for residency?" was that will doing so increase my chances of getting an ortho US residency as compared to applying for one straight out of a Pakistani med school? Obviously my chances are going to be nowhere near the chances of a US medschool grad, but will doing so be better than just applying straight after med-school? What is the process for applying anyways?

What are the different positions you have to go through before you become a "real" surgeon? Is this order correct: Med school -> Residency -> Resident -> Attending/surgeon? I'm 99% sure I didn't even get all the names right yet alone the order.

The odds are stacked up against me. There's no doubt about that. Every post in this forum so far has made sure to point that out. I get it. But can we move on from that now? I'm not ******ed. I know that as long as I'm not a US citizen and a US med school grad the chances of me getting a US residency are extremely low. Its supposed to be that way. What I meant by "What if I specialize in Europe and then came to the States for residency?" was that will doing so increase my chances of getting an ortho US residency as compared to applying for one straight out of a Pakistani med school? Obviously my chances are going to be nowhere near the chances of a US medschool grad, but will doing so be better than just applying straight after med-school? What is the process for applying anyways?

What are the different positions you have to go through before you become a "real" surgeon? Is this order correct: Med school -> Residency -> Resident -> Attending/surgeon? I'm 99% sure I didn't even get all the names right yet alone the order.

Let's stop with the ortho already. That's not going to happen for you in the US and the answer isn't going to change no matter how many times you rephrase the question. If you would be content with any specialty and just want to come to the US to be "a" doctor, you can compete with the 49% of FMGs/IMGs who get residency slots (actually less as many in that statistic are dead end prelim spots), mostly in undesirable locales at community hospitals doing primary care. If not, this country isn't going to offer many opportunities. Also bear in mind that US med school enrollment is increasing faster than US residencies, so the door may even be closed to FmGs in just a few years.

 

[AMEHigh]

The odds are stacked up against me. There's no doubt about that. Every post in this forum so far has made sure to point that out. I get it. But can we move on from that now? I'm not ******ed. I know that as long as I'm not a US citizen and a US med school grad the chances of me getting a US residency are extremely low. Its supposed to be that way. What I meant by "What if I specialize in Europe and then came to the States for residency?" was that will doing so increase my chances of getting an ortho US residency as compared to applying for one straight out of a Pakistani med school? Obviously my chances are going to be nowhere near the chances of a US medschool grad, but will doing so be better than just applying straight after med-school?

I'm not sure how else we can put it to you. No, even if you specialize in Europe and come to the states for residency, doing ortho will be extremely hard. In my experience IMGs, even those who were doctors in their previous countries, still have difficulty matching even in less competitive specialties such is IM, family, peds, etc.

For example, I rotated with an IMG who had moved here to the US with his wife. They were both previously doctors in some Asian country (can't remember which one). He was a surgeon and I'm not sure what she did. He was actually lucky enough to get a preliminary spot (a prelim spot is just a 1 year position that is pretty much a dead end unless you match in to an actual specialty afterwards), but his wife couldn't even get a preliminary spot. He attempted to match in to internal medicine after his prelim year, but didn't get accepted to any programs. When I was rotating with him, he seemed to be doing pretty well and the doctors seemed to like him, so I'm sure he had decent LoRs and seemed to know his stuff in general, but nope, he didn't get an acceptance.

Obviously this is only one anecdotal story and really, we're not trying to be debbie downers, but we're just being realistic. I'm really not sure if there are statistics on match rates on IMG doctors vs nondoctors, so I'm not sure if anyone can give you exact numbers, but as numerous people have pointed out, it will still be very very difficult and your best bet is to plan to do a less competitive specialty if you really want to practice in the US.

 

[LingoLaine]

Unfortunately, the way I see it, you have two choices:
1) live in the US as a non-surgeon, and probably as a non-physician; this is still tough, but you might be able to get an employee sponsor in some other field
2) be a physician and maybe even a surgeon somewhere else.

 

[billybadass]

Okay. Point noted. What are some less competitive surgical fields? I already understand the fact that those other fields are still competitive as hell too and my chances of getting accepted into them are still little to none.
I'm gonna go out on a limb here and say that about 80% of the IMGs that apply every year probably get rejected just because their English sucks and their accent is almost impossible to understand.
I'd also like to point out that even though the number of US students enrolling into med schools every year is increasing, so is the US population. Due to the increase in demand for health care, I think there's a great chance that more residency programs will have to be started. Residency is 8 years down the road for me right now. If more spots open up then hallelujah. If not, then there's always other countries.

 

[Why Not MD?]

Your best bets are Family Medicine, Pediatrics, and Internal Medicine. Please remember that internal medicine can expand into several specialties.

Something I also realized was that there is a significant number of IMGs (both US and Non-US) that were able to match into Diagnostic Radiology (PGY-2) positions. Not as many as in FM, Peds, and IM, but enough to catch one's attention.

I wonder if anyone can answer my question as to whether these were after a preliminary or transitional year, or simply matched into PGY-2 after year/s of practice in another country?

 

[BestDoctorEver]

Unfortunately, no, they wouldn't have to take you in. Getting in to med school and residency can be such a crap shoot. Even students with high scores and research and LoRs don't match. So I would obviously do well over the next few years of school, but you also have to be realistic about your options and be open to other plans as well.

You meant to say 'even students with high scores, research and LORs don't match [ortho]'. I find it hard to believe that an AMG student with good score, research and LORs have trouble matching some random non competitive specialty...

 

[BestDoctorEver]

Your best bets are Family Medicine, Pediatrics, and Internal Medicine. Please remember that internal medicine can expand into several specialties.

Something I also realized was that there is a significant number of IMGs (both US and Non-US) that were able to match into Diagnostic Radiology (PGY-2) positions. Not as many as in FM, Peds, and IM, but enough to catch one's attention.

I wonder if anyone can answer my question as to whether these were after a preliminary or transitional year, or simply matched into PGY-2 after year/s of practice in another country?

I think this question can be answered in the rad forum... I remember seeing a thread in that forum talking about a 'back door' for IMG to get into radiology by just doing a fellowship. I am assuming these IMG were board certified physicians in some other country before getting these spots...

 

[Law2Doc]

Your best bets are Family Medicine, Pediatrics, and Internal Medicine. Please remember that internal medicine can expand into several specialties.

Something I also realized was that there is a significant number of IMGs (both US and Non-US) that were able to match into Diagnostic Radiology (PGY-2) positions. Not as many as in FM, Peds, and IM, but enough to catch one's attention.

I wonder if anyone can answer my question as to whether these were after a preliminary or transitional year, or simply matched into PGY-2 after year/s of practice in another country?

Radiology has an "alternate pathway" for foreign trained radiologists who can stomach doing four years of fellowship and then pass the boards -- let's them bypass the US intern year and residency. Everyone else has to go through the normal match and intern year. Since jobs are tight in that field I probably wouldn't bank on this detour being around too much longer.

 

[Why Not MD?]

Interesting.. Thanks @Law2Doc!

 

[Law2Doc]

Okay. Point noted. What are some less competitive surgical fields? I already understand the fact that those other fields are still competitive as hell too and my chances of getting accepted into them are still little to none.
I'm gonna go out on a limb here and say that about 80% of the IMGs that apply every year probably get rejected just because their English sucks and their accent is almost impossible to understand.
I'd also like to point out that even though the number of US students enrolling into med schools every year is increasing, so is the US population. Due to the increase in demand for health care, I think there's a great chance that more residency programs will have to be started. Residency is 8 years down the road for me right now. If more spots open up then hallelujah. If not, then there's always other countries.

1. Surgical fields in general are probably more competitive than you should be looking. Again the goal needs to be "a" doctor. Once you start conditioning things by saying you want something more specific (surgical) you decrease the odds to pointless levels.

2. There wont be a jump in residency spots. At least not in the surgical and competitive specialties. There might be fewer. Right now the US is struggling with the fact that our health care is too expensive. While people talk about a doctor shortage, it's really a distribution problem -- not enough people are choosing to be primary care doctors in underserved areas. So no politician is going to back a bill to spend millions more training doctors, and especially not specialists or surgeons, because people want to devote less, not more tax resources to doctors. We probably will see fewer new residency spots in favor of an increased number of midlevels over the next few years, or worse, of less trained MDs thrown into the fray like we are seeing in Missouri. I'd say your "great chance" is really "zero chance". Things will be harder for you in eight years. Lower your goals or look to another country to live out your dream, I'm afraid.

 

[billybadass]

Oh my god this is hopeless. This whole time my question has been "How do I get an American residency?", not "Will I get an American residency?". For a couple of doctors/to-be-doctors, y'all are pretty dumb.
I'm still gonna aim for ortho in the US, but if that doesn't happen I have a lot of other choices. Worst case scenario: I end up being an orthopedic surgeon in Pakistan making about a million dollars a year. Best case scenario: I become an orthopedic surgeon in some European country.
So now, if I understand correctly, I should aim for ridiculously high scores on the USMLEs straight out of med school, and try and get my dad's chief-of-surgery friends in the US to help me get a residency. Oh and do a lot of research in between that time period.