Can I defer Surgery residency for Fulbright?

[iamg]

Hello all you wonderful people!
I have been a long time (read years) silent reader of SDN and this is my first post. I have a bit of a complicated question to ask you so please bear with me...

Background
I am an IMG (from a Western country) and graduated from medical school 2years ago. I am soon taking my Step1 and will be following it up with Step2CK and CS in order to submit my application in September 2014 for the 2015 match. I am only interested in Surgery at the top 20-30 hospitals associated with universities (since the university I did my MD from is already in top 50 in the world and also because some of these institutions offer the exact programme structures I seek).

I am also genuinely very interested in undertaking MPH (at some point in my career) and have a good practical experience in the field. I will therefore be applying for a Fulbright scholarship this year and from my background and references it seems like I have a pretty good chance of being awarded the Fulbright.

Timeline
Residency and Fulbright applications will be due in September 2014
Fulbright results come out in October/November 2014
Residency interviews will be October-January 2014/2015

Questions
If everything goes well and I am able to get the Fulbright for MPH (in October):
option 1) Can I request Residency programmes to defer my admission for 1 year? ie would this be a good enough reason for deferment at a top surgical residency programme?
option 2) Can I alternatively write to programme directors explaining my situation (in October/November) and then withdraw my application? If I am able to withdraw can I reapply to these top surgical programmes in September 2015 after my MPH without any negative implications of withdrawing the previous year?

[The reason for applying to both Fulbright and residency is that I don't want to be in a situation where I count too much on my chances at Fulbright and decide to wait for a year for a match and in the end don't end up getting the Fulbright either]

option 3) does anyone know if Fulbright can be deferred for a year or two? (in case above options are not viable).


Your advice is much appreciated. Thank you all for your 2cents from the world of medicine and beyond on this website.

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[luCZky]

I can't give you an answer for your questions (probably the PDs of these programs are the only one who can) but I just want to highlight that many residencies (especially these top ones) have a cut off rule according to number of years after graduation. I'm not sure whether you know it but you should be really aware of the fact that that one year at Fulbright could close you a door into many (if not to all) of them.

 

[iamg]

I can't give you an answer for your questions (probably the PDs of these programs are the only one who can) but I just want to highlight that many residencies (especially these top ones) have a cut off rule according to number of years after graduation. I'm not sure whether you know it but you should be really aware of the fact that that one year at Fulbright could close you a door into many (if not to all) of them.

Thanks for your reply. You do raise a valid point. The programmes I looked at mention no more than 5 years post-grad as application criteria. If I don't go ahead with the Fulbright pathway I will be 2.5 years out of med school. If I do go with the Fulbright pathway I will be 3.5 years out.

Considering that I am an IMG I was thinking that if there was some deficiency in my application to apply to top programmes, the Fulbright would make up for it and hence spending a year on MPH before starting surgery could get me into the desired hospital programme. Also while I genuinely want to pursue MPH and could do it either after becoming an Attending or half way through the residency (as per some of the surgical programmes that offer MPH), I would NO LONGER be eligible for Fulbright as I would already be in USA (which is one of the excluding criteria) ie I would have to pay significant amount from my own pocket to do an MPH later on. This is why I thought a chance at Fulbright could both enhance my residency application and also help me read an MPH debt free.

Appreciate your advice though

 

[gutonc]

Thanks for your reply. You do raise a valid point. The programmes I looked at mention no more than 5 years post-grad as application criteria. If I don't go ahead with the Fulbright pathway I will be 2.5 years out of med school. If I do go with the Fulbright pathway I will be 3.5 years out.

Considering that I am an IMG I was thinking that if there was some deficiency in my application to apply to top programmes, the Fulbright would make up for it and hence spending a year on MPH before starting surgery could get me into the desired hospital programme. Also while I genuinely want to pursue MPH and could do it either after becoming an Attending or half way through the residency (as per some of the surgical programmes that offer MPH), I would NO LONGER be eligible for Fulbright as I would already be in USA (which is one of the excluding criteria) ie I would have to pay significant amount from my own pocket to do an MPH later on. This is why I thought a chance at Fulbright could both enhance my residency application and also help me read an MPH debt free.

Appreciate your advice though

MPH will have virtually no benefit to your residency application unless you're applying for family medicine or Occ Med/Prev Med. Don't bother.

And just because programs say they have a 5 year cutoff doesn't mean that being 2 or 3 years out of graduation won't be a flag in your app. You're already a foreign grad, don't add any more potential issues to your application if you can avoid it.

 

[Psychotic]

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[gutonc]

Questions
If everything goes well and I am able to get the Fulbright for MPH (in October):
option 1) Can I request Residency programmes to defer my admission for 1 year? ie would this be a good enough reason for deferment at a top surgical residency programme?

Just to answer the Match waiver question, the answer is no. Match waivers are given for situations that arose after the Match and could not have been anticipated. You will know before you even start interviewing whether or not you got the Fullbright so you won't be granted a waiver.

option 2) Can I alternatively write to programme directors explaining my situation (in October/November) and then withdraw my application? If I am able to withdraw can I reapply to these top surgical programmes in September 2015 after my MPH without any negative implications of withdrawing the previous year?

Yes. You can just withdraw your entire ERAS application and move on. You can certainly apply the following year but, as outlined above, your chances will be even lower at that time.

Also, I'm not sure you realize how difficult the road is for IMG applicants. Yes, I get that you're at a "top" program, but that's not really something that's going to help your application if you don't have USCE, solid (240+) Step scores and good LORs from the US.

 

[iamg]

MPH will have virtually no benefit to your residency application unless you're applying for family medicine or Occ Med/Prev Med. Don't bother.

And just because programs say they have a 5 year cutoff doesn't mean that being 2 or 3 years out of graduation won't be a flag in your app. You're already a foreign grad, don't add any more potential issues to your application if you can avoid it.

Thank you. I see what you are saying. The earlier I apply and get in the better.
With re to MPH though: the top two surgical programmes I am looking at both have in-house MPH designed for surgical residents and seem to be quite supportive about residents pursuing the MPH either midway or at the end of residency (at which point I would not qualify for Fulbright). Also I have had a few years experience working in med school and then for UN in areas that combine public health and public policy with surgery - something along the lines of MPH encouraged by these surgical residencies/hospitals. Given my previous experience in the field as well the MPH options provided by the residencies I was hoping they would be more accepting of me pursuing MPH on Fulbright prior to starting residency and might consider deferment.

 

[iamg]

Just to answer the Match waiver question, the answer is no. Match waivers are given for situations that arose after the Match and could not have been anticipated. You will know before you even start interviewing whether or not you got the Fullbright so you won't be granted a waiver.


Yes. You can just withdraw your entire ERAS application and move on. You can certainly apply the following year but, as outlined above, your chances will be even lower at that time.

Also, I'm not sure you realize how difficult the road is for IMG applicants. Yes, I get that you're at a "top" program, but that's not really something that's going to help your application if you don't have USCE, solid (240+) Step scores and good LORs from the US.

I understand that chances would be low because I would be further away from graduation but would specifically withdrawing application from ERAS and telling PDs I did it for an MPH negatively affect my match the year after?

I appreciate that you are trying to give me a genuine warning about IMG matching into surgery and the road that lies ahead. I have spend over 2 years thinking the whole thing over and being as realistic as I can be about my chances. I ranked #1 in my country (developed Western nation) in an MCAT equivalent exam and was ranked #1 in the medical school interview. For many years I have helped draft important health policies for the country with the government and also sat on the NRMP/ERAS like Board of Advisors for residency matching. I am also about to begin a trial with the university for a medical device I invented for which patents are being sought. I have worked for the UN and have had multiple national and international awards, prizes and recognitions along with a parliamentary recognition. My LORs are not from US but they are from people who are all world authorities in their surgical specialties - two of whom are honorary members of AMA and ACS. I don't mean to say that I am the best applicant these residencies will get but I would like to think I do have some sort of chance. Thank you for your honest opinion though

PS I have thought about USCE as well but I doubt I will have time before September.

 

[iamg]

Maybe a PD will comment on deferring anyone for any reason, but my guess is there is no such allowance at any program, particularly at the type programs you are targeting.

You should really be focusing on obtaining a residency position - how would doing the Fulbright enhance your application for residencies that you have already submitted? If anything it becomes a red flag - programs will question your commitment to furthering your medical training.

They are not interested in having you match, and then defer - they would then need to fill your empty spot in the SOAP, I suppose. How in the world would that be in the best interests of any program?

I was thinking if I find out in October about Fulbright I could email the PDs about it and say hey I have gotten an MPH lined up could you please give me an year off? But I think your last few lines hold a lot of weight.. top programmes prob won't want to sort things out in a SOAP. Thanks, I guess I will have to find out if Fulbright allows deferment.

 

[ThoracicGuy]

Hello all you wonderful people!
I have been a long time (read years) silent reader of SDN and this is my first post. I have a bit of a complicated question to ask you so please bear with me...

Background
I am an IMG (from a Western country) and graduated from medical school 2years ago. I am soon taking my Step1 and will be following it up with Step2CK and CS in order to submit my application in September 2014 for the 2015 match. I am only interested in Surgery at the top 20-30 hospitals associated with universities (since the university I did my MD from is already in top 50 in the world and also because some of these institutions offer the exact programme structures I seek).

I am also genuinely very interested in undertaking MPH (at some point in my career) and have a good practical experience in the field. I will therefore be applying for a Fulbright scholarship this year and from my background and references it seems like I have a pretty good chance of being awarded the Fulbright.

Surgery residency is not easy to get into these days since the start of the 80 hour work week. As an IMG, you are at a disadvantage already. You do not have your Steps done yet and have graduated 2 years ago now. I'm not sure what school you're from (assuming it's a European school), but I would look at more than just the top 20-30 programs. American students that are matching from the top US schools aren't guaranteed to match in one of the top 20-30 programs just because they have a certain university name on their diploma.

A MPH is nice and all, but I don't think most surgery programs really do much with it. An MPH seems like it would be more useful to other fields than surgery, to be honest. Taking an extra year, as others have said, extends your time again.

So to answer your question, no, surgery residencies will no defer your match for a year, particularly are a top surgical residency. Letting the PD know about the reason for withdrawal could help you in reapplying, I suppose, as long as they remember you the next year. They could automatically discard any reapplications when they pull the applications in, so it could still potentially hurt you.

Overall, I see a few red flags for you: 1. FMG status. 2. Currently no steps (scores TBD). 3. At this time, 2 years since graduation, would be 3 when applying. 4. What have you been doing since graduation? Work in clinical medicine or elsewhere?

If you are set with matching in a residency program in the US, particularly a top surgical program, I wouldn't wait longer and would get everything in place for next year's match. Don't worry about the MPH now. Open yourself to more than just the top 20-30 programs, as well. Good luck.

 

[amine2086]

Hello all you wonderful people!
I have been a long time (read years) silent reader of SDN and this is my first post. I have a bit of a complicated question to ask you so please bear with me...

Background
I am an IMG (from a Western country) and graduated from medical school 2years ago. I am soon taking my Step1 and will be following it up with Step2CK and CS in order to submit my application in September 2014 for the 2015 match. I am only interested in Surgery at the top 20-30 hospitals associated with universities (since the university I did my MD from is already in top 50 in the world and also because some of these institutions offer the exact programme structures I seek).

I am also genuinely very interested in undertaking MPH (at some point in my career) and have a good practical experience in the field. I will therefore be applying for a Fulbright scholarship this year and from my background and references it seems like I have a pretty good chance of being awarded the Fulbright.

Timeline
Residency and Fulbright applications will be due in September 2014
Fulbright results come out in October/November 2014
Residency interviews will be October-January 2014/2015

Questions
If everything goes well and I am able to get the Fulbright for MPH (in October):
option 1) Can I request Residency programmes to defer my admission for 1 year? ie would this be a good enough reason for deferment at a top surgical residency programme?
option 2) Can I alternatively write to programme directors explaining my situation (in October/November) and then withdraw my application? If I am able to withdraw can I reapply to these top surgical programmes in September 2015 after my MPH without any negative implications of withdrawing the previous year?

[The reason for applying to both Fulbright and residency is that I don't want to be in a situation where I count too much on my chances at Fulbright and decide to wait for a year for a match and in the end don't end up getting the Fulbright either]

option 3) does anyone know if Fulbright can be deferred for a year or two? (in case above options are not viable).


Your advice is much appreciated. Thank you all for your 2cents from the world of medicine and beyond on this website.

I think there are too many hypotheticals in your questions for anyone to offer any solid advice. For starters, you have not even taken step 1. So, it's really impossible to say how competitive you will be when you apply for residency. You have not applied for Fulbright scholarship either. There is a very good chance you will not be offered the scholarship and thus will not have to worry about any of these.

 

[iamg]

Surgery residency is not easy to get into these days since the start of the 80 hour work week. As an IMG, you are at a disadvantage already. You do not have your Steps done yet and have graduated 2 years ago now. I'm not sure what school you're from (assuming it's a European school), but I would look at more than just the top 20-30 programs. American students that are matching from the top US schools aren't guaranteed to match in one of the top 20-30 programs just because they have a certain university name on their diploma.

A MPH is nice and all, but I don't think most surgery programs really do much with it. An MPH seems like it would be more useful to other fields than surgery, to be honest. Taking an extra year, as others have said, extends your time again.

So to answer your question, no, surgery residencies will no defer your match for a year, particularly are a top surgical residency. Letting the PD know about the reason for withdrawal could help you in reapplying, I suppose, as long as they remember you the next year. They could automatically discard any reapplications when they pull the applications in, so it could still potentially hurt you.

Overall, I see a few red flags for you: 1. FMG status. 2. Currently no steps (scores TBD). 3. At this time, 2 years since graduation, would be 3 when applying. 4. What have you been doing since graduation? Work in clinical medicine or elsewhere?

If you are set with matching in a residency program in the US, particularly a top surgical program, I wouldn't wait longer and would get everything in place for next year's match. Don't worry about the MPH now. Open yourself to more than just the top 20-30 programs, as well. Good luck.

Thank you for for taking the time out to reply. I am pasting this from my earlier reply: I appreciate that you are trying to give me a genuine warning about IMG matching into surgery and the road that lies ahead. I have spend over 2 years thinking the whole thing over and being as realistic as I can be about my chances. I ranked #1 in my country (developed Western nation) in an MCAT equivalent exam and was ranked #1 in the medical school interview. For many years I have helped draft important health policies for the country with the government and also sat on the NRMP/ERAS like Board of Advisors for residency matching. I am also about to begin a trial with the university for a medical device I invented for which patents are being sought. I have worked for the UN and have had multiple national and international awards, prizes and recognitions along with a parliamentary recognition. My LORs are not from US but they are from people who are all world authorities in their surgical specialties - two of whom are honorary members of AMA and ACS.

In addition to above I have done research in molecular biology. After graduating I have worked at the UN and worked as a surgical intern in a hospital (with postings in Trauma and Acute Care Surgery, Transplant Surgery, Cardiovascular Surgery and Gastrointestinal surgery). During this time I have also lead an international non profit global health organisation and as mentioned earlier started a medical device company.

The reason for limiting myself to top 20-30 programmes was that I would be leaving behind a lot of stuff I have worked on and it would to me only be justified if I was going for an institution that offered more than the current one I am at. I guess the true marker of my chance will be the Steps which I will be taking soon. It will probably be the rate limiting step.

Thanks for your advice

 

[Raryn]

A) There is absolutely no way to defer residency. The match is binding. You start on July 1 of the year you match or you don't start at all. There are rare circumstances where issues with paperwork/visa processing outside of your control may delay that date, but voluntarily delaying it a year for something short of major medical issues is not even remotely in the realm of possibility. And even if you did have major medical issues, you'd have simply lost the spot, not deferred it to the next year.

B) Every year you are away from graduation is a red flag. Doesn't matter if you're #1 most productive surgeon in western europe, that's still a disadvantage for applying to residencies. They want people they can train, who aren't too set in their ways, and who are close enough to medical school they at least have the basics in mind. 4 years out and even US grads can't get new residencies, at least at the "top programs."

C) You can always get an MPH after you complete residency. Or, in surgery, you can do it during a 1-2year break mid-residency similar to others who take research years. Yes, that would mean you'd have to pay for it. But the $50,000-$100,000 that would cost you is pennies in the long run compared to the risk of not matching and losing hundreds of thousands of dollars in income by delaying further.

D) If you do insist on starting the MPH prior to residency b/c you have a gap year, do realize you can always take a leave of absence from the MPH to start residency. You may lose whatever scholarships you had, but it is a much more reasonable option to defer the second year of an MPH compared to deferring residency (which is NOT possible).

E) Only you know your specific situation and if what you said is true, you are an accomplished applicant. Very far removed from your typical FMG. That said, being a foreign graduate IS a disadvantage, and you may find you don't get as many interviews as you would like by only applying to the top 20, 30, even 50 programs in any specialty. You would be best served by applying more widely, and if your interview yield ends up being high, simply canceling the interviews you don't like. ERAS applications are cheap (max out at $25 each) compared to a year of your life. But if you insist on applying to only 30 programs, that's your choice.

 

[rokshana]

to the OP…realize that less than 300 of the categorical GS positions in last year's match went to applicants other than US seniors…and that was ALL programs, not just the top 20-30 programs.

the CV you state here sounds great, and yeah, you very well may get some interview at top tier programs…but realize those top programs that do entertain IMG applications are considering applications that are at the same level…you may not stand out as much as you think…

and will you need a visa? doesn't matter how wonderful you are…needing a visa adds yet another red flag…

you need to ask yourself what you need to get where you want to be? US training? then you need to be open to not just the top 20-30 US surgical programs …and while you're top world medical school should make more of an impact, we are a bit ethnocentric in the US…mid to upper tier US schools are going to most likely be looked upon more favorably than your foreign school.

and with such an impressive CV, it would seen that you would have a great opportunities in your home country? why not stay? what does training in the US offer you that you can't get in your country?

an option of course would be to do a prelim GS spot…but there is NO guarantee that you will get a categorical spot out of it.

 

[iamg]

A) There is absolutely no way to defer residency. The match is binding. You start on July 1 of the year you match or you don't start at all. There are rare circumstances where issues with paperwork/visa processing outside of your control may delay that date, but voluntarily delaying it a year for something short of major medical issues is not even remotely in the realm of possibility. And even if you did have major medical issues, you'd have simply lost the spot, not deferred it to the next year.

B) Every year you are away from graduation is a red flag. Doesn't matter if you're #1 most productive surgeon in western europe, that's still a disadvantage for applying to residencies. They want people they can train, who aren't too set in their ways, and who are close enough to medical school they at least have the basics in mind. 4 years out and even US grads can't get new residencies, at least at the "top programs."

C) You can always get an MPH after you complete residency. Or, in surgery, you can do it during a 1-2year break mid-residency similar to others who take research years. Yes, that would mean you'd have to pay for it. But the $50,000-$100,000 that would cost you is pennies in the long run compared to the risk of not matching and losing hundreds of thousands of dollars in income by delaying further.

D) If you do insist on starting the MPH prior to residency b/c you have a gap year, do realize you can always take a leave of absence from the MPH to start residency. You may lose whatever scholarships you had, but it is a much more reasonable option to defer the second year of an MPH compared to deferring residency (which is NOT possible).

E) Only you know your specific situation and if what you said is true, you are an accomplished applicant. Very far removed from your typical FMG. That said, being a foreign graduate IS a disadvantage, and you may find you don't get as many interviews as you would like by only applying to the top 20, 30, even 50 programs in any specialty. You would be best served by applying more widely, and if your interview yield ends up being high, simply canceling the interviews you don't like. ERAS applications are cheap (max out at $25 each) compared to a year of your life. But if you insist on applying to only 30 programs, that's your choice.

Thanks for your post.
A) I think your point A is probably the most important as it basically ends the discussion. Deferring would mean NRMP/ERAS approval in addition to programme approval and since my case isn't a personal emergency the chances of deferring are zero.

D) The MPHs I am looking at are all 1 year degrees only so if I went ahead with that route I wouldn't require a leave of absence to finish things off on a later date.

B and C) again valid points especially since I would also have to take fare bit of time off to travel to US for the interviews and adding another year on that without income wouldn't be best. Plus I would be taking a significant cut in my income if i move from my current country's residency to US residency so overall I guess it adds up to a fair bit of money.

E) That's what I am counting on to make it to these programmes - a decent CV and experience along with good LORs. You have mentioned an excellent point that I can always apply to more places and then cancel interviews if need be. I was wondering if you could also tell me whether it is possible not to rank a programme after an interview eg say if I go to programme X and later decide not to rank it on NRMP is it possible? Or do I have to rank every programme I interview at?

Thank you for your clear cut advice

 

[Smurfette]

I agree with the advice others have given you on this thread.
You can rank as many or as few programs as you choose. You do not have to rank a program just because you interviewed there. Programs also do not have to rank you just because you interviewed there (although you'd have to do something pretty bad in order for this scenario to happen).

 

[iamg]

to the OP…realize that less than 300 of the categorical GS positions in last year's match went to applicants other than US seniors…and that was ALL programs, not just the top 20-30 programs.

the CV you state here sounds great, and yeah, you very well may get some interview at top tier programs…but realize those top programs that do entertain IMG applications are considering applications that are at the same level…you may not stand out as much as you think…

and will you need a visa? doesn't matter how wonderful you are…needing a visa adds yet another red flag…

you need to ask yourself what you need to get where you want to be? US training? then you need to be open to not just the top 20-30 US surgical programs …and while you're top world medical school should make more of an impact, we are a bit ethnocentric in the US…mid to upper tier US schools are going to most likely be looked upon more favorably than your foreign school.

and with such an impressive CV, it would seen that you would have a great opportunities in your home country? why not stay? what does training in the US offer you that you can't get in your country?

an option of course would be to do a prelim GS spot…but there is NO guarantee that you will get a categorical spot out of it.

Thanks rokshana for your advice.

-You are quite right in saying that even though my CV might stand out overall, when it comes to applying to top tier programmes I might be competing with people with similar level of experiences and accomplishments - in which case me being an IMG will come into play.

-The visa should not be too much trouble from what I have researched.

-Re my "top" medical school - I am not counting on it at all for my application. I am rather more reliant on my own CV and experience and my LORs.

- The subspecialty I want to pursue has less than 10 surgeons in the whole country. Most (or rather all) of them have trained either fully or partially overseas. Since this subspecialty is of high demand and the opportunities in training are rare my LORs who are these above-mentioned <10 surgeons are supporting me to train in US and then return to my home country. I also would like to return home after training in US - hence the whole trouble of leaving great opportunities in my home country for a few years and doing STEPS as well as taking a cut in my income (residency pays significantly more in my home country) is only for a better education and then to return home with skills my country needs.

- Can I apply to both prelim and categorical at the same hospital at the same time for same spec? or does that reduce my chances of getting categorical?

 

[iamg]

I agree with the advice others have given you on this thread.
You can rank as many or as few programs as you choose. You do not have to rank a program just because you interviewed there. Programs also do not have to rank you just because you interviewed there (although you'd have to do something pretty bad in order for this scenario to happen).

Thanks I guess it wouldn't hurt to interview at more places. You always learn something at interviews about your ownself.

 

[Psychotic]

.

 

[iamg]

Why have 2 (and by the time you could start any residency 3) years passed since you finished medical school? What have you been doing for the last 2 years? Since it sounds like you always planned to do a residency in the US, why haven't you already taken the Steps? Why have you allowed this much time to lapse? Is this typical for FMGs?

Not sure if you read my above replies but I am reposting stuff from above... After graduating I have worked at the UN and worked as a surgical intern in a hospital (with postings in Trauma and Acute Care Surgery, Transplant Surgery, Cardiovascular Surgery and Gastrointestinal surgery). During this time I have also lead an international non profit global health organisation and as mentioned earlier started a medical device company.

In addition to this the country I am in requires me to work for a certain amount of time after medical school in order to ensure I have an ongoing license to practice as a doctor. Hence I needed to work after graduation to get my license. Also being different from US system where medical students finish school and jump right into residency, we are required to work as Interns/Prelim Surg or Med in various specs before we are allowed to choose our specialty. ie it's thought that not until u start working at the intern/resident load for 1-3years can u appreciate what specialty you would like to be in long term. So spending 2 years post med school and doing mostly surgical runs with 80-90hour/week work has made me confirm my decision that I indeed want to do Surgery. As far as decision to go to US is concerned it is for better education and I am keen to return back home after residency/fellowship. The specialty I am interested in as mentioned above does not have as great learning experience in my home country and both my hospital and my government are happy for me to pursue this track so that I can return home with better education.

 

[Psychotic]

.

 

[iamg]

So it sounds like what one is expected to do to remain in your home country's residency pipeline is in conflict with what is the norm for AMGs in the US. I am still not sure that I understand why you didn't take the Step exams 2+ years ago and give US residencies a shot before now.

Regardless, my gut tells me that you should drop this Fulbright idea and get on with taking the Steps and applying for a US residency. And lose your fixation on the "top 20 to 30" programs unless on some subjective sliding scale you believe the training you could receive at home is on par with "lesser" US programs.

Well I am gonna keep this reply short as we are digressing a little but my dear colleague, many if not most of the healthcare systems outside the US ie the Commonwealth Countries and other European countries as well as developing countries (that are not part of Commonwealth) have House Officer/House Surgeon/Intern years (after finishing medical school) to give you practical hands on experience in various specialties. At the end of this designated period you are given a full medical license (before this you are on conditional registration with the medical council but you have already finished medical school and graduated with a degree). After these 1-2-3years you get to apply for residency. Working as an Intern/House Officer/Prelim year Surg or Med Resident is very different from being a medical student and shadowing doctors and allows you to make an informed decision on your final career choice.

In my case spending two years working at a resident workload of 80-90hours/week in surgery and in medicine helped me choose surgery as I have now had the chance to actual do hands on work. Also as I said before my reasons for going to US are slightly different from many FMGs/IMGs who have either financial and lifestyle incentives to move from their home country. I am purely doing it for a better education. I had to first confirm to myself that I wanted to do surgery. Then decide on the subspec and only then did the whole US training idea arise. If I wanted to do FM (which is pretty good specialty in my country) I would have not wanted to do residency in USA.

In summary my decision in my mind is more informed than most other people who want to migrate just because US is US. For me it has to be at a better programme than what is available to me in my home country. It has been a step by step process to decide to pursue further training in US. As far as USMLE is concerned I have got my exam scheduled in few months.

 

[iamg]

So it sounds like what one is expected to do to remain in your home country's residency pipeline is in conflict with what is the norm for AMGs in the US. I am still not sure that I understand why you didn't take the Step exams 2+ years ago and give US residencies a shot before now.

Regardless, my gut tells me that you should drop this Fulbright idea and get on with taking the Steps and applying for a US residency. And lose your fixation on the "top 20 to 30" programs unless on some subjective sliding scale you believe the training you could receive at home is on par with "lesser" US programs.

Also the scales are less subjective in today's world. There are enough world rankings of medical schools, postgrad/residency trainings and subspec trainings so I can objectively tell you that anything below top 20-30 would not be any better than where I am at now.

 

[Psychotic]

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[Psychotic]

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[Winged Scapula]

Iamg,

you've been given some excellent advice above. As someone who has done the same route as you (but as a dual citizen and without some of the impressive accomplishments you seem to have ), I have some thoughts (in no particular order):

1) you pretty much can't defer residency; either you match and take the position then or forfeit it. A waiver will not be offered for your delay.
2) in the US MPHs or any research are done *during* surgical residency; in general you take time off between the PGY-2 and 3 years to finish whatever projects/research you like; sometimes these are supported with salary/funds, in other situations you will be required to find the funds to pay for the tuition and living expenses
3) I'm not sure what subspecialty you are thinking about but if it is one that involves a fellowship, many FMGs do their base training in their home country and come to the US for fellowship - this is a much easier route in most cases
4) have you investigated what the barriers are to you in working if you train in the US and go back home? Having completed your Foundation years is helpful and I am frankly not aware of the current regulations, but in the past it was not simply a matter of nipping off to the states and then coming back and setting up a practice
5) the US medical/surgical faculty are not as aware of foreign training as you might think; thus many will not have heard of your medical school or know whom your letter writers are, nor will they care about your "MCAT equivalent" score or interview success in medical school.
I see you've mentioned this several times; I suspect your education will only benefit you because it is in an English speaking country, not because its "Top 50". I went to such an institution as well; for those US faculty that had heard of my school, it was usually not accompanied by any substantial knowledge of the education provided although some baseline quality was assumed.
6) USCE is important but is not available to you as a medical graduate unfortunately
7) the delay since medical school graduation is an issue, however, less so for someone who has been doing his FY. While the comment above about wanting to train surgeons "from scratch" is accurate, it *may* be less of an issue for someone who has not started specialty training. I find that foreign grads often overestimate the contribution of prior training, misunderstanding the American mind about these things.
8) you can apply to Prelim and Categorical at the same program; some places like Mayo have a good track record of getting their Prelims into Categorical programs (but it tends not to be at Mayo Clinic or other such well regarded programmes)
9) Finally, I am confused - I understand the desire to only come to the US for training that would be better than what you could get at home, but then you seem to imply that your subspecialty training isn't available at home. Did I misunderstand/misread? My best advise is that there is really no reason to come to the US if you can get the training you need in your home country. There are very few foreign nationals, with foreign training that get US surgical residencies at "Top 20/30" programmes without spending years toiling in research labs in those countries. There are simply enough US grads with equivalent impressive CVs to not take someone trained outside of the US. If they do, its generally no more than 1 per year/every few years. Of course, you are not the typical FMG and your experiences and successes may be enough to interest such programmes but frankly, without USMLE scores, we are having a premature discussion here.

Best of luck to you mate.

 

[iamg]

Iamg,

you've been given some excellent advice above. As someone who has done the same route as you (but as a dual citizen and without some of the impressive accomplishments you seem to have ), I have some thoughts (in no particular order):

1) you pretty much can't defer residency; either you match and take the position then or forfeit it. A waiver will not be offered for your delay.
2) in the US MPHs or any research are done *during* surgical residency; in general you take time off between the PGY-2 and 3 years to finish whatever projects/research you like; sometimes these are supported with salary/funds, in other situations you will be required to find the funds to pay for the tuition and living expenses
3) I'm not sure what subspecialty you are thinking about but if it is one that involves a fellowship, many FMGs do their base training in their home country and come to the US for fellowship - this is a much easier route in most cases
4) have you investigated what the barriers are to you in working if you train in the US and go back home? Having completed your Foundation years is helpful and I am frankly not aware of the current regulations, but in the past it was not simply a matter of nipping off to the states and then coming back and setting up a practice
5) the US medical/surgical faculty are not as aware of foreign training as you might think; thus many will not have heard of your medical school or know whom your letter writers are, nor will they care about your "MCAT equivalent" score or interview success in medical school.
I see you've mentioned this several times; I suspect your education will only benefit you because it is in an English speaking country, not because its "Top 50". I went to such an institution as well; for those US faculty that had heard of my school, it was usually not accompanied by any substantial knowledge of the education provided although some baseline quality was assumed.
6) USCE is important but is not available to you as a medical graduate unfortunately
7) the delay since medical school graduation is an issue, however, less so for someone who has been doing his FY. While the comment above about wanting to train surgeons "from scratch" is accurate, it *may* be less of an issue for someone who has not started specialty training. I find that foreign grads often overestimate the contribution of prior training, misunderstanding the American mind about these things.
8) you can apply to Prelim and Categorical at the same program; some places like Mayo have a good track record of getting their Prelims into Categorical programs (but it tends not to be at Mayo Clinic or other such well regarded programmes)
9) Finally, I am confused - I understand the desire to only come to the US for training that would be better than what you could get at home, but then you seem to imply that your subspecialty training isn't available at home. Did I misunderstand/misread? My best advise is that there is really no reason to come to the US if you can get the training you need in your home country. There are very few foreign nationals, with foreign training that get US surgical residencies at "Top 20/30" programmes without spending years toiling in research labs in those countries. There are simply enough US grads with equivalent impressive CVs to not take someone trained outside of the US. If they do, its generally no more than 1 per year/every few years. Of course, you are not the typical FMG and your experiences and successes may be enough to interest such programmes but frankly, without USMLE scores, we are having a premature discussion here.

Best of luck to you mate.

Thanks for your feedback. As an overseas trained person who has entered US healthcare system and as an AP and faculty member your advice is quite important.

1) This was really the main question to begin with and after all the responses it has been confirmed that the answer to deferring is absolutely NO.
Do you think withdrawing application and reapplying will hurt chances the year after though?

2) Yes, I saw that in some of the programmes that I looked at. They give you time during residency to do MPH. I was exploring the option of MPH helping me into a good programme as I will have some sort of US postgrad degree but that does not seem to be the case from all the above opinions.

3) I am aware of such fellowships and that would be my final option if things didn't work out. But since this involves taking STEPS which are valid for only 7 years I would have to retake my steps by the time it is fellowship time. And that does not seem to be all that easy. One of my Attending who has finished his primary residency wanted to do his fellowship in US but has not been able to pass Step 1 (he is 14years out of med school with 2yrs internship, 4years PhD and 6 years residency and 2 years as an Attending) and has had a lot of trouble going back to Biochem, Psych, IM stuff.

4) There is no trouble in coming back home. The health system is largely public with optional private practice. The hospital and department would be supporting me to get further training in US and return.

5) I am not counting on anybody in US about knowing my institution. Whether it is ranked in Top 50 or not is just for me to able to rank my options ie so that I can compare the options in US and that back home. I don't expect people to know about my university at all. I was just stating that my move out of the country would have to be justified by a better opportunity.
Having said that though I was hoping that my referees would be able to help my application to some degree. Ref 1 knows PD on one of the top tier programme and had supervised PD's work in some international project. Ref also sits on a few international committees with some prominent surgeons from programmes I want to apply in. Has been the head of world association for that specific surgical specialty and then also for the surgical subspec and has been the editor for over 10 major medical and surgical journals with high impact factors. He has also won several recognitions from AMA and ACS despite not being from US. And he has been visiting professor at 4 of the programmes I want to apply in.
Similarly my Ref2 trained in US in a top surgical programme and then returned home. Ref3 has had two of his proteges train in top 3 US surgical programmes in the past. Ref 4 + 5 are not from surgery - both trained in Ivy leagues and one of them was also a faculty member there as the head of department. Both decided to move out of US in their mid careers to my home country 5years ago for a better lifestyle (not sure if non surg ref would have much weight).
While some of this sounds good on paper I guess most people who would apply to the top programmes would also have similar or even better LORs so I am not sure how much to count on my LORs.

6) Do you think observership would help at all?

9) The surgical subspec I am interested in trains 1-3 people/every 1-5years. There are no set numbers. It also requires 6+years of primary residency. The centre isn't super large but has a good standing. However to get a job as an attending it is then recommended that you go and train further overseas for couple more years to get more experiences at larger centres. Hence the process is longer in some respect and might lead to doing USMLE later and then doing a fellowship in US. Also while the government would like more specialists in that field the bottleneck is at the fellowship level as they need enough large centres with right facilities and case load to be able to train more fellows.

I do agree with you that a lot of it is indeed premature discussion and I really need to focus on the STEPS. Your suggestions along with some of the other replies were quite helpful. Thank you.

 

[rokshana]

to clarify…you have to pass all the steps within 7 years of each other (i.e., the time difference between Step I and StepIII if taken sequentially can be no more than 7 years). Once you are licensed in a state, then it doesn't matter how long ago you took the steps for fellowship training…there are people who work for a few years then go back to fellowship.

there does seem to be a bit of a Catch 22 for you…you say that its not worth it for you to go out of your country to do residency unless its a top 20-30 program…but given your red flags (never mind that you have no step score to either strengthen or weaken for stats)- and yes, while you have an impressive extracurricular CV(but this will add to your application, but it still doesn't negate the red flags), the fact is that you are a Visa requiring FMG at least 2-3 years from graduation (in your country that may be the standard but in the US is its not and if you are looking at a US residency, you will be forced to play by US rules) makes you less competitive an applicant for said top 20-30 programs.

the US med school pop has increased by 30% in the last 10-15 years…more than enough qualified applicant that you will be competing with…and ten surg has a level of popularity with AMG…again < 20% of spots are filled by independent applicants and the unfilled % in the last few years have bee VERY low…2-6 empty spots per year at best. And fair or not..an AMG with a less impressive CV, lower steps score not low, but lower, 220s, 230s) WILL be consider over you…again, there be programs that will look outside the box, but since you are limiting yourself to the top 20-30 (which inherently will be competitive for US grads), you limit the number of programs that will think out of the box and consider you over those very qualified AMGs.

you certainly can apply to the 2014 match and if you are awarded the Fullbright, then you can withdraw your application and there will be no repercussions and can apply the next year.

but, as WS has asked…it sounds like the residency you need IS available in your home country…does getting the training in the US add to your ability to get the subspecialty? and may I ask, what IS the subspecialty…here many surgical subspecialties are residencies in their own right…(but also even more competitive than GS for foreign applicants).

those "rankings" are not as truly telling as one would think…IMHO mostly for the lay population and many upper to mid tier programs will give you excellent training and shouldn't be discounted just because some group or company decided to rank hospitals or programs.

the other option…are you in the EU…can you get the training in another EU country? Especially since the education systems are much more similar than is the US system.

 

[shiftingmirage]

Have you researched your chances of getting into a top 20 to 30 program based purely on being an IMG? By that I mean coming up with your list of top 20 to 30 programs that you'd be willing to go to, and seeing how many IMGs they have accepted in the last 3-5 years. How high does that number have to be for it to be worthwhile for you? Let's say it's only been 5 people total. Are you willing to make the sacrifices of taking Step exams, doing the Fulbright scholarship for those odds? What if it's 30?

 

[Winged Scapula]

1) This was really the main question to begin with and after all the responses it has been confirmed that the answer to deferring is absolutely NO.
Do you think withdrawing application and reapplying will hurt chances the year after though?

The simple act of withdrawing your application only hurts monetarily (its expensive to apply for residency) and temporally (ie, 1 more year out from graduation). There should be no repercussions from the programs. If you withdraw after interview, it would be polite to let the programs know that you will be withdrawing and the reason for doing so.

2) Yes, I saw that in some of the programmes that I looked at. They give you time during residency to do MPH. I was exploring the option of MPH helping me into a good programme as I will have some sort of US postgrad degree but that does not seem to be the case from all the above opinions.

Advanced degrees are not generally seen as helpful in obtaining a US residency especially in a surgical field. There are some fields (most notably Rad Onc) where a large number of applicants have a PhD (I believe it to be about 20% in Rad Onc). The only advantage the advanced degree would have would be if it was done in the US and allowed you to make some contacts in your subspecialty field.

3) I am aware of such fellowships and that would be my final option if things didn't work out. But since this involves taking STEPS which are valid for only 7 years I would have to retake my steps by the time it is fellowship time. And that does not seem to be all that easy. One of my Attending who has finished his primary residency wanted to do his fellowship in US but has not been able to pass Step 1 (he is 14years out of med school with 2yrs internship, 4years PhD and 6 years residency and 2 years as an Attending) and has had a lot of trouble going back to Biochem, Psych, IM stuff.

As rokshana noted, the Steps must be completed within 7 years, its not that they are only valid for that period. Thus, you could complete the Steps at any time, obtain your ECFMG certificate (which will enhance your ability to match into a US residency), and apply as your life and goals permit. Admittedly it can be difficult to go back to the basic sciences many years out but there are lots of study resources out there (although the best advise is to take it asap).

4) There is no trouble in coming back home. The health system is largely public with optional private practice. The hospital and department would be supporting me to get further training in US and return.

Yes, I am aware of the medical system in your country. If you have completed your FYs there, returning after training in the US is easier, however since the training is shorter here typically than in your country, there can be some issues. Make sure you have fully evaluated that with the appropriate authorities.

5) I am not counting on anybody in US about knowing my institution. Whether it is ranked in Top 50 or not is just for me to able to rank my options ie so that I can compare the options in US and that back home. I don't expect people to know about my university at all. I was just stating that my move out of the country would have to be justified by a better opportunity.

Gotcha. I understood you to believe that by being named on these "Top X" lists (which are mostly based on research dollars rather than clinical care/education) meant that these lists were taken as gospel by US faculty. Frankly, most Americans have not even heard of the city from where you are posting and that includes US medical faculty.

Having said that though I was hoping that my referees would be able to help my application to some degree. Ref 1 knows PD on one of the top tier programme and had supervised PD's work in some international project. Ref also sits on a few international committees with some prominent surgeons from programmes I want to apply in. Has been the head of world association for that specific surgical specialty and then also for the surgical subspec and has been the editor for over 10 major medical and surgical journals with high impact factors. He has also won several recognitions from AMA and ACS despite not being from US. And he has been visiting professor at 4 of the programmes I want to apply in.
Similarly my Ref2 trained in US in a top surgical programme and then returned home. Ref3 has had two of his proteges train in top 3 US surgical programmes in the past. Ref 4 + 5 are not from surgery - both trained in Ivy leagues and one of them was also a faculty member there as the head of department. Both decided to move out of US in their mid careers to my home country 5years ago for a better lifestyle (not sure if non surg ref would have much weight).

Clearly the best letter writers/referees are those who have trained in the US (so they are familiar with what it takes to train and be a surgeon in the US) and have maintained contacts in the US. In general the conventional wisdom is that you do not send more letters than are requested (I've never seen any programs ask for more than 4 letters, so don't send 5) and surgical programs prefer letters from surgeons, not other specialties.

While some of this sounds good on paper I guess most people who would apply to the top programmes would also have similar or even better LORs so I am not sure how much to count on my LORs.

Correct. Many (most?) programs will screen applications based on USMLE Step 1 scores. So it may be the case that no one even sees your wonderful accomplishments or your LORs. Assuming you pass the initial screen based on Step scores, some programs will not sponsor Visas so you may be screened based on that criteria. Some may use ECFMG certification as a criteria. The letters are helpful but they are way down on the list and generally only noted once you've obtained an interview. The role your referees can play is if you don't get invited for an interview by the programs where they have contacts is to place a phone call or email to their contacts asking them to review your application personally, as you may not have passed screening criteria. Very popular programs are going to receive hundreds of applications for training positions, so yours can get lost in the shuffle.

6) Do you think observership would help at all?

Nope.

9) The surgical subspec I am interested in trains 1-3 people/every 1-5years. There are no set numbers. It also requires 6+years of primary residency. The centre isn't super large but has a good standing. However to get a job as an attending it is then recommended that you go and train further overseas for couple more years to get more experiences at larger centres. Hence the process is longer in some respect and might lead to doing USMLE later and then doing a fellowship in US. Also while the government would like more specialists in that field the bottleneck is at the fellowship level as they need enough large centres with right facilities and case load to be able to train more fellows.

I'm not sure I'm following your line of reasoning here. Do you wish to come to the US because we train more residents in your specialty and its easier and potentially faster than at home? It sounds as if the recommended route is to come to the US for fellowship and not residency.

Best of luck to you.

 

[luCZky]

I've read this topic twice more and I've to say that IMHO your way of thinking about that residency stuff is bad. Imho you should once again consider all your options. I'm an European too and I believe that in the US you definitely get better training than in the EU but imho going this way it's worthy only when 1) you're a fresh graduate and/or 2) you're willing to stay in the US permanently.
In your specific case you've already "lost" 2 years at FY and you'll be almost 3 years after graduation by the time you enter the residency. And once you enter it you're starting from the very beginning no matter how long you've been practicing in the UK.
Do you really believe that saying that it is worthy to go this way?
Do you really believe that after 5 years residency and 4 years fellowship which means totally 9 more years of being again """student"""(please put the right numbers according to you) give you a better training than finishing your 3 year HMO residency (or what it is called in the UK) and having 6 "free" years of fully practicing as a surgeon? I don't think so. Truly saying imho it's BS. Doing surgeries day by day even in Africa gives you much better training than mostly watching or assisting to lecturers.
You're still talking about problems with getting a spot at home. I'm not sure whether you're talking about attending spots or fellowship spots from what you said. Sincerely, I do not believe that once you finish a whole training in that subspeciality you can have any problem with getting attending spot just because you didn't practiced overseas, it's BS.
So are you having a problem with getting the fellowship spot for your subsp.? Because you're required to have an international experience before starting? Or because there are spots only once in two or something like this years?
In fact it doesn't matter.
You've absolutely no reason why to stay and wait at home until they give you a chance. There are 30 more countries all over Europe where you as an EU citizen can do that fellowship under the same rules like anyone other and I don't believe that among these 30 countries there isn't such a program. You don't have to wait 1 or 2 or 3 or how many year like at home until they open that program.. just go and find the EU country where it's going to be open next year and apply there. And especially you don't have to wait another 5 years like until finishing the meaningless (in your case) residency in the US. The length of fellowship in the EU will be about the same like in the US so we're talking just about difference between getting 5 years training as a surgical resident in the US in comparison to getting 5 year practicing as a surgical specialist in your country (supposing moving back home once the fellowship is over in the EU). It doesn't matter how good or bad the fellowship program in EU will be... work hard, do some extra stuff to get better... and you'll be fine.. better than wasting another 5 years in the US residency.
Second way you can go is to finish your residency at home and after that to participate at any of the education/exchange programs to get some extra training in the US. This is the way people usually go.. they are just in training/practicing at their home countries and then with these "exchange/training" programs they go to get any extra experiences worldwide so they can do a better at home after that. ie you can finish the HMO at home and take the USMLE and apply for fellowship in the US/Australia/wherever... you don't have to loose extra 5 years doing the US residency while you do not intend to stay there permanently.

It's your choice but I would never go such a way you're talking about. Despite the fact that you have only about 5 months ahead to recall all the crazy "basic science" stuff that you have not seen like for 5 years? and you have to get absolutely stellar score to be even considered for that spots. So imho it's time to turn off the web and start studying otherwise all this thread is meaningless. Anyway it really doesn't matter now since until you get a 250+ scores your chances are zero to go that US way.

PS: stop thinking about who you do know now, what your achievements are so far, where your're now.. whether it's top1 worldwide.. it doesn't matter now. The only one what matters is whether you're able to get the subspeciality spot. If not then you have to do some cost/benefit analysis and I would bet that it that analysis taking 5 more years in the US residency can't give you better outcome than taking that subs in the EU or Australia or wherever and practicing as a specialist 5 years at home then.

 

[MadHopsMD]

Like others have mentioned take it one step at a time. Score 250+ on the boards. Even students who went to top American schools have hard time getting a surgical residency with average board scores.

 

[dragonfly99]

I think people have given you some good advise, above, and I probably can't add much that is helpful. The only thing I would say is I've trained at one of the nominally Top 5 places in the US and I would say that in general there are some more "high IQ" type people versus at other hospitals but that doesn't necessarily always translate into being better doctors and/or better clinical training. There do tend to be more research opportunities and more likely to be intramural/in house funding to do something like a research year (s) or MPH. I also think that although your CV is impressive, I think you are underestimating the difficulty of getting a surgical residency in the US, while being a non US citizen trained at a non US school. Also that you are coming across as a little too self confident, bordering on a little arrogant. I do think you have an excellent CV but remember that those top US programs are interviewing a fair number of people who also have impressive credentials and some have MD/PhD, MD/MPH, MD/master's, etc. from places like Johns Hopkins, Harvard, UC San Francisco and other top US schools. Or they may have had impressive volunteer experiences abroad, etc. There may be some faculty who have concerns about training someone who already did some clinical rotations/a rotating internship (or whatever it is called over there in Europe), even though I personally think it's a good way to do things (give people a chance to see/experience practicing a specialty a little before making a lifetime commitment to that).

Also, the US is a really big country and there are more than 20 or 30 good hospitals. Particularly if you are talking about training in a certain particular area, it may be that there is a hospital(s) or med school that may not be as famous/"top" in all areas but might be tops in the particular field you are interested in. Similarly, there might be a "famous"/otherwise Top 30 ranked hospitals that aren't so hot in your particular subspecialty.

I also agree w/the people who commented above about the heavy weight that USMLE Scores are given. Even for US students, those scores tend to have a lot of weight, and some people say a little too much...so it works to one's advantage if one does well but if one has a bad day , particularly for the Step I, it can be kind of disastrous. I think it is one of the few objective measures they have to rank medical students, so it tends to get weighted heavily. And there are a lot of smart people applying to surgery, so your scores need to be well above average. I think if you just want any/some surgical program, then with your CV you could get something, but it sounds like you are dead set on only certain ones and with needing a visa and having no Step scores yet, it's really hard to know how you are going to do. Some of the "top" US places may actually mind less having to deal with your visa issues, though it's kind of a pain for them, potentially - the "famous" places in general tend to deal with these issues more often and it may be less of a stumbling block there than @some other places. The lack of US clinical rotations and the lack of USMLE scores, and being 2-3 years from graduation, is probably going to hurt you more.

As far as withdrawing your application, I think you can withdraw during the process and as long as it's not before the Match day it won't ruin your chances for the next year, and most programs are so busy, and have so many applicants, they would not have a reason to be vindictive about it. But if you withdraw after being interviewed, it would be polite to let them know when you do it, and why you are doing it.

I've also seen (seemingly) a lot of Europeans, etc., come to the US just for fellowship, not residency, if they don't want to practice in the US. It sounds like kind of a pain doing an entire general surgery residency in the US if you really want to practice in your home country, but if the surgeons/people who wrote your LOR's in your home country thought it was the way to go, then maybe they know better than us (people posting on this forum).

 

[bambi]

What country are we talking about here?
If it is the UK as some people seem to think then at least some of what you have said about your CV isn't true!

 

[Otto of the Silver-Hand]

Hello all you wonderful people!
I have been a long time (read years) silent reader of SDN and this is my first post. I have a bit of a complicated question to ask you so please bear with me...

Background
I am an IMG (from a Western country) and graduated from medical school 2years ago. I am soon taking my Step1 and will be following it up with Step2CK and CS in order to submit my application in September 2014 for the 2015 match. I am only interested in Surgery at the top 20-30 hospitals associated with universities (since the university I did my MD from is already in top 50 in the world and also because some of these institutions offer the exact programme structures I seek).

I am also genuinely very interested in undertaking MPH (at some point in my career) and have a good practical experience in the field. I will therefore be applying for a Fulbright scholarship this year and from my background and references it seems like I have a pretty good chance of being awarded the Fulbright.

Timeline
Residency and Fulbright applications will be due in September 2014
Fulbright results come out in October/November 2014
Residency interviews will be October-January 2014/2015

Questions
If everything goes well and I am able to get the Fulbright for MPH (in October):
option 1) Can I request Residency programmes to defer my admission for 1 year? ie would this be a good enough reason for deferment at a top surgical residency programme?
option 2) Can I alternatively write to programme directors explaining my situation (in October/November) and then withdraw my application? If I am able to withdraw can I reapply to these top surgical programmes in September 2015 after my MPH without any negative implications of withdrawing the previous year?

[The reason for applying to both Fulbright and residency is that I don't want to be in a situation where I count too much on my chances at Fulbright and decide to wait for a year for a match and in the end don't end up getting the Fulbright either]

option 3) does anyone know if Fulbright can be deferred for a year or two? (in case above options are not viable).


Your advice is much appreciated. Thank you all for your 2cents from the world of medicine and beyond on this website.

Not sure if you are playing a joke on everyone, but in the slim chance that this is for real: You are in an unique situation because a Fulbright is very prestigious scholarship. I think a surgery PD (especially at the top 5 programs, never mind numbers 20-30) will understand that you would want to defer residency for such a high achievement. I doubt very seriously that they will hold this against you. Again, I' m not sure if this post is on the "up and up", but being a Fulbright Scholar will open a lot of doors ( this is an understatement) . And after completion of the Fulbright you will be able to name your residency ( again another understatement).

OP, if this post was written in jest, then the responses you received were quite funny ( no, they were hilarious. I found myself laughing out loud) and kudos to you. If the intent is serious, I beg you, for your own good, to seek advice elsewhere.

 

[gutonc]

Not sure if you are playing a joke on everyone, but in the slim chance that this is for real: You are in an unique situation because a Fulbright is very prestigious scholarship. I think a surgery PD (especially at the top 5 programs, never mind numbers 20-30) will understand that you would want to defer residency for such a high achievement. I doubt very seriously that they will hold this against you. Again, I' m not sure if this post is on the "up and up", but being a Fulbright Scholar will open a lot of doors ( this is an understatement) . And after completion of the Fulbright you will be able to name your residency ( again another understatement).

OP, if this post was written in jest, then responses you received were quite funny ( no, they were hilarious. I found myself laughing out loud) and kudos to you. If the intent is serious, I beg you, for your own good, to seek advice elsewhere.

Thanks for playing but no. Surgery PDs (all PDs in fact) are looking for one thing in their potential residents. Warm bodies that get work done.

Nobody's going to argue that a Fulbright isn't incredibly prestigious, but it's the sort of thing that helps you get into med school, not residency.

 

[keindo]

At the end of the day you'll find out empirically how strong your application are. The advice to temper your expectations are reasonable. It's completely false that being a Fulbright Scholar will allow you to name your residency, as the above poster said.

Overall life-strategy aside, for the purposes of your question the best path is:
1. Do as well as you can on Step 1 / 2. Look into what can make your application as competitive as possible.
2. Apply to the programs of your choice.
3. Based on your interviews you will know how competitive you are and how much your MPH work has mattered.
4a. If you get 20 interviews out of 20 applications, you'll feel confident in withdrawing knowing that your chances next year are likely still good (since a Fulbright at least balances an extra year away).
4b. If you get a handful of interviews, withdrawing might mean pursuing residency in your home country. You'll have to decide whether it is worth it at that time.

 

[iamg]

Thank you everyone for your kind replies. I have been extremely busy trying to forge ahead with my plans. Just thought I would let you guys know that I have been selected as one of the four finalists for the Fulbright Scholarship in my country. Final results won't be out for 2 months however.

Will keep you guys updated from time to time. Sorry for not replying to every message personally but I have taken everyone's advice into consideration.

Many thanks and regards. Watch this space for further updates.

 

[drcrispmd]

Did you get any of the steps taken?

Good luck on the Fulbright.

In regards to residency, how would you be as an itern. With all your expierence, will you be a team player? Will you give your senior residents (PGY 2 and beyond) issues when they tell you to do something? Will you be the intern that will argue with them because you have more exerience? These are things PD take into account as well.

 

[iamg]

Stopping by for a quick update. Got awarded the Fulbright. Sorting out my application for the non-clinical postgrad degree.

Haven't been able to take the Steps because of quite a few other significant developments. Will hopefully get to work on the Steps from next year.

Still aiming for surgery once I am done with Fulbright postgrad in US.

Further updates to follow. Thanks to everyone who has contributed to this discussion so far.

Regards

 

[iamg]

Did you get any of the steps taken?

Good luck on the Fulbright.

In regards to residency, how would you be as an itern. With all your expierence, will you be a team player? Will you give your senior residents (PGY 2 and beyond) issues when they tell you to do something? Will you be the intern that will argue with them because you have more exerience? These are things PD take into account as well.

Thanks for your reply and well wishes.

Haven't been able to start on the Steps yet, unfortunately. My strategy has changed a little but the end goal is still the same.

You raise some valid questions there re training in Surgery. I think age or experience does not (or at least should not) hinder one from being a team player. Leadership requires people to assume both the role in the front of the pack and at the back based on the situation involved and the experience of your workmates/colleagues. Even now when I sit on boards and execs of many private companies, community organizations and non profit NGOs I assume the role of a follower when I know there are people who can contribute better at the helm and teach me along the way. A personal insight into your strengths and introspection of your weaknesses is important in teams (no matter what field or profession) and I would happily love to learn the ins and outs of surgery from my senior residents ... A healthy discussion however should not be ruled out as it is also part of a learning process.