bashwell

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Hello everyone,

I am an IMG whose situation is a little different from the majority.

I graduated medical school more than 20 years ago, practiced as a surgeon(subspecialty) in my home country and came here to the US 10 years ago , did a few surgical fellowships in my subspecialty and was employed in the midwest with no board certification.

I quit that job (which I enjoyed) mainly because of family pressure/ situation and decided to pursue a residency. I have just completed 2 years of a prelim general surgical residency.

I am now applying to anesthesia/FM/ IM. Realistically what do you think my chances are?

Step 1 203
Step 2 204
Both first attempt
CK/CS- first attempt.

All three Steps were taken more than 15 years back when I needed them for a fellowship, I had not then thought I might actually move here.

I have a lot of publications but only in my subspecialty. I have good LORs but again only from surgeons.

Given all the strikes against me (older age, low scores, non-US IMG, no actual experience in anesthesia or IM or FM), I would sincerely appreciate any input (especially from any PDs/ faculty out there ) as to what my chances are and how best to maximize them.

At this point, I would gladly apply to any specialty which would take me.

Thanks in advance for your time.
I don't have any firm answers for you, but I will say I believe you may need to retake your USMLEs since they expire after 7 years. However, that could work in your favor because you could improve a lot.

Also, have a look at NRMP Charting Outcomes for the IMG (2016) because these are the people who you will be competing with and that PDs will be comparing you with.

Just my opinion but since you said you would be glad to be in any specialty, if I were you, I would drop anesthesia and IM (unless you are willing to apply to the lower tier programs) and instead focus everything on FM (or possibly psychiatry). FM seems more open than anesthesia or IM to candidates with the red flags you have. Good luck!
 
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I don't have any firm answers for you, but I will say I believe you may need to retake your USMLEs since they expire after 7 years. However, that could work in your favor because you could improve a lot.

Just my opinion but since you said you would be glad to be in any specialty, if I were you, I would drop anesthesia and IM (unless you are willing to apply to the lower tier programs) and instead focus everything on FM (or possibly psychiatry). FM seems more open than anesthesia or IM to candidates with the red flags you have. Good luck!
Thanks for your reply, Bashwell. Unfortunately my ECFMG scores and certificate are permanently valid thus destroying any hope of bettering my scores. I used the same scores 2 years back to get into surgery residency.

Also the only hope I have of getting a spot is to apply to lower tier programs, but my question is if even those will give me an interview.
I am also applying to Psychiatry but it seems a stretch to explain the jump from surgery to psych.
I read that many FM programs are asking for scores above 210 and I see from the forums that many US grads are applying.

All of these make me doubt if I will land any interviews.
 
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bashwell

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Mar 20, 2013
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Thanks for your reply, Bashwell. Unfortunately my ECFMG scores and certificate are permanently valid thus destroying any hope of bettering my scores. I used the same scores 2 years back to get into surgery residency.

Also the only hope I have of getting a spot is to apply to lower tier programs, but my question is if even those will give me an interview.
I am also applying to Psychiatry but it seems a stretch to explain the jump from surgery to psych.
I read that many FM programs are asking for scores above 210 and I see from the forums that many US grads are applying.

All of these make me doubt if I will land any interviews.
That's difficult and I'm sorry to hear it all. Maybe @aProgDirector will have good advice to offer you?
 

mvenus929

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I believe you may need to retake your USMLEs since they expire after 7 years.
I don't think that's true--I think you have to take them within 7 years to complete the series, else you have to start over. But I don't know how residencies are going to feel about someone who took standardized tests 15 years ago and didn't do that great on them at the time--a lot has changed in the last 15 years.
 
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aProgDirector

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As mentioned, much depends upon whether you've passed Step 3. If not, then you'll likely need to retake all of the steps, because in most/all states, you need to complete the entire series in 10 years. Some states are more strict with a 7 year cutoff. Whether that's a blessing or a curse is debatable -- relearning all the material for Steps 1 and 2 again will take some time, and there's no guarantee you'll do any better.

Your best chance of getting a spot is at your current institution. If you've done well there, and they like you, they might be willing to consider you.

Since you've already applied, it's just a waiting game to see if you get any nibbles.

You mentioned that you were employed with your current training. If there's any way to replicate that now, that would honestly be your best option.
 
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Sep 18, 2017
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I don't think that's true--I think you have to take them within 7 years to complete the series, else you have to start over. But I don't know how residencies are going to feel about someone who took standardized tests 15 years ago and didn't do that great on them at the time--a lot has changed in the last 15 years.
I think if you start any type of clinical training, your scores become permanently valid.

What you said is something many other people have told me i.e. scores from 2 decades ago cannot really be compared to scores from today. However since I cannot retake the tests, even if I want to, I am stuck with what I have.
 

PlutoBoy

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Thank you for your reply.

I passed my Step 3 many years ago within 7 years from the first 2 steps.

My institution (not current since July) is a small community hospital. I did approach the IM PD. They get over 5000 applications for IM, mostly IMGs with high scores (that is what he told me) so while he told me to apply, he said he would have to consider me based on overall merit . I am hopeful I will get a interview there. Beyond that, who knows?
I do have good LORs, and a sympathetic faculty so that might help. But he did say that none of my past training would really matter because all of it was in a surgical specialty.

I must clarify that I was previously in a surgical field but not a general surgical subspecialty. It is quite difficult to get a job with no Boards. That one time was a fluke and I was just out of fellowship. I have been a junior general surgery resident for the past 2 years, so am out of touch with my own branch. So while I am keeping all avenues open, I really would like to get a BC in any specialty at all, just because I would then have an unrestricted license and obviously more opportunities would be open to me.
Why not general surgery? Sounds like you may be a good applicant for that field. Your scores appear lower due to recent "score inflation".
 
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jthedestroyr

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In anesthesia, we get plenty of people that cross over from GS.

that in itself isnt going to hurt you in our field. scores are, but if you have strong letters from your PD and surgeon colleagues, it might be over come.

the problem is explaining why anesthesia. you have practically set a life in GS, therefore youd need to confuse us why you want to be on the other side of the curtain now.

completing GS prelim also allows you to apply to Reserved spots in anesthesia (people that finished a prior residency or prelim). you can also apply to categorical (repeat intern year) or advanced (would have to wait a yr before starting). my best guess is youd have most luck for reserved spots.
 
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Why not general surgery? Sounds like you may be a good applicant for that field. Your scores appear lower due to recent "score inflation".
I didn't apply to categorical GS the last 2 years, my mistake.
 
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Sep 18, 2017
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In anesthesia, we get plenty of people that cross over from GS.

that in itself isnt going to hurt you in our field. scores are, but if you have strong letters from your PD and surgeon colleagues, it might be over come.

the problem is explaining why anesthesia. you have practically set a life in GS, therefore youd need to confuse us why you want to be on the other side of the curtain now.

completing GS prelim also allows you to apply to Reserved spots in anesthesia (people that finished a prior residency or prelim). you can also apply to categorical (repeat intern year) or advanced (would have to wait a yr before starting). my best guess is youd have most luck for reserved spots.
Thanks, yes I am applying to all the reserved for Physician spots as well.

Like @aProgDirector said, I guess I just have to wait and see.

I was hoping to know if based on past experience if people thought I stood much of a chance.
 
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aProgDirector

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[QUOTE="img-2017, post: 19296613, member: 877802"I passed my Step 3 many years ago within 7 years from the first 2 steps.[/QUOTE]

If you've passed step 3, then you can't retake the USMLE. So your scores are your scores.

Your situation is unique enough that it's unlikely anyone here is going to be able to tell you what your "chances" are.

Your best chance is if the program that has had you as a prelim for 2 years were to offer you a 2nd year surgical spot.

Failing that, an IM or Anesthesia spot at the same place.

After that, it's anyone's guess. What can you do?

1. Your PD advocating for you might be very helpful, although they may only be "connected" with surgical programs and so that might not help.
2. You can try to find another job that doesn't require BC. You presumably have a full license by now. A surgical assist, perhaps. Or a "surgical hospitalist". Not easy, and may disappear to midlevels.
3. Hope for the best, see what happens with interviews.
 
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[QUOTE="img-2017, post: 19296613, member: 877802"I passed my Step 3 many years ago within 7 years from the first 2 steps.
If you've passed step 3, then you can't retake the USMLE. So your scores are your scores.

Your situation is unique enough that it's unlikely anyone here is going to be able to tell you what your "chances" are.

Your best chance is if the program that has had you as a prelim for 2 years were to offer you a 2nd year surgical spot.

Failing that, an IM or Anesthesia spot at the same place.

After that, it's anyone's guess. What can you do?

1. Your PD advocating for you might be very helpful, although they may only be "connected" with surgical programs and so that might not help.
2. You can try to find another job that doesn't require BC. You presumably have a full license by now. A surgical assist, perhaps. Or a "surgical hospitalist". Not easy, and may disappear to midlevels.
3. Hope for the best, see what happens with interviews.[/QUOTE]

Thank you.
You have summed up very nicely what my options are.

If I could just jump to the third year of surgery or even the second, at my program or anywhere else, that obviously would be the best thing to happen. But second year categorical spots are hard to come by and rapidly filled.
I guess my best bet would be IM at my previous institution since there is no anesthesia residency there.
And wait and see what other interviews I get. Just a waiting game.
 

AdmiralChz

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I simply don't see any explanation of interest in Anesthesiology or FM beyond wanting to complete a residency, to be frank. A program would have to take a huge risk with such a long time since graduation, and there are so many other applicants that it's going to be hard for things beyond surgical prelim. Without a compelling reason or LORs supporting your entry into these fields I don't see a very good likelihood.
 
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I simply don't see any explanation of interest in Anesthesiology or FM beyond wanting to complete a residency, to be frank. A program would have to take a huge risk with such a long time since graduation, and there are so many other applicants that it's going to be hard for things beyond surgical prelim. Without a compelling reason or LORs supporting your entry into these fields I don't see a very good likelihood.
Thank you.

What would be the risk to the program?
 
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