I saw this post this morning and I've kinda been thinking about it all day.
First, I work with plenty of competent, fun, inspiring FMGs as my attendings or as my fellow residents. I'm finishing up cardiology and ALL the attendings are FMGs. Such great teachers. Same in med school.
Second, without thinking about cause it's hard to understand effect, but after much thought, I can't say much about the reasons why it's harder for FMGs to match without getting tied up in a sociopolitical knot, so I won't. But I can confirm that in my program it's heartbreaking to not be able to interview and rank everybody. We get something like 700 apps for something like 150 interviews and we rank something like 80 people for 10 positions. All those slices are heartbreaking, but slice we must.
And third, the residency match is a once in a lifetime event for the future resident. It's HUGE. But for residency faculty & staff, it's a constant never-ending slog through app after app after app and a massive undertaking to get interview days to work and then the second it seems like it's over, it starts up again. Year after year after year. Each very special applicant is a drop in a river that never stops flowing. Nobody thinks this way on purpose, I don't think, but there's no such thing as "losing" a possibly great applicant when there are So. Many. Applicants. Forever.
Most, but not all, of the following is too late to use this year. Sorry.
Here's what I understand to be the FMG playbook, for those who don't have an obvious advantage like a NEJM pub:
- most of your apps should be at residencies that had an unfilled spot in the last 5 years (NRMP has this data)
- it's almost more important to have time and energy for SOAP during match week than for interviewing
- but go to every interview
- and get a second look after every interview (ask to shadow for a day, come back, hang out with residents, be fun & smart, send thank you cards)
- smile the whole time as if it's not sucking the life out of you to humble yourself like this
Here's what the FMG residents I work with had to do to get a residency spot:
- took an off-cycle position, PGY1 or PGY2, when a resident left the program. These positions show up on AAFP. They are rare.
- focused on this hospital because spouse works here, communicated often and well with the program, volunteered in a non-clinical role just to get in the door, wore a stupid teal colored volunteer jacket, gave directions to a whole lot of visitors, just to get known, and to get where there's a non-zero chance of getting in the room with residents/faculty, then that one time at rounds, THAT ONE TIME, answered a question that none of the residents could answer. Boom. Who do you think we called first when there was an opening.
- FMGs who have already done foreign residency and have already done foreign practice, who are willing to do residency again, automatically get a lot farther than FMGs who compete by the USMD yardstick.
Here are some of the general problems with FMG apps that you might want to avoid:
- everybody knows FMGs are applying to 200+ programs. You can tell by the unbelievably generic essays we get. If you don't want to be immediately weeded out, your essay has to show us why you would fit in here. For this program, if you don't speak Spanish, don't want to deliver a lot of babies, don't want to work with the underserved, don't want to train full spectrum, and/or don't have ties to the area, there are 300+ apps that will get an interview before you. And if your interest isn't legit, that comes through in the interview, and you don't get ranked. The average FMG just wants to MATCH SOMEWHERE and all of this residency-specific cheerleading/pride can seem kinda baffling but what are you gonna do.
- More to the point, a lot of FM residencies require a program-specific essay, in order to "weed out" the generic apps. Honestly, you should customize your essay for every program to which you apply, if at all possible. Even if it means that 200 times you have to spend the time to research each program enough to identify what they pride themselves on and write about how that resonates for you. You have to make yourself think it's not wasted time to do that much work, to mostly not get interviews, and mostly not get ranked.
- There's xenophobia and racism in this, granted, but it has to be crystal clear that your English is solid. There's no way we'd take a resident who is going to make it MORE likely that communication errors will affect patient care. Communication errors are already 30% of adverse events. So if you have grammar or readability errors in your essay, you're not getting through. If you aren't comfortable in conversation, you're not getting through. If you don't have recommendations that mention how well you communicate, that's bad. I'd say it's bad enough that you should wait to get in the match until multiple cranky old white people are delighted with your English (that's a hint: get a rest home gig for practice).
I hope some of this is helpful. I totally understand how discouraging it is to get all the way through med school and all the way through ECFMG and ERAS and then see the odds so not in your favor. Hang in there.
