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ER Residency as an IMG

ccmd2b

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    I'm currently starting St. Matthews SOM in Grand Cayman. I'm in the program in which I do some time in Maine and attain a masters of health science as well. I've worked in the ER as a tech for a total of 4 years in the past and I want nothing more than to be an ER doc. From what I understand however, it's next to impossible to land an ER residency spot.. especially for an IMG. Does anyone have any advice for me? I know some smaller ER's allow other non ER certified docs to work but I'd really like to do a residency in ER. Any info on my delima would be appreciated. Emergency is really the only field I'm interested in at this time. How hard is it to do a fellowship in ER say if I end up having to do an IM residency? Could that be an option if I don't land an ER residency right away? I've heard that you shouldn't just pick one residency on your match attempt. Thanks in advance everyone!
     

    leviathan

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      If you look at the alumni list from some of the better caribbean schools (I think St. George's University is one), I believe the number that match into EM is pretty close to US schools. I don't know about St. Matthew's though...

      ccmd2b said:
      I'm currently starting St. Matthews SOM in Grand Cayman. I'm in the program in which I do some time in Maine and attain a masters of health science as well. I've worked in the ER as a tech for a total of 4 years in the past and I want nothing more than to be an ER doc. From what I understand however, it's next to impossible to land an ER residency spot.. especially for an IMG. Does anyone have any advice for me? I know some smaller ER's allow other non ER certified docs to work but I'd really like to do a residency in ER. Any info on my delima would be appreciated. Emergency is really the only field I'm interested in at this time. How hard is it to do a fellowship in ER say if I end up having to do an IM residency? Could that be an option if I don't land an ER residency right away? I've heard that you shouldn't just pick one residency on your match attempt. Thanks in advance everyone!
       
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      colforbinMD

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        Sheerstress said:
        Check the FAQ thread - post 11 covers some of your Qs.
        Hello me from four years ago. I have to say your post stirred up some serious self reflection that I thought I would share with you. You see I was an ER tech for 4 years before finding out I was denied acceptance to a US school (who shall go unamed) that i thought I was guaranteed a spot at. In the quite frustrating time that followed I opted to go to Ross a few months later. One of the thing that helped convince me was the school put me in touch with a recent alumni who was then an EM PGY-2 and who told me that if I did well at Ross and on my boards I would have no problem getting into EM. Now I don't know if he was sugar coating or if the competetiveness of the specialty has just grown alot in the 5 years since he applied but I have since done well at Ross and finished with good board scores and thus far in the application process I have seen ZERO love. Sure Dean's lists come out Tuesday so it's supposedly stilll early but looking at the lists posted here on SDN I have to so far conclude that I may be in for quite a heart break. I wonder now if I would do it again and I still probably have to say yes because the time down on the islands was GREAT and my life has changed in several wonderful ways because I went to Ross that I would not trade for anything. Having said all that, though I would still do it again, I would advise you not too. If there is ANY shot you have to get into US DO or MD school then I recommend taking it (even if it's another year or so away) if your heart is truly set on EM. It's only getting harder to get into each year. Is it fair? Absolutely not. But then again neither is life.
        As to the post about St. George haveing comprable numbers to US schools when it comes to placeing people EM I would have to say this is not the case. Alot of US school students often have much wider opportunity to do things like rads, ortho, and derm etc. which I imagine steals some people who might have gone into EM for lifestyle issues like shift work and also of course numbers vary at US schools depending on each years classes interest in EM but for the most part US schools continually have a higher percentage of students match in EM each year. Ross for instance. When you see 12 people matched in EM there last years match you think AH it's definatly doable but when you put that in the context that Ross matched more students then any other school in the world that year (not sure the number but over 200) then you see 12/a few hundred is probably not the odds you wanna deal with. Whatever your decision I wish you luck. Hope my ramblin post helped somewhat. Sorry if it's not what you wanted to hear
         

        a_ditchdoc

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          Wow! Did every IMG on SDN just cringe a small bit or was it just me. I spent 12 years as a medic because I loved it, and 6.5 years in college thus far just to be an emergency physician. I sure hope someone shows me some love when the time comes. If anyone has any good advice or suggestions for me, it would be greatly appreciated. Feel free to PM...


          Ditch
           

          colforbinMD

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            ot trying to scare anyone. Just telling it as I see it. It is possible certainly, as several IMG/FMG residents will attest but it just seems to me to be REALLY TOUGH and getting tougher each year. I will hopefully be posting interview offers on the sticky thread soon so you will know if there is a sudden landslide of interest Good luck. Hopefully all those deserving will see some love.
             

            EMIMG

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              I have been in the situation in which you describe. I will tell you that you can obtain an EM residnecy as an IMG, but it is difficult.

              When I decided to apply to EM several years ago, I knew it would be a tough road. I had been an EMT during HS and college and med school and knew I had wanted to do EM. I had outstanding grades and good letters of rec (or I have been told). I applied to I believe 44 programs and was given 4 interviews with I think 2 wait-lists. I am still waiting to hear back one way or another from about 6 programs. There were actually some programs which flat-out rejected me based on my common application form before downloading my scores or letters of rec. And, I can honestly say that I am glad I did not match at those programs because if they are so superficial with looking at applications are they that superficial with treating patients?

              At any event, on the interview trail, I met US students who I know did not have board scores near mine and were getting a ton more interviews. But, the bottom line is I got 4 interview offers which was 3 more than I needed. I wound up matching at my top choice and then went on to match at a fellowship that I coveted.

              Now I have a great job at an academic institution. So, hard work will pay off.

              Just my thoughts.
               

              leviathan

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                drkp said:
                Hello me from four years ago. I have to say your post stirred up some serious self reflection that I thought I would share with you. You see I was an ER tech for 4 years before finding out I was denied acceptance to a US school (who shall go unamed) that i thought I was guaranteed a spot at. In the quite frustrating time that followed I opted to go to Ross a few months later. One of the thing that helped convince me was the school put me in touch with a recent alumni who was then an EM PGY-2 and who told me that if I did well at Ross and on my boards I would have no problem getting into EM. Now I don't know if he was sugar coating or if the competetiveness of the specialty has just grown alot in the 5 years since he applied but I have since done well at Ross and finished with good board scores and thus far in the application process I have seen ZERO love....

                Aww man, that's heartbreaking. I'm in the whole med school application business right now, and If things don't go well for me up in Canada, I know I could get into SGU or Ross or one of those "good" caribbean schools. The only thing is, if you as an American are having troubles getting an EM spot, it sounds like it would be absolutely impossible for me, because I need a hospital to sponsor me for either a J1 or H1B visa......anyone heard any love for Canadian students in EM?
                 

                trkd

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                  EMIMG said:
                  At any event, on the interview trail, I met US students who I know did not have board scores near mine and were getting a ton more interviews.

                  :clap: Congrats on matching your first choice EMIMG! If you don't mind, I was wondering if you could give a ballpark range you are talking about for your board scores. Are we talking 250+ or what? Closer to average?
                   

                  ER-ER-Oh

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                    I went to St. George's and matched in EM. I got 9 interviews out of 40 applications. I know the pain. But I matched at my first choice, so it can happen. You just have to make sure that out of the people from your school who will match into EM you'll be one of them. Some of the people at my school who wanted EM and didn't match were, of course, heartbroken. But you have to have confidence. Not fake confidence, not hubris. You need to focus and still be yourself, do nothing at 'all costs' because that makes you look desperate. Know your ****, but be like those docs you looked up to and respected. Keep in touch with any ER doc that can help you with a great letter or a phone call. Play the game without making it apparent your playing it. If you do research in 3rd/4th year, know what you're doing and email the doctors who are doing similar work in the field. Join ACEP and get involved. It's a delicate line to walk, to be enthusiastic without being a pain in the ass gunner. Be subtle in your ability to put people at ease around you. Good luck.
                     

                    rossguy31

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                      I am probably in the same class as the Ross student who posted above, but maybe not since Ross starts several classes a year. I am also applying to ER for next years match. I do feel I am getting passed over by many programs simply b/c I went to Ross, however, I have gotten slightly better results than the poster above. So far I have been invited to 7 interviews. I am dissapointed b/c I thought I would at least have double that. I do not feel confident at all about matching in ER with only 7 interviews, but do realize that some IMG's (esp from Ross and SGU) will match, and I hope one of them will be me!

                      I would agree that if you want a speciality like ER you should think twice about a foreign school, however, if you have no alternative it still might be possibe...will let you know!
                       

                      voronok45

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                        Hi I am an SGU student graduated last year. I totally understand yourconcerns about matching ER. I matched ER last year probably because of pure luck. Even if you have stellar scores, good letters you are still looked at as inferior applicants compared to US grads in majority of ER programs. Minority of programs will consider your application even if you have an IMG background. Most of this programs are in the North East or Michigan for some reason. This is your market. The ideal thing to do is to look at the list of students that matched ER from your particular school. Last year about 20 people matched ER from SGU and the total number of IMGs that matched were 40 something. The rest were probably Ross, Israel schools and some other european schools. You have to apply to a lot of programs and see what you get for interviews. I think its reasonable to match with 7- 9 interviews for an IMG. I know two people with 6 interviews that did not match last year. I myself had 9 and match my 3rd choice. Do not forget that we are treated differently and you probably need something on your application that stands out. Even tough most people will tell you that scores do not matter PD love them especially for IMG applicants. Another thing is be prepared to answer questions like why you decided to go to am IMG school. This question poped up on a few interviews. Also a lot of interview invites came later in the game for me so for those who are still waiting dont panic yet. I was getting invites even in december. US grads will get all their interviews early and start canceling some. It does not metter when you interview early or later towards the end. I matched in a program that was the last one I visited. Excellent choice by the way. Write good thank you laters and personalize them if you can based on the interview. I know thats gona be painful but its part of the process. Keep your hopes alive to the end. Its never over till its over. I think thats good for now. If you have an questions ask and I will try to keep up with the forum. I did not write this to get any one scared. This is what I encountered during my interview process. And the last thing is you dont get treated differently once you matched in the program.
                         
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                        SabaEM

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                          Hey everyone,

                          I'm a fourth year student at Saba University School of Medicine applying for EM residency positions. I applied to a total of 48 programs, including 3 year, 4 year, and 1+3 programs. So far, I have 7 EM interviews and 6 Transitional Year interviews. To my surprise, most of the invitations came prior to November 1st and I have heard from only one program since Dean's Letters came out. I am hoping for a few more interviews for a total of at least 10 so I can feel a bit more comfortable about matching. I was told from a couple of US med students and a program director that Nov 7-Nov 21 is a busy time for interview calls. Let's hope that's true this year for IMGs!

                          SabaEM
                           

                          rossguy31

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                            voronok45 said:
                            Dont worry about it, if you already have 7 you will break 10 without problems. You just have to give it some time. I was getting interviewes even in December. Plus 7 is a good number already for matching. Good luck with everything.

                            Voronko..do you mind telling us where you matched? When did you receive the interview (if you remember!) for the place you ended up matching?

                            My total is up to 10 ER interviews now...think 6 or 7 b4 Nov 1..rest since. I am still hoping to get more. What I think is weird is that several hospitals I expected to get interviews at b/c of a track record of taking caribb grads have not given me an interview, whereas many of the programs I have been offered don't have caribb grads.

                            Anyway i feel pretty good about my chances with 10 interviews, but a few more would be nice.
                             

                            SabaEM

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                              voronok45 said:
                              Dont worry about it, if you already have 7 you will break 10 without problems. You just have to give it some time. I was getting interviewes even in December. Plus 7 is a good number already for matching. Good luck with everything.

                              Thanks for the encouragement voronok. Today I received another interview...so the total is up to 8. Interestingly, 90% of the interview dates the program offered were already filled so I only had a couple of times to choose from...I guess second pickings are better than no pickings.

                              Rossguy, I've also had similar experiences as you--programs whom I didn't expect to hear from have offered interviews...but those with more IMGs haven't contacted me yet...

                              I guess at this point, we just have to wait for other students to cancel their interviews.

                              For those of you who applied in previous years, did you end up hearing yes or no from all programs? What percentage did you not get a response from either way? Thanks in advance.
                               

                              SabaEM

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                                so now i have a total of 10 EM interviews (in 9 states!)...feeling a bit more comfortable about matching. still 26 programs i haven't heard from though...hopefully a few more will send out invites :luck:
                                 

                                rossguy31

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                                  Must admitt I am still a little dissapointed about the number of interviews I have...it is a difficult world applying to ER as a caribb student. That said, I am pretty confident that I will match as I have 11 (not trying to one up you Saba!) interviews scheduled so far. Saba you cover the map a lot more than I do though, as my interviews are all concentrated in 4 states (only applied to east and midwest). Still hoping for a few more.
                                   

                                  Lifedrive

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                                    I applied to every EM program except for 2 or 3 places that I refused to live in being a single parent. 123 programs in all.

                                    So far I have 2 interviews that were offered early, and 32 rejections out of 123 programs. Two of the rejections were extremely disrespectful, but no worries.


                                    Background:

                                    IMG, US Citizen with outstanding LOR's from US and Australian physicians, good research background, and ranked 7th in my med school class, with a very strong Dean's letter. I passed step 1 and step 2 CS on my first try, but I did not break 200 on step 1.


                                    I paid approx $2600.00 to ERAS for my EM apps, and am still hoping that a few more interviews will come through. But if not, I plan to shine brightly at my 2 lone interviews, and hope for the best. Let's hope it is not a very expensive lesson.

                                    Best of luck, guys and gals.
                                     

                                    voronok45

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                                      Congrats on braking 10 interviewes, you guys will match somewhere. The game is still not over and you may get a few more interviews by december. It seems like you guys are stellar applicants. I am just wondering where you guys got your interviews. This may help other IMGs when they apply next year. Last year I got my interviewes in UConn, Beth Israel-NYC, Maimonides, Metropolitan Hospital, Newark Beth Israel, Albert Enstain-phili, Allegheny, St. Lukes-Bethlehem, UMDNJ-Newark, Brooklyn Hospital. I only applyed in four states: NY, NJ, PA, CT about 30 programs. If your guys have any questions for me let me know and I will try to answer. I think most people select a place based on location and a vibe they got during the interview or second look.
                                       
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                                      rossguy31

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                                        I am interested in helping others, but first and foremost I want to match! I am somewhat confident that I will indeed match, but I will not believe it until I see it. I now have 13 interviews, and about that many rejections.

                                        After the match I will be sure to share all my experiences if I think it can help.
                                         

                                        SabaEM

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                                          krust3 said:
                                          Any Updates Saba Or Ross!?

                                          well i've received a dozen interview offers and i'm actually really happy with the schools i've heard from. so far i've completed 5 em interviews; 2 more next week and the rest in jan/feb. at this point, i would advise those of you in 3rd year to make sure that you set up EM electives at programs you are highly considering. it is much easier to set up an elective despite the hassle of paperwork than to feel that you don't have enough interviews. that way, the programs will know you and you'll be much more likely to get an interview (especially if you get a letter from someone at the program). part of the reason i feel a bit more comfortable about matching goes back to the friendships developed with some faculty members at programs where i've rotated. you get 4 weeks to impress them with your fund of knowledge, work ethic, personality, etc instead of a mere 2-dimensional summary on paper. it's certainly worth the investment.
                                           

                                          krust3

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                                            how did you select what hospitals to conduct your electives at though? and how many electives can you use/spend in ER.

                                            thanks!

                                            i'm attending saba in fall 06, and i'm an urgent care PA in california hoping for ER as an M.D.
                                             

                                            rossguy31

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                                              I have not posted in a while..few changes. I have been offered 16 interviews so far, but only able to accept 15 due to schedule conflicts. I am on 4 waiting lists for interviews (including the program that offered me an interview that I couldn't schedule).

                                              Few answers to your questions Krust:
                                              First of all, if you are just entering med school I would keep my mind open to other possibilities besides ER. I was a paramedic and thought I wanted ER before starting, but some other rotations really interested me and I thought about doing them. If still interested in ER do it as your first elective in 4th year, that way you can get letters of rec and make sure its what you want to do. I would agree with the above poster...do ER somewhere that has a residency you are interested in if possible.

                                              The road to an ER residency as an IMG starts way before clinicals though. If you are going to get ER coming from SABA (or other foreign schools) the road starts in the first semester...If you don't get good grades and excel on the boards you will have a lot of trouble. Many IMG's I know who are applying to ER are not doing as well as the people posting on here. I suspect the people on here all had above average grades and board scores.

                                              As far as where to apply. I applied to many programs that I wanted, along with many that I thought I had a better chance at. To find out where you might have a better chance visit your school's (or other foreign schools like Ross's or St. Georges) match list available on there website. St. Georges website lists their match list for about the last 10 years. Also, on emramatch.org all programs fill out a survey which includes the number of fmg's they have. Again, do apply to some programs that you really want even if they don't have any...I have been surprised by a couple programs that don't have any fmg's offering me interviews. Most big names programs will reject you though unless you rotate there. The SABA poster above has some interviews that are very competitive b/c he rotated at some big name programs.
                                               

                                              awdc

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                                                For those IMG's who received interviews or are already residents/attendings, how important/necessary do you think it is to do an EM rotation at a place where there is an EM residency program (and getting a letter from one of the EM faculty)? Any pointers where a Ross student can go for a residency program affiliated rotation? Thanks in advance.
                                                 

                                                rossguy31

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                                                  I am an msiv from Ross applying for ER this year. I am doing pretty good so far, but there are some things I think I could of done to improve my application. One of them is if I had done a rotation somewhere that has a ER residency. I thought it was good to go somewhere that didn't have a residency b/c I wanted to get letters and thought I would have more interaction with attendings this way. I had a great rotation, and got 2 letters of rec, but think it looks bad. I was actually asked on an interview if I had rotated anywhere that had a residency.

                                                  As far as where to go....I would chose a program that you would really like to go to. If you do impress it will really help your chances of matching there. I know some fmg's who have gotten interviews at top notch places b/c they rotated there..places where they would have no shot at if they didn't.
                                                   

                                                  colforbinMD

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                                                    Also a Ross msiv (acctually alumni as of Nov 31) and I agree with rossguy. Especially about rocking the boards. They are huge. Definately THE most important piece of an app. you can build.
                                                    I would also just add a caution that I didn't know when I was an ms3. It's not allways so simple as pick a place you wanna go and do an audition rotation there.. Many of my top interests were places I could not rotate at because of what state they were in and two I thought I could rotate at rejected me saying they don't take foreign students (one has since offered me an interview the other has not). In the end I rotated at 2 programs with residencies and got 2 letters from PDs but see my other thread for info on how one chose not to interview me. Good luck all.
                                                     

                                                    voronok45

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                                                      Its good to rotate in a place where you want to do your residency. It may not happen like you plan it because a lot of places do not accept IMGs for rotations but take us as residents. Places in PA in particular are against that for some reason. I think whats more important is to get a good letter from a PD at any ER program with a residency. Those guys all know each other and a good letter from any PD will go a long way. Another important thing is to do well on your boards both or atleast one. For IMGs, I think its a number one priority. I think most of the guys with a good number of interviews will agree with me. It sucks but thats the way it works out. Another varient which matters is ER rotation grades. I think basic science grades do not matter that much in selection. If some one is willing to call for you and put a good word use it. Once you get to the interview all bets are off and it all about if they like you or if they think you are serious about joining their program. There has to be a catch. I would even let the program know your reasons in a thank you letter. Another thing that can help you is experience. If you worked as a paramedic, ER tech, etc. it will help you with some programs. Especially the once that have interest in prehospital care, etc.. I think these are some of the major points which I think can make a difference.
                                                       

                                                      trkd

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                                                        voronok45 said:
                                                        I think whats more important is to get a good letter from a PD at any ER program with a residency. Those guys all know each other and a good letter from any PD will go a long way. QUOTE]

                                                        Interesting that you say this. I was thinking about this today. Is it better to get a letter from the PD or from an attending that has gotten to know you much better but not as "known", I guess you could say. For example, the doc who let me rotate (though IMGs generally weren't allowed) took a particular interest in getting to know me but the PD hasn't been around much. I don't know who to ask for a letter. Is it always best to get a letter from the PD? :confused:
                                                         

                                                        voronok45

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                                                          What you can do and I would recomend that, is to get one letter from an attending that knows you better and who showed interest in you. Then see if you can arrange a meeting between you and PD of the program to discuss your future goals. Sometimes they are willing to write a letter based on the recommendations of other attendings and you can use both of this letters in your file. If not then I would use a solid letter from a less known person then a have ass letter from a PD that does not know you and would not do a good job. It does not hirt to ask. Hopefully this would be helpful. If you did not start the rotation yet then i would arrange a meeting with PD earlier in your rotation and see what you need to do to get a letter from them. Sometimes you have to be direct because those guys are busy but dont overstep yur boundaries.
                                                           
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