Help me to choose the right residency (confused!)

[MalekX]

Hello everyone,
I’ve been struggling having to make a big decision ever since I graduated from medical school a few years ago .I don’t think I am the only medical graduate who has been in such a dilemma: How to choose the right residency.
Before I go into the main topic, I will provide you with some information about me so you can understand more about my current situation.
I’m a US-IMG.I graduated from medical school overseas a few years ago.Then, I worked as a primary care physician for three years,and I spent a few months as an internal medicine resident. After that, I came to the USA to prepare for the USMLE.That was seven months ago.
Due to some personal and family issues,I didn’t do anything related to medicine, except for some sporadic and intermittent studies for USMLE Step1.
Thanks to God,my life is finally getting back on track again. I’ll be doing an internal medicine externship in tow moths,and I’m hopeful I will be able to take Step1.
I’m so glad I’m functioning again,but when I think about residency I feel worried.I want to do something important in my life.Yeah,I want to make difference in this life I think most of us do.
I believe that being an IMG with a five years gap in my studies would affect me when applying for the competitive residencies ( I will apply for a March 2013,so by 2013 I will have had a five years gap since graduation.)I’ve heard many stories about foreign graduates with great credentials who applied for surgery residencies, but their great credentials didn’t help them get a surgery residency.
I worked as an internal medicine resident for six months. During that time I was very dissatisfied. I felt impotent when dealing with chronic diseases .I hated myself every time we had to refer patients to the surgery ward so they could get definite solution for their problems. I still remember a female patient who kept coming to us for renal dialysis. She finally got a donor, and her transplantation went fine. When she left the hospital.I’m sure she was hoping not to have to visit us every again ,except for short follow up visits. I felt that she hated us. But of course, she appreciated the surgeon who solved her problem with a solution that would be expected to serve her for the next 10 years.
Sometimes, I try to convince myself that internal medicine is not less than any other specialty ,especially when I think about subspecialties like Cardiology or Hematology or Hematology .But even so , Surgery still has the upper hand in solving many medical problems.
When I think about some other specialties which are still competitive such as pathology and radiology, I feel they are very crucial and critical for patient lives.
What does an internist do anyway ? Except to order labs and some imaging, and then to interpret the data to come up with a final diagnosis?
One the other hand, I’m a family man. I have many dreams other than medicine. I feel surgery would steal too much time from me.So,now you can see the dilemma.
A friend of mine keeps advising me to stop thinking so much about the residency, since it’s still too early for the the match ,anyway. He said that the most important thing right now is to get decent scores in both steps, as that’s very impossible to show on my resume’.
Guys, I know he might be right but I’m not machine. I have a lot of troubles studying with out having a long term plan .In fact , because I can’t see my long term plan. I’m struggling to keep studying well these days. I want to know what I’m going to be doing in the next year .I will finish the internal medicine externship by October 2011 , What’ next?? Should I get another one? If so, exactly what externship should I get. Should I keep taking Internal medicine externships so I build my reume’? Should I take a risk and get a surgery one? Would,or wouldn’t that be a waste of time if I’m not going to apply for surgery?
Another friend has advised me to got the academic and research field because field because he thinks this field is more appropriate for me.
It’s woth mentioning that I’m not the only one who has felt dissatisfied with internal medicine.Ive read some articles that a big percentage of IM residents feel the same way.
I heard a great man speak the late Randy Pauch, who said:” If you don’t have a passion , try to look for one.When you have a passion you can achieve success.” Up until now , I haven’t felt a passion for studying Internal medicine .I only know I want to make an important difference in this wold but how , I don’t yet know.

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[McGillGrad]

Your #1 concern should be USMLE exams. It is premature to think about residency until you know how competitive your scores will be.

One step at a time.

 

[Winged Scapula]

And let's also clarify that being 5 years out of residency is not just a problem for "competitive residencies" but for almost all of them. Many programs have rules about not accepting applications from people "X" number of years out of training. Surgery tends to be less forgiving than other specialties especially if you haven't been working in the field since graduation.

Since you have time, I'd suggest doing some leg work and finding out specific program requirements for graduation date.

 

[MalekX]

Your #1 concern should be USMLE exams. It is premature to think about residency until you know how competitive your scores will be.

One step at a time.

I know this is right thing to do but I can't do anything with no long term plan.Also I want to know what do after the IM externship.

 

[MalekX]

And let's also clarify that being 5 years out of residency is not just a problem for "competitive residencies" but for almost all of them. Many programs have rules about not accepting applications from people "X" number of years out of training. Surgery tends to be less forgiving than other specialties especially if you haven't been working in the field since graduation.

Since you have time, I'd suggest doing some leg work and finding out specific program requirements for graduation date.

Thanks for posting here.I know that some programs require date of graduation not more than 2 years. Other not more than 5. So I guess I still have a good chance.

what if i spend the whole year in doing surgery externship and off course I will get LORs during that time .Do you think I can get a surgery residency in a decent place ?

 

[McGillGrad]

I know this is right thing to do but I can't do anything with no long term plan.Also I want to know what do after the IM externship.

As WS noted above, all you can do at this point is collect experience and make connections. Your step scores need to be as high as possible to be considered competitive in any residency. You are competing again fresh graduates who have recent experience.

Serious research may also help.

 

[Law2Doc]

There are other less competitive residencies besides IM. If you don't like IM, don't do IM. You had 6 months of exposure to IM in another country and didn't like it. Made you impotent, you said. Just get some viagra and try something else.

And I'm not sure I would classify pathology as a particularly competitive residency. Surgery, however, might be a bit of a reach.

 

[MalekX]

There are other less competitive residencies besides IM. If you don't like IM, don't do IM. You had 6 months of exposure to IM in another country and didn't like it. Made you impotent, you said. Just get some viagra and try something else.

And I'm not sure I would classify pathology as a particularly competitive residency. Surgery, however, might be a bit of a reach.

I'm not sure about pathology.I've heard people saying that pathology is so competitive . I hope it's not.

 

[gutonc]

I'm not sure about pathology.I've heard people saying that pathology is so competitive . I hope it's not.

Pathology the residency is not competitive at all. The Pathology job market however is brutal.

 

[Bostonredsox]

Pathology the residency is not competitive at all. The Pathology job market however is brutal.

That's because they get a job after residency and they don't leave it until they themselves become the next cadaver, at which point a new path is hired. Basically a hospital gets a new one every 25 years or so...terrible market.

 

[87DO15]

That's because they get a job after residency and they don't leave it until they themselves become the next cadaver, at which point a new path is hired. Basically a hospital gets a new one every 25 years or so...terrible market.

Just curious, how many pathologists does a hospital generally keep on staff?

 

[MalekX]

How about joining a clinical pathology program at a university program.Would that help me to get a PHD in pathology.Would that help me to do research?

Please, Help me guys.I wanna do something special in my life.I still remember when I was in the IM residency that almost residents from other specialities could do about 30% to 40% of our work

 

[physicsnerd42]

How about joining a clinical pathology program at a university program.Would that help me to get a PHD in pathology.Would that help me to do research?

Please, Help me guys.I wanna do something special in my life.I still remember when I was in the IM residency that almost residents from other specialities could do about 30% to 40% of our work

I'm guessing research is not the way to go for you. If you do the PhD correctly you'll be spending as much time working on it as you did in IM residency and you'll certainly be "helping" fewer people.

At this point, just get into whatever you can. If IM will take you back, do that. If it's FM or psych, go for that. With you background and the choices you've made, getting any residency will be difficult so you should take whatever you're able to get. Ever field of medicine allows you to do "important" things, and some of those fields let you do fellowships after which can allow you to change your focus. IM is one of those, which is a reason that you never should have left.

 

[Law2Doc]

I'm guessing research is not the way to go for you. If you do the PhD correctly you'll be spending as much time working on it as you did in IM residency and you'll certainly be "helping" fewer people.

At this point, just get into whatever you can. If IM will take you back, do that. If it's FM or psych, go for that. With you background and the choices you've made, getting any residency will be difficult so you should take whatever you're able to get. Ever field of medicine allows you to do "important" things, and some of those fields let you do fellowships after which can allow you to change your focus. IM is one of those, which is a reason that you never should have left.

If I'm understanding the OP correctly, he never was a US IM resident. So he never really "left". He gave it a try overseas but has yet to start here. That's the only way his story makes sense (ie he worked as a physician, but subsequently moved to the US to prepare for the USMLE).

I agree that OP is too focused on what he deems important vs non-important. Heck if you empty the trash cans you are important if you view it that way. Just figure out what makes you happy that you can get and don't worry so much as to whether you are making best use of the situation.

 

[Buzz Me]

I know this is right thing to do but I can't do anything with no long term plan.Also I want to know what do after the IM externship.

The first thing to do in your long-term plan? Do well on Step 1.

what if i spend the whole year in doing surgery externship and off course I will get LORs during that time .Do you think I can get a surgery residency in a decent place ?

Can't tell you what your chances are...especially not without Step scores. But the 5 years since graduation hurts you.

 

[TexasPhysician]

How about joining a clinical pathology program at a university program.Would that help me to get a PHD in pathology.Would that help me to do research?

Please, Help me guys.I wanna do something special in my life.I still remember when I was in the IM residency that almost residents from other specialities could do about 30% to 40% of our work

You need to do a lot of self-evaluation on what you want to do for your life. If you want to practice medicine in the US being an FMG + 5 years out of training, you need to apply to maybe all primary care fields and hope for anything. You can't be picky here. You have a very tough road.

If you want to do research, sure get a PhD and teach somewhere.

 

[MalekX]

Guys,I really appreciate your cooperation but some posts scared the devil out of me.I wasn't aware that being a 5 years graduate would hurt that much.I mean what if I get a double 99 with a year USCE and LORs + US citizen.Would it still difficult to get a residency in a competitive program.Forget about Surgery.How about Combined IM/EM,Competitive IM programs or Radiology.

 

[MalekX]

If I'm understanding the OP correctly, he never was a US IM resident. So he never really "left". He gave it a try overseas but has yet to start here. That's the only way his story makes sense (ie he worked as a physician, but subsequently moved to the US to prepare for the USMLE).

I agree that OP is too focused on what he deems important vs non-important. Heck if you empty the trash cans you are important if you view it that way. Just figure out what makes you happy that you can get and don't worry so much as to whether you are making best use of the situation.

Hello Lw2Doc.I feel comfortable when i sometime think this way.I guess practicing IM in USA would be totally different than a 3ed world country.

This discussion is helping me to make a peace with my internal world and with the Internal medicine as well. Thank you all guys.

 

[MalekX]

You need to do a lot of self-evaluation on what you want to do for your life. If you want to practice medicine in the US being an FMG + 5 years out of training, you need to apply to maybe all primary care fields and hope for anything. You can't be picky here. You have a very tough road.

If you want to do research, sure get a PhD and teach somewhere.

Thanks for trying to help.I have a concept in my life which is if I dream about something I will get it or I will get something a little bit less than it.So If I dream or plan for ( Anything) I would wind up with ( Nothing ).Thanks again

 

[TexasPhysician]

Guys,I really appreciate your cooperation but some posts scared the devil out of me.I wasn't aware that being a 5 years graduate would hurt that much.I mean what if I get a double 99 with a year USCE and LORs + US citizen.Would it still difficult to get a residency in a competitive program.Forget about Surgery.How about Combined IM/EM,Competitive IM programs or Radiology.

I'm not trying to scare you, but being an FMG means you need a lot of luck too. The US citizen thing would help.

I've seen FMG's with 99s, externships, great LOR's etc. and have to apply to every Family Medicine program multiple times just to get any spot. One particular one I know was a neurosurgeon in his country and he wasn't offered a surgery spot anywhere in the US. He ended up doing FM as well.

I've seen other FMG's get into radiology and think it was easy. This is very rare though.

 

[Buzz Me]

I wasn't aware that being a 5 years graduate would hurt that much.I mean what if I get a double 99 with a year USCE and LORs + US citizen.Would it still difficult to get a residency in a competitive program.Forget about Surgery.How about Combined IM/EM,Competitive IM programs or Radiology.

Yes, it would still be difficult.

Having great scores and applying fresh out of med school still doesn't guarantee anything even in less competitive fields...when you're talking about more competitive fields in stronger programs it's even harder.